The High Cost of Fixing My Teeth

I am now the proud wearer of a new, all metal crown.  It covers the very last rear molar of my bottom teeth. So far back it can’t be seen when I smile. A poor little, worn-down tooth which once sported another crown.  Unfortunately it fell off years ago.  Probably didn’t cost enough.

This is not about teeth or – really --  fixing them.  It’s about the totally off-the-wall, totally outrageous cost to maintain an essential part of one’s body.

Hello Washington? I know you’re there – and probably eating your taxpayer-subsidized lunch somewhere with your taxpayer-subsidized, nicely filled and crowned teeth. 

So a quick reminder. Without teeth, people can’t eat.  If they can’t eat they get sick.  And before they die of starvation and malnutrition and fall out of the health care system – they can cost Washington, insurance companies and all of us who pay for things a great deal of money.

What set off this rant was the cost of repairing this one, afore-mentioned poor little worn-down tooth.  It started last April with the root canal, needed so my regular family-type dentist could build up the tooth enough with a core and post to hang a crown in place. Since I live in one of the most if not THE most medically expensive areas of our country – the root canal –performed by an endodontist who specializes in root canals - cost $1600.  Molars, should you not have had to find out, have four roots.

After a few months for my bank account to digest that, it was time for the crown. As I said it’s a metal crown. No room back there for the added heft of porcelain fused to the metal.  Doesn’t matter.  The cost, my dentist told me, was the same. $1250.  Add in the post and core, another $360.  Plus something called Intraoral-Periapical-First Film. An almost throwaway $32.  Total cost: $1614.

And grand total for the whole deal – root canal plus crown – a bank account draining $3214!

Now like most Americans, I don’t have dental insurance.  My union health coverage used to pay for $1000 worth of dental work a year.  That went bye-bye some years ago when medical costs began to soar. I could buy insurance myself but usually outside dental policies are so expensive and pay so little it’s not worth the effort. Even employees of giant companies with Cadillac health insurance usually get a measly $1500 worth of dental coverage annually.  At best it pays for cleaning and half the cost of a few filings and maybe a small, front tooth crown.  Medicare?  Foggedddaboudditt!

To get deadly serious for a moment, what do people do who CAN’T pull $3200 bucks out of their pocket? 

A number of recent studies have linked everything from heart disease and diabetes to Alzheimer’s Disease to poor dental health.  Our bodies are a closed system.  Each part connected to the rest of the parts.  As that old song “Dem (Dry) Bones” told us so many decades ago.

It makes absolutely no sense that dental health care isn’t simply part of the overall health care system. Included in our medical insurance of all kinds – private, Medicare and Medicaid.  As with so much of the mess that we call our health care system in the US --- we’re among the few highly developed economies without almost fully covered dental and medical care.

Therefore my bank account is now $3300 dollars smaller.  I don’t know what I might have done with all that money  -- fly to the moon and stay there perhaps -- but I do know that if I were a typical parent with my own tooth issues and kids who needed braces and such  – I’d probably be wishing they still made crowns out of gold – so I could pawn my mouth for next week’s groceries.

 

Whither Dental Insurance?

Good Grief Charlie Brown! I had oral surgery today – but that isn’t the news. The procedure is fairly common and with anesthesia – painless. I couldn’t face sitting with my mouth open for an hour while a surgeon performed micro-surgery on my uncooperative, failed-root-canal-tooth. Anesthesia didn’t change the mouth open part (and people who know me will probably say I never shut it anyhow). But I didn’t have to know what was going on or hear it. If dental surgery can ever be considered “comfortable” – this was it.

Until I had to pay for it.

I have some dental insurance in my plan. It pays only, however, for preventive measures – like teeth cleaning and necessary xrays before getting a tooth filled. It doesn’t pay for the filling. Or the crown. Or the oral surgery.

So as I was sitting in the recovery room holding ice to my gauze-stuffed cheek – the moment of truth arrived. My credit card (or more accurately my husband’s because I couldn’t get mine out with just one available hand; the other, you’ll remember, was holding the ice pak) was taken and the receipt returned.

$2100. And that didn’t included the $350 or so for the initial consultation and the panoramic xray needed to be sure my remaining 2 wisdom teeth - never to be touched without major jaw surgery – weren’t affected. The nice lady at Guardian said oh yes –that panoramic xray would have been eligible for the 75% reimbursement. Except that the plan only allows for one set of full-mouth xrays every 5 years. And I had a set back in ’09. Every 5 years???? Whose mouth stays the same for 5 years?????

Back to the $2100. It could have been $400 less if I had opted to stay awake and totally panicked for the surgery. I figured I could live without a few things for myself at Macy’s when I start my Christmas shopping. I needed that IV drip!!!

What do people do who need emergency dental procedures – and who aren’t as lucky as I am? Who simply don’t have that money? Maybe pay it off over 2 years? I didn’t see anything in the surgeon’s office about installment plans.

Why isn’t dentistry in general simply included with our regular health insurance plans? After all – you can get pretty sick and cost the health care system a pretty big chuck of change from a tooth or gum infection. In fact a bad tooth left untreated can do more than make you sick. It can kill you. Not having your teeth – or for that matter your eyes – tied into your regular health insurance makes absolutely no sense at all.

Until you talk to your dentist.

I asked mine and his answer was that the various dental associations –which ostensibly represent their members – don’t want the hassle of dealing with a broken insurance system. One that will cost each dentist additional time and money. Dentists would have to hire full time insurance clerks – the way physicians do. One of the reason group practices are so common. So the dentists deal with maybe one half-baked dental insurer --- which most of their patients don’t use even if they are lucky enough to have separate dental insurance. And they charge the rates they wish to charge without all the red tape medical doctors must deal with --- not the least of which involves Medicare and Medicaid.

So -- no pressure from dentists and oral surgeons to be included in the health insurance system. Or maybe pressure applied by their lobbyists in the other direction. As in “don’t you dare, Congressman so and so, to include us in that new health insurance law”.

As a result, I paid $2100 out of my own pocket today. And considered myself among the lucky ones.

The Health Care Debate

I’m getting so tired of being yelled at on cable TV and talk radio and blogs by yahoos who are upset about everything and taking it out on health care. They don’t have jobs anymore or their homes have been foreclosed or they can’t use their McMansion as a piggy bank anymore because it’s worth less than they paid for it. Or they’re old and afraid of change – especially if it comes with an Obama label.

Almost no one is talking about what we as Americans should be talking about. Things like how to cut costs in a way which won’t really harm people and which might actually help them. Things like what DO we do with the 46 million uninsured Americans if we don’t have a government plan for them. Things like whether everyone has a right to the most expensive medical care and if so who should pay for it. The debate has become one about health insurance reform – not health care reform.

First off – anyone with a 3rd grade education must know that in an aging society, any program which now absorbs 16 percent http://www.forbes.com/2009/07/02/health-care-costs-opinions-columnists-reform.html of the GDP and is projected by the Congressional Budget Office to double in the next 25 years isn’t possible to sustain. Most of our health care dollars are spent in the last years of life as diseases which might have been prevented must instead be managed. We also have a growing younger population, thanks to immigration and religious groups which still encourage oversized families. Those two extremes of the age scale are real; we can’t stick our heads in the sand and pretend they’re not.

So what do we do about these escalating costs? Yes – we do need mandatory electronic medical record-keeping. And some legal restraints on insurance companies. The phrase “pre-existing conditions” should be outlawed. Profits should be capped along with top managers’ salary packages. Insurers can’t be allowed to deny payments for medically necessary treatments, procedures and drugs. A good model might exist in the Czech Republic. Although Czechs still have a form of government-run health care, they pay premiums to one of several private insurance companies. Private companies which aren’t allowed to make a profit. They also have a small co-pay for each doctor visit, day in the hospital and prescription drug. No one is denied care and Czechs can choose their doctors and hospitals. But there are no unnecessary tests or procedures. And doctors are salaried. As they are at some exemplary US medical facilities like the Cleveland Clinic.

I’m not totally convinced another Medicare-like government-run health insurance plan –at least as the Obama administration has explained it – is the right move. But if we don’t have a government plan, we need to make all health care plans portable. So you don’t have to change doctors when you change jobs or when your company decides it can get a cheaper plan from another insurer. And if you lose your job – as hundreds of thousands of Americans have in this recession – there should be some kind of government subsidy that kicks in along with your unemployment insurance. Perhaps you would have to pay back some of that subsidy through a small payroll deduction when you’re employed again. Or pay such a small deduction while you are employed to build up a subsidy fund. Something along the lines of New Jersey’s tiny but required payroll deduction for a fund which now provides a short but paid work leave when a baby is born or a parent needs care.

And now here comes the biggie. The one the very powerful drug lobbies will fight tooth and nail. And it isn’t what every other country does – negotiate drug prices down. We need that too – but it would become a lot less important if we simply didn’t need so many expensive drugs.

Right now the medical system is geared toward fixing what’s wrong with you. Instead of preventing the illness in the first place. Yes – we need to pay for preventive care. Lots of it. And it doesn’t have to be expensive. Think about something like obesity. More than two thirds
of Americans are now overweight or actually obese. http://www.nytimes.com/2009/08/11/health/11stat.html?_r=1
The Centers for Disease Control say one third of children fall into these categories. Drug companies make zillions on insulin and related drugs as fat people develop diabetes. A disease which is totally preventable in this population. Add in the anti-cholesterol drugs, the heart procedures and drugs, the high blood pressure drugs – all stemming from too much food and too little exercise.

If we spent just a little money on health education –starting in nursery school – it would pay off big time. Instead of the current emphasis on expensive team sports – which benefit only a few well-coordinated athletes, let’s teach every kid lifetime personal nutrition and exercise habits. Instead of letting school districts slash physical education classes when budgets get tight -- make them mandatory. As sacrosanct as basic English grammar. The proposed tax on sugary soft drinks and fruit drinks would be a good start toward paying for that. A similar “sin” tax has certainly helped reduce cigarette smoking even as it helps pay for smoking-cessation programs and the health ravages smoking causes.

Let’s give doctors financial incentives to push their patients into healthier lifestyles instead of simply handing out prescriptions. And if all doctors had the same incentives, they couldn’t complain that their patients will simply find another doctor who’ll let them take the easy way out with a pill for high cholesterol instead of a prescription for fewer burgers and fries.

If we simply make good health a national passion, instead of an afterthought, medical costs will stop rising. And eventually, as new, healthier generations come along, costs will fall. Fixing the broken health care system doesn’t require brain surgery. Just a little brain power. And some heavy lifting.