
Why Dentistry Is Separate from Medicine - df3
https://www.theatlantic.com/health/archive/2017/03/why-dentistry-is-separated-from-medicine/518979/?single_page=true
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mtdewcmu
The real question is not why is dentistry kept separate from medicine. The
real question is why dental insurance is treated like a luxury, compared to
regular health insurance. The problem is that so many people are unable to
afford dentistry, because of poor or no coverage.

~~~
PeterisP
If you have a type of expense that's (a) unpredictable, and (b) rare, then
it's a good fit for insurance.

Car crashes are unpredictable and rare, so it makes sense to insure them.

Regular car maintenance is predictable and tends to happen in (almost?) every
insurance period, so it's not - some payment plan or bundling may be an
option, but insurance makes no sense, it would only be more expensive than
paying directly because of an extra middleman.

Getting a broken leg or cancer is unpredictable (there are individual risk
factors, but they are just as relevant for car crashes) and rare, so it makes
sense to insure them.

Dental care, on the other hand is common and regular - e.g. someone who didn't
have coverage for broken leg or cancer most likely won't get a broken leg or
cancer in the next year, but all the people who have been unable to afford
dentistry generally almost all _will_ need dentistry in the next year. Some
payment plan or bundling may be an option, but insurance makes no sense, it
would only be more expensive than paying directly because of an extra
middleman. If you are unable to afford dentistry, then you'd be unable to
afford the insurance price hike.

It's not a problem of insurance as such, it's a problem of who pays for
healthcare of poor people. USA has a weird historical artifact in that in the
last >100 years insurance has become almost a synonym for employer-funded
healthcare payment plans, not as real insurance. If you want employer-funded
healthcare to include dentistry, then that's not going to be solved by medical
people but the employment market - industries where workers have market power
(e.g. IT) will get such conditions, and industries where worker's don't have
market power (e.g. fast food) won't. Also, this can't solve the manner of
dentistry for unemployed or underemployed people who don't get employer-funded
insurance and thus a dentistry-included insurance would be as expensive or
more than just paying for a dentist.

~~~
AnthonyMouse
> If you want employer-funded healthcare to include dentistry, then that's not
> going to be solved by medical people but the employment market - industries
> where workers have market power (e.g. IT) will get such conditions, and
> industries where worker's don't have market power (e.g. fast food) won't.

And how is that anything useful anyway? It's not like dentistry is any cheaper
when your employer pays for it. If anything it will be more expensive because
of the added bureaucracy and separation of who pays from who benefits. This is
one of the reasons costs have spiraled out of control in the US healthcare
market. If you need money for dentistry, ask your employer for a raise, not
dental insurance.

~~~
chimeracoder
> If anything it will be more expensive because of the added bureaucracy and
> separation of who pays from who benefits.

Yes, real insurance (like car insurance or renter's insurance) will always
have an expected value that is negative - the expected sum of all future
payouts must be less than the sum of all future premiums paid. So insuring
against completely predictable events is never worth it unless someone else
pays for it, and even then it's less efficient than if they gave you the extra
money directly.

Not all dental and vision benefits are completely predictable and routine, but
the overwhelming majority of covered benefits are, unlike health insurance
(which isn't really "insurance", despite the fact that we use the term).

~~~
mtdewcmu
>> So insuring against completely predictable events is never worth it unless
someone else pays for it, and even then it's less efficient than if they gave
you the extra money directly.

It's worth it if the government guarantees it. Dental insurance might not be a
good business to be in, but nevertheless people need it. It's a market
failure, and it needs government intervention.

~~~
ghaff
I don't understand why you think dental EDIT: care is a market failure. There
are dentists people can go to and get care. Pricing is mostly not affected by
if you have insurance or not. (Most dentists will just charge you if their
rates exceed what insurance pays.)

If you're arguing that "someone" ought to pay for dental care that's a
different matter that doesn't really have anything to do with insurance per
se.

ADDED: And one actually gets into cost discussions about things like crowns
and alternative treatments with dentists. It actually seems like a good model
of how healthcare spending _should_ work. Yeah, I have insurance that pays
some but thats orthogonal to the cost discussion I have with my dentist.

~~~
mtdewcmu
It's a market failure if people are suffering due to being unable to afford
proper care. It's possible that the blame lies elsewhere than the insurers
themselves. Maybe dentists charge too much. But the market isn't providing
what people need. The ideal solution would be single-payer, but expanding
Obamacare and Medicaid to cover adequate dental services would be a big leap
forward.

~~~
AnthonyMouse
The true problem you're identifying is poverty. Dental care isn't outrageously
expensive. It doesn't have huge margins or vast inefficiency. The reason
people can't afford it is because they're _poor_.

No bureaucratic solution involving government-subsidized dental services is
going to produce a better outcome than taking the same money and giving it to
those people in cash.

~~~
deong
The problem is that poor people need cash for lots of things. If you're poor
enough that you can't go to the dentist, you're poor enough to be hurting in
any number of ways. If we give you $500 and say, "now this is for the dentist
-- save it in case you need it", they're quite rightly going to tell you to
fuck off and go buy food and gas for the car to get to work. And then when
they need a dentist six months later, we're right back where we started,
except with the added shittiness of a bunch of upper middle class
conservatives preaching about how they "wasted" the money.

~~~
AnthonyMouse
> The problem is that poor people need cash for lots of things.

That isn't the problem, it's the reason why giving them cash is better.
Because if they can't afford to put gas in their car to get to work, using
that money will keep them from borrowing it from the credit card company. And
then in six months they'll still have $500 less credit card debt _plus_ having
not paid 25% APR for six months.

~~~
deong
I'm not arguing that they're wrong. I'm arguing that it isn't in any way a
solution to the problem of paying for dental care.

~~~
AnthonyMouse
How isn't it? They can get the dental care already, the problem is that doing
so will put them in debt. Giving them money cancels the debt, which solves the
original "problem".

The only way it doesn't pay for dental care is if they don't buy dental care
at all because they need something else more. But if they're _correct_ to do
that because the other things really are more important, what kind of idiots
are we to think we should be finding a way to redirect the money back to
dental care?

The only real solution then is to get them enough money that they can pay for
the dental care _and_ the more important things.

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feld
Dental/oral health is crucial. You can die from dental problems. I will never
understand why the entire dental industry is treated as if it is cosmetic or
non-essential. Stress to your immune system and failure of major organs is not
taken seriously, but it is a very real risk.

~~~
wslh
You can also detect certain kind of cancers via oral inspection.

~~~
err4nt
And I've heard organ diseases and organ health can sometimes be immediately
evident to experienced dental workers that doctors inspecting other areas of
the body might not see as well!

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10dpd
NHS Dentistry in England and Wales is one of the biggest hidden scams yet to
be revealed. The 'Unit of Dental Activity' scheme encourages dentists to delay
treatment unnecessarily to cover their basic costs. The sooner the UK
government acknowledges that the current NHS Dentistry setup is not
sustainable, the better it will be for all.

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barking
Dentists in the UK receive a bachelor degree, as do doctors. However it was a
sanctionable offence in the eyes of the General Dental Council for a dentist
to title themselves Dr.

This was purely a Dental Council regulation, anyone at the time could call
themselves doctor, it wasn't a criminal offence.

With the arrival of dentists from EU countries who were allowed to do so, UK
dentists felt they were being put at a disadvantage in the eyes of the general
public.

The GDC eventually relented with an announcement to the effect that dentists
doing this would not be taken action against any longer.

But they clearly didn't approve!

~~~
partycoder
In the US they have the title of DDS (doctor of dental surgery).

~~~
ww520
The title "doctor" has been abused by different trades.

Optometrist is Doctors of Optometry (O.D.s). Pharmacist is Doctor of Pharmacy
(Pharm.D). Nurse has the Doctor of Nursing Practice (DNP). Veterinarian is
Doctor of Veterinary Medicine (DVM). Physical therapist is Doctor of Physical
Therapy (DPT). Chiropractor is Doctor of Chiropractic (DC). Of course dentist
is Doctor of Dental Surgery (DDS).

Medical doctors have to use another term Physician to avoid the confusion.

~~~
rudimental
The wikipedia article has some interesting history:

"Doctor is an academic title that originates from the Latin word of the same
spelling and meaning.[1] The word is originally an agentive noun of the Latin
verb docēre [dɔˈkeːrɛ] 'to teach'. It has been used as an academic title in
Europe since the 13th century..."

"In the United States, the use of the title "Doctor" is dependent upon the
setting. The title is commonly used socially by physicians and those holding
doctoral degrees;[57] however, there was formerly a division between Letitia
Baldrige and Miss Manners on its social usage by those who are not
physicians.[58] Baldrige saw this usage as acceptable, while in contrast, Miss
Manners wrote that "only people of the medical profession correctly use the
title of doctor socially," but supports those who wish to use it in social
contexts in the spirit of addressing people according to their wishes."

[https://en.wikipedia.org/wiki/Doctor_(title)](https://en.wikipedia.org/wiki/Doctor_\(title\))
[https://en.wikipedia.org/wiki/Doctor_(title)#Development_in_...](https://en.wikipedia.org/wiki/Doctor_\(title\)#Development_in_English-
speaking_countries)
[https://en.wikipedia.org/wiki/Doctor_(title)#United_States](https://en.wikipedia.org/wiki/Doctor_\(title\)#United_States)

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autokad
i'm very happy its under a separate umbrella. think of all the years of
unnecessary education they'd pile on to dentistry and the bottle necks they
would put up to raise the wages to MD level.

currently it costs 150$ to show up 10 minutes early for an appointment to be
seen 20 minutes late for an interaction that lasts 5 minutes. and then i say
'my knee also hurts' and they say you need to schedule another appointment if
you want to discuss any other ailments. insurance covers 100$ of that, but I
am under no illusion of the cost.

do we need to raise dental awareness? sure. do we need to put it under the
bureaucracy and price fixing of the medical system? i dont think so

~~~
mivade
> think of all the years of unnecessary education they'd pile on to dentistry
> and the bottle necks they would put up to raise the wages to MD level.

That seems more an indictment of the medical education system than the
insurance system. There are already parallel medical education systems in the
US (MD vs. DO, although there is little practical difference). Seeing either
type of physician is treated equally by health insurance. Why can't health
insurance also cover DDS visits as well?

~~~
chimeracoder
> MD vs. DO, although there is little practical difference). Seeing either
> type of physician is treated equally by health insurance

Uh, not exactly. MDs and DOs do receive different sorts of education, and
insurance can distinguish between them.

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dmersky
Do the math and you'll find dental insurance is a ripoff. Additionally, while
some people can't afford much of anything, others who complain about the cost
of dental care, buy things as or more expensive because they value those
things more: Big screen TV for example. They don't value dental care as much,
until they are in pain. Then they expect an entitlement. People pay for what
they want. Dental insurance is a subsidy, not insurance. Delta Dental of CA
has over $600,000,000 invested in tradable securities. They didn't pack away
that much money giving away dentistry for free.

~~~
qrbLPHiKpiux
Delta Dental of CA has over $600,000,000 invested in tradable securities - all
from your premiums paid to them with a piddly $1000 annual maximum with absurd
limitations. I agree. It is a scam.

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partycoder
In the middle ages, the main practitioners of medicine were "barber surgeons",
barbers that were also surgeons and dentists.

[https://en.wikipedia.org/wiki/Barber_surgeon](https://en.wikipedia.org/wiki/Barber_surgeon)

Also, all this was done in a very unsanitary way. In fact medicine was
unsanitary in the West until Florence Nightingale conducted an statistical
survey showing that cleaner spaces had fewer mortality rates.

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merqurio
I just saw this week an endocarditis due to the lack of dental hygiene. None
of us was properly trained to evaluate if the patients​ teeth were ok. Shame.
Dental health is not even available in lot of public health system like the
Spainish one. I'll never understand why it's treated differently.

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bigtex
Break a tooth on a Friday night and need dental work? You think, I will goto
the ER and they can help. Nope, they will just give you medicine to deal with
the pain until you can see your dentist on Monday morning. I am not aware of a
ER in the DFW area that has a dentist on call.

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Rainymood
Make sure to poke a very thin wooden stick regularly (daily, before bed, after
brushing) between your teeth and marvel (or be disgusted) at the amount of
plaque that comes out which you missed by just brushing -- honestly it's an
insane amount.

~~~
7sigma
better than wooden sticks and flossing are the interdental brushes. Those
clean a lot better in my experience and my oral health improved a lot after i
started using them.

~~~
mturmon
These brushes helped me a lot too. The brush is a lot easier for my large
hands to manipulate than floss is, so regular use of the brushes has given me
better results. Alas, I had to learn the hard way not to neglect my gum
health.

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pjc50
Even further on the fringe of medicine: opticians.

~~~
peteretep
That's a bit different, as an opthalmogist is a real doctor who treats eyes.
Dental equivalent would by a dental hygienist, I guess.

~~~
barking
Ophthalmologists are specialists just like any other medical specialist, e.g.
a dermatologist. Does the fact that general practitioners refer people on to
dermatologists mean that family doctors are not 'real doctors'? Sorry if that
sounds aggressive, I am unfairly taking the inference from what you said that
opticians are somehow 'fake'.

~~~
masklinn
> I am unfairly taking the inference from what you said that opticians are
> somehow 'fake'.

Opticians are equivalent to pharma techs (or dental hygienists as dogma1138
noted), could you be thinking about optometrists (sometimes called Ophthalmic
Opticians in the UK)?

~~~
barking
Probably, I wouldnt know which is which. I have been very impressed any time
I've had my eyes checked.

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kome
In Italy, until the 1980 dentists were medical doctors that decided to
specialize in dentistry. It's still the case for a large part of them. But now
there are separate schools.

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jonwachob91
The most painful thing about this article (and the comments) is the lack of
understanding that Doctor is a level of education not a field of study.

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drcnyu555
Let's settle the dust! Dentist here; what's up ?

~~~
qrbLPHiKpiux
Dentist here, too.

~~~
drcnyu555
Great . its unusual to find dentist on HN . Where you from my friend ?

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grabcocque
Despite the article's pretence this is some universal historical wart, I take
it this is an American foible, another artefact of the arcane clusterfuck that
is US healthcare?

In the U.K., dental care is available on treated on the NHS just like other
forms of care.

~~~
peteretep
This is deeply misleading.

All non-emergency health in the UK is mediated via your GP. Except dentistry.
All expert medical procedures in the UK will be carried out by an MD, no
matter what part of your body they're on. Except for your teeth. For any
serious medical treatment in the UK that requires anaesthesia, or surgery, you
are likely to be treated at a general hospital which happens to have an
appropriate unit. Except ... dentistry, where they have specialist dental
hospitals.

Finally, treatment on the NHS for all medical conditions is free at point of
use, except for prescriptions. Except dentistry, which is merely subsidised,
and generally provided by dentists who work privately, and offer to provide
slightly different treatments on the NHS than they do privately.

~~~
dghf
> All expert medical procedures in the UK will be carried out by an MD, no
> matter what part of your body they're on

Point of pedantry, which doesn't really affect your argument: the professional
medical degree in the UK is the MBChB (Bachelor of Medicine / Bachelor of
Surgery -- abbreviation can vary by institution). The MD is either a research
degree (similar to a PhD) or, at certain older universities, a higher
doctorate similar to a DSc. In either case, most British doctors don't have
one.

