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May 07, 2006
In the Teeth of Government-Supplied Medical Care
Don Boudreaux
This storyline in today's New York Times says a lot:
In a Dentist Shortage, British (Ouch) Do It Themselves
And this photo caption on today's NYT home page says even more:
Britain's state-financed dental service, stretched beyond its limit, no longer serves everyone and no longer even pretends to try.
Something as important as health-care should not be supplied by the state.
Posted by Don Boudreaux in Health | Permalink
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Comments
It doesn't matter who says it, like you, there are people that will not look at the obvious problems with government supplied....anything! Keep on trying though, and I'll do the same.
Love the site, BTW.
-Chris
Posted by: Christian B. | May 7, 2006 7:51:02 AM
At least, unlike Canada, private dentistry is legal in the UK and British private dentists are very popular - to the point of being oversubscribed themselves and driving up prices.
Any trained US dentist could probably make a killing by moving here, but the training factor means it's taking time for supply and demand to get into balance.
Posted by: Richard Gadsden | May 7, 2006 8:14:40 AM
*****"At least, unlike Canada, private dentistry is legal in the UK and British private dentists are very popular - to the point of being oversubscribed themselves and driving up prices."*****
This is false. Private dentistry is alive and well in Candada. Indeed in most (all?) provinces, dentistry for adults is NOT covered by Medicare.
Although I'm not a big fan of socialized medicine, it's wrong to point to the British experience with dentistry as an example of the inevitable botched job done by government medicine. It's rather an example of the botched job done by underfunded government medicine.
You'll see few capacity problems with America's own version of government medicine, Medicare. And that's because America's powerful gray lobby insures lavish funding levels. Britain's problem, as always, isn't socialized healthcare per se. Britain's problem, rather, is niggardly funded socialized healthcare.
Posted by: 99 | May 7, 2006 11:19:48 AM
This is really back to front. What you see in the UK dental sector is not a crisis of state provision, but of privatisation. The government has been withdrawing from the dental sector over many years, claiming that the private sector would be the saviour of the health service.
Added to this, the closure of dental schools in the 1990s (the Conservative government then in power claimed that the UK was producing too many dentists) has meant that there are now shortfalls in the number of qualified dentists which cannot be made up from elsewhere.
Posted by: Alexei McDonald | May 7, 2006 1:33:50 PM
I just went to the dentist here. Boy am I glad it was here in America.
>You'll see few capacity problems with America's own version of government medicine, Medicare.
That is because the private sector is large enough to provide incentives for supply and make up for many of the problems caused by the socialized sector.
>This is really back to front. What you see in the UK dental sector is not a crisis of state provision, but of privatisation.
That is what they always say - blame it on the capitalism, imperfect though it is, but never on the socialism. How come the Brits have always had bad teeth? How come before any privatization had come about there were still huge problems? How come there are no problems in the (almost) completely private American system?
>Added to this, the closure of dental schools in the 1990s (the Conservative government then in power claimed that the UK was producing too many dentists)
If the government is deciding on the supply of dentists, I beleive that could also be in part to blame. You must let the market decide the number of dentists along with the numbers of all of other supply.
Posted by: liberty | May 7, 2006 4:23:00 PM
Ah, if only the transition to capitalism was as pain-free as liberty would have you believe. It's a rough ride, especially when you have someone as incompetent as Tony Blair in charge.
Posted by: Alexei McDonald | May 7, 2006 5:51:05 PM
I recently spent two weeks in the UK on business just as this story was exploding in the headlines. During my 2 weeks of BBC watching, the news media was absolutely obsessed with three dominant story lines:
- Dental care in UK sucks
- Health care in UK sucks
- Long term care in UK sucks
The dental angle is one of typical care-rationing and ignoring market realities. Gov't is arbitrarily dictating too-low compensation for dental care; as a result, dentists are fleeing the system.
The result now is a bad hybrid: a crappy socialized system and an underdeveloped private system based largely on govt dentists moonlighting in their spare time.
The dentist story that struck me most was a case of true (socialized) market failure: in some areas there simply were no dentists available to provide care, govt or private. Bizarre. Video of people lined up at the door of the dentist's office, as if in line to buy tickets to a blockbuster movie.
Next big story: long-term care (LTC) for oldsters. Lots of pity stories about how middle class old people have to sell their houses to afford LTC. The solution proposed by a certain comission: gov't simply pay for everyone's LTC, regardless of income. Yes, the same government that can't afford now to provide dental care should pick up that huge tab also.
In none of that reporting did anyone mention the possibility of private LTC insurance, which has a thriving market here. Or indeed any kind of suggestion that perhaps it's *just* that a person be responsible in some way for their own fate.
Posted by: Kevin | May 7, 2006 6:12:25 PM
"It's rather an example of the botched job done by underfunded government medicine."
How come, then, that all countries with socialized medicine suffers from similar problems? This isn't a unique case.
Posted by: Henri Hein | May 7, 2006 6:34:43 PM
"What you see in the UK dental sector is not a crisis of state provision, but of privatisation. "
I'm going to quote myself from a previous thread:
"I can say that as someone who has been subjected to a nationalized health care system: it is not something I would wish on my worst enemy. "
It's ironic that people are concerned that privately run health providers may refuse service to some people. I have lived for many years in countries with nationalized health care sectors, and many years in the US. I have never had service denied me in the US. Conversely, on many occasions, I have had service denied me from government-run health care facilities in Denmark.
Posted by: Henri Hein | May 7, 2006 6:43:00 PM
So if the problem is that the state is too involved in healthcare, why is it that here, in the U.S., where you can walk in to a dentist's office and pay cash for treatment, we have so many people in such dire need of basic dental care? I don't see how it can possibly be that the minimal state involvement here in the U.S. could have screwed things up so badly for everyone else. I don't know anybody who has had their dental care paid for by the state.
But I do know several people who, at one time or another, have had to defer dental care for years, until they were able to get a job with dental benefits, at which point they had to have *major* work done. Though this is only an anecdote, it makes it pretty clear to me that a single-payer system would have saved resources at the end of the day. These folks could have had their cavities filled when they were small, rather than waiting until they needed root canals.
Posted by: mark | May 8, 2006 9:40:15 AM
Mark,
Something to keep in mind. People don't always value things intelligently, and frequently this leads to problems getting worse.
For example, I know a woman who's parents were morons, who didn't think routine childhood dentistry was important. So they never rolled her or her brother in for routine dental cleanings (annual cost, $120, or about $0.33 a day, less than the cost of a cup of coffee). As a result when she developed small cracks in her teeth (a very routine problem) they weren't sealed (a relatively cheap, painless proceedure that runs under $200 and only has to be done once). As a result by the time she sought dentistry for herself at age 20, those cracks had developed into a large number of cavities, which were both expensive and painful to have fixed.
I suspect a LOT of Americans with dental problems are like her parents: they don't put any value on preventative dental treatment, and thus develop very expensive problems.
Posted by: quadrupole | May 8, 2006 11:52:50 AM
I found some sites on flouride and dentistry, thinking part of the problem in UK was lack of flouride. Strangley, the sites indicate that the UK may actually have fewer dental probs than the US ?
http://www.fluoridealert.org/health/teeth/caries/who-dmft.html
http://www.whocollab.od.mah.se/euro.html
Posted by: liberty | May 8, 2006 12:30:06 PM
People don't seek dental care in the US because going to the dentist sucks. No further explanation is needed.
Seriously, a cleaning is about $150 and getting a cavity filled is about $200. Get these preventive services done regularly, and you're not likely to need a any thousand-dollar procedures. But in addition to the low monetary cost, you have to take time out of your day to get jabbed with pointy instruments and lectured for not flossing. The failure of some in the US to get dental care has nothing to do with "the system" and everything to do with basic instinctual pain-aversion.
Posted by: Noah Yetter | May 8, 2006 12:48:15 PM
The parallels with the US K-12 education system are so obvious it is painful.
Posted by: happyjuggler0 | May 8, 2006 6:51:01 PM
"I don't see how it can possibly be that the minimal state involvement here in the U.S. could have screwed things up so badly for everyone else"
I'm not sure what you meant by that, but whatever you think of the US government's involvement in the health care sector, there's nothing "minimal" about it.
Posted by: Henri Hein | May 9, 2006 12:26:13 AM
Off the top of my head here are some US government distortions of the health care market.
1) Subsidizing companies that pay health insurance to their employees, thus killing price signals to a huge portion of the consumers in the market.
2) The AMA is the doctor's union, and it creates its own regulations. Sweet for them, shortages (aka higher prices) for the rest of us.
3)All non-profit hospitals must accept all patients in the emergency room regardless of ability to pay. Guess who pays if they can't? ( 3a: For-profit hospitals must accept all emergency room patients who are at risk of loss of life regardless of ability to pay. This is one market distortion I don't have a problem with).
4) The FDA exists. I'm tempted to say no more about the FDA, but I leave you with this: They extend the trial period of drugs by years because they want to "protect" users of drugs for needless deaths from bad drugs. What could be wrong with that? The delay keeps life saving drugs off the market years for years. The lives lost outnumber the lives saved. Europe manages a quicker drug approval process than us but I don't recall hearing about how they are flooded with drugs that kill.
5) Medicare subsidizes healthcare for the elderly, distorting market incentives. The government does not offer full reimbursement. This distorts once again price signals. Guess who pays, both the taxes and the payment deficit?
6) Medicaid is free for the poor, thus distorting once again market price signals.
Needless to say we most definitely don't have a free market health care system in the US.
By the way, whenever someone says x million Americans are without health insurance, then assuming they have the right number, they are still wrong about the implications. See point numbers 3 and 6. We all still have healthcare access even without insurance.
Posted by: happyjuggler0 | May 9, 2006 3:10:30 AM
Here is another big one:
Insurance companies cannot offer policies that cover catastrophic issues only. That drives up the price of insurance, which in turn drives away customers.
Posted by: Henri Hein | May 9, 2006 8:00:26 PM
By using simple yet powerful video animations it is easy for a dentist to save vast amounts of time explaining simple dental procedures to patients. The patient simply watches a narrated video presentation about the treatment for the dental condition that they are experiencing. The explanation is presented professionally and uniformly. Additional questions can be answered by the dentist to fill in all the details for the patient. Products like The Dental Wizard Patient Education DVD are great for this purpose.
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Posted by: Dan Carter | Oct 13, 2007 1:03:22 AM
The problems of the British NHS parallel our problems with medicaid dentistry here. The pay is lousy, and a dentist can only make a living by fraudulent claims or cutting corners treating patients.
I took my US staff to a dental convention in Birmingham, England, and was horrified by the low standard of dental care evident in Brittain. Instead of labs displaying beautiful examples of veneers, crowns, and implant prostheses, nearly all lab work exhibited was dentures and partials.
The problem between the US and England is more English have grown up on socialized dental care and thinking about paying out of pocket is unthinkable to them. I visited penpals in England whose daugther needed orthodontics IMMEDIATELY to prevent the case from going surgical. The cost would have been under $1000. Yet the family would not think about paying for it out-of-pocket, since there was a small chance that with enough pleading to the local council, NHS might cover the child's braces. The false hope of obtaining mediocre NHS care for nothing probably doomed this child to have a severe facial deformity.
Rely on the government for anything, and you will probably get something crappy, if you get it at all. IN ALL INTERVENTIONS INTO HEALTH CARE WITH WHICH I AM ACQUATINED, GOVERNMENT INTERVENES TO MAKE IT CHEAP AND ACCESSIBLE. IN VIRTUALLY NEVER INTERVENES TO INCREASE THE QUALITY OF OUTCOMES.
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Posted by: Edmond Acosta | Dec 18, 2007 6:32:34 AM
Great post,
An enjoyable read!
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Posted by: Great post, | Oct 1, 2008 6:21:08 AM
Yeah - private dentistry is legal in the UK and British private dentists are very busy at the moment as waiting lists on the NHS are huge!
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