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October 15, 2007
In the Teeth of the State
Don Boudreaux
CNN reports on a new study that finds that Brits are pulling their own teeth and otherwise providing self-dentistry because of their difficulty of finding affordable dentists -- yet further evidence that government-supplied health care is unhealthy. Here are the opening paragraphs:
Some English people have resorted to pulling out their own teeth because they cannot find -- or cannot afford -- a dentist, a major study has revealed.
Six percent of those questioned in a survey of 5,000 patients admitted they had resorted to self-treatment using pliers and glue, the UK's Press Association reported.
England has a two-tier dental care system with some dentists offering publicly subsidized treatment through the National Health Service and others performing more expensive private work.
But more than three-quarters of those polled said they had been forced to pay for private treatment because they had been unable to find an NHS dentist. Almost a fifth said they had refused dental treatment because of the cost.
One respondent in Lancashire, northern England, claimed to have extracted 14 of their own teeth with a pair of pliers. In Liverpool, one of those collecting data for the survey interviewed three people who had pulled out their own teeth in one morning.
"I took most of my teeth out in the shed with pliers. I have one to go," another respondent wrote.
Others said they had fixed broken crowns using glue to avoid costly dental work.
(HT Brian Summers.)
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Comments
One of my best depression stories is my mother talking about how her father knocked an impacted molar out of her mouth with a hammer and a chisel because they could not afford a dentist.
Posted by: spencer | Oct 15, 2007 5:02:19 PM
There's no way that there can be a shortage of services in a Socialist Utopia. Ask Muirgeo if you don't believe me. Just don't expect an answer! :p
quack, quack, quack...
Posted by: brotio | Oct 15, 2007 5:57:23 PM
There's no way that there can be a shortage of services in a Socialist Utopia. Ask Muirgeo if you don't believe me. Just don't expect an answer! :p
quack, quack, quack...
Posted by: brotio | Oct 15, 2007 6:00:57 PM
This isn't a very impressive arguement against socialized medicine, imo. Six percent isn't a very big number. I would guess it's not very different for Americans. And I've actually known several people who've refused dental treatment because of cost, so they claimed. Though I tend to think fear might have been a contributing factor.
Posted by: shecky | Oct 15, 2007 7:18:39 PM
Well, it's not exactly like the capitalist utopia lacks problems when it comes to adequate dental health, either. Indeed, a cursory glance at this New York Times article suggests Americans teeth go untreated more than British ones:
http://www.nytimes.com/2007/10/11/business/11decay.html?_r=1&ref=business&oref=slogin
Posted by: Jasper | Oct 15, 2007 8:41:26 PM
6% of 60,776,238 (UK population, CIA factbook) is 3,646,574. Last time I checked 3 million is a large number.
If this was the case in the US, with a population of 300M, that's 18M.
What is a "big number", Shecky?
Roughly three million Brits won't pay the artificially high prices imposed by the British government. We're not talking about serious dental treatment. Getting a tooth pulled isn't that much, nor is getting a filling. I have refused dental treatment because the dentist recommended $6500 worth of work (5 crowns at $1300/ea). They're getting done, just not all at once or I've talked with the dentist about other options such as on-lays, which are about half the price.
And if I decide that his prices are too high, I'll go somewhere else. I don't have any particular loyalty to him. This is something that can't be done in the UK because ALL dentists cost a lot.
When you raise the cost of something through price controls, you push out lower quality, but otherwise acceptable, products. While you end up with higher quality dentists, on average, by raising prices, you lower the quality received by dental patients, on average. This is true because fewer people can afford or think it's worth the higher prices. Lower quality, but wider accessibility increases the average quality for consumers because more people consume the product.
The example that I always think of is what would happen to the average quality of a car if the government said all cars must be sold for no less than $25,000. The average quality per car would go up. BUT the average car per person goes down because now very few people can afford or think it's worth paying $25,000 for a car.
Posted by: Ken | Oct 15, 2007 8:54:48 PM
Considering all of your biting letters and op-eds I thought you might appreciate reading this from a soccer player that never even went to college.
http://www.timesonline.co.uk/tol/sport/columnists/article2658348.ece
Posted by: Kinney | Oct 15, 2007 9:33:13 PM
Clearly this is Dick Cheney's fault.
The right wing conspriacy lives!
No blood for dental work.
Posted by: Russ Wood | Oct 15, 2007 9:37:22 PM
Bleh! I'm not sure how this necessarily a guvmint issue. Simple economics says that if you don't have the money you are refused the transaction. Hence people who don't want pay the money to go to dentists get to play with pliers. Actually I thought the fact that the public dentistry system was falling by the wayside is because dentistry isn't seen as a medical necessity as opposed to, say, l'il kids with cancer.
Posted by: Gil | Oct 15, 2007 9:54:50 PM
Don, if it turns out that a higher percentage of Americans have pulled their own teeth rather than paying a private dentist, will you start advocating single-payer dentistry? Or will you only modify your tune: "Obviously the market is working, people rationally prefer to self-medicate, and the fact that fewer British citizens pull their own teeth is evidence that the British taxpayer is being overcharged to provide luxury-level extraction services that their citizens would be unwilling to pay for if it came from their own pockets."
Posted by: T L Holaday | Oct 15, 2007 10:55:42 PM
And yes, I am an American who has pulled his own teeth with pliers and done his own filling repair rather than pay a private dentist.
Posted by: T L Holaday | Oct 15, 2007 10:57:29 PM
TL --
As I understand the British situation, there are two ways to get dental care: (1) through NHS, and (2) privately. It appears that each dentist has some quota of NHS patients that they'll take, and they can take the rest privately. NHS pays dentists poorly, so the dentists have to charge the private patients more to offset the NHS patients.
As a result, the very inexpensive NHS services are over-utilized, and people have a tough time getting service.
Meanwhile, this system has made dentistry less attractive to new entrants, further decreasing supply. (The UK now has roughly 1/3 fewer dentists per capita than the US -- 4/10,000 v. 6/10,000. )
Posted by: chris | Oct 16, 2007 12:44:53 AM
As a British ex-patriot (with perfect teeth and living happily in America), I am shocked to see the level of dentistry that has befallen my countrypersons. You would think that with 42 percent of GDP being expropriated by the govenment, there would be some decent toothcare. But then again, where there are high housing prices, food expenses, and parking costs a bloody fortune, then who has the time to worry about dentistry? I don't know how many Brits live over here, but I can ssure you there are a lot of us.
Posted by: TheAlbatross | Oct 16, 2007 12:53:54 AM
No, 6% isn't a whole lot. Compared to the 94% who seem to
Gil makes a good point, in that nobody seems to be stopping anyone from getting dental care. 6% simply aren't interested in waiting *or* paying. In addition, getting to the point where one needs 14 extractions, I suspect the blame is probably pretty much on one's own neglect. Brushing after meals isn't rocket science.
Posted by: shecky | Oct 16, 2007 1:22:57 AM
Doing it yourself is that not taking privatization to its real extreme? In which case we could perhaps say that this is indeed proof for that there is a need for some more public sector provisioning of dental services.
Cheers!
Posted by: Per Kurowski | Oct 16, 2007 9:20:58 AM
Per Kurowski,
You lost me here. Huhhhhhh?
"Doing it yourself is that not taking privatization to its real extreme? In which case we could perhaps say that this is indeed proof for that there is a need for some more public sector provisioning of dental services.
Cheers!
Posted by: Per Kurowski | Oct 16, 2007 9:20:58 AM"
How do you use "doing it yourself" as proof that there is need for some one "to do it for you"?
That is a contradiction.
Posted by: vidyohs | Oct 16, 2007 10:09:45 AM
The problem with comparing free market system with socialized medicine is that you can't really use the U.S. as a proxy for a free market system.
It's more free market than the European systems but anyone who believes we're not saddled with a "socialism light" medical system just isn't paying attention.
It's pretty obvious that the care, availability and access in the private market is better. It's also not too genius to notice that the prices in that system are inflated to make up for losses incurred in the Medicare, NHS (or whatever the socialist albatross hanging around the neck of the medical profession is called). This type of price distortion is seen in New York City where we have apartment price controls and in the pharmaceutical industry where Americans pay much more to subsidize the drugs sold at discounts to socialist systems.
Obviously we have some of the same problems in America as in Britain because we are also weighed down by socialized medicine. Just to a lesser extent.
Posted by: Methinks | Oct 16, 2007 10:14:20 AM
Where's 'you know who'? On break?
How long before he again tries to persuade us that supporting socialized health care isn't a sign of a socialist?
Posted by: Sam Grove | Oct 16, 2007 10:33:54 AM
This is not surprising. Government intervention usually means reduced supply in all phases of production. I am actually surprised that the problem is not worse. I do find it oddly humorous that the "government is grand" crowd is trying to argue that 3.5 million people ripping their own teeth out with pliers is not problematic and might be socially desirable.
Posted by: John Pertz | Oct 16, 2007 10:42:42 AM
Methinks
I couldn't agree with you more:
"The problem with comparing free market system with socialized medicine is that you can't really use the U.S. as a proxy for a free market system.
It's more free market than the European systems but anyone who believes we're not saddled with a "socialism light" medical system just isn't paying attention."
And, Billary is in the wings carrying the Guiness Stout. LOL
Posted by: vidyohs | Oct 16, 2007 10:51:31 AM
My brother just went on MEDICARE recently. His wife retired from Shell Oil, he turned 70, and opted to go with MEDICARE. His experience in just finding a primary care physician is something I wouldn't wish on anyone. He has been at it for about six months and still hasn't found one he has any confidence in at all.
I dread having to listen to him describe an effort to find a dentist.
My own experience here in Houston leads me to believe that if each individual were more proactive in investigating medical care providers, and then arranging to discuss services and terms with them on a cash basis, most people would find health care that is till affordable. Particularly dental care.
By seeking out alternatives to the top notch dentist in Friendswood, Texas, I got an estimated $11,600 of dental work (crowns, bridge, fillings) for $3,400 cash. The dentist that took me was excellent, and his work from 15 years ago is still solid in my mouth.
The dentist I now use is recognized as one of the top 50 in Texas and takes AMERIPLAN patients. I had the plan for some five years and my wife and I established a rapport with him. AMERIPLAN negotiated a 50% discount price, paid in cash upon completion of service. After some years I went to my dentist and pointed out that my paying a fee for the plan was not a factor to his bottom line. I asked him if he would treat us the same as people on the plan if we guaranteed cash payment as we always did on the plan. The upshot is that I pay a 50% discounted price on all dental work and get my care from a premier dentist. Biannual cleanings, xrays, and examination cost me $65. And we cancelled the plan some four years ago.
My dentist is in business, he has costs in dealing with the regulatory restrictions on him. My paying cash does does away with an enormous cost in paperwork and time spent on collecting money from me. That is precisely why he was taking the AMERIPLAN people in the first place.
Doctors and dentists are service providers, they advertise seeking the opportunity to serve you, when you select a doctor and contract him to perform, you remain the one with the money.
Do you worship your employee and decline to negotiate with him in honesty and candor? I can respect the time and effort it took the man to earn his right to practice medicine, but I don't let that interfere with my knowledge that is my money that purchases his services. Since it is my money I have a right to expect high qaulity service, if I don't get it and pay anyway....then I deserve what I got.
Posted by: vidyohs | Oct 16, 2007 10:57:43 AM
And one more,
We talk about the problems of the healthcare system without wasting a whole lot of time on the others that are also caught in the system, the providers.
How is this for an "assumption" and sticking it to the doctor? This is from a friend on another discussion link.
"In reading this article on PFFS plans on health care from AARP News
Letter, one can see how so called government operates on us. Here is the
article in part that grabbed my attention:
***; that by law PFFS plans ( unlike MA managed care plans) do not have a
contract with any providers before policies are sold. Instead, a Doctor
or hospital that agrees to treat an enrollee is automatically "deemed" to
have agreed to the plans terms and payment conditions--without any
negotiation. (and obviously without any knowledge of the true state of affairs - vidyohs)
Posted by: vidyohs | Oct 16, 2007 11:06:05 AM
Just out of curiosity...why does it seem that so many Brits have such bad teeth? Seems to me that CNN was jumping on the opportunity to rehash an old stereotype that our neighbors from across the pond would rather see gone from the history books, as well as main stream media. Slow news day, CNN???
Just thinking out loud.
Posted by: Randy | Oct 16, 2007 11:44:57 AM
Interesting story, vidyohs. Here's another:
I don't know if dental insurance works this way but health insurance does in at least NY, IL and VA.
A doctor performs a procedure for which he bills the insurance company $100. The insurance company pays him $43. If he billed $43 to the insurance company, he would get much less - say, $19. So, to get paid $43, he must bill $100.
If a patient comes to his office and needs the same procedure but the patient is paying cash, the doctor cannot charge the patient $43. That is considered "insurance fraud" in those states. He must - by law - charge the cash paying patient the same $100 he bills the insurance company even though the insurance company pays him only $43. So, the cash paying patient is always screwed or the doctor commits insurance fraud. In fact, this "insurance fraud" is what usually happens. The doctor codes the procedure as something else entirely and charges the $43 - but always taking a risk of being charged with insurance fraud. As one of my doctors told me "I spend all day lying". Not all doctors are willing to take these personal risks, though.
Who lets the insurance company get away this kind of fleecing? Why, its the government the socialists keep proclaiming is there to protect us from "corporatism" (or whatever).
Posted by: Methinks | Oct 16, 2007 3:02:19 PM
I'm from the UK and in my area it's impossible to find an NHS dentist; everyone has gone private. There are three dentists in my town, but none of them take adult NHS patients (I believe they take children).
There are two opticians, they don't take adult NHS patients either.
There is one NHS doctor's surgey and it only operates during weekday working hours so if you can't take time off work you never see a doctor until you're so sick you can't go in. You have to make an appointment before seeing a doctor and they usually go within the first hour that the phone lines are open (9am to 10am). If you get an appointment and turn up on time you'll usually wait between one and two hours to actually see your doctor.
There's one NHS hospital in the nearest city. I haven't been there n a few years but it was filthy when I went. There's also a private hospital which I went to for an operation - I would have lived there if I could.
Posted by: Simon Clark | Oct 16, 2007 3:39:59 PM
"This isn't a very impressive arguement against socialized medicine, imo. Six percent isn't a very big number."-Shecky
That's six percent of the entire population (assuming their sample was representative). I wonder what percentage of the population actually needs a tooth pulled. If, let's say 20% (1 in 5) of the population needs a tooth pulled that's 6/20 or 30% of the people who need a tooth pulled did it themselves. That seems like a pretty big number to me.
"By seeking out alternatives to the top notch dentist in Friendswood, Texas, I got an estimated $11,600 of dental work (crowns, bridge, fillings) for $3,400 cash." vidyohs
Good negotiation vidyohs. MD's will do the same thing. When I got married to my wife, she had a $3,000 outstanding debt to repair a retina tear from when she was a student without insurance. They were letting her pay it off at $25 a month which was pretty generous of them considering that would have been a 15+ year payout with 0% interest on the entire debt. When we got married I called the Dr. and ofered $1,500 cash to make the entire debt go away. They took it without hesitation.
"If a patient comes to his office and needs the same procedure but the patient is paying cash, the doctor cannot charge the patient $43. That is considered "insurance fraud" in those states. He must - by law - charge the cash paying patient the same $100 he bills the insurance company..."Methinks
I believe that what they do is charge you $100, and "write off" the remaining $57 as bad debt. A busines associate negotiated has colon resection and chemotherapy. By doing this he basically made his $3,000 deductible and 20% co-pay go away. He paid in cash, and had the insurance company directly reimburse him.
Posted by: Kevin S. | Oct 16, 2007 4:37:45 PM
Where is Dr. Troy Camplin Ph.D when you need him? I'm sure he has a view on this that is far superior to anyone else's.
Posted by: onlyhalfimpressed | Oct 17, 2007 3:52:39 AM
Yes, Kevin. The other thing they do is just code it as a different, less expensive procedure. But whether they write it off as bad debt or code it differently, by law it is insurance fraud - absurd. The doctors are clearly not the problem. Clearly, if the insurance industry were deregulated and forced to compete and people were actually responsible for paying for their own medical care costs would decline and everyone would have more access. As an impoverished student with no insurance, I also worked out payment plans with my doctors. Even with no insurance, I still had access.
Posted by: Methinks | Oct 17, 2007 8:50:06 AM
Yes, Kevin. The other thing they do is just code it as a different, less expensive procedure. But whether they write it off as bad debt or code it differently, by law it is insurance fraud - absurd. The doctors are clearly not the problem. Clearly, if the insurance industry were deregulated and forced to compete and people were actually responsible for paying for their own medical care costs would decline and everyone would have more access. As an impoverished student with no insurance, I also worked out payment plans with my doctors. Even with no insurance, I still had access.
Posted by: Methinks | Oct 17, 2007 8:50:14 AM
"absurd" - Methinks
Agreed. Another demonstration that our current "free market" health care system isn't really all that free.
Posted by: Kevin S. | Oct 17, 2007 11:41:37 AM
At the root of the problem in the UK is the fact that entry to the dental profession has traditionally been regulated by the government in conjunction with the powerful lobby of the British Dental Association. Both had a big incentive to reduce access - the government because it paid training costs and the BDA because if you restrict supply, you force up prices (note that the vast majority UK dentists are not and have never been directly employed by the NHS - they are independent contractors).
The restricted supply has meant that dentists are in apowerful negotiating position. Because demand outstrips supply, the dentists can simply refuse to do NHS work if it doesn't pay well enough. This is why there is a shortage of NHS dentists and why private treatment prices are incredibly high. As a result, many people in the UK travel to other parts of Europe - where supply has not been artificially restricted - to get cheaper and often better, treatment.
Deregulating supply is the answer.
Posted by: HJ | Oct 22, 2007 6:36:22 AM
When treatment abroad can be had through websites like http://www.dentalholiday.co.uk for 70% less than the usual private dental cost in the UK, it's no wonder hundreds of disgruntled brits are drive in hoards for implants, crowns and veneers - the most common types of major dental work which the NHS does not have covered.
Clinics like them have native english staff directly in the clinic, lots of freebies, a relaxed atmosphere, and highly expert doctors and technology.
It's no wonder we go abroad when it's just a 1-2 hours flight away.
Posted by: Daniel Shaw | Apr 14, 2008 12:15:09 PM
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