If you need something explained, Vox is the place to go. Now, we’re bringing those principles to our latest franchise, Explain It to Me, which launches Wednesday, September 18 and focuses on answering your questions. Weekly podcastA weekly newsletter, and a video series. Each week, we’ll tackle a question from a listener and look for an answer.
This week, for our podcast, us Today, explained Colleague Matt Collette asks: Why does going to the dentist sometimes feel like a scam?
“I feel like every time I go to the dentist, it’s a little bit of a mystery,” she says. “When I’m in my regular doctor’s office, there’s not this step where they say, ‘Hey, we recommend you do something, and here’s what it’s going to cost.’ That just seems so [different from] How do I think about health care — not only do I want this procedure, but do I want to pay for this procedure? And how do I want to pay for this procedure?”
Matt is not imagining things. There are major differences between the ways dentistry and medicine work, including how dental and medicine offices bill and how patients pay for services.
This difference attracts attention Dr. Lisa Simon. He is an Oral Health and Medicine Integration Fellow at the Harvard School of Dental Medicine. He is also a dentist And After spending time in a community health care center as a doctor dentist, he went to medical school. “I realized that the ways in which dental care and medical care are separated were really hurting my patients,” Simon told Vox, “and I wanted to do something about it.”
“I think it’s this legacy, and maybe partly this dichotomy between medicine and dentistry, where we almost act like dentistry is optional and medicine is mandatory, which is not how our bodies work,” he said.
We sat down with Simon to discuss the history of dentistry, why dental insurance works so differently from medical insurance, and how to avoid making the dentist feel like you’ve suffered a fire fest.
Below is a portion of our conversation, edited for length and clarity.
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John Quillin Hill
Why does the dentist seem like a scam? What did Matt pick up on?
Dr. Lisa Simon
There is a fundamental tension in the way dentistry is paid for, which is that the average dentist is in private practice and their income depends on providing you with a procedural service. So they are encouraged to provide you with more services, and you are discouraged from wanting to pay for them. What would be our goal, which is to never get a cavity, and what is the goal of dentists, which is to make money through the many procedures that they are very skilled at.
John Quillin Hill
Have you heard dentistry described as a scam before? Is this feeling common to Matt?
Dr. Lisa Simon
I hear it all the time. Even in the field, I’ve heard it referred to as the mechanic’s principle. [If] I bring my car to the mechanic and the mechanic says, “Oh, yeah, pretty bad confubulator you’ve got there, I must have it repaired,” I have no knowledge or skills to be able to tell if that’s true or not. Being cheated.
But the reality is that most dentists probably aren’t cheating you in this evil, mustache-twirling way, but there may be legitimate clinical differences in someone’s style.
You may have a more conservative dentist [who is] Going to wait and see if it gets bigger and maybe it doesn’t need a filling right away, or you may have a dentist that is more aggressive and wants to do some treatment earlier because they have different clinical experience and are legitimately recommending what they Think it will be best for you.
John Quillin Hill
So why is dental work still so expensive? Why does it feel different from regular health insurance?
Dr. Lisa Simon
In a way, dental insurance is extremely expensive: for the average person, a dental procedure like an implant is a crazy amount of out-of-pocket money. In other ways, dentistry is actually super-duper cheap. That’s just 4 percent of our average health care spending as a country. If you think about the single cost of a one-day hospital ICU stay — which can easily be $50,000 — it’s much more expensive than dental care. The idea behind medical insurance is that if this very expensive, absolutely horrible nightmare thing happens to you, you’re not financially on the hook for it.
Dental insurance isn’t really insurance; It just doesn’t work that way. It is a discount plan. It originated in the ’40s and ’50s with unions that tried to provide a nicer perk for their members.
What it does is it makes the cheapest things — like your cleanings, your exams, or your X-rays that you get every year — free or really cheap. But if you actually need things, you’re going to pay progressively more for these more expensive things, which is basically the opposite of how medical insurance was originally designed to work.
John Quillin Hill
So should we call it insurance? Should we call it a discount plan or should we say, “Here’s your dentist loyalty card?”
Dr. Lisa Simon
Honestly, I think that’s a great point. It’s not insurance. Calling it insurance is probably more of a scam than any other type of scamming going on. And that’s not to say that it might not be a good idea financially for an individual, but as a framework designed to provide care and healthcare for a badly unmet need in our society, I don’t think so. It will design.
