I went to my dentist a month or two ago. I was shocked by the price for a deep teeth cleaning. A teeth cleaning is included with an annual membership and the deep cleaning is an upcharge from the basic cleaning. I suspect my dentists requires a deep cleaning as a way to charge as much for my free service as the service usually costs retail. I’m in and out of his office in less than 30 minutes usually.
At my last visit the annual membership fee was also due, so my total bill was enough to buy an iPhone 11 on eBay. I don’t think I even spoke to the dentist during the visit; I just met with the dental hygienist. Why was the price so high?
To answer that question I need to share another anecdote. About ten years ago I spoke at a health policy conference. In the exhibit hall outside the conference rooms were booths manned by exhibitors. One booth was a trade association of general dentists. I asked the lobbyists about their public policy agenda. They only had two pet issues they lobby for: 1) to protect the right of general dentists to perform specialty procedures. That is, protect them from specialists who would limit general dentists’ scope of practice to general dentistry. The second policy agenda: 2) protect general dentists from lesser-trained dental therapists who, if allowed to practice independently, could undercut their prices and reduce their income. I asked them what they thought of dental therapists. They assured me it was a bad idea.
I’ve written about dental therapists before but it’s a topic worth revisiting. Kaiser Health News reported on dental therapists who practice basic dentistry in Minnesota.
All six of Michelle Ehlert’s children have Medicaid plans that should cover their dental care. But for years, she and her husband paid for dental care out-of-pocket — sometimes thousands of dollars a year.
That all changed when Ehlert’s family found a clinic in neighboring Otter Tail County run by Apple Tree Dental, where dental therapists, who prioritize treating Medicaid recipients, provide much of the clinic’s care.
Now, “we actually go to the dentist like we’re scheduled to,” Ehlert said. “It really is indescribable how much of a difference it’s made.”
What are dental therapists compared to a dentist?
Dental therapists are licensed providers who offer basic care traditionally provided by dentists, including fillings and simple tooth extractions. Over a dozen states have turned to them to increase access to oral health care, and federal advisers say at least eight more are considering doing the same. Like Minnesota, some states have deployed therapists specifically to benefit underserved populations, such as rural residents, Medicaid recipients, and Native American tribes.
Dental therapy has existed abroad since 1921 but was first practiced in the U.S. in 2004 within the Alaska Tribal Health System. Today, only five college programs offer dental therapy training.
One problem with the program in Minnesota is it came with too many restrictions.
The new licensure came with strings attached, requiring the therapists to practice in areas that didn’t have enough dentists to serve the population, or to primarily treat low-income, uninsured, and underserved patients.
Under the supervision of a dentist, dental therapists can complete oral evaluations, fill cavities, and extract children’s baby teeth. In Minnesota, dental therapists with advanced training can treat patients without having a dentist on-site.
In other words, dental therapists are restricted in such a way they can’t undercut and compete with dentists unless it’s for patients dentists do not want. That is no accident. What dental associations claim is protecting patients is more about protecting dentists’ income against competition.
Across the border in Wisconsin, a bipartisan group of lawmakers introduced bills in 2017 and 2019 to create the license class. The Wisconsin Dental Association opposed the measures, arguing that the state should invest in its existing workforce rather than create another profession. Marquette University and the Academy of General Dentistry joined the association in its objection.
The most important routine dental service people need (in my opinion) is teeth cleaning once or twice a year. Cleanings are performed by dental hygienists under the supervision of a dentist, who may or may not inspect their work during any given cleaning. Instead of paying for an annual membership and an upcharge for three deep cleanings a year (a total cost of about $700 annually), I’d rather visit a dental therapist’s spartan office and pay $75 per visit. If he or she found something of concern they could refer me to a doctor of dental medicine. In most states that’s not allowed but it should be.
To read more about dental therapists’ educational training requirements, see: Dental Therapy | School of Dentistry (umn.edu)
Devon, funny you should mention it but I have “Better Dental” insurance. My PRIME Dental pays to $3,000 per person, per year after the 2nd year and the sleazy Cornhusker State employee dental insurance pays to a mere $1,500 but they overcharge government workers. The State is charging full time employees with families $716/month for UHC health and sleazy dental insurance. Trump’s Plan is just $416 a month with PRIME Better Dental in the FREE and Open Markets. This means that a 30-year-old Nebraska State employee with a husband and son can purchase Trump’s Plan from ME at 813-507-4657 and SAVE $303/every month PLUS get Double the Dental! Is $303 a month enough to buy a new Cadillac?
Here is what I say Devon. You better write this down because you will never remember it. I know you like to spend your HSA funds for dental as rapidly as possible and you have a PhD in economics but let me tell ya that YOU are breaking all the rules. Just tell people I think you should get Trump’s Prime Dental with the higher annual benefits because I don’t want you taking any money out of your tax free HSA just because you went to the dentist. Don’t tell people that you do it Devon, they don’t need to know.
The Smart thing to do is to pay with an ordinary VISA and not your HSA-VISA. You have the FREEDOM to keep the receipt, and let your tax dodge money grow. Anything you can do with an IRA you can do with a tax-free HSA including investing in mutual funds, stocks, real estate, art, silver or gold. Did I ever tell you that the HSA was the doorway to the 21st Century Financial service sector? People will do what you tell them Devon.
I asked everyone I enrolled on tax-free MSAs, “What moron would spend the money that is growing tax free?” If you can just pay with your debit card and keep the receipt. I talked to an old HSA in 2017 who had $200,000 in his HSA then. He also had $40,000 of Qualified Medical Expenses (QME). He was a young guy, a 50 year old dentist from Des Moines, Iowa. My point is people will do what you say so use your head for the clients’ sake. Make them wise.
I also saw around 2000 that investigate reporters traveled America checking dental clinics to determine what percentage gave fraudulent dignoses. They told all the dental clinics that they had dental insurance that will pay for any diagnosis. Out of 50 dental clinics only (2) didn’t inflate the price and diagnoses. One of the location that was HONEST was Creighton University School of Denistry in Omaha, Nebraska. My father went to Creighton Prep before raising the flag on Iwo Jima and 15 additional Japanese beaches before he was 20. Fighting Japanese with malaria and he went bald young.
Devon, for every Nebraska State employee we can lure to Trump’s plan where they save $303 a month, enough to purchase a new car, the taxpayers save $2,336 a month. Devon, you’re the economist so what do you think. Is there any fraud going down here with the World’s largest insurance company when measured by 2022 collected premium. Devon, this is your Andy Rooney Golden Rule company that United Healthcare bought so you know everybody is probably low rent.
I showed the 7-Eleven boss Tom in 1996 that Golden Rule didn’t have a Dependent Conversion Privilege (DCP) so diagnosed children of 7-Eleven Franchisees would be screwed! Wham Bam Thank You Ma’am I had the 7-Eleven account in December 1996! Besides, we were in more states than any competitor and that is why State Farm sold TIME. Trust me, 7-Eleven’s 28,000 stores were everywhere! We were the only logical choice so I knew the 7-Eleven guy was just stalling. We took 7-Eleven Arabic calls for decades. I never learned how to speak Detroit Arabic but my ex-wife got pretty good at understanding them. .