General Medicine Health Care Health Care Reform

Root Canal lessons…

This week marked my third root canal this year. Ouch! 2009 also included a dental implant and subsequent crown.
Who pays for this professional service? See figure 1…
950 dollars is indeed the going rate. Notice the guarantor is yours truly, not Anthem, Humana, GE, General Motors, UPS or anyone else. A regular Discover card pays. Even if dental insurance was involved, this family would have been over the 1000 maximum months ago.
Lessons learned and thoughts..
Akin to the Mickey Mantle quote, “If I knew I was going to live this long, I would have taken better care of myself,” I say: “if I only knew these necrotic painful teeth were in the cards, you bet there would have been more brushing and flossing.” Yes, I admit, a failure of personal responsibility in my own dental care.
A number of thoughts rumble through the white matter as the credit card swipe renders me 1000$ less rich. Thoughts like, I may have checked the wrong box on career day, or envy that the endodontist has no forms to justify the bill to a third party payer and then no denials of payment, or about the financial pain 7000 dollars/year of dental care would have caused less fortunate families.
After the drilling, as the jaw thumps and heart races form the epinephrine, I wonder about the parallels to medical services. It costs 950$ for a root canal because the specialist is providing a valuable service to improve quality of life. This skill required training, dedication and capital investment in high tech equipment. Econ 101: consumers pay for a service and create supply/demand dynamics, except in medical care, where a third party pays and often consumers consider the medical service free. Let’s see, do not care for your teeth and pay your own money for root canals, do not care for your arteries or lungs and your employer, or in medicare’s case, your neighbor pays for your heart cath and stent and medicines and dialysis and stroke care and lung cancer treatments, etc. It is December, the heart procedure is free.
So what about an hour defibrillator implant, pacemaker or ablation procedure. Or, an office visit to a medical doctor for evaluation and management. These are valued services too, but yet the payment schema is convoluted, with third party payers, deductibles and co-pays. Why is dental care economics so different? What if, individuals payed more of their health care bills like they payed their dentist?
As said by fellow cyclist and a famous podcaster, health and success is about making a series of good choices. If one had to swipe their credit card for a medical service rendered, would this not help incentivize these good lifestyle choices? I suspect so, don’t you.
No misinterpretation please, I am not denying the role of insuring against major hospitalizations, surgery or chemotherapy. An electrophysiologist’s career is often spent fixing arrhythmia that are not at all lifestyle dependent and admittedly, there is much in medicine which is an aberrancy of nature rather than lifestyle dependent.
Another master of the obvious, Mary Barry, MD said it well in her monthly editorial in the Greater Louisville Medical Society journal…

Risk-taking on a personal level has long been celebrated in America, to the point where NASCAR fans take their ATVs on the trail without helmets and end up dead or paralyzed (with all of us paying their medical bills). The addiction community sees obesity as a disease, along with alcoholism, narcotics abuse,etc. I see it also as a series of wrong choices bolstered by a lifelong failure to learn ways to exercise regularly and well. Once people feel imprisoned in their bodies, it is far harder to get them out and about and motivated and happier – but they can do it. Taking responsibility for “being the best we can be” should be our national goal. Acting on that responsibility should save our patients’ health, and it should also save them money.
This author has learned his lesson in dental prevention. Money and pain schooled me; why should it be so different for acquired diseases that “good choices” can prevent?

4 replies on “Root Canal lessons…”


Great post! I had one of those dental years two years ago, despite flossing, tongue scraping, and brushing three times a day. Are we just getting older? And, great food for thought about how we pay ouy of pocket for our teeth but have society pay for our medical treatment, some necessary as a result of bad choices. Good, insightful perspective. Well done!

Unfortunately, I lost a very old filling from a molar not long after losing my job (and my health care insurance). No money available to have it fixed. The tooth has subsequently broken, and recently started being painful.

I still have no health care insurance and no job. I certainly cannot afford $950 to have the tooth pulled and an implant done. In fact, I just have to live with this mostly hollow, broken tooth, for now, and hope the pain continues to respond to Tylenol.

I had great hopes for health care insurance reform, but as the Dems cave (again, sigh…) it looks like not much will happen. In the meantime, people who aren't fortunate enough to be gainfully employed will just have to do without all of it. As a nation, we ought to be ashamed of ourselves for not taking better care of ALL our citizens.

This was a great post, Dr. John. Got me riled, though. Thanks for letting me rant.

Dear Rheumablog,

Sorry to hear about the tooth pain.

I am for increased coverage for all. Although,presently the medical profession is full of pessimism, I have hope that things will improve. Most of Europe's citizens are covered and their quality numbers are as good as ours in many parameters.

I watch the political process with interest. I am watching my colleagues suffer about something that has yet to happen – this presumptive suffering is something my Dad advised me to avoid.

Another dumb random thought about your tooth… As a very poor med student at UConn, I remember visiting the dental school. Think they cared for me on the cheap. I was in the chair for a long time, but the results were good.

BTW, my mom is a newly diagnosed RA patient. I am sending her to your site.


Thanks for the response and your understanding, Dr. John. I have, tentatively, been thinking about checking with our local dental school for help with this. I have to admit I'm a terrible dental patient — old, old phobias — but I'm about at the point where wanting the pain to stop takes precedence over this outdated and fairly irrational fright.

I'm keeping my fingers crossed for health care insurance reform. It's inevitable, but it would be nice if we could adopt it sooner rather than later. So many lives could be improved and so many more saved if we'd be more compassionate toward each other.

Thanks for referring your Mom to my site. RA is a frustrating and sometimes baffling disease, and it's nice to know you're not alone in the battle. Tell her to check out RA Guy's website (it's in my blogroll) in particular. He's gathered a great deal of information and presents it in a very clear, understandable and even humorous way. And goodness knows, we can all use a laugh.

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