The Washington Post’s Wonkblog recently published a piece inspired by the American dentist who paid a lot of money to shoot Cecil the lion in Zimbabwe, asking why he – and dentists in general – make so much. Which was all pretty interesting to me, since I’ve never really thought about the economics of dental care.
But once you do focus on the issue, it turns out to have an important implication – namely that the ruling theory behind conservative notions of health reform is completely wrong.
For many years, conservatives in the United States have insisted that the problem with health costs is the fact that we don’t treat health care like an ordinary consumer good. People have insurance, which means that they don’t have the “skin in the game” necessary to incentivize them to watch costs. So what we need, the thinking goes, is “consumer-driven” health care, in which insurers no longer pay for routine expenses like visits to the doctor’s office, and in which everyone shops around for the best deals.
The usual response has been that this involves going where the money isn’t – that because health costs are dominated by big expenses that must be paid by insurers, there just isn’t much savings to be had from increasing deductibles and co-payments, for instance.
But what if even the underlying premise – that individual choice holds down costs – is all wrong?
As it turns out, substantially fewer people have dental insurance than have general medical insurance. And even when dental insurance is available, it typically leaves patients with a lot of skin in the game. But dental costs have risen just as fast as overall health spending, and it may be that the reduced role of insurers has actually raised those costs.
According to Wonkblog: “In the rest of medicine, insurers have an important function in limiting costs and promoting quality. The market power of Medicare and major national insurance companies allows them to insist on better rates for their customers when they negotiate with doctors and hospitals.”
“‘There’s been less presence from all kinds of insurance payers in the dental sector,’ explained Andy Snyder, who is in charge of oral health at the nonpartisan National Academy for State Health Policy. ‘Medicare does not cover routine dental services, and private dental coverage is far less common than private medical coverage. So, the dental industry has faced less of the cost containment and quality improvement pressures that the rest of the health care sector’s experienced over the last couple of decades.'”
So more skin in the game is not just useless, but actually counterproductive.
Help us Prepare for Trump’s Day One
Trump is busy getting ready for Day One of his presidency – but so is Truthout.
Trump has made it no secret that he is planning a demolition-style attack on both specific communities and democracy as a whole, beginning on his first day in office. With over 25 executive orders and directives queued up for January 20, he’s promised to “launch the largest deportation program in American history,” roll back anti-discrimination protections for transgender students, and implement a “drill, drill, drill” approach to ramp up oil and gas extraction.
Organizations like Truthout are also being threatened by legislation like HR 9495, the “nonprofit killer bill” that would allow the Treasury Secretary to declare any nonprofit a “terrorist-supporting organization” and strip its tax-exempt status without due process. Progressive media like Truthout that has courageously focused on reporting on Israel’s genocide in Gaza are in the bill’s crosshairs.
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In addition to covering the widespread onslaught of draconian policy, we’re shoring up our resources for what might come next for progressive media: bad-faith lawsuits from far-right ghouls, legislation that seeks to strip us of our ability to receive tax-deductible donations, and further throttling of our reach on social media platforms owned by Trump’s sycophants.
We’re preparing right now for Trump’s Day One: building a brave coalition of movement media; reaching out to the activists, academics, and thinkers we trust to shine a light on the inner workings of authoritarianism; and planning to use journalism as a tool to equip movements to protect the people, lands, and principles most vulnerable to Trump’s destruction.
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Today, we’re asking all of our readers to start a monthly donation or make a one-time donation – as a commitment to stand with us on day one of Trump’s presidency, and every day after that, as we produce journalism that combats authoritarianism, censorship, injustice, and misinformation. You’re an essential part of our future – please join the movement by making a tax-deductible donation today.
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