NY Times October 13, 2013
Patients Mired in Costly Credit From Doctors
By JESSICA SILVER-GREENBERG
The dentist set to work, tapping and probing, then put down his tools and delivered the news. His patient, Patricia Gannon, needed a partial denture. The cost: more than $5,700.
Ms. Gannon, 78, was staggered. She said she could not afford it. And her insurance would pay only a small portion. But she was barely out of the chair, her mouth still sore, when her dentist’s office held out a solution: a special line of credit to help cover her bill. Before she knew it, Ms. Gannon recalled, the office manager was taking down her financial details.
But what seemed like the perfect answer — seemed, in fact, like just what the doctor ordered — has turned into a quagmire. Her new loan ensured that the dentist, Dr. Dan A. Knellinger, would be paid in full upfront. But for Ms. Gannon, the price was steep: an annual interest rate of about 23 percent, with a 33 percent penalty rate kicking in if she missed a payment.
* * * * *
About a month ago I began to feel some pain in a molar on the lower right side of my mouth. I was puzzled since the pain was only felt biting down, unlike the nonstop pain that usually accompanies a cavity.
A visit to my dentist revealed the problem. My tooth had a hairline fracture that extended beneath the gum line. Bacteria was penetrating through the opening in the tooth and causing an infection inside the tooth that was oozing out into the gums. He referred me to a root-canal specialist who took one look at the tooth and told me it had to be extracted.
I went back to the dentist and discussed my options. I could get a bridge, either permanent or removable like the denture described in the Times article above. A permanent bridge involves drilling holes into the two teeth bordering the one that is removed in order to support the bridge and the false tooth it supports. But the best option was what they call a dental implant. This involves putting some bovine bone into the pit beneath the removed tooth to replace the bone that bacteria had eaten away. Once the bone fused with my own, the oral surgeon will put in some hardware into the bone that could support an artificial tooth. I have already had the tooth removed in a procedure that costs $1390. I go back to his office in February to get the implant, which will cost around $3000. That’s just one tooth. What if I develop other fractures? An old friend from Bard College, who was featured in a video I did about Hurricane Sandy’s impact on his neighborhood in Rockaway, is 5 years older than me and just had implants to replace three teeth. The cost? Including extractions, it will come to $20,000.
Puzzled by the fracture itself, I asked my dentist how it could have happened. My wife warned me from time to time about eating hard candy, but more I suspect because the crunching sound annoyed her late at night rather than any threat it posed to my teeth. Could that have been the cause, I asked the dentist. He replied that teeth tended to have a life span. Oh great, another sign of my approaching demise.
And so he plays his part. The sixth age shifts
Into the lean and slippered pantaloon,
With spectacles on nose and pouch on side;
His youthful hose, well saved, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.
William Shakespeare, “All’s Well that Ends Well”
I can’t remember exactly when my old friend Tony Long, the creator of massive minimalist sculptures who died of leukemia in 2002, told me this but it has stuck with me over the years. “Louis, you have to take care of your teeth. Can you picture what it will be like if you end up with dentures that you have to put into a glass of water at night? What would some younger woman think of that when you take her to bed?”
Ironically, I have led a charmed life dentally. Except for a wisdom tooth that I had pulled about a decade ago, I have never had an extraction before this one. Not only that, I have not had a filling since living in Houston in 1974. My trips to the dentist for the past forty years have been for cleaning and exams. My dentist told me that it is much more typical for someone my age to be enduring root canal work and bridges or implants on a regular basis.
Despite this, I have had bad dreams over the years of my teeth decaying. My guess is that these dreams and an irrational fear I have of having a tooth pulled (there is zero pain involved plus you get the benefit of a Vicodin prescription) are some kind of Freudian neurotic projection of castration fears. There’s actually a website called http://www.teethfallingoutdream.org/ that tells you everything you need to know, including this:
Dream Psychology: Freud and Jung
The interpretation of teeth falling out in dreams has been widely covered in psychology. Freud associates this symbol to sexual references, such sexual repression or fear of castration for men.
Jung and many other contemporary dream interpreters have a wider perspective and focus their analysis on symbols of personal power and the ability to renew oneself. For instance, they prefer to talk about the representation of loss or the process of releasing the old to give place to the new, as opposed to focusing only on more Freudian sexual references.
On a more mundane level, there’s also my memory of a woeful tale my mother told me when I was 9 years old or so, about to go to a dentist for my first filling. She told me about having a tooth pulled when she was in her teens. It was a painful disaster with the tooth breaking as it was being pulled and the dentist being forced to cut the remainder out with a scalpel—at least that’s the way I remember it.
Leaving aside all the existential dread summed up in the phrase that my Rockaway friend told me–“We are falling apart”–there’s the economics. When I retired from Columbia University, I lost my dental insurance. My wife has a plan through her workplace that covers me but it is utterly useless. I tried to make an appointment about six months ago for a routine checkup but the fucking dentist did not even return my call. In a way, this besides the point since dental insurance generally does not cover implants as a September 30, 2010 NY Times article explained:
An implant to replace a single tooth can cost $3,000 to $4,500, depending on where you live. Implants to replace a full or partial set of teeth can run from $20,000 to as much as $45,000.
Why so much? Implants typically involve the work of both a surgeon and a dentist. Several office visits may be needed to put in the screws and to add the prosthetic teeth.
More dental insurance plans are covering the costs, but the annual reimbursement limit is typically $1,500, an amount that hasn’t changed in four decades. That may be enough to cover half the cost of a single implant; you will end up paying the rest.
Fortunately I don’t need to apply for credit (my oral surgeon thankfully is not set up for this) or borrow money to have the implant done but what if the rest of my teeth start to develop problems? I like the idea of having implants if necessary but not if the cost approaches that of a hip replacement. Maybe going toothless (sans teeth, as Shakespeare put it) is not the worst thing in the world, especially for someone like me who has been married for more than a decade and whose only hope is that I can enjoy another couple of decades of marital bliss.
PBS aired a documentary on “Dollars and Dentists” last year that can be seen at http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists/. This is much more about how poor people are being screwed through the new business model of corporate dental chains that cater to poor people on Medicaid, often run out of storefronts like Kool Smiles. If you’d prefer to read a transcript of “Dollars and Dentists”, you can go to http://www.pbs.org/wgbh/pages/frontline/health-science-technology/dollars-and-dentists/transcript-23/. Be prepared to see just one more example of how the wealthy are screwing the poor on every level, from home foreclosures to dental work:
MILES O’BRIEN: [voice-over] FRONTLINE and the Center for Public Integrity have spent the past year investigating the business of Medicaid dentistry and the new corporate model for treating America’s poor kids.
We were able to obtain and analyze Medicaid data from two states, Virginia and Texas. We found that, on average, Kool Smiles used crowns more frequently than other providers on children 8 and under.
In Texas, half of all the restorative care on kids 8 and under, stainless steel crowns, 50 percent more than the state average. Virginia, 50 percent more crowns than average. That’s a big difference than other Medicaid providers. Why?
Dr. POLLY BUCKEY: Our focus is looking at each and every child and looking at where their decay is, what their risk for getting cavities.
MILES O’BRIEN: It’s not because the crown pays more?
Dr. POLLY BUCKEY: The focus on each and every child we see is to restore that child to a state of good oral health.
MILES O’BRIEN: Then how do you explain that discrepancy, that difference?
Dr. POLLY BUCKEY: All I can tell is what we do. I can’t tell you what someone else does.
MILES O’BRIEN: [voice-over] Kool Smiles later gave us data comparing itself favorably to other providers. But the company did not address whether kids who visit Kool Smiles are more likely to leave with a crown.
Kari Reyes was not happy with what happened when Marissa went to get her crowns.
KARI REYES: The doctor was shoving the crown into Marissa’s gums, and her gums were bleeding just everywhere. She started screaming like, painful, like a shrieking, painful, scary scream for a mother to hear come out of her child.
MILES O’BRIEN: Kari says she thought Marissa’s local anesthetic had worn off.
KARI REYES: I asked Dr. Collins, I said, you know, “Could you stop and numb her mouth?” She ignored me. So I, you know, just kind of sat there, and I was rubbing Marissa’s legs. And she’s crying and screaming this whole time.
What a nightmare. And certainly a lot worse than anything a middle-class man like me would ever have to put up with. Capitalism sucks, especially when it comes to health care.
Signing up for Obamacare
