I got through the explanation quite well, it was already pretty interesting. Then I came here to comment and found out your link to the skit. If this isn't follow up care I don't know what it is ❤❤❤
Hi Doctor Glucosefuckin! Next time you should let Jonathan explain. He can handle the dentists, plus I'm sure he could have done a much better job of explaining this in a clear and concise manner. Thanks again for being alive! Keep doing that please = ) ALSO! More Ortho videos please!
But based upon what the Doc said, they are scary. They made sure that dental care was outside of Medicare because they wanted to not be regulated or subject to governmental reimbursement rates.
He forgot to add a ton of politics which could have fixed the US healthcare system but didn't. Oh course that would make this even more depressing than it already is.
@@TheFirebird123456 tbf "no insurance companies and your pricing has to be subject to the same kind of fair commerce tribunal that other businesses have" would have sorted it
Not just US. In the UK we have exactly the same divisions with eyes. Eye test, glasses, contacts = private. Eye conditions/injury = NHS. Teeth? We tie a piece of string between a door knob and the bad tooth and slam the door 😂.
Excuse me, I have a brother in Australia and he told me that doctors get (I think) 8 dollars for every patient they manage to see (this was 4 years ago). Is this a lot, or not at all? How well do doctors live there compared to let's say America where they earn anywhere from 200k up to 400k+ US dollars, and do they have debt in Australia?
Unironically the bit about Dentists lobbying to not be in Medicare is exactly what happened with Australian Medicare. Turns out people who go into a profession to help people can still be greedy fucks.
@@Kushibunny Ahem, my lord, that would be 1000 dollars for less than 15 patients. Can they choose to consult infinite number of patients? Does the consult have to be successful, as in to hit their therapy just right and heal the person?
As an OD I hate having to explain that when I find a medical condition during an exam it goes from a vision exam ( $0 or low copay) to a medical exam ($30 or last week $100 out of pocket). Patients feel like it's a bait and switch but really it's just because the system is ridiculous.
@@chrisstehlik7927 IDC10 codes. Everything done or diagnosed falls under one code or another. Well-patient checkup changes to complex assessment and adds a diagnosis, which generates codes under which the patient/insurance is billed.
On the other hand if you are taking a medication that can affect vision but paying out of pocket for your eye exam now maybe it can be partially covered by your medical insurance.
Dr. G's message is SO accurate and SO on-target. Sadly, I see many patients getting "medical" care who have chronic debilitating problems all over their body brought on by neglect of their teeth...poor nutrition (from eating too little or only junky things that are easy to chew)...chronic inflammation (stimulated by dental abscesses or caries)...repeated infections in other parts of their body seeded from infections in their teeth...chronic pain...sinus infections. And these problems go on and on because their physicians never looked at it, didn't think about it, figured that treating it was somebody else's problem, etc. I try to do my part by identifying the problem and putting it in my report. I have seen more than a few patients get a lot better after their caries were fixed...you can't cure their AIDS, but eating better, fixing a source of pain, and stopping seeding infections goes a long way toward making their life better.
@MyFiddlePlayer. You’re so right. My little brother never took care of his teeth, he almost died of infection that spread to his heart. He needed a valve replaced but his heart surgeon knew he needed all of his teeth pulled first. The oral surgeon REFUSED to pull all of them. The heart surgeon tried his best to get him to pull them all, even telling him my brothers’ replaced valve would become infected if he didn’t. DUDE DID NOT CARE. My brother did indeed have to have his valve replaced again, the heart surgeon made the oral surgeon pull the rest….and my brother never got a bill for that. People highly underestimate the importance of good. dental hygiene.
But the outpatient surgery under general anesthesia to remove the bone infection is dental (not covered) because it's in my jaw but if it had been in my shin, then medical insurance would have covered it.
Hey, this is actually very helpful because it means we can directly petition our representatives to update medicare to include dental and vision. That is much easier than getting a health insurance company to pull its head out of its ass.
Healthcare is fundamentally an insurance. Insurance is based on sharing the risk ie everyone pays but not everyone gets sick. But everyones teeth decay and their eyesight gets worse as they age. So the sharing of risks does not really work, at least not with privatized healthcare insurance. When healthcare is based on taxes which are a percentage of your income then this can work up to a point. Better off people pay more than less fortunate ones in taxes so if the tax percentage is high enough (and in many countries the percentage is progressive) then some level of dental and eye care can be provided for everyone. I say 'some level' because new treatments like dental implants and lasik ops are still prohibitively expensive (for no reason based on how much the actual operation and materials cost) to be provided for everyone.
Fun fact; until recently (mid last decade) there was a singular enterance exam for med and dentist school in North Belgium. Succeeding meant that you could chose any study at any university in the country :) Also, dentist care should be included!
This is absolutely true. The sad part is people have to refer to private companies to cover for dental, which in Medicare is part C. The only dental that Medicare covers is extractions of teeth for the sole purpose of prepping for treatment of esophageal cancer. There are talks however, of Medicare expanding its coverage to the deficient areas of healthcare but nothing has been set as of yet Dr G, you should make a video of why prosthodontics are covered (like dentures) but not implants. Despite them being cheaper (in the long run) and improving the quality of life to patients.
Implants are (to insurance) a relatively new treatment and are considered purely cosmetic. Even though there is at minimum a decade of research and case studies showing otherwise 😜 There is starting to be a shift in insurance where some companies are offering plans that provide implant coverage, but they are rare.
@@abbunnies9784 I have a documented allergy to metal, and have to have all ceramic fillings. Its been in my chart FOR TWENTY YEARS, and my dental insurance still treats my fillings as cosmetic and won't pay as much as they would for the ones that would cause me constant pain. 🤔
This is basically the same in the UK - dentistry is only partially covered by the NHS so, unlike any other specialism, NHS dentistry is only substantially subsidised, not free (except for children and people on certain low-income or disability welfare benefits). However, unlike with Medicare, dentistry _was_ originally fully included in the NHS. A lot of factors led to the introduction of dental charges but as I understand it a big one was that British teeth had been _so_ neglected when people couldn't afford dentistry that the NHS was struggling financially under the burden of the massive demand for dentures. (I do know that another one was the reluctance of dentists to join the NHS - originally only a quarter of them did.) In the first 9 months of the NHS it provided over 33 million artificial teeth (the UK population in 1948 was less than 50 million). Charges for dentures were introduced in 1951 and were of course hugely controversial, leading to the resignation of the Health Secretary who had created the NHS, Aneurin Bevan. Once that precedent was set, other dental charges soon followed and here we are today with our internationally-notorious orthodontic reputation.
Yeah, a lot of the slander towards British teeth comes from the fact that non medically necessary procedures like cosmetic orthodontic work often aren’t covered by the nhs and people don’t tend to get private insurance, so if a procedure isn’t free people don’t want to pay for it leaving them with potentially aesthetically unappealing mouths in comparison to the Hollywood grin.
Dental was included in Medicaid back in the 1980s. I remember my mom getting her teeth done the same time we got ours done. And today medicaid for kids covers dental up to age 21. Though it is suspicious to me that when I was getting dental through my work my kid never had any cavities and I even got her molars sealed so she was less likely to have cavities. Then later when she got care through medicaid she suddenly needed a root canal.
Medicaid is totally different. Medicaid is provided by the states rather than the federal government. The program for kids is even more different, it's actually called CHIP and is a specialized program for kids that does cover dental. For adults, Medicaid offers little dental coverage, and good luck finding a dentist who'll take it.
Most state Medicaid dental programs offer coverage that is dangerously insufficient. Dental coverage for adults on Medicaid isn’t even legally required so most states put the bare minimum into it. There are only 8 states that offer comprehensive dental coverage to adults on Medicaid.
Root canal, you can't predict or delay. You need it, YOU NEED IT. 5 am, your tooth nerve dies, you need root canal surgery, earliest appointment at 7am emergency.
@@bordomsdeadly Yeah, it's pretty bad. I used to work in a customer service center for a state's medicaid program as we had to assign adult patients to a "primary dentist" which was a joke, especially for folks who lived in rural areas. Complete nightmare.
As an American ex-pat, the ONLY thing I can say about health care that isn't better everywhere else is dental/eye care. I'm sure there are some places where they do actually cover dental and eyes, but a lot of places are just as bad as the US in that regard. Though it is still cheaper out of pocket vs. the US.
I moved to Canada. Care here is vastly different from province to province and rural vs the big cities. If you want an upgrade for anything, don’t move to Nova Scotia. You may not have to pay for care, but trying to get a doctor to treat anything is impossible. The upside was that after waiting 3 years, I had the most thorough visit of my life, but I was so much sicker than necessary by the time I got there
@@SAOS451316 Yep. Probably why the average life expectancy is three years higher in Canada than in the US, which is wild considering their lifestyles are otherwise pretty similar.
You are just as informative and entertaining without a skit format. I'm fascinated/horrified by what I hear about American medicine and that Canadian is following a different but also dark path
In the Netherlands dentistry is no longer covered under basic health insurance, but an additional package that needs to be purchased and usually still covers only part of the costs. It's only covered under basic health insurance for 0-18 year olds. I'm a policy consultant for a small city in the Netherlands. My job is fighting poverty, and dental issues getting WAAY out of hand is a huge problem there. Literally have people too sick to work or simply not being hired because of severe dental problems.
@@monicaspoor2993 there is no such thing as a free market under capitalism, capitalism means that markets will always be unfair and hence not free But ik what you mean the so called free market capitalist people are like weeds. They privatize things, they get worse from that, and then they blame public stuff and say more things should be privatized actually 🙄
I live in Sweden, our health care system has its flaws but I still think it's amazing. We don't have to pay more than about $120 per year for doctors' visits, labs, etc. You pay a certain amount for each visit, but once you reach that number, all visits are free for the rest of the year. However, dental appointments aren't included in that. I know people (myself included) who don't want to go to the dentist because it's too expensive. I'm a doctor myself, and I know that oral health can impact your general health (especially heart disease), so I have no idea why it's not covered in the same way. I have a friend who's a dentist, and he basically said that the cost is high because people need to brush and take care of their teeth. If they did that, they wouldn't have any problems 🙄 Meanwhile, we treat smokers with lung cancer or COPD without charging them extra...
As a naturalized US citizen, your videos are SO helpful! I have called my insurance company several times over the years to try to make sense of this overcomplicated system but I think I'm finally understanding the basics thanks to you.
Here's your reminder that the Hippocratic oath forswears ever performing surgery, as that is the domain of barbers, not physicians. Rivalry in the field of medicine has a bit of a history.
@@slantdwave probably in part the ridiculous cost of dental care and because after one or two terrifying dental exams we are so terrified of going to yet another dentist that will yell at us and throw tantrums(my first appointment with one for an abcess) that we wait years to see another dentist the dentists think the patients should just get everything pulled to have fake teeth because there is nothing left as well as many dental offices(as well as private practices and veterinary hospitals) being bought owned by price gouging greedy private equity companies and the drive to extract as much money from patients as possible. That seems to be common that dentists(like Aspen Dental) suggest pulling everything because the patient who can’t afford care hasn’t been to a dentist in years to decades. Dentists really are out of touch terrorizing monsters in a country where healthcare is so expensive it’s unaffordable, it really makes no sense.
@@slantdwave I see this with my Medicaid patients. Some prefer to pull their teeth and get dentures because Medicaid is limited on what they pay state to state.
Fellow eye dentist here. I’d love to see you do a video about the recent changes to MIGs. It could be ophthalmologist Dr G and Joanathan talking to gov’t official and gov’t Jonathan about what qualifies as evidence. Love the content.
This is interesting, I wondered why dental wasn't included in Medicare. So the ADA had no concern for the health of individuals, they just wanted dentists to have no limits on what they could charge patients. This is why so many people, even with dental insurance, can't afford dental care.
you know what i just remembered? the fact that dental care is so expensive where i live that my relatives go overseas for it cuz that's cheaper. y'all should do that too.
Because the Republicans have convinced the least educated as a society that our system is way better than others (it’s not and that is backed by data and research studies).
From a physician's perspective, I see so many medical complications from poor dental health. If everyone had good dental care, it would SAVE society a ton of money. I always figured teeth were not covered because they are the most likely to have problems if not cared for properly.
Hey doctor . I'm so happy to say that I got into med school 😊 I spent the last year watching your videos while working hard towards my dream , your videos really helped me regain focus when things got rough . Keep posting more videos they always make me laugh and I'm a huge fan ❤
Same here in Ontario, Canada -- dentistry and eye exams are not included under OHIP. (I believe eye exams are covered for certain individuals, though that may no longer be the case due to some optometry vs government problems) It's real bad!
Yes, thank you! I'm poor but I also have the absolute worst eyes so I've always known that you can see an eye dentist but no other poor people that I know (everyone) knows that before I go on my get your eye conditions treated by the right person rant. Also, you can check with the eye dentist to see how much a refraction costs. It's 40 at my place and then I get my glasses at Costco which is the cheapest If the online places can't handle your prescription AND you don't have to have a costco card to go to the vision center or the pharmacy.
I think glasses and vision tests are separate because it's a common medical need and people generally can't perform well in their lives without visual acuity, so insurance companies save a lot of money by excluding so many people from care, and those people are then forced to purchase the care anyway because they can't drive or do their job without glasses/contacts. If half the population needed another medical device like hearing aids or a wheelchair there would be separate hearing and walking insurance
As a policy wonk, I must say that was a very well done history of health insurance. Your inner Internal Medicine Chief Resident was definitely shining through.
Arguments for or against universal healthcare aside, it would be great if we could do things like Germany does. My German ex-bf told me that as long as you have been faithfully going to your bi-annual dental exams, if you still have a dental issue of any kind, it's covered 100%. But if you fail to go to all of your exams, that's when you have to start paying.
This is proof Dr G could be successful making both sketches and informative videos, because this was an amazing explanation for a complicated topic. Thanks!
I've also been told that dental insurance is a lot more "stable" on the cost side - most people end up paying around the same amount for dental work over their lifetime, wherase medical costs vary wildly between individuals. Thus the rates are very different. This combined with the fact that dental work can be put off for so long makes it so the "best" way to do dental work is to get 1 year of dental insurance, get like 15 fillings that year, and then cancel your insurance plan until 10 years later when you do it again. hence dental plans have a maximum coverage to reduce the amount of that you can get away with. Essentially, it's because insurance's job as a cost "smoother" reacts very differently between medical insurance where cost is mostly driven by acute problems, and dental insurance where cost is mostly driven by chronic problems.
We need to change this. Dentists should not be looked up to or down upon, but should be treated, AND PAID, the same as body doctors. And so should eye doctors.
So speaking as an admin in the dental industry were my job is 80% dealing with insurance, and 10% being a reptionist and 10% therapist in Canada...this is accurate even here. While some provinces provide low income/senior dental coverage, what the province i live in has set as the amounts covered barely covers the cost of materials for treatment in many cases, and does not cover or fully cover the time of the people completing the treatment. This is because the government has not updated the pricing of what is covered by their dental coverage plans for at least a decade, or possibly more. Another factor is that certain procedures that are largely considered a best long term treatment, i.e. crowns, are often not covered under those plans. This limits what the dentists are able to do for best LONG TERM treatment. By long term treatment, i refer to helping the patient retain their teeth as much as possible, for as long as possible. Pulling a tooth that is infected and causing pain instead of root canaling and crowning it is a great short term solution. But long term there is bone loss that will occur in that spot because the root is not there to stabilize the bone. This leads the the bone around the surrounding teeth to go away, and then those teeth become loose and more likely to become decayed, which leads to then needing to be removed. I would not be surprised if this was the case in many places, and i also would not be surprised if that was one of the arguments posed by the ADA. Simply put, because the dentists would be limited in being able to provide optimal care, and in a profit focused clinic would be less inclined to prioritize care for patients under that coverage, they lobbied against the medicare system. I do not agree with it, as dental infections can be life threatening, and there are many studies that have shown strong links between oral health and heart disease, diabetes, mental health and overall well-being. Even if you are limited in being able to provide optimal dental treatment, the patient should be the focus. There are a lot of good dentists out there who are patient focused and go above and beyond for their patients, i have seen it first hand. But there are those that or primarily profit focused. I understand that it is a business, but a balance is necessary.
And yes, almost all dentists i have met love golf. And because it's Canada, in the golf off season, many of them play hockey, in a dentist hockey league. Yes, you read that right. Our dentists have their own teams and a league. You can bet they avoid hitting each other in the face because they don't want to ruin the other person's teeth.😂
As always, nice video. Incredible the differences between each countries. In Brazil we have universal healthcare, including teeth. But, despite being universal, there is not enough care for so many patients at the same time, waiting list can get enormous. The good part is the "capillarity" of the system, so a grandma from a small rural village can get access to a world class dental treatment, if necessary.
I feel this even in Ireland. They won’t cover hearing aids under private health insurance here. They are regarded as cosmetic! Thankfully the Public health care system is still okay here to help with that.
I find optometrists and ophthalmologists both use a common shorthand that’s hard always to understand, as a GP. Optometrists know their stuff in my opinion and have helped me in a pinch for foreign body exams.
personally i like the fact that eye doctors are specialized when it comes to vision. you get really good and talented doctors who know how to focus dem eyes while the other nice doctors can keep yo eyes healthy.
I don’t know the history but ironically dental and vision are also not covered in Canada 🇨🇦 either (vision I think 💭 children get checkups up to a certain age but don’t quote me don’t have kids). Also as you mentioned ophthalmology issues are covered such as diseases, retinal detachments, …
I spent over an hour yesterday talking with insurance companies so I cheered wholeheartedly when u said that we make things way more complicated than it needs to be
Love this his lesson, Dr Glaucomfleckon! I’ll add one comment that Kaiser Permanente does include vision checks and eyeglass/contacts prescriptions within their medical insurance benefits. They even waive the co-pay. KP isn’t perfect, but this is one of several positives of their version of insurance.
Dental and eye care are also in Finland so separated from all the other care that it sometimes blows my mind. Almost everybody pretty much have to deal with them in private sector.
My private medical insurance in Australia covers both eye glasses & dental procedures and check ups. You don’t need insurance in Australia, everyone has medical care for free, it offers you more freedom of where you go and speeds up obtaining services. Also it covers, massage, chiropractory, Chinese medicine, etc
The thing that doesn't make sense from the insurance point of view is they don't want to pay for anything right? So their objective should be to prevent injury right? So they should pay for peoples' glasses even just for the lenses, because otherwise they might run the risk of walking into a traffic light and breaking their nose, which ultimately costs $2500 on average over the average cost of $150 for a pair of lenses. The stupidity is they'd happily pay for the medical consequences of dental or vision preventative care they aren't providing even if it ends up costing more on the sole basis that the chance of someone without good vision might still be able to see where they are going. This also means if we want to change that we need to make the insurance companies bleed by requesting care for injuries sustained from lack of vision or poor dental care, hit them where it hurts, their bank accounts!
How many people actually sustain injuries that require medical treatment due to not being able to afford glasses? If people are just going to buy their own glasses then there is no benefit to the insurance company in paying for them. And if the few people that actually go without glasses because they aren't covered usually don't receive any injuries that require treatment, then there still isn't much benefit. The cost of the glasses would probably be more than the cost of the treatment.
@@thomasdalton1508 That's what I said, they need to receive more bills for treatment of injuries sustained due to lack of vision or dental care. The moment it makes monetary sense to do preventative care over dealing with the consequences the vision and dental plans will be bundled in no time.
I'm 2 years behind on my annual vision check because I know that they'll say I need a new pair of glasses even though I don't. I can't see details at long distances (default state) but I also need some small (but technically surgical) procedures every few weeks and the anesthesia messes with my vision. Plus, if insurance doesn't want to pay for them, it's obviously not that important. (/s) I'd happily get them if they were covered but I'm not paying $400+ for glasses that will become useless in a few weeks when the procedures are over. I'd even let them take the glasses back so that if someone else needs that exact Rx, they can have them too. I don't technically need my Rx to drive when I'm not dealing with anesthesia anyway. I just prefer it because it makes me feel safer. I just avoid driving until the effects wear off but theoretically, I could just wear 2 pairs of frameless glasses, my current Rx and a strong pair of reading glasses, stacked on top of each other like world's jankiest bifocals. It'd be a bad idea that would likely result in quite a lot of emergency medical costs for my insurance but I could. (Disclaimer: please do not actually drive if your vision is significantly reduced and you don't have appropriate and accurate corrective lenses.) And that's just driving and not even mentioning how people are so casual with knives in the kitchen... my mom's insurance would need to set up one of those "buy 10, get 1 free" loyalty stamp cards for her with the ER with how she treats knives.
Of course, insurance companies love the complication because it means less competition, guaranteed business, and higher prices. Insurance wasn't always like this, with fixed and transparent reimbursement schedules rather than negotiating prices in _de facto_ secret and forming _ad hoc_ networks of care and insurance cooperatives.
When I think about health insurance not covering glasses or contacts, it brings to mind something from a few years ago where I sprained my wrist (this is relevant, bear with me) and at my doctor's office they gave me a cheap but good enough wrist brace. I got the bill for the visit in the mail and while I was expecting to have to pay for the brace, they charged me $60-70 bucks for something I could have gotten at a pharmacy for $20 (cheaper if I'd ordered it online), and that my insurance didn't cover it. I did some digging while I was going back and forth with them about it over email, and discovered that they'd charged me for a fancy leather brace that was *not* the one they gave me -- and the insurance company refused to cover it *because* it was listed as a fancy premium one and they said it wasn't their responsibility to cover. I bet if you pressed them on it, that's probably the same excuse insurance companies would use for not covering glasses for adults. Incidentally, the doctor's office never acknowledged that they charged me for a different brace than they gave me, but when I told them I was ready to bring the brace and packaging back to the office to compare it to what they said they sold me (possibly in front of a waiting room full of patients), they suddenly 'found' a discount they could apply to my bill that made up the difference.
Hey Doctor G, I would love to see a video essay on how to US health insurance, and how to beat the prior authorization gremlins. Also, how do I get in touch with you? You are a treasure, dude!
Interesting video! I've always thought it was ridiculous how dental insurance is essentially a payment plan. It's certainly not insurance for a catastrophic event.
In Australia, Medicare doesn't cover Dentistry at all and it falls under 'Extras' on Private Health Insurance; as do glasses - while the actual Optometrist appt/test IS free under Medicare, but your glasses/contacts are on you (unless you have Extras!) And even if you have Extras, dental fees are so far removed from dental cover it is ridiculous. And what little Public Dentistry there is, has insane waiting lists. That being said, I did have an impacted molar removed last year via the public system ... I was in a lot of pain, and had to wait a month, including 2 courses of antibiotics for the infection to go down, and stay down while I waited. But, I did get a fantastic, experienced, dentist, who also understood my medical issues. I got extremely lucky. I've worn glasses since I was 3 or 4, and am obsessive about my check-ups, and keeping my prescription up to date; but dental? It is so insanely expensive that I can't go unless something is very wrong. So, not entirely different. And the reasons are pretty similar, the Dentists fought to stay out of Medicare 🤷🏻♀️ And are guilty of highway robbery!
Well, in my country public medicine is something (for now) and yet everything related to dental medicine is totally separate from general medicine. And even in private medical plans that say they include dental coverage, they really don't include it. But yes, private medical plans or work plans generally include free glasses per year and surgeries.
I'm from a developed country with puplic health care and weirdly both dental and eye care aren't included in that. The dentist vs physician animosity must be a global thing😂
I was hoping hoping for Ortho Bro to tell us more about teeth. I had no idea before watching him that I have both upper AAANNDDD Lower teeth. I wanna know more!
Same in the UK. Optometry is mostly out of pocket, and while there are NHS dentists, they are very hard to see and post people pay if they can afford to.
That is interesting, because here in the Netherlands, dental care is also excluded from health insurance, except for minors. (If your teeth fall out when you are 19, bad luck!) You can pay for extra insurance especially for teeth. But we haven't had the history you describe, so that is odd, that is about the same situation as in your country. Eyes and eye diseases are covered but glasses and contact lenses you have to buy yourself. I had cataract in both eyes and now I have built in glasses of - 3 and the glasses I wear are also about - 3. You can take extra insurance for glasses because the frame is not that expensive but the glass (lenses??) is.
Same situation in Denmark, which makes me wonder about the narrative. When you say insurance though, is that anything like free healthcare? Because you say some things are not included so I wonder if it's different from any other insurance that you pay for.
Interestingly it's kind of the same in the UK. Dentistry while covered by the NHS is not single payer like the rest of it is. The government covers part of the cost but the patient is expected to pay a fee depending on the tier of treatment they need unless they're an exempt category (kids, on the dole, etc). Also eyeglasses and eye exams aren't included but opthalmology is an NHS service.
I'm not 100% sure these are the only reasons, as in the UK we also have a divide between 'normal' healthcare and dentistry in that healthcare is free except for dentistry (I don't know about vision stuff), so anything about medicare simply doesn't apply here as we don't work the same way. I think pretty much all dentists operate as private practices that also take NHS patients, but it's very hard to find a dentist that is accepting new NHS patients. Checkups cost a set amount (about £25, and at my last one my dentist spent no more than one minute looking at my teeth) and treatments are not free. They have set prices depending on how complicated they are, with the top band being around £300, which is low compared to US prices, but when you could have major surgery and/or months of cancer treatment or dialysis and never pay a penny for it, that's expensive. What frustrates me is that a filling is somewhat comparable to getting a cast put on a fractured arm or something like that, which would be free.
Canadian here: even with our healthcare, my medically required ophthalmology visits are covered but my optometry visits and glasses are not, which arguably i *need* glasses to manage life especially as i have a very high myopic prescription (below -25) and they’re very expensive, so of course that makes sense 🙄
In England they created one National Health Service that covered everything, Dental, Eyes, the whole thing. In Canada the health plan used to only cover medical issues. We now have Dental care for families making less than $90,000.00 per year.
I have a disorder where iritis and uveitis are super common and flare up for me a lot, especially with the wildfire smoke hanging out in my area lately. It makes the whole eye doctor thing annoying and complicated because insurance companies are not interested in making things easier. Vision says its a medical problem, medical says its a vision problem, doc office wants the bill paid and eventually come after the patient to collect. Ugh.
Just recently been on the opthalmologist vs regular eye insurance goose chase. Medical kept telling me it was a vision thing, and the eye insurance kept telling me it was a health thing. Would help if the providers knew what they were providing!
I've been running into the same issue with medical devices for my jaw. It's dental! It's medical! The dental office that takes my medical insurance doesn't take my dental insurance, and the office that takes my dental insurance won't take my medical! And who knew a dental office could conduct an at-home sleep study -- that wasn't covered by either insurance! Good luck to you, I hope you're able to get everything covered.
Which is why I just took out a second mortgage to pay $56k for oral surgery because years of dental neglect by my parents then not being able to afford it as a young adult, combined with medications I took, absolutely wrecking my entire mouth, until infection an infection that wS barely being kept in check but could no longer be cured without removing all my teeth and part of my jaw. I’m not even 40. We had “enough” money for 2 year after 12 years married and me having chronic health problems… it was really nice not having to pinch pennies and worry about every $5-10 we spent. That’s over for at least another decade. If nothing else “historic” happens again. So why aren’t dentist separate like optometrists (fine), but anything medically necessary from an oral surgeon covered like regular surgery?
Alternative explanation: Health insurance were originally created only for workers like in factories and stuff, and they just apply for illnesses that would stop the worker from being able to do his/job. Not long ago, dentists were just a guy with pliers along a drummer boy that appeared in town on a weekly basis like in "Django Unchained".
Doctors and looking down on other medical professions, name a more iconic duo. Here in Texas, Congress failed to renew the PREP Act to let pharmacists, pharmacy interns, and pharmacy technicians administer vaccines under a wider scope during the pandemic because the AMA lobbied claiming pharmacy knows nothing about vaccines. For reference, technicians go through hours of CE and practice to become certified while interns and PharmDs have a 4 credit hour course (vs doctors' 8 credit hours of pharmacology). Ironically enough, TTUHSC's school of medicine asked us at its school of pharmacy if anyone, professor or student, was available to teach their immunizations course because they lost their previous staff. We declined :)
Ah, Texas. We sure do like to do things our own way. Not always the right way, mind you, but our way. Meanwhile, my entire family and I all prefer to go to the pharmacy for our vaccines. Whenever I've moved in the past, the first place that I'll establish a medical/customer relationship is my new pharmacy. Even my highly specialist nurse aunt and her even more highly specialist doctor-professor (UT, not TT lol) husband advocate about how vital a good pharmacist and pharmacy are, especially as they get older and have more prescription needs themselves. Maybe as the doctors get more specialized, they reach the other end of the bell curve and appreciate pharmacists again lol. The whole "a wise man knows that he doesn't know how much he doesn't know" thing. Tl;dr: we love and appreciate the pharmacy and all of its employees in this household. (Not Big Pharma, though. No non-academia suits or board rooms, only labcoats and scrubs.) Idk your role at TTUHSC but thank you regardless. Stay cool and hydrated! I prefer my pharmacy staff and their support system to be not melted and instead housed within the same storage temps as my medicines and most medicines can't handle this heat. 😂
I thought part of the separation was because barbers did dentistry. I agree however that eyes & teeth need to be part of our universal health care. Those two are part of extended health insurance coverage. However, ophthalmologists are covered as they are MDs who are specialists whereas optometrists aren’t. A coworker was always sick & because she now had extended health care she was able to get proper dental care. Unfortunately her teeth had deteriorated so much they were removed & just by removing the decayed teeth she experienced an increase in good health.
I was not expecting you to say that most eye-related things use medical insurance. At my last job, the insurance had two providers - one for medical, one for teeth and eyes. And trust me when I say Mutual of Omaha was about the most useless insurance I’d ever had when I needed teeth pulled
Most people only need eye exams and glasses/contacts, which uses vision insurance. But if you need to see an ophthalmologist or get eye surgery, that's all medical insurance. (I wasn't able to see an optometrist to get new glasses or get my vision checked for about a decade because I couldn't afford the visits, but I was able to see a retina specialist when I had some other eye issues manifest. The state medical insurance covered medical visits, so luckily I didn't have to worry about losing my vision. It was weird to get everything about my eyes meticulously documented but have no ability to get glasses for them lol)
> I was not expecting you to say that most eye-related things use medical insurance. He didn't say that. He said that most things *he* does, as an ophthalmologist, fall under medical. (An optometrist may not say the same.)
I have astigmatism so I wear glasses all the time. Not that I mind of course, but I've considered lasix. My grandparents have offered to pay for the lasix as a graduation gift. I don't know if I'll do it or not, or even if I'm eligible but it is a bit strange for surgery to be a gift.
Even in Canada adult teeth care isnt covered by free healthcare. Eye care was for the Eye Drs who used to do a lot of optometry and opthamology. Only in 2023 is the federal government trying to make optometry exams beyond one per year paid out of pocket. Eye Drs are surgeons who will also see eye diseased folks as consults for optometry but whoa no more optometry mixed in. So this is a change in my life time, as a child who started wearing glasses i always saw an Opthamologist, and the changes came in the 80s where optometry grew up.
In the UK, Dentists and GPs, while being part of the NHS appear to work like a franchise, where they own their surgeries and get paid for treatments (NHS dentists even charge excesses to patients on the NHS and also offer private treatment in the same surgery). It would be so much simpler if they were paid like consultants in the hospital and if their surgeries belonged directly to the NHS. Still, I would take this system over the (even more compkex and expensive) one in the USA any day!
now try to determine whether a "limited purpose flexible spending account" for dental and vision expenses should cover the unreimbursed expenses for vision stuff that is otherwise covered by health insurance rather than vision insurance. or whether health savings account finds should or should not be applicable toward those same expenses. then you get to do a history lesson on the tax code too. (But if you can answer accurately thats better than anyone at ADP, BRI or any other benefits administrator rly)
Unfortunately the whole separate dental thing isn't limited to the us. Here in the Netherlands our insurance providers are required to offer a base package by law. It includes most medical needs but doesn't include dental for some reason. If you want dental to be covered as well it requires an addon which you have to pay extra for. There has been some talk that it should be included in the base package but as of now that still isn't the case. It really should be included because now people tend to skip dental healthcare if they have low income. Which quite often results in either higher costs later or just having terrible teeth and the issues that come with that.
If you prefer to hear this information in skit form, click this link: ua-cam.com/video/TL7zwBoCt18/v-deo.html
Oh good, I panicked as I can't take in any information that isn't in skit form
I wish every informational video, pamphlet, and book about anything had one of these. I want all of my information in skit form, please.
It, too, is brilliant. As always. As expected. Much appreciated, Doc Glauc!
I got through the explanation quite well, it was already pretty interesting.
Then I came here to comment and found out your link to the skit.
If this isn't follow up care I don't know what it is ❤❤❤
Hi Doctor Glucosefuckin! Next time you should let Jonathan explain. He can handle the dentists, plus I'm sure he could have done a much better job of explaining this in a clear and concise manner. Thanks again for being alive! Keep doing that please = ) ALSO! More Ortho videos please!
I was expecting the scary dentist who likes golf to show up.
We’ll know what happened if this is his last video.
Please don’t tell him I told you this
But based upon what the Doc said, they are scary. They made sure that dental care was outside of Medicare because they wanted to not be regulated or subject to governmental reimbursement rates.
Wait to you hear of the even more scary dentists who like racing cars.
@@differnet Tbf no one did, they just were successful in not doing so.
So the pride of a bunch of dead guys and the greed of a bunch of living guys.
You'd be amazed how many of the world's problems essentially boil down to that.
US healthcare, baby!
He forgot to add a ton of politics which could have fixed the US healthcare system but didn't. Oh course that would make this even more depressing than it already is.
@@TheFirebird123456 tbf "no insurance companies and your pricing has to be subject to the same kind of fair commerce tribunal that other businesses have" would have sorted it
No one in Washington actually wants that
"US healthcare in a nutshell: we make things way more complicated than they need to be."
The accuracy.
Not just US. In the UK we have exactly the same divisions with eyes. Eye test, glasses, contacts = private. Eye conditions/injury = NHS. Teeth? We tie a piece of string between a door knob and the bad tooth and slam the door 😂.
Here in the Netherlands we also have that divide.
*more profitable
Same here in Australia
Should get this on a mug, it applies to most of the software companies I've worked for: "We make things way more complicated than they need to be"
Oh, Dr. G is an ophthamologist! No wonder he has time to make all these videos; he has a loyal scribe helping him with everything.
what if he is the scribe and the real Dr. G was the friends we made along the way
*Jonathan head nods*
And thank the gods he does!
Work-life balance. Don't tell surgery.
And the rest of us docs are jealous. I so want a jonathan.
As an Australian, this is such a well-levelled and easy to follow explanation of a weird thing specific to American healthcare!
As an American we don't care. Worry about your own country
Excuse me, I have a brother in Australia and he told me that doctors get (I think) 8 dollars for every patient they manage to see (this was 4 years ago). Is this a lot, or not at all? How well do doctors live there compared to let's say America where they earn anywhere from 200k up to 400k+ US dollars, and do they have debt in Australia?
@@MrOrthodox13doesn't sound right. Standard GP consult is like $70. That's like a 10 to 15min consult.
Unironically the bit about Dentists lobbying to not be in Medicare is exactly what happened with Australian Medicare.
Turns out people who go into a profession to help people can still be greedy fucks.
@@Kushibunny Ahem, my lord, that would be 1000 dollars for less than 15 patients. Can they choose to consult infinite number of patients? Does the consult have to be successful, as in to hit their therapy just right and heal the person?
As an OD I hate having to explain that when I find a medical condition during an exam it goes from a vision exam ( $0 or low copay) to a medical exam ($30 or last week $100 out of pocket). Patients feel like it's a bait and switch but really it's just because the system is ridiculous.
Well can you blame them? Can they ask you to remediate it at a later time so they dont have to pay right away, but come at a later date?
Well it is a bait and switch; it’s just not *your* bait and switch.
If it's the same exam, why charge differently ? simply because there's different reimbursement rates??
@@chrisstehlik7927 IDC10 codes. Everything done or diagnosed falls under one code or another. Well-patient checkup changes to complex assessment and adds a diagnosis, which generates codes under which the patient/insurance is billed.
On the other hand if you are taking a medication that can affect vision but paying out of pocket for your eye exam now maybe it can be partially covered by your medical insurance.
Dr. G's message is SO accurate and SO on-target. Sadly, I see many patients getting "medical" care who have chronic debilitating problems all over their body brought on by neglect of their teeth...poor nutrition (from eating too little or only junky things that are easy to chew)...chronic inflammation (stimulated by dental abscesses or caries)...repeated infections in other parts of their body seeded from infections in their teeth...chronic pain...sinus infections. And these problems go on and on because their physicians never looked at it, didn't think about it, figured that treating it was somebody else's problem, etc. I try to do my part by identifying the problem and putting it in my report. I have seen more than a few patients get a lot better after their caries were fixed...you can't cure their AIDS, but eating better, fixing a source of pain, and stopping seeding infections goes a long way toward making their life better.
@MyFiddlePlayer. You’re so right. My little brother never took care of his teeth, he almost died of infection that spread to his heart. He needed a valve replaced but his heart surgeon knew he needed all of his teeth pulled first. The oral surgeon REFUSED to pull all of them. The heart surgeon tried his best to get him to pull them all, even telling him my brothers’ replaced valve would become infected if he didn’t. DUDE DID NOT CARE. My brother did indeed have to have his valve replaced again, the heart surgeon made the oral surgeon pull the rest….and my brother never got a bill for that.
People highly underestimate the importance of good. dental hygiene.
But the outpatient surgery under general anesthesia to remove the bone infection is dental (not covered) because it's in my jaw but if it had been in my shin, then medical insurance would have covered it.
Why jump to AIDS there? Wtf?
You tell 'em!
Hey, this is actually very helpful because it means we can directly petition our representatives to update medicare to include dental and vision. That is much easier than getting a health insurance company to pull its head out of its ass.
You do not have the $$ the ADA has. It will not change in my lifetime or yours.
@@ljerry8440not with that attitude!
@@ljerry8440comrade, thinking that things can't be changed is how harmful systems continue to function and do harm for as long as they do.
Healthcare is fundamentally an insurance. Insurance is based on sharing the risk ie everyone pays but not everyone gets sick. But everyones teeth decay and their eyesight gets worse as they age. So the sharing of risks does not really work, at least not with privatized healthcare insurance. When healthcare is based on taxes which are a percentage of your income then this can work up to a point. Better off people pay more than less fortunate ones in taxes so if the tax percentage is high enough (and in many countries the percentage is progressive) then some level of dental and eye care can be provided for everyone. I say 'some level' because new treatments like dental implants and lasik ops are still prohibitively expensive (for no reason based on how much the actual operation and materials cost) to be provided for everyone.
Fun fact; until recently (mid last decade) there was a singular enterance exam for med and dentist school in North Belgium. Succeeding meant that you could chose any study at any university in the country :)
Also, dentist care should be included!
This is absolutely true. The sad part is people have to refer to private companies to cover for dental, which in Medicare is part C. The only dental that Medicare covers is extractions of teeth for the sole purpose of prepping for treatment of esophageal cancer. There are talks however, of Medicare expanding its coverage to the deficient areas of healthcare but nothing has been set as of yet
Dr G, you should make a video of why prosthodontics are covered (like dentures) but not implants. Despite them being cheaper (in the long run) and improving the quality of life to patients.
Good idea
Probably covered for the same reason that glasses are, but corrective surgery is not.
Can't give any permanent solutions...
Implants are (to insurance) a relatively new treatment and are considered purely cosmetic. Even though there is at minimum a decade of research and case studies showing otherwise 😜
There is starting to be a shift in insurance where some companies are offering plans that provide implant coverage, but they are rare.
@@abbunnies9784 I have a documented allergy to metal, and have to have all ceramic fillings. Its been in my chart FOR TWENTY YEARS, and my dental insurance still treats my fillings as cosmetic and won't pay as much as they would for the ones that would cause me constant pain. 🤔
This is basically the same in the UK - dentistry is only partially covered by the NHS so, unlike any other specialism, NHS dentistry is only substantially subsidised, not free (except for children and people on certain low-income or disability welfare benefits). However, unlike with Medicare, dentistry _was_ originally fully included in the NHS. A lot of factors led to the introduction of dental charges but as I understand it a big one was that British teeth had been _so_ neglected when people couldn't afford dentistry that the NHS was struggling financially under the burden of the massive demand for dentures. (I do know that another one was the reluctance of dentists to join the NHS - originally only a quarter of them did.) In the first 9 months of the NHS it provided over 33 million artificial teeth (the UK population in 1948 was less than 50 million). Charges for dentures were introduced in 1951 and were of course hugely controversial, leading to the resignation of the Health Secretary who had created the NHS, Aneurin Bevan. Once that precedent was set, other dental charges soon followed and here we are today with our internationally-notorious orthodontic reputation.
Yeah, a lot of the slander towards British teeth comes from the fact that non medically necessary procedures like cosmetic orthodontic work often aren’t covered by the nhs and people don’t tend to get private insurance, so if a procedure isn’t free people don’t want to pay for it leaving them with potentially aesthetically unappealing mouths in comparison to the Hollywood grin.
An undeserved reputation too, e.g. we rate at 5th in the world on the Decayed, Missing and Filled Teeth index. The US was 9th, one place below Mexico.
@@Oligodendrocyte139I presume the higher the better? The name of the index sounds like its bad! 😂
@@cphilips502 It’s ranked on the basis of a low score (number of dodgy teeth) is best 😀. So Denmark were top with 0.4, UK had 0.8, US 1.2.
@@Oligodendrocyte139 Oh I see, thank you very much!
Dental was included in Medicaid back in the 1980s. I remember my mom getting her teeth done the same time we got ours done. And today medicaid for kids covers dental up to age 21. Though it is suspicious to me that when I was getting dental through my work my kid never had any cavities and I even got her molars sealed so she was less likely to have cavities. Then later when she got care through medicaid she suddenly needed a root canal.
Medicaid is totally different. Medicaid is provided by the states rather than the federal government. The program for kids is even more different, it's actually called CHIP and is a specialized program for kids that does cover dental. For adults, Medicaid offers little dental coverage, and good luck finding a dentist who'll take it.
Most state Medicaid dental programs offer coverage that is dangerously insufficient. Dental coverage for adults on Medicaid isn’t even legally required so most states put the bare minimum into it. There are only 8 states that offer comprehensive dental coverage to adults on Medicaid.
Root canal, you can't predict or delay. You need it, YOU NEED IT. 5 am, your tooth nerve dies, you need root canal surgery, earliest appointment at 7am emergency.
@@kcroto Dentists near me will give 2 free cleanings and an X-ray every year, and that's all adult medicaid will cover.
@@bordomsdeadly Yeah, it's pretty bad. I used to work in a customer service center for a state's medicaid program as we had to assign adult patients to a "primary dentist" which was a joke, especially for folks who lived in rural areas. Complete nightmare.
I would also like to know why hearing aides for older adults aren’t covered by medical insurance.
As an American ex-pat, the ONLY thing I can say about health care that isn't better everywhere else is dental/eye care. I'm sure there are some places where they do actually cover dental and eyes, but a lot of places are just as bad as the US in that regard. Though it is still cheaper out of pocket vs. the US.
I moved to Canada. Care here is vastly different from province to province and rural vs the big cities. If you want an upgrade for anything, don’t move to Nova Scotia. You may not have to pay for care, but trying to get a doctor to treat anything is impossible. The upside was that after waiting 3 years, I had the most thorough visit of my life, but I was so much sicker than necessary by the time I got there
@@JHabcCanada has one of the worst universal healthcare systems in the world and it's still better than what the USA has.
@@SAOS451316 Yep. Probably why the average life expectancy is three years higher in Canada than in the US, which is wild considering their lifestyles are otherwise pretty similar.
What is an ex-pat? (English isn't my first language)
@@titorosado6198 It is short for 'expatriate', which means someone who moved away from their original country, an emigrant.
You are just as informative and entertaining without a skit format. I'm fascinated/horrified by what I hear about American medicine and that Canadian is following a different but also dark path
In the Netherlands dentistry is no longer covered under basic health insurance, but an additional package that needs to be purchased and usually still covers only part of the costs. It's only covered under basic health insurance for 0-18 year olds. I'm a policy consultant for a small city in the Netherlands. My job is fighting poverty, and dental issues getting WAAY out of hand is a huge problem there. Literally have people too sick to work or simply not being hired because of severe dental problems.
Bike land not as perfect as it seems😔
Past decade and a half or so we decided to embrace the 'free market' as our lord and saviour, and are now dealing with the consequences of that.
@@monicaspoor2993 there is no such thing as a free market under capitalism, capitalism means that markets will always be unfair and hence not free
But ik what you mean the so called free market capitalist people are like weeds. They privatize things, they get worse from that, and then they blame public stuff and say more things should be privatized actually 🙄
I live in Sweden, our health care system has its flaws but I still think it's amazing. We don't have to pay more than about $120 per year for doctors' visits, labs, etc. You pay a certain amount for each visit, but once you reach that number, all visits are free for the rest of the year. However, dental appointments aren't included in that. I know people (myself included) who don't want to go to the dentist because it's too expensive. I'm a doctor myself, and I know that oral health can impact your general health (especially heart disease), so I have no idea why it's not covered in the same way. I have a friend who's a dentist, and he basically said that the cost is high because people need to brush and take care of their teeth. If they did that, they wouldn't have any problems 🙄
Meanwhile, we treat smokers with lung cancer or COPD without charging them extra...
We definitely need a dentist character to show up. Maybe pick up his opthamology friend to go golfing...with Jonathan as the caddy.
Odds are Jonathon would be the driver, the caddy, and swing the club.
As a naturalized US citizen, your videos are SO helpful! I have called my insurance company several times over the years to try to make sense of this overcomplicated system but I think I'm finally understanding the basics thanks to you.
I love the skits, but also, how the doc can talk about serious information in a light way without the need to push in a joke and still be fun.
"Physicians looked down on dentistry and didn't think what they did was real medicine."
Why the past tense, Doctor?
Here's your reminder that the Hippocratic oath forswears ever performing surgery, as that is the domain of barbers, not physicians. Rivalry in the field of medicine has a bit of a history.
I'm trying to figure out why my patients are seeing dentists that want to pull all 23 teeth out.
@@slantdwave probably in part the ridiculous cost of dental care and because after one or two terrifying dental exams we are so terrified of going to yet another dentist that will yell at us and throw tantrums(my first appointment with one for an abcess) that we wait years to see another dentist the dentists think the patients should just get everything pulled to have fake teeth because there is nothing left as well as many dental offices(as well as private practices and veterinary hospitals) being bought owned by price gouging greedy private equity companies and the drive to extract as much money from patients as possible.
That seems to be common that dentists(like Aspen Dental) suggest pulling everything because the patient who can’t afford care hasn’t been to a dentist in years to decades.
Dentists really are out of touch terrorizing monsters in a country where healthcare is so expensive it’s unaffordable, it really makes no sense.
@@slantdwave I see this with my Medicaid patients. Some prefer to pull their teeth and get dentures because Medicaid is limited on what they pay state to state.
Fellow eye dentist here. I’d love to see you do a video about the recent changes to MIGs. It could be ophthalmologist Dr G and Joanathan talking to gov’t official and gov’t Jonathan about what qualifies as evidence. Love the content.
What's an eye dentist?
This is interesting, I wondered why dental wasn't included in Medicare. So the ADA had no concern for the health of individuals, they just wanted dentists to have no limits on what they could charge patients. This is why so many people, even with dental insurance, can't afford dental care.
Or we didn't want to get paid 30 cents on the dollar for the same work
People can afford dental care
you know what i just remembered? the fact that dental care is so expensive where i live that my relatives go overseas for it cuz that's cheaper. y'all should do that too.
Right, like half the people I know go down to Mexico to get their dental work done. 5 hour drive to save like $4000 seems like a deal.
Thank you for explaining our screwed-up medical and dental system here in the USA. I never understood before why it is so idiotic.
Wow, thanks so much for this brief overview and clear explanation of how we got to this craziness. Appreciate it!
Abolish health insurance companies. 😤
Amen!
The people ought to be able to pay their doctors directly funnily enough the considerations for payment are based off of a federal program
Or just make universal healthcare like every other developed nation…
@Pman353 Pman, with universal Healthcare, there wouldn't be a need for insanely massive health insurance companies. So basically what I suggested lol
Because the Republicans have convinced the least educated as a society that our system is way better than others (it’s not and that is backed by data and research studies).
"Fewer of my patients die than yours."
"Yes, but you're a dentist."
- Quacks 2017
From a physician's perspective, I see so many medical complications from poor dental health. If everyone had good dental care, it would SAVE society a ton of money. I always figured teeth were not covered because they are the most likely to have problems if not cared for properly.
Hey doctor . I'm so happy to say that I got into med school 😊 I spent the last year watching your videos while working hard towards my dream , your videos really helped me regain focus when things got rough . Keep posting more videos they always make me laugh and I'm a huge fan ❤
Same here in Ontario, Canada -- dentistry and eye exams are not included under OHIP. (I believe eye exams are covered for certain individuals, though that may no longer be the case due to some optometry vs government problems)
It's real bad!
Yes, thank you! I'm poor but I also have the absolute worst eyes so I've always known that you can see an eye dentist but no other poor people that I know (everyone) knows that before I go on my get your eye conditions treated by the right person rant. Also, you can check with the eye dentist to see how much a refraction costs. It's 40 at my place and then I get my glasses at Costco which is the cheapest If the online places can't handle your prescription AND you don't have to have a costco card to go to the vision center or the pharmacy.
We charge $30 at our place. Medicare doesn't cover that part of the exam. 🤷
Eye dentist? All I am picturing right now are those weird photos where they photoshop mouths in the eye sockets.
I think glasses and vision tests are separate because it's a common medical need and people generally can't perform well in their lives without visual acuity, so insurance companies save a lot of money by excluding so many people from care, and those people are then forced to purchase the care anyway because they can't drive or do their job without glasses/contacts.
If half the population needed another medical device like hearing aids or a wheelchair there would be separate hearing and walking insurance
As a policy wonk, I must say that was a very well done history of health insurance. Your inner Internal Medicine Chief Resident was definitely shining through.
Arguments for or against universal healthcare aside, it would be great if we could do things like Germany does. My German ex-bf told me that as long as you have been faithfully going to your bi-annual dental exams, if you still have a dental issue of any kind, it's covered 100%. But if you fail to go to all of your exams, that's when you have to start paying.
This is proof Dr G could be successful making both sketches and informative videos, because this was an amazing explanation for a complicated topic. Thanks!
I've also been told that dental insurance is a lot more "stable" on the cost side - most people end up paying around the same amount for dental work over their lifetime, wherase medical costs vary wildly between individuals. Thus the rates are very different.
This combined with the fact that dental work can be put off for so long makes it so the "best" way to do dental work is to get 1 year of dental insurance, get like 15 fillings that year, and then cancel your insurance plan until 10 years later when you do it again. hence dental plans have a maximum coverage to reduce the amount of that you can get away with.
Essentially, it's because insurance's job as a cost "smoother" reacts very differently between medical insurance where cost is mostly driven by acute problems, and dental insurance where cost is mostly driven by chronic problems.
We need to change this. Dentists should not be looked up to or down upon, but should be treated, AND PAID, the same as body doctors.
And so should eye doctors.
So speaking as an admin in the dental industry were my job is 80% dealing with insurance, and 10% being a reptionist and 10% therapist in Canada...this is accurate even here.
While some provinces provide low income/senior dental coverage, what the province i live in has set as the amounts covered barely covers the cost of materials for treatment in many cases, and does not cover or fully cover the time of the people completing the treatment. This is because the government has not updated the pricing of what is covered by their dental coverage plans for at least a decade, or possibly more.
Another factor is that certain procedures that are largely considered a best long term treatment, i.e. crowns, are often not covered under those plans. This limits what the dentists are able to do for best LONG TERM treatment.
By long term treatment, i refer to helping the patient retain their teeth as much as possible, for as long as possible. Pulling a tooth that is infected and causing pain instead of root canaling and crowning it is a great short term solution. But long term there is bone loss that will occur in that spot because the root is not there to stabilize the bone. This leads the the bone around the surrounding teeth to go away, and then those teeth become loose and more likely to become decayed, which leads to then needing to be removed.
I would not be surprised if this was the case in many places, and i also would not be surprised if that was one of the arguments posed by the ADA. Simply put, because the dentists would be limited in being able to provide optimal care, and in a profit focused clinic would be less inclined to prioritize care for patients under that coverage, they lobbied against the medicare system.
I do not agree with it, as dental infections can be life threatening, and there are many studies that have shown strong links between oral health and heart disease, diabetes, mental health and overall well-being. Even if you are limited in being able to provide optimal dental treatment, the patient should be the focus.
There are a lot of good dentists out there who are patient focused and go above and beyond for their patients, i have seen it first hand. But there are those that or primarily profit focused. I understand that it is a business, but a balance is necessary.
And yes, almost all dentists i have met love golf. And because it's Canada, in the golf off season, many of them play hockey, in a dentist hockey league. Yes, you read that right. Our dentists have their own teams and a league. You can bet they avoid hitting each other in the face because they don't want to ruin the other person's teeth.😂
As always, nice video. Incredible the differences between each countries. In Brazil we have universal healthcare, including teeth. But, despite being universal, there is not enough care for so many patients at the same time, waiting list can get enormous. The good part is the "capillarity" of the system, so a grandma from a small rural village can get access to a world class dental treatment, if necessary.
I feel this even in Ireland. They won’t cover hearing aids under private health insurance here. They are regarded as cosmetic! Thankfully the Public health care system is still okay here to help with that.
Dr you are a rare person with values & humour.
I find optometrists and ophthalmologists both use a common shorthand that’s hard always to understand, as a GP. Optometrists know their stuff in my opinion and have helped me in a pinch for foreign body exams.
personally i like the fact that eye doctors are specialized when it comes to vision.
you get really good and talented doctors who know how to focus dem eyes while the other nice doctors can keep yo eyes healthy.
I subscribed for the skits, but I stay here for the serious info. Thank you, Dr. G, for saying what needs to be said.
I don’t know the history but ironically dental and vision are also not covered in Canada 🇨🇦 either (vision I think 💭 children get checkups up to a certain age but don’t quote me don’t have kids). Also as you mentioned ophthalmology issues are covered such as diseases, retinal detachments, …
Physicians still look down on dentists (even the competent residency trained ones), and not all dentists agree with lobbying groups.
I spent over an hour yesterday talking with insurance companies so I cheered wholeheartedly when u said that we make things way more complicated than it needs to be
Love this his lesson, Dr Glaucomfleckon! I’ll add one comment that Kaiser Permanente does include vision checks and eyeglass/contacts prescriptions within their medical insurance benefits. They even waive the co-pay. KP isn’t perfect, but this is one of several positives of their version of insurance.
I was expecting teeth bro to hit you with a golf club.... 😂😂😂
As a dentist I was always curious about it. Thank you
With such a reach, this is far better content, IMO. Still like the jokes ofc.
Anyhow, this is very insightful!
You should do one on the surgeons and their history and why they think they're so special
Related: reader’s digest « I Went to 50 Different Dentists and Almost All of Them Gave Me a Different Diagnosis «»
Dental and eye care are also in Finland so separated from all the other care that it sometimes blows my mind. Almost everybody pretty much have to deal with them in private sector.
My private medical insurance in Australia covers both eye glasses & dental procedures and check ups. You don’t need insurance in Australia, everyone has medical care for free, it offers you more freedom of where you go and speeds up obtaining services. Also it covers, massage, chiropractory, Chinese medicine, etc
Very well put. Tell Jonathan great job writing it.
The thing that doesn't make sense from the insurance point of view is they don't want to pay for anything right? So their objective should be to prevent injury right? So they should pay for peoples' glasses even just for the lenses, because otherwise they might run the risk of walking into a traffic light and breaking their nose, which ultimately costs $2500 on average over the average cost of $150 for a pair of lenses. The stupidity is they'd happily pay for the medical consequences of dental or vision preventative care they aren't providing even if it ends up costing more on the sole basis that the chance of someone without good vision might still be able to see where they are going. This also means if we want to change that we need to make the insurance companies bleed by requesting care for injuries sustained from lack of vision or poor dental care, hit them where it hurts, their bank accounts!
How many people actually sustain injuries that require medical treatment due to not being able to afford glasses? If people are just going to buy their own glasses then there is no benefit to the insurance company in paying for them. And if the few people that actually go without glasses because they aren't covered usually don't receive any injuries that require treatment, then there still isn't much benefit. The cost of the glasses would probably be more than the cost of the treatment.
@@thomasdalton1508 That's what I said, they need to receive more bills for treatment of injuries sustained due to lack of vision or dental care. The moment it makes monetary sense to do preventative care over dealing with the consequences the vision and dental plans will be bundled in no time.
I'm 2 years behind on my annual vision check because I know that they'll say I need a new pair of glasses even though I don't. I can't see details at long distances (default state) but I also need some small (but technically surgical) procedures every few weeks and the anesthesia messes with my vision. Plus, if insurance doesn't want to pay for them, it's obviously not that important. (/s) I'd happily get them if they were covered but I'm not paying $400+ for glasses that will become useless in a few weeks when the procedures are over. I'd even let them take the glasses back so that if someone else needs that exact Rx, they can have them too.
I don't technically need my Rx to drive when I'm not dealing with anesthesia anyway. I just prefer it because it makes me feel safer. I just avoid driving until the effects wear off but theoretically, I could just wear 2 pairs of frameless glasses, my current Rx and a strong pair of reading glasses, stacked on top of each other like world's jankiest bifocals. It'd be a bad idea that would likely result in quite a lot of emergency medical costs for my insurance but I could. (Disclaimer: please do not actually drive if your vision is significantly reduced and you don't have appropriate and accurate corrective lenses.) And that's just driving and not even mentioning how people are so casual with knives in the kitchen... my mom's insurance would need to set up one of those "buy 10, get 1 free" loyalty stamp cards for her with the ER with how she treats knives.
Of course, insurance companies love the complication because it means less competition, guaranteed business, and higher prices. Insurance wasn't always like this, with fixed and transparent reimbursement schedules rather than negotiating prices in _de facto_ secret and forming _ad hoc_ networks of care and insurance cooperatives.
When I think about health insurance not covering glasses or contacts, it brings to mind something from a few years ago where I sprained my wrist (this is relevant, bear with me) and at my doctor's office they gave me a cheap but good enough wrist brace. I got the bill for the visit in the mail and while I was expecting to have to pay for the brace, they charged me $60-70 bucks for something I could have gotten at a pharmacy for $20 (cheaper if I'd ordered it online), and that my insurance didn't cover it. I did some digging while I was going back and forth with them about it over email, and discovered that they'd charged me for a fancy leather brace that was *not* the one they gave me -- and the insurance company refused to cover it *because* it was listed as a fancy premium one and they said it wasn't their responsibility to cover. I bet if you pressed them on it, that's probably the same excuse insurance companies would use for not covering glasses for adults.
Incidentally, the doctor's office never acknowledged that they charged me for a different brace than they gave me, but when I told them I was ready to bring the brace and packaging back to the office to compare it to what they said they sold me (possibly in front of a waiting room full of patients), they suddenly 'found' a discount they could apply to my bill that made up the difference.
Hey Doctor G, I would love to see a video essay on how to US health insurance, and how to beat the prior authorization gremlins. Also, how do I get in touch with you? You are a treasure, dude!
He would get dissapeared by the powers that be
Interesting video! I've always thought it was ridiculous how dental insurance is essentially a payment plan. It's certainly not insurance for a catastrophic event.
In Australia, Medicare doesn't cover Dentistry at all and it falls under 'Extras' on Private Health Insurance; as do glasses - while the actual Optometrist appt/test IS free under Medicare, but your glasses/contacts are on you (unless you have Extras!)
And even if you have Extras, dental fees are so far removed from dental cover it is ridiculous. And what little Public Dentistry there is, has insane waiting lists. That being said, I did have an impacted molar removed last year via the public system ... I was in a lot of pain, and had to wait a month, including 2 courses of antibiotics for the infection to go down, and stay down while I waited.
But, I did get a fantastic, experienced, dentist, who also understood my medical issues. I got extremely lucky.
I've worn glasses since I was 3 or 4, and am obsessive about my check-ups, and keeping my prescription up to date; but dental? It is so insanely expensive that I can't go unless something is very wrong.
So, not entirely different. And the reasons are pretty similar, the Dentists fought to stay out of Medicare 🤷🏻♀️ And are guilty of highway robbery!
I like this format of Dr G explains things!
Well, in my country public medicine is something (for now) and yet everything related to dental medicine is totally separate from general medicine. And even in private medical plans that say they include dental coverage, they really don't include it. But yes, private medical plans or work plans generally include free glasses per year and surgeries.
I'm from a developed country with puplic health care and weirdly both dental and eye care aren't included in that. The dentist vs physician animosity must be a global thing😂
I was hoping hoping for Ortho Bro to tell us more about teeth. I had no idea before watching him that I have both upper AAANNDDD Lower teeth. I wanna know more!
Really enjoying this format!!
Come for the funny skits, stay for the short-form yet in-depth critiques of the healthcare system.
Same in the UK. Optometry is mostly out of pocket, and while there are NHS dentists, they are very hard to see and post people pay if they can afford to.
Sir, when could you introduce us to the cardiac surgeon
I was just trying to figure this out! Perfect timing
That is interesting, because here in the Netherlands, dental care is also excluded from health insurance, except for minors. (If your teeth fall out when you are 19, bad luck!)
You can pay for extra insurance especially for teeth.
But we haven't had the history you describe, so that is odd, that is about the same situation as in your country.
Eyes and eye diseases are covered but glasses and contact lenses you have to buy yourself.
I had cataract in both eyes and now I have built in glasses of - 3 and the glasses I wear are also about - 3.
You can take extra insurance for glasses because the frame is not that expensive but the glass (lenses??) is.
Same situation in Denmark, which makes me wonder about the narrative.
When you say insurance though, is that anything like free healthcare? Because you say some things are not included so I wonder if it's different from any other insurance that you pay for.
This explains why the dentists are represented like an underground society in your videos.
I will vote for you. That's one. You have a MILLION subscribers, which is a lot but not enough.
Interestingly it's kind of the same in the UK. Dentistry while covered by the NHS is not single payer like the rest of it is. The government covers part of the cost but the patient is expected to pay a fee depending on the tier of treatment they need unless they're an exempt category (kids, on the dole, etc). Also eyeglasses and eye exams aren't included but opthalmology is an NHS service.
I'm not 100% sure these are the only reasons, as in the UK we also have a divide between 'normal' healthcare and dentistry in that healthcare is free except for dentistry (I don't know about vision stuff), so anything about medicare simply doesn't apply here as we don't work the same way. I think pretty much all dentists operate as private practices that also take NHS patients, but it's very hard to find a dentist that is accepting new NHS patients. Checkups cost a set amount (about £25, and at my last one my dentist spent no more than one minute looking at my teeth) and treatments are not free. They have set prices depending on how complicated they are, with the top band being around £300, which is low compared to US prices, but when you could have major surgery and/or months of cancer treatment or dialysis and never pay a penny for it, that's expensive.
What frustrates me is that a filling is somewhat comparable to getting a cast put on a fractured arm or something like that, which would be free.
Canadian here: even with our healthcare, my medically required ophthalmology visits are covered but my optometry visits and glasses are not, which arguably i *need* glasses to manage life especially as i have a very high myopic prescription (below -25) and they’re very expensive, so of course that makes sense 🙄
In England they created one National Health Service that covered everything, Dental, Eyes, the whole thing. In Canada the health plan used to only cover medical issues. We now have Dental care for families making less than $90,000.00 per year.
I have a disorder where iritis and uveitis are super common and flare up for me a lot, especially with the wildfire smoke hanging out in my area lately. It makes the whole eye doctor thing annoying and complicated because insurance companies are not interested in making things easier. Vision says its a medical problem, medical says its a vision problem, doc office wants the bill paid and eventually come after the patient to collect. Ugh.
this makes me soo glad i live in the UK where i don't have to worry about that
Thanks for sharing your knowledge Doc!
Addendum: we make things way more complicated than they need to be *because it must be profitable.*
It's also "we make things way more profitable than it needs to be"
Just recently been on the opthalmologist vs regular eye insurance goose chase. Medical kept telling me it was a vision thing, and the eye insurance kept telling me it was a health thing. Would help if the providers knew what they were providing!
I've been running into the same issue with medical devices for my jaw. It's dental! It's medical! The dental office that takes my medical insurance doesn't take my dental insurance, and the office that takes my dental insurance won't take my medical! And who knew a dental office could conduct an at-home sleep study -- that wasn't covered by either insurance!
Good luck to you, I hope you're able to get everything covered.
Which is why I just took out a second mortgage to pay $56k for oral surgery because years of dental neglect by my parents then not being able to afford it as a young adult, combined with medications I took, absolutely wrecking my entire mouth, until infection an infection that wS barely being kept in check but could no longer be cured without removing all my teeth and part of my jaw. I’m not even 40.
We had “enough” money for 2 year after 12 years married and me having chronic health problems… it was really nice not having to pinch pennies and worry about every $5-10 we spent.
That’s over for at least another decade. If nothing else “historic” happens again.
So why aren’t dentist separate like optometrists (fine), but anything medically necessary from an oral surgeon covered like regular surgery?
Saint Apollonia
Alternative explanation: Health insurance were originally created only for workers like in factories and stuff, and they just apply for illnesses that would stop the worker from being able to do his/job.
Not long ago, dentists were just a guy with pliers along a drummer boy that appeared in town on a weekly basis like in "Django Unchained".
Gosh it took me a long while to realise this wasn't a satirical short
Doctors and looking down on other medical professions, name a more iconic duo. Here in Texas, Congress failed to renew the PREP Act to let pharmacists, pharmacy interns, and pharmacy technicians administer vaccines under a wider scope during the pandemic because the AMA lobbied claiming pharmacy knows nothing about vaccines. For reference, technicians go through hours of CE and practice to become certified while interns and PharmDs have a 4 credit hour course (vs doctors' 8 credit hours of pharmacology).
Ironically enough, TTUHSC's school of medicine asked us at its school of pharmacy if anyone, professor or student, was available to teach their immunizations course because they lost their previous staff. We declined :)
Ah, Texas. We sure do like to do things our own way. Not always the right way, mind you, but our way.
Meanwhile, my entire family and I all prefer to go to the pharmacy for our vaccines. Whenever I've moved in the past, the first place that I'll establish a medical/customer relationship is my new pharmacy. Even my highly specialist nurse aunt and her even more highly specialist doctor-professor (UT, not TT lol) husband advocate about how vital a good pharmacist and pharmacy are, especially as they get older and have more prescription needs themselves. Maybe as the doctors get more specialized, they reach the other end of the bell curve and appreciate pharmacists again lol. The whole "a wise man knows that he doesn't know how much he doesn't know" thing.
Tl;dr: we love and appreciate the pharmacy and all of its employees in this household. (Not Big Pharma, though. No non-academia suits or board rooms, only labcoats and scrubs.) Idk your role at TTUHSC but thank you regardless. Stay cool and hydrated! I prefer my pharmacy staff and their support system to be not melted and instead housed within the same storage temps as my medicines and most medicines can't handle this heat. 😂
I thought part of the separation was because barbers did dentistry. I agree however that eyes & teeth need to be part of our universal health care. Those two are part of extended health insurance coverage. However, ophthalmologists are covered as they are MDs who are specialists whereas optometrists aren’t.
A coworker was always sick & because she now had extended health care she was able to get proper dental care. Unfortunately her teeth had deteriorated so much they were removed & just by removing the decayed teeth she experienced an increase in good health.
I was not expecting you to say that most eye-related things use medical insurance. At my last job, the insurance had two providers - one for medical, one for teeth and eyes. And trust me when I say Mutual of Omaha was about the most useless insurance I’d ever had when I needed teeth pulled
Most people only need eye exams and glasses/contacts, which uses vision insurance. But if you need to see an ophthalmologist or get eye surgery, that's all medical insurance.
(I wasn't able to see an optometrist to get new glasses or get my vision checked for about a decade because I couldn't afford the visits, but I was able to see a retina specialist when I had some other eye issues manifest. The state medical insurance covered medical visits, so luckily I didn't have to worry about losing my vision. It was weird to get everything about my eyes meticulously documented but have no ability to get glasses for them lol)
> I was not expecting you to say that most eye-related things use medical insurance.
He didn't say that. He said that most things *he* does, as an ophthalmologist, fall under medical. (An optometrist may not say the same.)
100% correct. Doc gave in and Medicare sets all the standards for healthcare
I have astigmatism so I wear glasses all the time. Not that I mind of course, but I've considered lasix. My grandparents have offered to pay for the lasix as a graduation gift. I don't know if I'll do it or not, or even if I'm eligible but it is a bit strange for surgery to be a gift.
Even in Canada adult teeth care isnt covered by free healthcare. Eye care was for the Eye Drs who used to do a lot of optometry and opthamology. Only in 2023 is the federal government trying to make optometry exams beyond one per year paid out of pocket. Eye Drs are surgeons who will also see eye diseased folks as consults for optometry but whoa no more optometry mixed in. So this is a change in my life time, as a child who started wearing glasses i always saw an Opthamologist, and the changes came in the 80s where optometry grew up.
In the UK, Dentists and GPs, while being part of the NHS appear to work like a franchise, where they own their surgeries and get paid for treatments (NHS dentists even charge excesses to patients on the NHS and also offer private treatment in the same surgery). It would be so much simpler if they were paid like consultants in the hospital and if their surgeries belonged directly to the NHS. Still, I would take this system over the (even more compkex and expensive) one in the USA any day!
The UK underpays their doctors that’s why they are all running to Canada and Australia.
You've nailed it again.
now try to determine whether a "limited purpose flexible spending account" for dental and vision expenses should cover the unreimbursed expenses for vision stuff that is otherwise covered by health insurance rather than vision insurance. or whether health savings account finds should or should not be applicable toward those same expenses. then you get to do a history lesson on the tax code too. (But if you can answer accurately thats better than anyone at ADP, BRI or any other benefits administrator rly)
Unfortunately the whole separate dental thing isn't limited to the us. Here in the Netherlands our insurance providers are required to offer a base package by law. It includes most medical needs but doesn't include dental for some reason. If you want dental to be covered as well it requires an addon which you have to pay extra for. There has been some talk that it should be included in the base package but as of now that still isn't the case.
It really should be included because now people tend to skip dental healthcare if they have low income. Which quite often results in either higher costs later or just having terrible teeth and the issues that come with that.
Dentists vs. Physicians: The original Sharks vs. Jets.