Author's Note: This is the fourth in a series of articles examining America's oral health care crisis. Be sure to read part three, "Resolving to Take Better Care of Our Teeth Could Save Our Lives -- And Billions of Dollars."
Have you or a member of your family skipped a visit to the dentist because of the rapidly rising cost of dental care? Many Americans have and the numbers are increasing.
While lawmakers and the public have been focused on rising medical costs and the millions of Americans without health insurance, scant attention has been paid to what has been happening to the cost and availability of dental care.
For every adult without health insurance, an estimated three lack dental insurance, according to the Kaiser Family Foundation. Research conducted by the National Association of Dental Plans found that just slightly more than half of all Americans had dental insurance in 2007.
One of the reasons so many of us decide against dental insurance, even if our employers pay part of the premiums, is the relatively skimpy coverage it provides for anything other than routine checkups and cleanings. A typical dental plan requires a 50 percent copay for complicated procedures and high-ticket items like crowns and bridges. Many plans have a "missing tooth clause," meaning they won't pay for replacing a tooth if it was missing when you enrolled in the plan. And most dental plans limit coverage to just $1,500 a year. That's hardly more than a down payment on your kid's $6,000 braces.
The result: Many of us who do have dental insurance postpone visits to the dentist because of the cost. This often puts our health in jeopardy because of the close connection between oral health and overall health.
In recent years, the cost of dental care has been increasing at a faster clip than the cost of medical care overall. Between 2008 and 2012, according to the Bureau of Labor Statistics, in the health care sector only the prices of hospital services, nursing home care and adult day care services rose at higher rates of annual inflation than dental care.
As a result of this steep increase in the cost of dental care, dentists on average are now making more money than many physicians.
According to the American Dental Association, the average net income in 2009 for general dentists in private practice was $192,680. The average for specialists, including orthodontists and dental surgeons, was $305,820. By comparison, the average income for pediatricians and family practice physicians in 2012, according to WebMD's Medscape, which tracks physician compensation, was $173,000 and $175,000, respectively. To be sure, many dentists make significantly less than the average, and their prices reflect that. And dentists who don't own their own practices or who work in public health settings typically make less than general dentists in private practice, and considerably less than specialists.
Americans understand how expensive dental care has become, which partially explains why only 36 percent of all adults in the United States are expected to visit a dentist this year -- and why, according to the Kaiser Family Foundation, one in four nonelderly Americans have untreated tooth decay. Another reason many of us forego needed care is the lack of transparency in dental pricing. The research firm Empirica last year found that after not being able to afford it, the most cited reason people give for not visiting the dentist was fear from not knowing the costs.
As in medical care, finding out in advance how much you'll have to pay out of your own pocket for dental work can be next to impossible.
This lack of transparency and the high out-of-pocket expenditures for typical patients inspired Los Angeles-based entrepreneur Jake Winebaum to launch a free online service (www.Brighter.com) to help people find out how much dentists in their communities charge for everything from routine checkups to root canals and other complicated procedures and use group buying power to negotiate more affordable prices.
Winebaum told me that as his provider relations team began negotiating with dentists to participate in Brighter.com's network, they found that prices for the same procedure at two comparable dentists in the same city -- even on the same street -- varied up to 700 percent.
Winebaum was inspired to start Brighter.com after his father-in-law, who is on Medicare, told him his dentist planned to charge him $6,500 for three crowns. Since Medicare has no dental benefit, he would have to pay the entire amount on his own.
"I went online to see if $6,500 was a good price or a bad price for his dental work, but I couldn't find any reliable information on the Internet about what a crown should cost," Winebaum said. "I found that dental patients lack price transparency and negotiating leverage, and that impacts their willingness and ability to get the dental care they needed."
Brighter.com is finding that giving consumers the ability to compare dentists and the prices they charge is having a significant effect on what they wind up paying. Winebaum says that since launching Brighter.com in Los Angeles, the company's members have saved an average of 50 percent on their dental care. Earlier this month the company expanded into neighboring Orange County. It plans to expand statewide later this year and across the U.S. in 2015, and it is also now marketing its services to employers.
Brighter.com and similar services are helping people save money, but more needs to be done to improve access to dental care, especially in rural and poor areas of cities where dentists don't practice. In the next column we'll look at what some states are doing to improve access to affordable care.