[PeterisP]

If you have a type of expense that's (a) unpredictable, and (b) rare, then it's a good fit for insurance.

Car crashes are unpredictable and rare, so it makes sense to insure them.

Regular car maintenance is predictable and tends to happen in (almost?) every insurance period, so it's not - some payment plan or bundling may be an option, but insurance makes no sense, it would only be more expensive than paying directly because of an extra middleman.

Getting a broken leg or cancer is unpredictable (there are individual risk factors, but they are just as relevant for car crashes) and rare, so it makes sense to insure them.

Dental care, on the other hand is common and regular - e.g. someone who didn't have coverage for broken leg or cancer most likely won't get a broken leg or cancer in the next year, but all the people who have been unable to afford dentistry generally almost all will need dentistry in the next year. Some payment plan or bundling may be an option, but insurance makes no sense, it would only be more expensive than paying directly because of an extra middleman. If you are unable to afford dentistry, then you'd be unable to afford the insurance price hike.

It's not a problem of insurance as such, it's a problem of who pays for healthcare of poor people. USA has a weird historical artifact in that in the last >100 years insurance has become almost a synonym for employer-funded healthcare payment plans, not as real insurance. If you want employer-funded healthcare to include dentistry, then that's not going to be solved by medical people but the employment market - industries where workers have market power (e.g. IT) will get such conditions, and industries where worker's don't have market power (e.g. fast food) won't. Also, this can't solve the manner of dentistry for unemployed or underemployed people who don't get employer-funded insurance and thus a dentistry-included insurance would be as expensive or more than just paying for a dentist.

[LyndsySimon]

> If you have a type of expense that's (a) unpredictable, and (b) rare, then it's a good fit for insurance.

That fits fine for things like cleanings, cavities, and implants - but what about impacted wisdom teeth and resultant issues? Broken teeth due to impact injuries? Even people with excellent dental hygiene have a decent chance of chipping a tooth, and even those types of things aren't covered under medical insurance.

[ethagknight]

I believe injury-related dental issues are covered by medical insurance. At least that was the impression I had from reading through my latest insurance policy from United Healthcare.

[madengr]

I work for Honeywell. They just dropped paying their share for dental insurance. It's now 100% employee paid, thus I dropped the insurance and just pay out of my HSA. The insurance makes no sense financially, short of having multiple teeth knocked out.

[ghaff]

I looked up mine. It's possibly a positive value for me if I were paying the whole amount. But, then, I probably have more dental care that the typical twenty something so I'm probably benefiting from the pool.

[madengr]

The only one that was worth it was a policy from Delta Dental. We went to sign up for it, and you were required to have a health plan through the ACA.

I have a wife and two kids. Three cleanings, a surface filling, and a sealant, was $800. This is our experiment going without dental insurance. We'll see how it goes this year.

Though I'm putting $600/month into the HSA since our health insurance through Honeywell sucks, and they have dropped dental. I'm waiting for them to drop health insurance.

[ghaff]

It's definitely marginal in most cases if your employer isn't paying in. It's not even like the annual max for most policies is all that high. It probably works out if you're getting semi-regular crowns or other work in that general vein on a semi-regular basis but it's hard to make the case in general.

[AnthonyMouse]

> If you want employer-funded healthcare to include dentistry, then that's not going to be solved by medical people but the employment market - industries where workers have market power (e.g. IT) will get such conditions, and industries where worker's don't have market power (e.g. fast food) won't.

And how is that anything useful anyway? It's not like dentistry is any cheaper when your employer pays for it. If anything it will be more expensive because of the added bureaucracy and separation of who pays from who benefits. This is one of the reasons costs have spiraled out of control in the US healthcare market. If you need money for dentistry, ask your employer for a raise, not dental insurance.

[chimeracoder]

> If anything it will be more expensive because of the added bureaucracy and separation of who pays from who benefits.

Yes, real insurance (like car insurance or renter's insurance) will always have an expected value that is negative - the expected sum of all future payouts must be less than the sum of all future premiums paid. So insuring against completely predictable events is never worth it unless someone else pays for it, and even then it's less efficient than if they gave you the extra money directly.

Not all dental and vision benefits are completely predictable and routine, but the overwhelming majority of covered benefits are, unlike health insurance (which isn't really "insurance", despite the fact that we use the term).

[mtdewcmu]

>> So insuring against completely predictable events is never worth it unless someone else pays for it, and even then it's less efficient than if they gave you the extra money directly.

It's worth it if the government guarantees it. Dental insurance might not be a good business to be in, but nevertheless people need it. It's a market failure, and it needs government intervention.

[ghaff]

I don't understand why you think dental EDIT: care is a market failure. There are dentists people can go to and get care. Pricing is mostly not affected by if you have insurance or not. (Most dentists will just charge you if their rates exceed what insurance pays.)

If you're arguing that "someone" ought to pay for dental care that's a different matter that doesn't really have anything to do with insurance per se.

ADDED: And one actually gets into cost discussions about things like crowns and alternative treatments with dentists. It actually seems like a good model of how healthcare spending should work. Yeah, I have insurance that pays some but thats orthogonal to the cost discussion I have with my dentist.

[mtdewcmu]

It's a market failure if people are suffering due to being unable to afford proper care. It's possible that the blame lies elsewhere than the insurers themselves. Maybe dentists charge too much. But the market isn't providing what people need. The ideal solution would be single-payer, but expanding Obamacare and Medicaid to cover adequate dental services would be a big leap forward.

[AnthonyMouse]

The true problem you're identifying is poverty. Dental care isn't outrageously expensive. It doesn't have huge margins or vast inefficiency. The reason people can't afford it is because they're poor.

No bureaucratic solution involving government-subsidized dental services is going to produce a better outcome than taking the same money and giving it to those people in cash.

[GrinningFool]

> Pricing is mostly not affected by if you have insurance or not.

Based on the bill breakdown I get from my dentist, it appears negotiated rates are a thing here too. I regularly see a total price, an insurance discount, and paid-by-insurance amount. The 'discount' ranges from 10-50% depending on the service.

[ghaff]

I am not an accountant, but in the US, I'm guessing that there are tax advantages to offering employees dental insurance rather than just paying employees more. This is somewhat mitigated by the fact that employees could just put money for routine teeth care into a flexible spending account. (That said, most bigger ticket dental items like crowns are typically only covered by about 50% anyway because they're often at least partially cosmetic.)

[AnthonyMouse]

> I am not an accountant, but in the US, I'm guessing that there are tax advantages to offering employees dental insurance rather than just paying employees more.

That's just an example of bad policy, not a reason to encourage that as a solution to the problem. If buying dental insurance or dental services is tax deduction when paid by the employer but not the employee, fix your tax code.

[ghaff]

I don't actually disagree. But in the meantime I'll take the dental insurance and the tax benefit that comes with it.

[AnthonyMouse]

That's assuming there is a tax benefit. What does it do to the EITC? Does your state or spouse's employer or school have a dental program you get disqualified from if your employer offers coverage? Maybe there is a way for the employee to claim it as a deduction? The US tax code and welfare system is so convoluted that it's difficult to identify whether a given thing will actually save you money without consulting a tax attorney.

[ghaff]

>Regular car maintenance is predictable and tends to happen in (almost?) every insurance period, so it's not - some payment plan or bundling may be an option, but insurance makes no sense, it would only be more expensive than paying directly because of an extra middleman.

And your dealer would probably be happy to sell you an extended warranty or something else along these lines and pocket the nice margins.