[Someone1234]

> why do you need a middleman between a doctor and a patient anyways?

I agree, we don't.

Problem is right now if I pay for dentistry via "insurance" then it is pre-tax dollars and or my employer pays some/all of the premium. If I pay it completely out of pocket, I am now using post-tax dollars and my employer isn't picking up a percentage.

Our incentives themselves are irrational. You're essentially forced to go through insurance/your employer, and punished if you don't.

I'd love to see both dental + health insurance "unbundled" from employment, and a large HSA-like pre-tax savings account which can be used on premiums, that employers can choose to contribute to (in cash dollars). That way if you wanted to skip dental insurance, and pay per-treatment you could (and pick any health insurance plan you liked, including ones that could include dental benefits).

PS - The reason the existing HSA structure doesn't work for well for dental is two fold: It requires high-deductible health insurance, and the cap is low when you start using it for other areas (vision/dental).