I am very skeptical of the claim that a highly desirable product isn’t available because of lack of regulation. Far more likely, regulation of some sort reduces availability of that product.
Can I point out that libertarians have been ranting about compulsory licensure laws for my entire lifetime? The sort of rent-seeking you describe is the inevitable result of the sort of Big State you favor.
> And the very fact that this topic, while important to families’ finances and health outcomes, does not touch at core questions of values and national identity means that talking about it can be non-polarizing and, hopefully, help diminish the tendencies through which this country is currently tearing itself apart.
As soon as the Democrats try to remove these regulatory bariers to (independent dental hygenist) business formation, Republicans will discover their new, long held principle of allowing only the highest quality dental care.
Excellent troll piece. Guaranteed tons comments. Had to check my calendar to make sure it wasn’t April 1. I’m a huge fan of the columns. This one sort of broke the mold.
A dentist once told me that they attend conferences where all they do is come up with clinical founding ways to justify unnecessary expenditures.
That's why they have those super high res X-rays that can point out meaningless micro cavities. He told me you can just fill those with a $10 high fluoride toothpaste
I am confused, my own experience is that I have avoided dentists for long periods of time and paid a very high price in remedial treatments and different approaches to avoid more severe future issues. I now approach my biannual dental appointment with less fear and dread, which is good thing.
The kind of self dealing you see in dentistry is also common in other “health” specialties.
In most (maybe all) states in order to get a prescription for eyeglasses, you have to undergo an exam every year or two by an optometrist. The exam can cost several hundred dollars and they will try to get you to pay extra fees for various scopes and machines which are of dubious value.
As a result many people don’t get new glasses when they need them. The eyeglass market is already pricey due to consolidation.
In Europe you can just walk into an eyeglass store and get a free prescription by an optician. People get new glasses when they need them and they can go to an optometrist when they want.
Dentists and optometrists are much like the medieval guilds who used regulation to increase profit and cash flow.
I’m one who has been abused by Dentists for MONEY ONLY! They worked on every tooth I had until I simply walked out and expressed my opinion that they were THIEVES doing serious harm and creating needless pain. Life is better now !
With my dentist, I can see my x-rays on a big screen next to the dentist chair. If a tooth needs something expensive, the dentist can point right at the screen to show why. For example, they can point to a dark smudge and explain that that's a cavity.
Seeing the x-rays on the screen adds a lot of transparency to the process and gives me confidence that when they recommend something, it's really needed and that they're not just making stuff up to sell me something.
Excellent article. We go an hour and a half to see a pediatric dentist because the one (1) pediatric dental practice in our town is a complete scam. Our family dentist that sees kids but can't treat anything serious (???) found a cavity in each of our kiddos, and referred us to them (since they're the only one in town). When we got them in to see the pediatric dentist, they "found" 6 cavities in one kiddo and 4 in another, all of which they said needed crowns, so basically destroying the teeth to "save" them. This made no sense to me, and everything about the rushed nature of the visit sent off alarm bells. So we had them send the x-rays to our regular dentist. Our regular dentist "completely disagreed with the treatment plan and recommended we go to another pediatric dentist." So we found one in the nearest real city. They found two cavities in each that needed treatment, just fillings, 3 of which they could do with a laser and without any anesthisia, and possibly another couple in front teeth that they said would fall out in like six months so there was no point in treating (which turned out to be correct). I was bewildered that cavities are that subjective a thing, and couldn't believe a practice would essentially destroy kiddos teeth to make money.
I spent half of last year in Buenos Aires and I was shocked by the simplicity of the process of receiving dental care: I simply made an appointment and went. The price was extraordinarily low (it was maybe $10?) both because Argentina is an affordable place for Americans but also because they have a better regulatory framework. My experience was so positive that I feel somewhat inspired to take advantage of whenever I'm in a more affordable country with decent healthcare and just get my teeth cleaned while I'm there.
>I spent half of last year in Buenos Aires and I was shocked by the simplicity of the process of receiving dental care: I simply made an appointment and went.<
This, uh, sounds pretty much like my experience in the United States of America. Have you encountered a significantly different methodology in the States?
Hey Matt, this is not okay. Do you think that dentists are so different from me and you? They came to this country just like everybody else in search of a dream! Oh sure, it starts with a few jokes and some slurs: "Hey, denty!" Next thing you know you'll be saying, "They should have their own schools!"
Loved this post -- I HATE dentists. My biggest pet peeve is constantly being badgered to get X-rays, even though other countries don't do this and we know x-raying your head every year for 50+ years has really serious risks. And dentists will not hear any criticism. I must have had 10-15 dental X-rays in my life, none with any findings whatsoever. The only thing I got out of it was radiation exposure!
Molly Ivins used to write great articles about regulatory capture in Texas. Dentists are a great example, but they're hardly alone- hairstylists, nail salons, all sorts of other professions have excessive licensing requirements because the profession wants to practice protectionism, they can contribute to state legislators' campaigns, and the legislators know the public doesn't really notice this type of thing. It's the same reason why we're required to file tax returns instead of just getting sent a tax bill by the IRS like basically every other country does- the tax preparation industry doesn't want the rest of us to benefit from that.
And I know I flatter myself by thinking anyone might take this comment seriously in the first place, but I would like to add that despite my pessimism I truly appreciate folks like Matthew Yglesias who do *try* to cultivate common ground.
I am very skeptical of the claim that a highly desirable product isn’t available because of lack of regulation. Far more likely, regulation of some sort reduces availability of that product.
Can I point out that libertarians have been ranting about compulsory licensure laws for my entire lifetime? The sort of rent-seeking you describe is the inevitable result of the sort of Big State you favor.
> And the very fact that this topic, while important to families’ finances and health outcomes, does not touch at core questions of values and national identity means that talking about it can be non-polarizing and, hopefully, help diminish the tendencies through which this country is currently tearing itself apart.
As soon as the Democrats try to remove these regulatory bariers to (independent dental hygenist) business formation, Republicans will discover their new, long held principle of allowing only the highest quality dental care.
Excellent troll piece. Guaranteed tons comments. Had to check my calendar to make sure it wasn’t April 1. I’m a huge fan of the columns. This one sort of broke the mold.
A dentist once told me that they attend conferences where all they do is come up with clinical founding ways to justify unnecessary expenditures.
That's why they have those super high res X-rays that can point out meaningless micro cavities. He told me you can just fill those with a $10 high fluoride toothpaste
I am confused, my own experience is that I have avoided dentists for long periods of time and paid a very high price in remedial treatments and different approaches to avoid more severe future issues. I now approach my biannual dental appointment with less fear and dread, which is good thing.
Than I read articles like this and this piece in my local newspaper: https://www.theage.com.au/national/my-dentist-charged-me-thousands-for-a-mouth-full-of-unnecessary-fillings-20240110-p5ewbm.html
The kind of self dealing you see in dentistry is also common in other “health” specialties.
In most (maybe all) states in order to get a prescription for eyeglasses, you have to undergo an exam every year or two by an optometrist. The exam can cost several hundred dollars and they will try to get you to pay extra fees for various scopes and machines which are of dubious value.
As a result many people don’t get new glasses when they need them. The eyeglass market is already pricey due to consolidation.
In Europe you can just walk into an eyeglass store and get a free prescription by an optician. People get new glasses when they need them and they can go to an optometrist when they want.
Dentists and optometrists are much like the medieval guilds who used regulation to increase profit and cash flow.
I have had to re read this several times.
In Australia we seem to have a different view on the merit and e of dentistry to public health measures and policy.
Here is an article from today’s Age
https://www.theage.com.au/politics/federal/what-would-it-cost-to-give-everyone-free-checkups-at-the-dentist-20240109-p5ew2b.html?btis
I’m one who has been abused by Dentists for MONEY ONLY! They worked on every tooth I had until I simply walked out and expressed my opinion that they were THIEVES doing serious harm and creating needless pain. Life is better now !
With my dentist, I can see my x-rays on a big screen next to the dentist chair. If a tooth needs something expensive, the dentist can point right at the screen to show why. For example, they can point to a dark smudge and explain that that's a cavity.
Seeing the x-rays on the screen adds a lot of transparency to the process and gives me confidence that when they recommend something, it's really needed and that they're not just making stuff up to sell me something.
Excellent article. We go an hour and a half to see a pediatric dentist because the one (1) pediatric dental practice in our town is a complete scam. Our family dentist that sees kids but can't treat anything serious (???) found a cavity in each of our kiddos, and referred us to them (since they're the only one in town). When we got them in to see the pediatric dentist, they "found" 6 cavities in one kiddo and 4 in another, all of which they said needed crowns, so basically destroying the teeth to "save" them. This made no sense to me, and everything about the rushed nature of the visit sent off alarm bells. So we had them send the x-rays to our regular dentist. Our regular dentist "completely disagreed with the treatment plan and recommended we go to another pediatric dentist." So we found one in the nearest real city. They found two cavities in each that needed treatment, just fillings, 3 of which they could do with a laser and without any anesthisia, and possibly another couple in front teeth that they said would fall out in like six months so there was no point in treating (which turned out to be correct). I was bewildered that cavities are that subjective a thing, and couldn't believe a practice would essentially destroy kiddos teeth to make money.
I spent half of last year in Buenos Aires and I was shocked by the simplicity of the process of receiving dental care: I simply made an appointment and went. The price was extraordinarily low (it was maybe $10?) both because Argentina is an affordable place for Americans but also because they have a better regulatory framework. My experience was so positive that I feel somewhat inspired to take advantage of whenever I'm in a more affordable country with decent healthcare and just get my teeth cleaned while I'm there.
Separately, Scott Alexander recently discussed a forthcoming product -- a genetically-modified bacterium -- which apparently cures teeth decay. Seems promising: https://www.astralcodexten.com/p/defying-cavity-lantern-bioworks-faq
>I spent half of last year in Buenos Aires and I was shocked by the simplicity of the process of receiving dental care: I simply made an appointment and went.<
This, uh, sounds pretty much like my experience in the United States of America. Have you encountered a significantly different methodology in the States?
Hey Matt, this is not okay. Do you think that dentists are so different from me and you? They came to this country just like everybody else in search of a dream! Oh sure, it starts with a few jokes and some slurs: "Hey, denty!" Next thing you know you'll be saying, "They should have their own schools!"
Not cool bro, not cool.
Loved this post -- I HATE dentists. My biggest pet peeve is constantly being badgered to get X-rays, even though other countries don't do this and we know x-raying your head every year for 50+ years has really serious risks. And dentists will not hear any criticism. I must have had 10-15 dental X-rays in my life, none with any findings whatsoever. The only thing I got out of it was radiation exposure!
Molly Ivins used to write great articles about regulatory capture in Texas. Dentists are a great example, but they're hardly alone- hairstylists, nail salons, all sorts of other professions have excessive licensing requirements because the profession wants to practice protectionism, they can contribute to state legislators' campaigns, and the legislators know the public doesn't really notice this type of thing. It's the same reason why we're required to file tax returns instead of just getting sent a tax bill by the IRS like basically every other country does- the tax preparation industry doesn't want the rest of us to benefit from that.
The problem with opinions "orthogonal" to hot-button political topics is that they won't be orthogonal for long.
Everything can be framed as a "Trojan horse" of the "enemy." This applies to literally any position, issue, or topic, no matter how benign.
Everything said or done by those who you already deeply distrust is just a ruse in service of nefarious goals.
And I know I flatter myself by thinking anyone might take this comment seriously in the first place, but I would like to add that despite my pessimism I truly appreciate folks like Matthew Yglesias who do *try* to cultivate common ground.