Saturday, January 23, 2010

Where does the money go?

I'm no healthcare expert, nor do I pretend to understand all the nuances and implications of the healthcare bill whose future is now in doubt in Congress, despite the fact that I regularly read the latest developments in the New York Times. But one question that definitely has not been answered, at least not in a way I understand, is how this proposed bill will lower costs. I simply don't understand why healthcare costs so much in the US.

For comparison purposes, lets turn to the world of dentistry. I haven't had dental insurance for several years now, and I haven't been to the dentist since 2006 as a result. When I looked into it in 2008, I found that an initial exam with x-ray at the dental clinic my friend recommended in Iowa City would cost $175. Just to take a peek! I didn't go then because I didn't have the money, and while I've thankfully had no dental complaints in the past four years, I don't actually know that there isn't a problem that needs attention.

Here in Georgia, we're in the process of doing Reziko's teeth. Genetics tossed him some pretty bad teeth to begin with, and in addition he's neglected getting them looked at for even longer than me, so I was quite relieved when I finally convinced him to get them taken care of (mostly by explaining how much more costly it would be to deal with a problem in the US!).

The clinic we're going to is small, clean, and professional. It's dentists are certified by the National Dental Association of Georgia, which in turn is certified by the European Dental Association. All of their tools, materials, and equipment are manufactured in Europe, America, or Japan and are held to high standards of quality. These guys know what they're doing, and they do it well.

One of the dentists here is Reziko's friend, but he's being treated by another, as the friend was on vacation when we wanted to get started. We stopped in before New Years for a consultation, and the initial exam and x-ray were free. We've come to the clinic nearly every day since January 4. The first couple of weeks were to treat some inflammation and remove some surface decay, now we've moved on to filling teeth (5!) and fitting a couple prostheses (crowns, I think they're called in English? I'm rusty on dental terminology).

In total, including all of the above plus special toothpaste and mouthwash and antibiotics, our bill is not going to top $250. That's right, just $250. True, for the average Georgian family $250 is still a lot of money to pay out of pocket, but when you consider that our entire treatment cost is just a little less than one and a half times what we would have paid in Iowa just for the first exam, the difference is truly remarkable.

As a layperson, I can't speak to the cost of materials, instruments, equipment, office space, or support staff neither in the US, nor in Georgia. Nor can I attest to the take-home pay of dentists in either country. But, other than perhaps dentist's salaries, I can't imagine that expenditures are so much astronomically higher in the US that they account for the huge difference in treatment cost. So where is that money going? And what has whoever gets it done to earn it? I think that these are the questions that need to be answered in the (now more tenuous) US healthcare debate.

Has anyone had experience with healthcare outside the United States? What were your impressions of the quality of care and cost?

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