Tuesday, April 25, 2017

A trip to the dentist

I went to see a dentist, since it has been over six months since I saw my dentist in Hong Kong. The experience with the dentist has left me mulling over the differences in medical systems.

We had a great dentist in Hong Kong. My wife’s insurance paid for dental care, and it was not that expensive; the cost was about US$120 per visit. I never understood how Dr. Leung stayed in business (and sent his sons to private international school, and to private universities in the US), since he had an office in Central, and a receptionist plus two assistants, yet he did all the dental cleaning and consultations himself. 

About 10 years ago, he got headphones so you could listen to music while he cleaned your teeth. Then about 5 years ago he got video goggles, and then a video screen, so you could watch videos. I think young people got more hip music, but I got the likes of Yanni. I loved that Dr. Leung explained everything thoroughly, and that he was very conservative. He did not do anything unless it was really necessary, and did not suggest additional treatments or cosmetic upgrades.

In Saint Louis, I had to pick a doctor from a list of doctors provided by our insurer. It took over two hours to find an appropriate dentist, because the list had minimal information and I had to google each one. I eliminated all those that said they had over 35 years of experience—yes, I admit to being ageist, but I recently read an article that recommended doctors with some experience but not too much time away from their training. I also wanted a dentist reasonably nearby. One practice I called only served children—that was not clear on my list or on their website. Finally I found a doctor I will call Dr. Smith. She had about 10 years of experience, and I was able to make an appointment for the following week.
The electronic reader I signed
First thing I noticed was that even to make the appointment, I had to give them all my insurance information. Then, when I arrived and spoke to the receptionist, I was asked to sign an electronic reader three times, even though I was not shown the text to which I was agreeing. I thought this was a bit odd. I always grumbled at the Hang Seng Bank that they made me sign a blank form before they entered my information, and I did not expect to have to sign with no statement in the US. Ironically, one of my signatures was supposed to indicate that I accepted HIPAA, the national privacy rule. I commented to the receptionist on how weird it was that I was signing a privacy release form without seeing the text, and she said they would print a form out for me later. They did. Of course it is four pages long, in small type, so I guess they don’t want people like me to actually stand there and read it.

As an aside, the form says in 13 languages that you can call for assistance in other languages. The line in Chinese is in traditional characters, and seems to be written by some non-thinking bureaucrat. It literally says, “Note: If you use traditional Chinese characters, you can receive language assistance service. Please dial 1-800-XXX-XXXX.” (注意: 如果您使用繁體中文,您可以獲得語言援助服務. 請致電 1-800-XXX-XXXX.) What does "traditional characters" have to do with it?! Why did it not just say “If you speak Chinese…”?! Plus, all mainland immigrants must feel left out, since it is in traditional and not simplified characters! And it does not specify whether the service is in Mandarin, Cantonese, or any other "dialect."

I was then brought into a room for X-rays. They took a panorama of my mouth, and then an image of each pair of teeth, so lots of X-rays. The assistant assured me because the machine is digital and does not use film like they did in the old days, the amount of radiation is less than what I would get from a sunny day. It was a more elaborate process than at Dr. Leung’s.

Then I was moved to a consultation room. When I sat down, someone else’s records were on the computer screen in front of me. Ha! I wonder if that is allowed under HIPAA. The assistant quickly changed the records to mine, and I waited a few minutes until Dr. Smith came in. She told me that my teeth were fine, and that one sensitive tooth is actually fine. Then she said the manager would come to see me. I wondered, why?

The manager came, and then I understood. She used the computer screen to show me what each of my cleaning processes would cost, and was covered and not covered by my insurance. Most bizarrely, the first column was the “list price” and the next column showed the discounted price negotiated by my insurance company. The third column showed what the insurance company would pay, and the fourth and last column showed the portion I would have to pay. She said there were three levels of cleaning, including a top level “laser cleaning” which is not required but highly recommended. The screen showed that for the top level, I would have to pay for it entirely—the insurance did not cover it. Bizarrely, the prices are for one quarter of your mouth, so each procedure is listed four times. Turns out, my insurance only pays for the basic cleaning. How am I supposed to decide whether I really need the laser cleaning? I decided to try it once. But I had to schedule a separate appointment for the cleaning. It had taken an hour for the initial consultation, and it would be another hour for the cleaning. Dr. Leung does the cleaning in 30 minutes. He works and moves very fast. The technician is more deliberate. Not sure which is better. I’m happy with a technician doing the routine cleaning, but I know some people prefer to have the “real” dentist work on their teeth.

Another interesting difference is that both my dentist here and the technician wore a special kind of magnifying glasses with an LED light in the middle of the forehead. They are called dental loops and my technician told me they cost over US$2000. At the same time, and probably because of the LED light, they had me wear yellow safety goggles while they worked on me.

One advantage of being in the US is that it is much easier for me to chat with service personnel, and I enjoy that very much. Hierarchy and language differences made chit chatting more difficult for me in Hong Kong. On the other hand, some of the conversations here are kind of strange. My dental hygienist was shocked that I had lived in Hong Kong, and that I could survive 15 hours in an airplane. She admitted that did not like leaving home, and said that when she goes to Florida for a vacation, she worries something might happen and so as soon as she arrives she begins planning how she would escape. This is not Hong Kong, where people dream of vacations in Thailand. (In fairness, people in Missouri also dream of tropical vacations, but in the Caribbean).

I realized once I had the cleaning done that Dr. Leung charged about $130 for the same process, but just my portion of the bill here was almost $400! The insurance paid another $600. It is not like Hong Kong is a poor country with a lower cost of living. It is hard to understand why the cost in the US is so much higher for medical care.

Elisabeth Rosenthal, who was the NY Times Beijing correspondent for 6 years in the 1990s, has written a book on the medical system. I heard her speak on NPR’s Fresh Air where she talked about the problems of the US’s medical system. She was a physician before becoming a reporter, initially as a medical reporter before becoming an international correspondent. She is very clear about the ways that medicine is not a market like automobiles. She notes that a for-profit health care industry will seek to treat a medical condition, not to cure it. A cure for diabetes would wipe out a billion dollar industry. She also explains how prices will rise to whatever the market will bear, and they never go down (“sticky prices”). The Republican faith that market competition will solve all of the US’s health care problems is simplistic at best. I found the process of finding a dentist and choosing service to be quite time consuming—and I can’t really say I chose intelligently.

Now my dentist has recommended I see a surgeon about a cyst above a tooth. Dr. Leung knew about that tooth and said we’d just watch it. I suspect the surgeon will want to operate. My cousin, who is a surgeon, has told me that surgeons believe they can solve any problem with their scalpel. That’s why they’re surgeons. So if the oral surgeon recommends an operation, is it just a way for him to drum up business? Do I really need this surgery? I may have to ask Dr. Leung.

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