QDP and the end run
When I saw the news release on Quality Dental Plan, I thought, “Ooh, end run.”
That assessment was both appropriately autumnal and exactly right. Dentists in the QDP have decided they can offer care cheaper and, no doubt, more advantageously by bypassing insurance.
That's not to say they're boycotting insurance. They're just offering "in-house dental savings plans" that typically cover preventive care and offer reduced fees on restorative services.
More than 60 percent of Americans don't have dental insurance and so often procrastinate on getting checkups, the dentists say — sometimes ending up with expensive problems that could have been prevented cheaply if caught earlier. They say QDP can help, and it's open to employers as well as individuals.
If you're interested, the site's search feature will indicate whether there's a participating dentist near you.
Now, if you please, let's talk about insurance conceptually.
Outside health care, the concept is minimizing catastrophic risks: Your chance of being hit is small, but you throw money into the pot and it covers whoever does get walloped. It's like a hired heavy you call in for big fights. He eats a lot, but he's needed so rarely that there are a lot of you feeding him.
Inside health care these days, though, insurance isn't usually about catastrophic risks: It's about everything minus whatever copays and deductibles apply, and on average the costs you bear yourself are quite a bit smaller than the premiums you pay. This hired heavy is on permanent bodyguard duty. He gives you an edge in every interaction, but because you use him so much, there are just a few of you ponying up for his grocery bill.
If no one else had a giant warrior, you might save money. But when everyone does, it becomes a question of whose fighter is mightier … and entrenched and powerful middlemen don't typically lead to overall systemic cost reductions. True insurance levels the cost of catastrophic risk; health insurance today generally just levels costs, period.*
Big companies have been skirting insurers for a long while now, by setting up plans in which they bear all the ordinary costs and obtain insurance in the true sense for catastrophic health costs. But then, they're giants themselves; wading into the fray unprotected is very different for them than it would be small companies.
I've heard of primary care physicians setting up concierge practices in which insurance does not figure, and then there are these dentists, and I'm sure other examples exist as well. I'll be interested to see how they're doing in a couple of years.
* On consideration it strikes me that this statement doesn't account for insurance companies' not inconsiderable wellness efforts. So I hereby add that this note to the record.
** Second note: I won't assign responsibility for my words to anyone but myself, but it's only fair to say that I wouldn't have written this if I had not been simultaneously reading "Priceless: Curing the Healthcare Crisis" by John Goodman and a detailed critique of it by The Incidental Economist's Austin Frakt.
Heather Stauffer covers Lancaster County, nonprofits and health care. You can reach her at 717-285-4237, 717-236-4300, ext. 289, or firstname.lastname@example.org. Follow her on Twitter, @StaufferCPBJ.