I took Jonah to the orthodontist this morning for a tune up. He sat back in the chair and the assistant fixed a loose hook and added new chains to the front of his mouth. Two other assistants worked on kids in neighboring chairs. The orthodontist peered over to check out their work from time to time, but he mostly chatted with the moms. He talked about taking a week long trip to a resort in Aruba with his wife and three boys. He also explained that he gave his twin boys the option of getting new Toyotas for their 17th birthdays or a used Range Rover to share.
Yesterday, Obama rightfully blasted the Fat Cats on Wall Street. He failed to put regulations with teeth into place when he had the opportunity. I hope it's not too late.
But there are other Fat Cats that need regulation. Fat Cats that are taking trips to Aruba with money from our dental insurance and from our savings account. We need regulation not only of Wall Street, but in the dental chairs, as well.
Apt. 11d 
i really hated pulling into the parking lot behind my orthodontist in his mercedes as a junior in high school paying for my braces working at a fast food place. i also suspected him of enjoying his work, and my pain, far too much. it is just not good manners to talk to people about your trips they are paying for.
LikeLike
This reminds me that I haven’t been to a dentist since 1999. I have dental insurance and really should go.
LikeLike
I once had a babysitter who lived in a part of my town I was not familiar with. One day I was driving her home and we passed an ENORMOUS house. Very unusual for this area. I said, “What’s that?” She said, “I think it’s owned by an orthodontist.”
LikeLike
In countries were dentists and orthodontists are paid less well, are teeth less good? Is it harder to get an appointment? I don’t mean these as rhetorical questions, but dentistry and orthodontistry seem to me to be great examples of the sort of jobs that no one goes into because of their intrinsic interest in other people’s nasty mouths. They are also jobs that take a fairly long education, especially in places like the US (I expect many other countries are somewhat different) where you have to get a BA first. This is to say, people go into these jobs for the money, not because of their love of straight teeth, and that w/o these incentives you’ll get less and/or worse care. Maybe the trade off is small enough that it’s worth it, but we shouldn’t just assume that it is. (Obviously, we’re a wealthy enough society that we could provide standard dental care to everyone, and it’s wrong that we don’t. But that’s a different question of whether we should have price caps or something on braces. I suspect the result would be more snaggle-teeth. But this does seem a bit like a case where envy, rather than injustice, is doing the work of the analysis.)
LikeLike
Huh? It’s like abortion. If you don’t want orthodontia, don’t buy it. But don’t try to stop other people from spending their money as they see fit.
LikeLike
I’m pretty sure that a lot of orthodontia is cosmetic, and thus gets priced like a luxury good. Does seem like if you don’t want to send your orthodontist to Aruba you should stop buying orthodontia.
Now, I actually have a kid with teeth issues, who probably needs non-cosmetic orthdontic care (she has baby teeth embedded in bone that will prevent her permanent teeth from coming in), but it’s been clear to me since I was a kid that a fair amount of orthodontics is cosmetic. Of course, as everyone opts for the cosmetics, it becomes a standard, too. I don’t think I’m yet in the social circles where nose jobs are standard care for your children as well, and hope that I never am. But, I know that there are places where nose jobs (and breast implants) are indeed things you get for your children so that they fit in with everyone else.
LikeLike
I was told that I needed orthodontia for non-cosmetic reasons. My teeth are straight enough, but they only meet in two places, so I’m only chewing on four teeth. He wanted me to be able to chew using all 28 teeth. Since this was six months before I was going to college and treatment involved breaking my jaw and then getting braces, I said no. So far I’ve gotten away with it.
LikeLike
Our orthodontist usually has his wife do the consult about the fee- “this is how much it costs, this is how much your insurance pays, these are your payments”. She points all of this out with her hand dripping with diamonds, including one ring that’s the size of a walnut. Not kidding.
Truthfully, it’s their money and they should spend it how they like, but flaunting their wealth to the people who are creating it for them is vulgar.
LikeLike
One anecdote. My sister-in-law (European, living in Europe, socialized medical plan) pointed out that her son had just finished his time in braces. It cost 4x what our daughter’s braces cost, in the US.
Our area is affluent, but that means that there are more orthodontists competing for clients. The orthodontist bargains with the patients’ parents. There is no health insurance involved, so parents pay attention to the cost. In Europe, there are restraints on opening practices, and the patient is not the one paying for the orthodontia.
LikeLike
One of the things I’ve learned about from Dave Ramsey (and also from The Millionaire Next Door) is the broke doctor. Go to medical school, graduate, buy into a practice, buy a new car, buy a new house and without really trying, you’ve got a million dollars or more in debt. DR refers to this as “doctoritis”. Doctors and dentists are also notoriously bad at investing. I’m sure that Laura’s orthodontist has a large income. However, I’m trying to learn not to extrapolate income or financial security from spending patterns. If Bob lives in a big house, that just means that Bob lives in a big house. It doesn’t mean that Bob can afford a big house.
LikeLike
Jonah’s dentist told him that braces were a necessity. He had a half inch gap between his two front teeth and it was going to throw off his whole mouth. However, the dentist is the wife of the orthodontist, so she might have been thinking about the trip to Aruba.
His braces are covered in part by the dental plan. Steve’s job pays for the dental plan, though Steve does have a portion taken out of his paycheck. His business passes on the cost of the insurance onto the consumer. So, the price of braces and all medical procedures affects everyone. If we want to extend medical care to more people, then costs have to be controlled.
LikeLike
If we want to extend medical care to more people, then costs have to be controlled.
Sure. But what we can’t expect, and shouldn’t expect, is that there will be as many people who want to become orthodontists and dentists if they generally make less money. That likely means longer waits, less done, etc. Also, lots won’t be covered on public plans, if we ever have such, as lots is mostly cosmetic. So, people who want it will still pay more. But complaining about the trip to Aruba (which isn’t necessarily a wildly expensive trip) seems petty and misguided.
LikeLike
“If we want to extend medical care to more people, then costs have to be controlled.”
How about we all do our part by getting several price quotes while choosing an orthodontist? (“I know you’re rated the best orthodontist in Shelbyville, but times are tough and Dr. Smile says he can do it for much less.”) Let’s create stronger market pressures rather than waiting for the feds to do the job for us.
LikeLike
That would be great, but here Dr. Smile doesn’t exist.
The orthodontists here (and my guess is everywhere) actually meet to discuss things like advertising, pricing, etc. I’m actually good friends with an orthodontist’s wife- not the one I go to. Orthos actually advise new orthos on where to put practices, etc.
LikeLike
Aah, that gap in J’s teeth was so endearing. I’m going to miss it.
We’ve reluctantly come around to orthodontic care for our daughter, but we resisted for a long time, on the grounds that orthodontists can’t be trusted. I pretty much have the same trust level for them that I do for car salesman.
LikeLike
“The orthodontists here (and my guess is everywhere) actually meet to discuss things like advertising, pricing, etc. I’m actually good friends with an orthodontist’s wife- not the one I go to. Orthos actually advise new orthos on where to put practices, etc.”
Price-fixing is illegal, isn’t it? I would be more than happy to see that sort of thing broken up.
LikeLike
If I were the sort of person who believed that the way to make things more available was to impose price controls, I have to say that orthodontia would still be way down on my list of necessities for which price controls are appropriate. Until we put a cap on the price of every house and apartment in America (many realtors and developers seem to me to be a lot richer than orthodontists), and every article of food sold in every grocery store, and every automobile and every gallon of gasoline and heating oil sold in America, I would hold off on orthodontists.
LikeLike
What about social pressure? When the price-gauging orthodontists find themselves persona non grata at school events, I would imagine they’d take the hint.
But I tend to think this goes back to a generalized decline in American standard of living. It used to be we could all scrape together the money for orthodontia. These days it’s getting harder and harder to cover all these middle class markers. (And make no mistake, perfect teeth are a serious marker of middle class-dom.)
LikeLike
Jen: huh? My father’s family couldn’t afford orthodontia. His father was a police detective. Orthodontia wasn’t even on their list of things to buy for children. And when I was young, and they used to show us movies of starving (well, malnourished) children in Appalachia, those children weren’t wearing braces. When was that time, when everyone could afford orthodontia?
LikeLike
When the price-gauging orthodontists find themselves persona non grata at school events, I would imagine they’d take the hint.
You get to go to Aruba and you get to pass on hearing the 3rd grade butcher “Jingle Bells.” Take away the whole “shoving your hand in peoples’ mouths all day” and you’ve got something very close to as good as it gets.
LikeLike
I’m with y81 here. Back in the day, not everyone, even in middle-class communities on Long Island where I grew up, got orthodontia. My husband got braces after we got married; when he grew up, orthodontia was not one of the things his parents paid for. He did resent that, fwiw. Perhaps in another family with two working parents, my sisters and I might have gotten orthodontia.
My daughter clearly inherited his mouth (more teeth than jaw space), and her teeth were going every which way until she got braces a year ago. E’s teeth seem to be more straight, and I may be more resistant to the suggestion for him to see an orthodontist.
LikeLike
“You get to go to Aruba and you get to pass on hearing the 3rd grade butcher “Jingle Bells.” Take away the whole “shoving your hand in peoples’ mouths all day” and you’ve got something very close to as good as it gets.”
I don’t know. You guys are all really grossed out by mouths, it seems, but I don’t think it’s that horrible of a job. And surely being a janitor is grosser, but they don’t get regular trips to Aruba.
LikeLike
“It used to be we could all scrape together the money for orthodontia.”
‘Jen: huh?’
No kidding, y81. Orthodontics have always been an upper-middle class thing, rather than a middle-middle-class thing.
MH, are you up for a career change? I was thinking the FBI could send you to dental school and then infiltrate you into the shadowy orthodontic world in order to bring it down, Donnie Brasco-style. I’m a little bit worried that you might go native, though.
LikeLike
AmyP, yeah price fixing is illegal. They go after gas stations here who do it.
The orthos would tell you that they are making sure the standard of care is unified and reasonable.
In defense of orthos, my friend’s husband does an awful lot of people I know at no or partial cost. Now granted, that generosity is on the backs of paying customers, but it’s still a very good thing.
LikeLike
“Price-fixing is illegal, isn’t it? I would be more than happy to see that sort of thing broken up. ”
yeah, but how? I think this is one of the really difficult parts of free-market capitalism, how to prevent collusion. It’s supposed to break down because people break away (i.e. with no enforcement mechanism, a person who charges less can steal business). But, if they know the end result of that is going to be ever lower prices (and that they won’t be able to drive the others out of business) they don’t break out, and price fixing occurs.
The meeting together to do it seems addressable, but, lets face it, these guys are friends. They talk together. They divide up the work, and they limit new entrants.
LikeLike
Amy, I’m not going back to school for anything.
LikeLike
I agree about the class distinction of orthodontia. I still think it tells me a lot about people in my generation, whether they had orthodontia or not (and, in this case, I’m differentiating between *perfect* teeth, the kind Europeans used to consider uniquely American) and my teeth, which are good, but imperfect. I had the same orthodontist make a different recommendation on whether I needed braces conditionalized on the availability of insurance. That experience made me so suspicious that I have had a really hard time signing on to orthodontics for my daughter, who seems to really need them.
(I think that one of the things that’s happen in the last few decades is that things that used to be for the ‘richer’ among us have become expected for those with less money. Orthodontics are an example, but so are various consumer goods, like designer shoes and handbags, cashmere, granite counter tops, big houses, multiple televisions, . . . .). Some of the transition is a decrease in costs — I still remember when the price of silk blouses came down in the US (China related). Some of the change is a media culture and the easy borrowing of the last few decades.
LikeLike
“yeah, but how? I think this is one of the really difficult parts of free-market capitalism, how to prevent collusion.”
Walmart. If it only dentistry weren’t a bit too out of Walmart’s price range. Maybe Costco?
LikeLike
I got my braces in 1979 (for a severe overbite) and I would agree that many people skipped at that time.
But by the time my nephews got braces in the mid 1990s it was happening to probably 85% of the kids in their school class, according to my sister. (I have trouble believing it’s not cosmetic, at that rate.) They were living in a borderline working class area of Salem, Oregon at the time. My sister and BIL were a teacher and a pastor, respectively, and could scrape up the money.
I agree with bj on this one; orthodontia used to be considered a luxury good, then made the transition to “everyone’s doing it”, and may now be transitioning back.
LikeLike
At a guess, the orthodontists must have some sort of trade association. That association can collect data, and publish figures for members, to give them an idea of the going rate in their neighborhood.
All the orthodontists in our area were in the same price range. It was close enough that a friend was able to guess the cost for my daughter’s work off the bat.
For most people, orthodontia are a cosmetic choice, not a medical choice. They can charge what the market will bear. It’s like plastic surgeons. There are some people who need their services, but the bulk of their business is vanity. Not that there’s anything wrong with that!
LikeLike
I was in junior high/high school from the late 80s to the beginning of the 90s, and only a few unfortunate kids had braces (do you remember headgear?). The braces of the time were incredibly disfiguring, putting the icing on the cake of adolescence.
As a parent, I’d hesitate to go with braces just because kids are not that good at taking care of them and following the regimen properly. It would really tick me off to pay big bucks for braces and then have to deal with tooth decay, too.
LikeLike
Are greedy orthodontists going to send this country into another great depression with their crazy and corrupt financial practices? If not, I don’t think regulating them is as important as regulating Wall St.
LikeLike
I lived in a suburb with a pretty decent split between lower and upper middle class homes, and a scattering of large apartment complexes, and my sense was that most of the kids in my junior high had braces. My parents were working two jobs a piece almost until the point when I got my braces, and so I suspect that some percentage of the cost was covered by insurance. This was the early 1980s, and I would have said that only the very poorest families in the district weren’t getting braces for their kids.
My father didn’t get braces (absolutely NO family income for this in the early/mid-1960s) and, while it could be argued that it was a cosmetic issue for him as a young adult, not having had braces has definitely become a dental/health issue as he has aged. It’s not easy to keep teeth clean when they overlap, and as the enamel thins, bone density declines, and gums recede (all parts of the aging process), decay on the front teeth can lead pretty quickly to tooth loss.
LikeLike