Saturday, February 2, 2008

Monopolies bite, or, another shot fired over the bow of the Medical Industrial Complex

For some time I have been intending to write a post about the sky-high price of dentistry in the United States, and here's the article that finally pushed me to do it.

Americans go to Mexico for a cheaper perfect smile
By Robin Emmott
Fri Feb 1, 1:43 PM ET

It was fear of the hefty bill as much as fear of the drill that kept American musician Don Clay away from U.S. dental clinics for 30 years.

When a sorely infected tooth eventually drove him to the dentist last month, it was to a clinic in a Mexican border city better known for violent crime and drug cartels.

Shrugging off concerns about hygiene and Mexico's brutal drug war, thousands of Americans are heading to Ciudad Juarez and other Mexican border cities for cheap dental treatment.

"I had to get my teeth fixed. I need a perfect smile to make a successful career in music. Treatment in the United States is so pricey," said Clay, a Texan trying to get a record deal as a hip-hop artist.

U.S. dental treatment costs up to four times as much as in Mexico, making it tough for uninsured Americans to treat common problems such as abscessed teeth or pay for dentures.

A dental crown in the United States costs upward of $600 per tooth, compared to $190 or less in Mexico.

Aspiring Mexican dentists are moving to border cities in droves and are luring American patients away from farther flung discount destinations such as Hungary and Thailand.

Americans have long crossed the border for cheap medicines, flu vaccines, eye surgery or specialist doctors, but dentists are now in highest demand.

Dental clinics are on almost every block in central Ciudad Juarez, ranging from dingy dives to clinics that look more like posh hair salons. Getting there involves dodging prostitutes, drug pushers and cowboy-boot sellers.

"We've gone from a handful of patients when we started 2-1/2 years ago to 150 new patients a month," said Joe Andel, an American who owns the Rio Dental clinic in Ciudad Juarez with his Mexican dentist wife, Jessica.

Rio Dental, which uses U.S. labs to make its crowns, picks patients up at the airport in El Paso, Texas, across the border and has treated people from as far away as Alaska and Hawaii.

"The Internet makes this possible. It allows patients to find us and research us and shows we can do dental work of equal or superior quality to the United States," Andel said.

Internet bloggers swap stories and compare notes about Mexican dentists, but it always comes down to money.

Dentistry in the United States has become prohibitively expensive for some patients, with bills that can run to tens of thousands of dollars. Malpractice insurance premiums, operating costs that are much higher than in Mexico and dentists seeking to claw back the rising cost of their tuition all weigh.

Even among Americans who have medical insurance, many find they are not covered for treatment other than the basics, and paying on credit means high interest payments.

"I did $4,000 of dental work in the United States and put it on my credit card. Because of the interest, I only paid off $400 in three years," said a U.S. teacher from New Mexico getting treatment in Ciudad Juarez who gave his name as Bill.

Cosmetic dentistry, which insurers do not cover and which can be paid in dollars in many Mexican border clinics, is also popular, Ciudad Juarez dentist Luis Garza said.

"If you want a perfect smile, you have to pay for it, and we can do it cheaper, that's all," he grinned.
(Editing by Catherine Bremer and Eric Beech)

Copyright © 2008 Reuters

If you are a U.S. dentist, this could be bad news. If you are a U.S. dental patient, this is definitely good news.

Of course I'm going to explain why, silly.

For decades and decades, dental-care providers in the United States have had a monopoly on the market. Now, there are two different types of monopolies in a free market: natural and man-made. Natural monopolies occur in areas where competition can't start and develop because of physical or current technology limitations. Examples of natural monopolies include utility companies and, at one time, the phone company and cable television. Man-made monopolies are those that depend upon some type of force or coercian to keep out competition. In a free market, the only way a monopoly can exist for any length of time without having competition is through government intervention OR by being so efficient and innovative that other companies can't compete because they are unable to bring the same or similar product to market at a competitive price. This last is the only example of a good man-made monopoly, and the minute this man-made monopoly starts to rest on its laurels, a competitor will appear to exploit its laxity.

So, what does this have to do with dentists? Read on, please.

Like any industry, the dental profession seeks to maximize its profits. According to my Internet research, there are 56 ADA (American Dental Association) accredited dental schools in the U.S., and the competition to enter them is fierce, with only students possessing the best-of-the-best academic records even considered. There is nothing wrong with this. Any group should be allowed to set its professional standards at whatever level it considers appropriate. The ADA sets its standards so high to ostensibly produce only the best dentists, but it really does so to keep the pool of available dentist fairly static so as to maintain a high income for dentists. In 2004, there were 175,705 active dentists in the United States, and of that number the average income for a general practitioner was $185, 940, and $315,160 for a specialist.

If these incomes were the result of healthy competition in the marketplace, I'd be all for them and more. The problem is, they aren't the result of any type of competition at all. They are a result of a man-made monopoly aided and abetted by the Unitied States government, which allows the ADA to be the sole body to decide what constitutes necessary dental training and standards. No alternate, competing body is seriously considered or recognized. The U.S. government uses its muscle, based on standards promulgated by the ADA, to stifle alternative forms of treatment and/or accreditation, without a care for the real victims of this monopoly, the dental consumer. Naturally, as consumers faced outrageous dental prices, they began to look for a cheaper alternative. As the article above shows, they found one. Good for them. No doubt you'll hear many stories of unclean dental practices performed by Mexican dentists (unclean practices happen in the U.S. too). Some of these will likely be true. What you won't hear of are the thousand of successful procedures performed at a fraction of the monopoly-inflated U.S. price; that would be bad for the U.S. dental business.

I am not anti-dentist. Dentists perform a vital service for their patients. What I am against is, as if you couldn't guess already, the artificial shortage of dentists created by the ADA monopoly on standards and practices with the willing assistance of the U.S. government. As long as this continues, Americans will be forced through sheer economic necessity to seek out less-costly options to get their needed dental care.

Take care.

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