Last time I went to Miller Motorsports Park, I wound up with pneumonia from a day digging at the Salt Flats. This time it wasnāt quite that bad, but when I crawled out of bed from the first night of fever, knelt on the cold wood floor, and spit bloody pieces of a tooth into my hand, I have to admit that I made a few hasty and ill-considered vows to never again visit the Beehive State. Then I examined my mouth in the mirror. Iām currently, ahem, between healthcare. Could I let this minor bit of dental rectification wait a while?
Nope — my reflection was enough to frighten children. More than it normally is, even. Time to investigate the wide world of cash-on-the-barrelhead dentistry.
Strictly speaking, I should have signed up for my “Obamacare” when the last dregs of my “COBRA” ran out last year, but after seeing that the best “Bronze option” plan I could find charged ninety-seven dollars per week and didnāt kick in until Iād spent $6500, I decided to wait until I had a new day job.
My new day job was with the same contracting company for whom Iāve done half-a-dozen gigs since 2003. They explained to me that they no longer offered healthcare for full-time employees, but that I was welcome to use their ACA exchange. So now Iām paying five grand a year for coverage that doesnāt kick in until I spend $6500 a year. This is, apparently, Mr. Obamaās miracle. Once upon a time I paid $2000 a year for coverage that kicked in once Iād spent $250. The good news is that, uh, well — every poor person I know doesnāt pay enough taxes to see the ACA penalty, and even if they did it wouldnāt change their decisions regarding healthcare because poor people have low future time orientation.
Thatās why they are poor. Low future time orientation.
I have the same problem. The only reason that I am not desperately poor is because I know how to make money in a hurry. Someday I will be desperately poor. I have the mentality of a poor person. Thatās why I didnāt sign up for ACA until last month, which meant that I wouldnāt receive any benefits until May, so my dental and healthcare expenses related to this Utah Ebola would be entirely paid by me. Well, they would have been anyway — but now they wonāt even count towards my $6500 deductible.
Sucks to be me. I should have married that FBI agent when I had a chance. I hear the government employees donāt have to deal with the ACA, for the same reason that the Waffen SS didnāt test out the gas chambers on their officers. (Yes, I know the Waffen SS had little or nothing to do with the gas chambers.)
Where was I? Oh, yes — I was arriving at “ImmediaDent”, your cash-basis weekend dentist to the stars. My longtime companion Vodka McBigbra used to go to ImmediaDent when I was her source of dental insurance, and they always did a remarkably decent job on her teeth, so I wasnāt all that frightened of the prospect. The problem was that they had a couple hoursā worth of root canals ahead of me, so I set an appointment for the following day and promptly went to a motorcycle store so I could buy one of those bad-ass Arai helmets with the Kanagawa Oki Nami Ura on it. The girl at the motorcycle store was very pretty and I did not smile.
When I arrived for my 6pm appointment the following day, there were still a few emergencies ahead of me. Two hours later, I was still waiting. The people around me, who were also waiting, were remarkably relaxed about this, but I was not. I will pay any price and bear any burden to not wait for something. Years of semi-comfortable internment in the middle class had enabled me to forget that poor people wait. To be poor is to declare, openly, that your time is worthless. So you wait — at hospitals, in the court system, at the check-cashing store, in the welfare line, for the relatively few restaurants in your neighborhood.
As an honorary member of the working poor, my time was honorarily worthless. So I waited, and eventually I was taken to a back room. There were two Chinese dentists, one male and one female, working on a wide variety of people. The male dentist had unconsciously adopted part of his customersā street argot.
“What hurting with you bro?” This was delivered to an enormous black man rolling around in pain on a dental couch.
“ITāS MY TOOTH, MAIN!”
“Oh, let me look… That tooth gotta come out, bro!”
“IT GOTTA WHAT?”
“It gotta come out! Talk to your family!” Then he returned to look at my poor #25 incisor. “Weāll do an F6 on this.”
“What,” I asked, “is an F6?” He looked at me as if I were a chimpanzee who had magically acquired the power of speech.
“Three surface filling.”
“No problem,” I responded. About half an hour later, an ImmediaDent representative came out and gave me the total — $338 — to the penny.
“Let me tell you about our financing options,” she began…
I handed her my Sapphire. “I refuse to finance any teeth that are not made of gold,” I replied.
“We can do that, you know. We do gold teeth.” For a brief moment I considered having the front twelve or so teeth in my mouth capped in gold. Actually, Iām still considering it.
The male dentist returned, jabbed a needle in my mouth, then ground the remaining surface of my tooth nice and smooth. Then he disappeared. I reached back and periodically administered my own suction to keep the blood off my tongue. I heard him on the phone.
“Grandma! This Doctor Chang! Your boy (said “boy” being my age) need the tooth to come out! We take a credit card!” Then he was called into another room, where a client was trying to talk him out of doing any anesthetic. The client was a trifle agitated. At this point it was about 9:05PM.
“DOC! I DONāT FUCKINā NEED IT AND I CANāT PAY FOR IT ANYWAY! JUST DRILL AND IāLL BE FINE! IāM NO FUCKINā PUSSY AND SHIT!”
“You do nitrous!” Dr. Chang replied. “Itās almost free! You big man! Handle it with nitrous only!” This reminded me of a story that a woman told me once about a night with her friends in a dentistās office. This story reminded me of every sketchy story I know about every woman I have ever loved. I started to feel very sorry for myself. This is my life, I told myself. A combination of romantic depression and late-night discount dentistry. I dipped a finger in my mouth and made a blood-infinity on the back of my left hand. Then the female dentist came in.
Without a word, she did the rest of the grind-and-fill herself in under ten minutes. Iām used to my white-collar dentists who take forever and use no fewer than two assistants at all times. Not this lady. She was fast and competent and utterly silent. It was like watching a brilliant painter at work. When she was done she turned to leave. Not a word had passed between us.
“When, ah, will…” I see you again? “…I be okay to eat something?”
“When itās not numb. You can leave now, though.” Anything you say, maāam. In another room, Doctor Chang was yelling at a patient.
“Hey Bro! You canāt leave you got one more root canal left! Gonna hurt till we fix it! Might as well stay.!”
On the way out I picked up my receipt. When I got home I looked at the filling. Top notch work. Iād waited three hours for about ten minutesā service but that ten minutes had been flawless. Most interesting to me was the way the business operated. My old dentist, a thrillingly awkward and coltish woman of my own age who closed her practice without giving much warning or any reason whatsoever, had always wrapped our interactions in layers of expensive tissue paper. The quiet Muzak, the dual hygenists, the endless questions and details, (“Are you still taking multivitamins?”) the mystery bill to be handed to my insurance company then balance-billed to me later after their negotiations were complete. A free toothbrush after every visit. I could predict the beginning and end of our appointments to within a five-minute window.
This, on the other hand — this was performance art, the fascinating future of cash-basis medicine. Every price discussed and negotiated up front. No hidden profits, no massive insurance companies sending reams of paper from block-long concrete edifices. No dental records, even. If I keep going to ImmediaDent, it will eventually be impossible to identify me from dental records. How wonderful is that? Dental care in real time, for real money, with no fluff.
The next day, V. McB. called me to see how it had gone. “I told you they were fine,” she laughed. “And for the record, they never make me wait.”
“Nobody, darling,” I responded, “ever makes you wait.”
Come the first of May, Iāll theoretically have “Bronze Dental Coverage” as part of my ACA boondoggle. Iām sure that if I operate the system correctly, I will eventually have access to a quiet dental office with multiple hygenists and motivational posters on the wall. I wonder if Iāll go. Probably not. I think Iāll just go see Dr. Chang again, bro.
If I had “fuck off” money I would replace my fake tooth (front, center courtesy of sport in Europe without a mouthguard) with platinum, set with my initials in diamond. Sadly I donāt think that would fly around the olā cube farm.
BTW my healthcare for the fam is only ~$200 /month but it doesnāt pay for shit. I am looking at probably ~$2950 out of pocket this year and they donāt pay anything until $3k. Until the ACA kicked in it was normal insurance, thanks Obama. And I donāt mean that ironically. Good fucking job, jackass.
Your health care now is better than mine was long before Obama brought us the ACA. Now I pay nearly $200 per WEEK and nothing kicks in until $6k. You really have nothing to complain about compared to most peopleās coverage. And thatās if they can even get coverage, thanks to the GOP removing the safeguards in the original ACA. Meanwhile everyone in Congress and the Senate enjoy essentially free healthcare for themselves and thier families. Itās not ALL Obamaās fault.
Iām honestly curious as to whom the ACA actually serves. As far as I can tell itās given businesses an excuse to cut full-time benefits while simultaneously raising costs for everyone else. Iām hoping there are some corner cases — people who were fired for having cancer, that sort of thing — who actually benefit.
Iām 20 with a full time job of 2 years. I pay less than 20 dollars a week for full coverage including prescriptions and dental. ACA did make me go to 29 hours from 32 when the definition of full-time changed, but since Iāve been full time itās been great.
Iām a 31-year-old cancer survivor who can, thankfully, get full coverage insurance with a $1k deductible/$1,500 out of pocket max for $320/month through the exchange. No more pre-existing conditions and with the checkups and tests Iāll probably hit that deductible every year for the next 10. Iāve been reading your stuff and greatly admire some of the things youāve written (especially regarding parenting), but the reality is that the exchange depends on the insurance companies choose to put out in a given state. The options Iāve been given in Oregon have ranged widely but even by choosing the most expensive option Iāll end up paying the least should something happen, which is what insurance is for after all.
Iām frankly happy to hear from one person who has had their life at least partially ameliorated as a result of ACA.
At least thereās someone out there who is seeing a benefit.
It makes it easier to pay my tab š
You are paying $800+ per month for what? And I am well within my rights to complain. Before the ACA kicked in my insurance actually covered stuff. I have a decent job that had decent benefits. Obamacare fucked that up.
I hate the dentist. Loath it. Detest. Itās not their fault, itās mine. I have a sensitive gag response. Tongue depressor at the doctorās office, donāt even try it, Doc. Iāll gag and possibly even puke up something on your white lab coat. When I played HS football, mouthpieces were required. Iād take a razor blade and shave and cut mine down to nothing. Basically the appearance of a mouthpiece, just enough to fake out the ref and not draw an equipment flag.
So I have not gone to the dentist even though Iāve had coverage continuously for, well, all my life. My longest stretch was 20 years. Yeah, mybad, donāt preach. My grandmother lived through the depression in abject poverty, didnāt have dental insurance till she went on Medicare and when she died at 99.5 (yes, six months shy of 100), she had one cavity in her mouth despite her love of candy. Up till recently, I had her teeth.
Went to one of those beautiful office dentists with the pretty receptionist and the hygienists with dazzling white smiles. Told the dentist of my, uh, difficulties. No problem, weāll use nitrous. He applied the tubes to my nose, turned it to half volume. “Go fast,” I said.
Uurck! Nope. “Can you turn this thing up?”
Dentist turned it up more. “No, I mean does this thing go to eleven?”
It only goes to seven, I was informed. So much for my Spinal Tap reference.
He went back in. Uuuuck! Nope. So we worked on breathing exercises and finally, as he meticulously repaired my cavity in the way back of my mouth, we got on with it.
Halfway through he stopped. “My hands are getting numb, I have to step out.”
“By aww meanz,” I said.
“The gas you are exhaling is actually getting me high,” he said.
“Ah don fee nuffinā yet,” I answered. And it was true. My dentist-anxiety blew right through enough gas to tranquilize five hookers, and I was completely lucid, aware. Canāt even get a buzz, I thought to myself as I waited for the dentist to shake it off. Had to spit in the bloody mini toilet a few times. Ugh. Anxiety building. Cāmon, hurry this up.
Fast forward couple years. I went to a different dentist. One man shop. Office set up in a former bank branch, drive through still in place. Indian fellow with a degree from New York University. I told him of my gag issue, asked if he was fast. I mean, get in, get out, no messing around.
“You will know not that I am even there,” he replied. And he was right. Slam, bam, thank you maāam. No pretty hygienists with big white smiles, no discussion or preamble. He nailed me with the needle, applied extra on the inside gum (“Gagging response is mostly caused by nerves in the tongue, so this will hurt more now, but you will gag much less.”). Whiz, bang, boom. Ten minutes. Outta there.
Letās give a hand to the foreign born dentists in our midst. No pretension. No ceremony. Theyāre craftspeople. Measure, cut, repair, next. In fact, Iāve even decided to do some maintenance dentistry with my Indian doctor. “Ten minutes, maximum, my friend.” Okay. I can hack anything for 10 minutes. Deal.
I donāt know if you were going for it but the whole scene at the dentist could have come directly from Snow Crash. Excellent.
Hiro Protagonist! š
Snow Crash was good, but Cryptonomicon was Stephensonās best work, IMO.
Absolutely. Thatās his durable work, and the one for which he will be remembered.
Cryptonomicon was genius, but The Diamond Age may edge it out for me. I am kind of glad the last few (Reamde, Analemma) were dialed back a half step, before they got to be so good that I actually died from enjoyment.
Geeking out aside, great piece, Jack.
My favorite part of Anathem is when theyāre on the road and the thousand-year dude says, “Weāll need a sextant. I assume we can devise one from first principles.”
I used ” Dr. Scala Credit Dentist ” in the 1970ās he was also an Immigrant , quite Elderly and ran up and down the hall servicing 5 or 6 patients all at the same time .
Fast , efficient and polite , he was cheap too .
10 years later the fancy-schmancy Dentist sniffed and told m those were all crappy temporary fillings but I never had any troubles with any of them .
Iām using a nice Elderly Korean Dentist now , also polite if rather slow .
-Nate
(Yes, I know the Waffen SS had little or nothing to do with the gas chambers.)
Organizationally, yes, the gas chambers were run by the “Deathās head” TotenKopf SS, while the Waffen SS were a fighting force. Offhand, though, since even domestic German police battalions were instrumental in the final solution my guess is that the Waffen SS was involved as well, if not directly in the operation of the death camps.
Itās been reported that when U.S. forces liberated Dachau they summarily executed about 400 Waffen SS who were bivouaced there. To borrow a phrase, sucks to be them.
If it soothes you at all, Federal Employee healthcare does not cover dental visits for “dependents.” And after retirement, its all on my dime.
and waiting…yeah, even on active duty, in a flight suit, wearing field grade officer rank, my time was worthless. A trip to the “medical hobby shop” was a guaranteed half day. Two if it was your annual flight physical.
I m betting the “fibbies” probably use something similar to TriCare, so you would get to see a real Dr. but the ones that accept TriCare are not practicing concierge medicine.
But I am totally enthralled by the idea of a JB sporting a gold grille. Or better yet, start a trend and rock a faux carbon fiber grill.
My wifeās a hygenist so twice a year I have to sit in her chair as she wields those torture instruments. But the comment about a night in a dentistās office reminded me of my wife once telling me that one of her ex-bosses would sometimes at the end of the day plop into the chair and turn the nitrous on for awhile and drift away.
Did you buy a bike? I have a motorcycle insurance story from Canada but it would identify me too much and I might want to be racist with this handle in the future.
Wow dr Chang sounds straight out of movie. I was imagining chang from the hangover.
My problem with my last couple trips to the dentistās office was the steady push to upsell me on every new-fangled procedure available. I also donāt want to be lectured. I know I donāt take care of my teeth as well as I should. Just figure out whatās wrong, fix it then send me on my way, please.
Jack you have outdone yourself.
This reads like the only scene from “Blade Runner” not included in the “We Really Mean It This Time, This Is the FINAL Directorās Cut” DVD Boxed Set.
jp
“I just do the eyes.”
The VA is horribly slow. You wait for hours and I pay very large copays…$50 per visit….meds deductibles vary.
But that is still less than Medicare part B monthly. The problem is, they canāt cure me. They even admit they canāt manage my pain. They just want me to die and leave them alone.
I would say ACA mostly helps the working poor who canāt get health insurance from their employer and never could (Restaurant workers maids etc). It also seems to help lower paid temps. I know a draftsman temp who uses the exchanges because with the gov kick in it costs him half what the temp agency charges. In fact it seems to help many households below 150% of the poverty line because it would then make many of the expensive employee plans unafforadable per the ACA and allow you to qualify for assistance. As far as costs for health insurance it was out of control well before the ACA. Starting around 2000 it seems to slowly filtering thru the ranks of private insurance but the cost increases became very evident starting in 2005 if you look at the numbers. In 2000 I was single and paid $150 a month for full health coverage on my own. I had low copays and really low deductibles. In 2005 I had health insurance for myself and my wife and my cost (after 40% from my employer) was $325.00 a month. Which was fine until 2006 when they added a $3,000 deductible, but still $20.00 copays for most things. (my son was born in 2006 so the 3k sucked) in 2007 they cut the employer contribution to 30% and raised the premiums 15% so I packed and left for greener pastures. By 2009 Iām working for a fortune 100 company and the changes snuck in there too (despite being a self insured insurance conglomerate) I was paying over $100.00 a week for a family plan after 50% employer contribution $3500 deductible per person $5500 family max out of pocket. $28.00 copays.
Currently I pay $85.00/week family plan (80% paid by small business employer) 3500 per person deductible plus 20% copay on hospital stays until another $2000 a person 100% paid afterwards. $9k family max out of pocket. $30.00 copay $45.00 specialty copay.
The owner threatened to pull insurance at one point, so I checked out the local health exchange. Since my household income for a family of five is not particularly high I would get the gov kick in and my per week cost would drop $5 a week and the deductibles would drop over 1k. But because Iām offered a plan at work I canāt switch.(the law needs work)
In short I can sum it up this way the health care system was screwed well before ACA. I do believe that an unintended consequence was a premature cost increase on private plans (mostly in the form of deductibles) or maybe intended since the law had many insurance company execs help write it. But really it maybe pushed the costs ahead a year or two not really a huge leap.
This is what people donāt seem to get. Your health insurance (if you had it) has pretty much always been expensive. Youāve just been shielded from the actual costs because your employer(s) picked up most of the tab. But even then, employer-provided plans have been steadily increasing co-pays and other out-of-pocket costs for a long time, before ACA was even a thought.
That makes sense but for the large number of Americans in perma-temp situations like yours truly, it amounted to legal justification for shifting the costs entirely to the employee with no corresponding increase in pay.
The cost shifting has been happening, regardless. Cadillac medical benefits are headed in the same direction as defined benefit pension, which is to say that theyāre unsustainable and on the way out.
It occurred to me from this post and your situation from last year that whatās coming is people with insurance under ACA (or any plan, for that matter) forgoing the preventative care because the deductible is too high and then only going in when itās an emergency, rather like what the uninsured have been doing already.
Iām single, so in theory my cost should be pretty low, However, as an “older” person my cost is higher than a 30 year olds. Doesnāt matter that I have no pre existing conditions or have been pretty healthy for most of my life. The policy I carried for nearly 10 years became a casualty of the ACA. Regulations did not allow it to be offered anymore. Thanks Obama
Due to the cost we have had to drop our heathcare plan(small business, 14 employees) as a company benefit. Our cost was going to rise almost 175% and it made no sense to continue. Each employee was given a raise( that was the amount the company paid for insurance divided as best we could among all). In addition, our cost for workmens comp insurance has gone up over 100%, even tho there have been zero claims. Thanks Obama
But what really chaps my ass; due to not carrying health insurance for my self, Iām assessed a fine( they can call it a tax, but itās a fine. You can call a turd a rose but that doesnāt make it one) &%$@ Obama
While the system we had might not have been the greatest, this is certainly no improvement. We are punishing the over 100 million who are working decent jobs, to take care of the 30 million who are not. While I donāt have a good solution, this one seems to be an abject failure for anyone working a decent job. Except for government employees who still get the same as they had(that we pay for) Thanks a $%&*# bunch Obama
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We are so happy you had great results at ImmediaDent. I enjoyed your post!
Stephen Valenti
Director of Marketing
Samson Dental/ImmediaDent
” That tooth gotta come out, bro!ā”
Hahahahahahaha…..that kills me
“āDOC! I DONāT FUCKINā NEED IT AND I CANāT PAY FOR IT ANYWAY! JUST DRILL AND IāLL BE FINE! IāM NO FUCKINā PUSSY AND SHIT!ā”
ROTFLMAO
that reminds me…I gave my dentist a copy of Dustin Hoffmanās excellent movie:
“Marathon Man”
now every time I go in there, once Iām strapped in the chair she leans over and asks me
“..is it safe?”
a couple times…and then cackles hysterically
pretty funny, but also a little disoncerting….when youāre in the chair!! š
I am a dentist. TTAC follower for years. Actually wrote a bit for the website years ago. (Three Pedal Fugue in A Minor)
I enjoy your writing and respect artistic license, but I just want to point a few things out for your protection.
If you were serious:
Simple cavities do not bleed. Ever. Maybe if the gum grows into the hole, but even then there should be no prolonged bleeding. I have no idea what else the source of bleeding was. Iām not sure you are fixed yet.
The fee you paid was very high for a simple 3 surface filling. Maybe X-rays were also taken?
Iām afraid the AHC dental insurance will cover only minor dentistry, and then only on children. In Indiana anyway. And our fees are higher for all policies because the state is bought by insurance lobbyists. I pay 4X higher than my friends same age in AZ.
By the way, standing wave effects on bass frequencies cause bass players to be unable to hear their volume well from in front of their amp. Their volume has to be assessed quite far out in front of the amp. It was rude to ask you if you had any idea how loud you were. He should have known that. He is used to having sound engineers set his levels no doubt.
I used to have a Pedulla 5 string bass. Ever played Pedulla?
Hi Dr. Doug,
I was playing guitar, so I should have known better š But the fact is that Iām a little deaf from years of racing cars, particularly in the frequencies covered by 4cyl race motors and six-string guitars.
There was one X-ray taken in addition to the filling.
I think my mouth was bleeding because I got zinged in the lip with a drill due to coughing. (I was still recovering from bronchitis).
Thank you for reading!
My dentist and I graduated from college at about the same time, which means I will have funded a small portion of his career from my career. Meanwhile, I wonder if Iād be ahead if Iād have just gone to a cash-based provider all these 25+ years. Naw, I have a family.
“For a brief moment I considered having the front twelve or so teeth in my mouth capped in gold. Actually, Iām still considering it.”
That line, if you will pardon the pun, is gold. Itās a good thing I wasnāt drinking anything when I read it.