This is the story of two brothers that ended up with two very different futures – an observation by their dentist. Two brothers, Mike and Jeff, loved playing baseball. Growing up practicing together improved their skills. Their competitive nature, and constant practice, made them above average athletes. Both played high school and college baseball. They developed similar career interests, studied together, and graduated from college with business degrees. They met their future wives in college and almost planned a dual ceremony, except for the fact that Mike’s wife was not from Sacramento. Mike and his bride were married in her hometown of Scottsdale, Arizona.
Eventually, the couples settled in Sacramento and soon they were busy with raising their families. Each had one boy and one girl! Because of their good education, Mike and Jeff secured great employment. Mike got a position with the state, and Jeff was co-owner and manager of a printing shop. Their incomes were equitable and each bought homes in the same neighborhood. The brothers eagerly waited for their children to grow up so they could all play baseball together. It was truly a great life!
I was fortunate to provide years of dental care to these families. However, over time, I became increasingly disappointed in their attitude toward dental care. The difference I observed between the two families was related to their dental health. Insurance appeared to have power and control over patient’s mindset which could detrimentally affect their decision-making capability.
Mike’s job with the state provided dental insurance that had a maximum benefit of $1,000 per calendar year. This was a benefit that would expire every year if not used. On the other hand, Jeff did not have dental insurance. Mike was influenced by the fact that he had dental insurance. His philosophy was, “if my dental insurance doesn’t cover it… I don’t need it“. As well, “if it can wait until January when my $1,000 benefit is renewed, then I will wait“. I explained to Mike that most dental benefits are severely limited, and the maximum benefit of $1,000 was set 50 years ago with no significant changes since then. He was influenced by the dental insurance company and chose to only do what the insurance plan allowed. He would not spend more than $1,000 per year if more treatment was needed. This choice eventually led to tremendous pain and suffering which could have been avoided. This tragedy affected not just him but his entire family.
Jeff did not have dental insurance, and therefore was not influenced in dental treatment decision making for himself and his family. When a problem was discovered that needed attention, he took immediate action before the problem advanced requiring more expensive and painful treatment. His dental treatment decisions were not influenced by dental insurance. I was surprised to witness the fact that having dental insurance could have such a significant influence on treatment choices. The problem is that Mike made decisions based on his limited benefits which actually controlled his actions towards bettering his family‘s lives. He sometimes waited weeks or months to receive authorization for treatment. He also waited for benefits to be refreshed in January. This allowed the problems to get worse and cause unnecessary pain and expense to correct problems that could have been controlled by more timely treatment. It was sad to see Mike and his family suffer because of the power of insurance limitations. Jeff’s family with no insurance actually had healthier teeth and less problems because they would act on the problems when they were at a manageable stage. Was it because Jeff’s family took better care of their teeth because they knew they did not have dental insurance? Was it because Mike’s family had dental insurance and allowed treatment planning to be guided by available benefits? Or was it that having dental insurance controlling their benefits and treatment options put a psychological limitation on Mike’s behavior that could end up being more detrimental than beneficial to his family?
I believe the brothers who had so much in common did not make similar dental health decisions due to limited insurance benefits.