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Comment by rkischuk | Hacker News Reader

I said "not always". Although it seems possible that scheduled wisdom tooth extraction may have been possible with proper care, regular x-rays, etc, that's not really the point.

In my recollection, scheduled wisdom tooth extraction has usually been on the same 50% co-pay as emergency wisdom tooth extraction. And I don't think the "emergency" part has the cost implications in dental that it does in other medical realms.

Neither is pleasant, but the cost would probably be the same either way. I don't try to justify the tiering of the co-pay, but recognize that moving it down to the 20% co-pay range just means the actuaries factor that change into everyone's premium.

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I said "not always".

You said "typically (not always)" and I say pretty close to never.

I don't try to justify the tiering of the co-pay

You said the co-pay was tiered "because such procedures are typically (not always) preventable" (emphasis mine).

(i'm note 100% sure that by 'tiered' you mean that you pay 50% for this instead of the flat or 0 co-pay most dental coverage has for checkups and the like)

Sure, you can micro-parse the language, and yes, I mean it's at the 50% co-pay or whatever.

If I were trying to explain the rationale in this case, I'd theorize it's because this is typically something that happens once in a lifetime (if at all). I'd expect once one wisdom tooth gets cranky, they'd yank the rest at the same time. So, in this case, the thought would be that people partially pay for it when it happens rather than making everyone in the insurance pool pay for that risk every month, especially people with no wisdom teeth.

But I am not an actuary or insurer, so I don't know for sure.

It's not always a 50% co-pay. That will vary by state and by plan. I have pretty cheap & awful dental insurance, but wisdom teeth extraction was 100% covered. I think my only cost was the copay for anesthesia.

Dental insurance is pretty cheap -- there are a limited number of high-dollar procedures that happen infrequently. Plus, major costs like anesthesia are usually part of medical coverage. So while the insurance pool is more likely to pay for a wisdom extraction for many folks between 18 and 30, that's a one time event.

Medical insurance, on the other hand, needs to cover a broad array of overpriced procedures with nearly unlimited liability. I had a back surgery that cost my insurance company about $75k. The recent birth of my child cost nearly $25k!

some people dont have space for wisdom teeth, and in such cases they need to be removed - whether it can bedone simply with some freezing or some more complex surgery depends..... but uf you dont haveenoughspace, as many dont, they gotta come out.

I'd go with a business rational over the theory of distributive just over lifespans. It's an adverse-selection problem. Wisdom-tooth extraction is usually not an emergency (Nick's case excepted!)-- they have to come out sooner or later, but often you've got some time. And it's a big cost compared to most dental work. If the insurer covered all or most of it, you'd have people signing up for dental coverage, getting their teeth pulled, and dropping out.

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