Many Cutbacks but Not for Straight Teeth

WITH her husband newly unemployed, Kim Moldofsky isn’t about to drop thousands of dollars guilt-free.

Except to straighten out her firstborn’s teeth.

The way she sees it, dipping into their rainy-day savings to correct her son Isaac’s overbite is a sound investment when few exist. “If you look at what would be happening to our money sitting in banks, we are not getting much return on it,” said Ms. Moldofsky, a new-media consultant who lives in Morton Grove, Ill. “This is something we will get a return on.”

Even in the best of times, paying $4,500 to $7,000 for braces (depending on the severity of alignment issues) is a stretch for many — not to mention the thousands that some spend on preparatory work. Dental insurance pays roughly $750 to $2,000; often, the whole tab is paid out of pocket.

As job losses and salary reductions wreak havoc on family budgets, financing the perfect smile is a big-ticket purchase that many middle-class parents find is worth scrimping for. For Ms. Moldofsky, family dinners at restaurants and tennis lessons are out, and her boys no longer attend private school, partly because of the expense. But 11-year-old Isaac’s orthodontics remain a priority.

“Could we have avoided doing this? Probably,” she said. Still, she added, “I think having well-aligned teeth — this is going to sound shallow — but it sends a message to people.”

Paul Zuelke, whose health care firm gives advice on practice management to 800 orthodontists who together see 25,000 new patients a month, said “a large number” of those families are struggling financially. But they would “rather buy mac and cheese for dinner than not pay their bills,” he said.

Even those who are insolvent place a high priority on their children having straight and healthy teeth. A few times recently, patients have called clients of Mr. Zuelke’s to say they are filing for bankruptcy but don’t plan to list the orthodontist as a creditor. They still intend to pay for straight teeth.

In a society that places extraordinary value on appearance, orthodontics is increasingly seen as a necessity, not a luxury, and even though the number of patients appears to have declined since the start of the recession, many families are going to great lengths to keep tooth-straightening in their budgets. Some orthodontists, with business slowing, are dropping fees or letting families stretch out payments.

The latest figures from the American Association of Orthodontists, compiled before the recession began, counted about 4 million patients younger than 18 in North America in treatment in 2006, up from 2.6 million in 1989. Experts say the number has dropped recently.

Mr. Zuelke estimated that orthodontists saw an 8 percent decline in new patients in 2008 from the previous year, coming on top of a 12 percent falloff in 2007 over 2006. This year, however, there’s been a slight uptick in patients in the first quarter, he said.

Dr. Roger Levin, the founder of Levin Group, which advises 500 orthodontists nationwide on how to manage their practices’ finances, said that since August, revenue for orthodontists has decreased 10 to 12 percent. “Fewer patients are coming in,” Dr. Levin said.

Why are cash-strapped families still considering braces at all? The answer seems to be that giving the next generation a leg up is a priority. “If you go into a job with teeth out of a novelty store, people aren’t supposed to discriminate,” said Dr. Benjamin Burris, an orthodontist with several offices in Arkansas. “But people do.”

To pay for braces, families typically face three choices: either upfront payment in full for a modest discount; third-party financing, often with interest; or in-office financing, which entails a hefty down payment, then interest-free monthly fees over two years or so.

But in this economy, “a lot of practices are more flexible with their payment options,” Dr. Levin said. Since last fall, Dr. Hyue Young C. Park, of Markin & Park Orthodontics in Maryland, has allowed her patients to make the down payment over a few visits, so that a large upfront sum is not a barrier to treatment. Her office also waives a $380 fee for X-rays and dental records for all patients.

Recently Dr. Park and her financial coordinator decided to let one family pay “$300 for the first six months, then $100 for the remaining months,” she said. The understanding was that if they had extra money — say, a tax refund — they would put it toward treatment.

Once a mortifying rite of adolescence, braces carry less of a stigma now that many tweens and teenagers have them. Braces are as innocuous as glasses these days, said Steven Kelly, 13, of Newton, Mass., who has worn his braces for two years. “They just blend in,” he said. “You don’t notice them.” In fact, try breaking it to a seventh grader that she’ll have to survive junior high school with a jumbled “social six” — the catchphrase for the half dozen teeth that are front and center. “There are more kids coming in, wanting them, expecting them,” said Dr. David Cordes, an orthodontist with offices in Westfield, Mass., and Enfield, Conn.

“I feel sorry for a lot of parents,” said Dr. Burris, who takes pro bono cases through a foundation he recently created, Smile for a Lifetime. “That’s why we work with them.”

Free Dental Health Screening for Hundreds

SPRINGFIELD, MO-- It's an effort the make the community healthier.
About 250 clients without insurance lined up to get a free appointment with the dentist Friday night.

Jordan Valley Community Health Center hosted the clinic for those in need of some serious dental care.

The clinic picked up the tab, and says it will end up saving money in the future. "It's very expensive on the state, it's very expensive for the patients and it's very expensive for the hospitals to go to the emergency room for a dental problem," says Dr. Dennis Thousand with the Jordan Valley Clinic.

He says more often than not, patients without health insurance who have dental problems end up going to the emergency room.

"I had to save up to get these two teeth done so I'd be saving up again to get these others done and now they're all swollen and in pain, so I'm grateful for this," says Karen Remmen.

Dr. Thousand says dental problems can lead to much more serious health problems if not treated.

Those who attended Friday's clinic will go in for a scheduled appointment this Wednesday.

UAlbany Students Extract a Real-World Experience

UAlbany students Reena Patel, Mariam Sharifipour, and Christopher Theall saw firsthand on a trip to Mexico how having access to good dental care is not taken for granted in other parts of the world.

Patel, a human biology major, and Sharifipour and Theall, biology majors, are all prehealth students. Sharifipour is president of the Pre-Dental Club at UAlbany. An e-mail went out to prehealth students informing them of the opportunity to go on a mission trip with local dentists Jan. 30-Feb. 5.

"This trip created a pathway for my career and gave me an experience of a lifetime; it showed me the skills and work I need to do and work hard for in order to pursue a career in dentistry," said Patel, of Auburn, N.Y. "Also it taught me how lucky I am to be living in the conditions I live in, because not everyone gets that luxury."

Sharifipour, a native of Orange County, Calif., is already a licensed dental hygienist. "This field is pretty much what I know best and what I love," she said. After graduation in May, she plans to work for a year, take more mission trips, and then apply to dental school. "I cannot imagine myself doing anything different. It is my passion. The towns we visited are very remote and poor. Having a dentist or access to dental care is not an option for these people, let alone dental insurance or coverage," Sharifipour said.

Theall said the trip was a great opportunity in two ways: He had the chance to assist in many dental procedures and learn more about the field, while giving medical treatment on a missionary trip, something he has always wanted to do.

The group faced obstacles, including having $12,000 worth of dental instruments confiscated as they entered Mexico. The equipment has not yet been returned. In addition, hot water and electricity were in short supply.

"Our working conditions were not easy," said Sharifipour.

The group went to several small villages, including San Luis, with Barry Loffredo, DDS, and Donald Deluke, DDS, both of Schenectady, N.Y. "These three students came together and worked as a team. They were a tremendous asset to the mission of the trip," said Loffredo.

"For meeting two students that I barely knew, and working with two dentists that I have never actually worked with ... you would think that we were working together for years," said Patel, adding, "Beyond the hardships that we faced to perform our journey, we all have never laughed so hard on a trip in our lives."

Sharifipour said the most compelling part of the experience for her was the appreciation shown by their patients. "They thanked us with a fiesta on our last day of work. They invited us back next year," she said.

St. Helen's Church of Schenectady assisted with the cost of transportation from Albany to JFK, as well as room, board, and travel insurance.

Devil in the detail of scheme

OF all the several bold ideas contained in the interim report from the federal Government's National Health and Hospitals Reform Commission, released this week, the plan for a universal dental scheme is the one that has, perhaps, captured the public's imagination the most.

Over the past two years the nation has been bombarded with horror stories of pensioners nursing mouths filled with rotting teeth which they can't afford to get fixed, and of others lingering for months, even years, on waiting lists for public treatment.

There is wide support for some sort of re-think. But the NHHRC's proposal has not been greeted with open arms on all sides.

Famously, the Australian Dental Association -- the nation's peak group for private dentists -- attacked the plan almost immediately as "impractical, nonsensical, (and) overly simplistic" and declared it "flies in the face of much of the deliberations that have taken place on this issue over the past decade".

Responses from individual dentists have been more moderate, although still widely diverging. Tony Burges, a dentist in Sydney's inner-west suburb of Drummoyne, says the NHHRC's proposal is "a reasonable suggestion" but the "devil will be in the detail".

The ADA made a number of specific criticisms, including the claim that the costs of the scheme would be "crippling" and unaffordable, potentially costing over $11 billion.

However, a modelling report prepared by consulting firm PricewaterhouseCoopers at the NHHRC's request, and published this week, makes clear that based on certain assumptions about claiming patterns, the extra cost to government would be just $3.9billion a year. This amount would be more than covered by the proposed 0.75 percentage point increase in the Medicare levy.

But it turns out this affordability comes at a price.

The PwC report outlined three variations of what specific dental services the proposed Denticare scheme might cover, ranging from a fuller coverage to lesser. But none is truly comprehensive.

All exclude root canal treatments, crowns and bridges, periodontic care (involving cases of advanced gum inflammation leading to bone loss) and orthodontic treatments (including braces).

Crowns and bridges have been blamed for the soaring costs of the Howard government's Medicare-based dental scheme, which the Labor government has so far failed to scrap due to opposition in the Senate.

The existing Medicare scheme pays $2150 in Medicare rebates for private dental treatment per year, provided the patient is referred to the dentist by a GP who has assessed them as having a potentially life-threatening chronic condition that is being exacerbated by their dental problems. An analysis of spending in the Medicare scheme last year showed patients enrolled in it were making claims for crowns and bridges at a higher rate than would be seen in the normal dental patient population: about 7.4 per cent of total Medicare treatments, on a per-tooth basis.

However, the affordability means that basic dental treatment, which would be covered by any of the foreseen Denticare options, would be much more equitable.

At present, individuals going to private dentists spend an average of 0.79 per cent of their income on out-of-pocket charges to private dentists, an amount that rises to 0.96 per cent of taxable income once the cost of private health insurance premiums for dental cover are added in. Together this accounts for 78 per cent of total expenditure on dental services.

Under Denticare, individual funding of dental services would shrink to an average of 0.37 per cent of taxable income, equivalent to 29 per cent of spending on dental services.

The Denticare scheme, funded by the increased Medicare levy, would allow patients to choose cover under private insurance plans, in which case Denticare would pay the premium and the policy would cover 85 per cent of the fees, leaving the patient to pick up the remaining 15 per cent.

Other patients who wished to avoid the 15 per cent gap could elect to be covered under the public system, where treatment would be totally free, with the downside of some waiting.

Patients opting for private treatment would no longer need to pay separately for dental premiums. Overall, the average proportion of income spent on dental would rise from 1.24 per cent at present to 1.3 per cent under Denticare, with the increase due to the expansion of programs such as school dental and oral health promotion.

But this conceals the fact that according to PwC, equity -- meaning access for the poorest -- would be substantially increased under the proposal.

According to the modelling, taxpayers with annual household income of up to $25,218 currently pay just under 2 per cent of their taxable income on dental costs, or $11.25 per taxpayer per week.

This would fall to $8.94, just under 1.5 per cent of taxable income, under Denticare.

Those in households with annual income between $25,219 and $44,286 would be better off by 74 cents per taxpayer per week, and taxpayers in households with income between $44,287 and $67,129 would be $1.15 better off per week.

Taxpayers in households with income over $67,130 would be paying more under Denticare ($1.37 per taxpayer per week more, rising to $2.74 per week for income over $108,277).

Yet there are many assumptions in the Denticare modelling, and unexpected changes in consumer behaviour could have a significant effect on the impact of any scheme, should one be approved by the federal government.

For example, it's not easy to predict how many more dental services will be provided as a consequence of making dentistry more affordable for the less well-off. Also, about 35 per cent of people who visit the dentist do not at present have private dental cover, even though they visit a private dentist. How their needs will be met if they continue to eschew the private option, and rely instead on the public Denticare scheme, is not totally clear.

Burges feels that Denticare will come unstuck in the details.

"My personal view has always been that private dentists are probably best placed to treat most people in the population," he says.

"The NHHRC has budgeted about $4.5billion (for Denticare) ... but it could easily blow out and be very expensive to run. I think there's real potential for any universal scheme to blow out and be very expensive, and that might lead the government to cut costs."

Most unusual credit card deals

What do you have in your wallet? I bet at least one credit card! Nowadays you can hardly find a person having no plastics at all. The average U.S. consumer carries from three to six credit cards in his/her wallet. It seems that many people start to forget what cash looks like!
According to statistics, there are about 900 million debit and credit cards in circulation. It is obvious that lenders need to offer something really beneficial and interesting in order to draw attention to their products and snag new customers.
We have analyzed the credit card market to find three most unusual credit card offers that will really surprise you! If you are tired of standard zero-APR-no-annual-fee-cash-back-rewards-program plastics, consider the offers below: they provide innovative features and unique rewards!

1. Credit cards that smell

Commerzbank AG, one of Germany's major banks, has launched a range of Visa and MasterCard branded credit cards in four aromas – coffee, mint, cinnamon or orange. Now you know how money smells!

Marketing gurus have always known that smell is a powerful persuader to buy. For example, newsagents use the smell of bakery outside their stores to attract customers. Travel agencies spray coconut aroma in their offices – it makes customers think about exotic far away countries and book trips.

Credit cards with aroma will definitely draw attention to your plastic money. They will become a conversation opener at every checkout: "What pleasant smell! Is it really a scented credit card? I have never seen – and smelled - such cards before!"

Coffee, mint, cinnamon and orange are a good choice for credit card aroma because all these scents are food related. You will like at least one aroma out of four! Plus, they will suit both man and women.

Scented credit cards can lower your level of stress and ensure a better state of mind due to their aromatherapy effect. Orange fragrance is stimulating and energetic. Coffee and cinnamon are considered to be comforting and warming. Mint has a relaxing effect.

There is one more important psychological aspect of scented credit cards. Every time you open your wallet, you will smell your favorite fragrance and feel positive. However, it can make you spend more than you have planned!

2. Finance your plastic surgery!

Plastic surgery, for example breast augmentation and rhinoplasty, has become as common as teeth whitening. So no wonder that a credit card designed for plastic-surgery patients had to appear in the market one day.

CareCredit is issued by GE Money Company. This plastic is targeted at consumers who want to finance various medical procedures typically not covered by insurance. They include dental treatments, cosmetic surgery, cosmetic treatments, vision care and laser eye surgery, hearing aids, and even veterinary medicine for your pets.

The credit card spending limit is equal to the price of the procedure you want to finance. It gives you the freedom to get the healthcare now and pay for it later. But be careful: just because you have money for plastic surgery, it doesn’t mean that you really need it!

CareCredit can only be used for healthcare services. No Interest financing program will let you cut down your borrowing costs. Just make regular on time minimum monthly payments and eliminate the entire balance by the end of your promotional period. If you need more time to pay off your credit card balance in full, you can take advantage of several extended payment plans.

If you are interested in this offer, you can fill out an application form at participating doctors' offices. At the present moment there are over 100,000 healthcare providers in this program, for example American Dental Association, Society for Excellence in Eyecare and American Society of Plastic Surgeons.

3. The American Dream

Do you like to participate in lotteries? Now you have a chance to get sweepstakes entries and win a large cash jackpot just for using your plastic! How is it possible?

American DreamCard™ MasterCard® issued by HSBC Bank Nevada, N.A. offers the unique rewards program. It offers sweepstake entries just for making day-to-day purchases. You will earn one entry for each dollar spent for merchandise, cash advances and balance transfers during the promotion period. As you see, there is no need to be a big spender to win big!

Monthly winners will receive 50% of the total amount of dollars spent by all American DreamCard holders during each drawing period. It means that the monthly sweepstakes jackpot depends on the number of credit card users and the amount of money they spend.

The credit card comes with no annual fee and a variable interest rate on all transactions. It is necessary to mention that all interest rates are tied to the highest Prime Rate during a three-month period.