Seeing Beyond the Edge of Your Own Plate

When I first signed up for my own health insurance, a professional teeth cleaning at the dentist cost around 100 euros. My private insurance company gave me vouchers each year for a maximum spend of 130 or so. Two sessions were covered outside of my deductible, so basically free.

Initially, I only went to a dentist near my parents’ house, and they usually charged an amount within the voucher’s range. The first time I went to a dentist in Munich for the same procedure, my teeth almost fell out when I got the bill. Almost 300 euros!

I freaked out so much, I called them and demanded an explanation. I didn’t get a very good answer. What I did hear was, “Don’t worry, the private insurance will cover it.” They were right. The cap on the voucher didn’t really matter. My health insurance paid up without questions. But it did make me think. Shortly thereafter, I had an actual surgery at the same place, and the bill ended up cheaper than the cleaning. That made me even more suspicious.

So, ever since that incident, I’ve been making the circuit among dentists in my area. “There have to be cheaper options. This one feels like daylight robbery!” It was a matter of principle. How could the same procedure double in price in a matter of months? I figured my dentist was overcharging.

I’ve since gone to three other dentists, yet the result was more or less the same everywhere. Sometimes the cleaning was a bit cheaper, sometimes more expensive.

One interesting data point happened when my wife and I went to the same dentist for the same procedure in the same week. She was on public health insurance at the time. Her price? 120 euros. They even gave her an x-ray to make some additional checks. My price? 250. No x-ray.

In the German healthcare system, it’s normal for pricing to vary between public and private insurance types. But by a factor of 100%?! For the exact same, totally standardized treatment?! Jesus! So, as it turned out, I wasn’t wrong: My dentist was overcharging—except all the other private dentists also seemed to do it. When prompted, their excuse was always the same: “Don’t worry! The private insurance will cover it.”

Another interesting data point came from a family friend who works for public health insurance. She said that a few years back, after many arguments and public ballyhoo, the government agreed to raise the teeth cleaning contribution. Instead of 60 euros, they would sponsor 80 euros of each treatment. So you, as the publicly insured, would pay only 20 euros or so for the service. “Guess what happened next?” she said. “The dentists all raised their prices. From 100 euro or so to 120.” And everyone in public health insurance was no better off.

Eventually, my wife also switched to private health insurance. The most recent teeth cleaning she went to, the dentist told her she would do an additional, “deep gum pocket cleansing.” Her bill came back: over 500 euros. You already know what she told her. “Don’t worry…”

In hindsight, I don’t know why I thought it was a good idea, but I did go to the same dentist for my next teeth cleaning. I flinched when I heard her say she was going to do a “deep gum pocket cleansing.” “Uh-oh…here we go,” I thought. To my surprise, the process took not very long. I was in and out of the place in the span of 25 minutes. It was the fastest cleaning I’d ever gotten—but definitely not the best. No explanations. No fluoride application. She didn’t ask me to rinse once.

Anxiously, I waited for the bill, ready to explode. “If she’s gonna charge me over 500 euros, I’m gonna lose it,” I said. Final tally? 350 euros—not 500 but still the most expensive teeth cleaning I’ve ever had. I’m inclined to send an email calling out her scheme, but I can guess the answer. “Don’t worry! The private insurance will cover it.”

We have a saying in Germany: “That person can’t see beyond the edge of their own plate.” It means someone is too focused on the short term, taking a too narrow point of view.

When dentists raise their prices in lockstep with public rates or test the boundaries of how much private insurances will reimburse for their patients, the consequences are not as simple as “don’t worry, someone else will foot the bill.” Because guess who’s paying my private health insurance? Me! And in the six years I’ve been privately insured, my monthly contribution has increased by over 50%. If private health insurance gets too expensive, less people will opt in to it—and dentists will have fewer people to charge higher rates to.

That last dentist I went to used to run the practice with her father. He had a health issue, and now, she’s alone. Maybe she feels real urgency to get as much as she can while the getting is good. But healthcare is not a casino. You can’t max out your hot streak in a week and then quit. It’s a big, long-term system with long-term participants and long-term consequences. The only way everyone can still participate tomorrow is if everyone shows a little restraint today.

It’s hardest to do when you’re in the thick of it, but that’s also when it’s most valuable: Look beyond the edge of your own plate.