In 2009 Matt Taibi in the wake of the financial crises undertook a memorable diatribe in Rolling Stone magazine, famously describing Goldman Sachs as “a great vampire squid wrapped around the face of humanity, relentlessly jamming its blood funnel into anything that smells like money”. The article is an entertaining yet depressing ode to the corrupt and destructive nature of unregulated international finance. However, while most of Europe is still suffering from the fallout of the latest global financial crises, Norway has largely remained aloof from the worst of it. Its citizens, protected from within by a tight social safety net woven with a compound of oil and social democratic principles, and from external forces a by a sturdy safety cage of strict banking regulation, tariffs and only partial EU integration. As a result, the tentacles of international finance have so far (touch wood) been unable to reach far into Norwegian society or to inflict much harm on its populace. Nevertheless, while the vampire squid is largely kept at bay, there is one local sea creature of private industry that inexplicably is allowed to float around with impunity within the cage and through the safety net. From a distance it appears benign: all of Norway’s neighbours have similar and largely harmless members of the the same family, but a closer look reveals Norway’s strain has a much more vicious sting capable of inflicting disproportionate harm on the weakest members of Norwegian society. I am talking of course about the jellyfish of Norwegian dentists.
As an Englishman who just got two root canals, in criticising the Norwegian dental system I realise I am setting myself up for a multitude of scorn and mockery. Well, I will save time and make a joke for you. If English people had to pay as much as Norwegian’s for their dental treatment, they would owe more to their dentist than to their mortgage provider. Ha ha! It is funny because English people have notoriously bad teeth and Norwegians pay extortionate fees for their dentists. I’m not talking 50% more expensive or even 500% we are talking sometimes more than 1000% more expensive. For example, a root canal in Norway costs roughly 5000 NOK in the UK its a mere 452NOK (at current rates). Meanwhile a check up in the UK costs 170 NOK in Norway its 800 NOK . The funny thing is, that English people, accustomed to entirely free health care actually complain about it being expensive.
This huge difference in price is largely accounted for by significant subsidies from the UK government. They have long considered, (logically in this authors opinion) that teeth are a vital part of public health and should therefore come under the umbrella of the National Health Service (NHS). Norwegians meanwhile, left at the mercy of an entirely private dental industry, bear the full cost of whatever work that is needed in adulthood.
I wouldn’t be particularly surprised in almost any other country, but Norway’s state provision and willingness to intervene in society is so wide ranging in every other area that appears like a black hole in the otherwise extremely detailed blueprint for the paternal state. Yes teeth, the white things you need to eat food, the stuff you need to stay breathing, are not considered part of healthcare.
This is, therefore, not about relative price comparison, but about an incongruous public policy. Norwegian wage levels are the highest in Europe and labour costs make up the majority of costs in dentistry – that Norway pays the most in absolute terms for their dentists is hardly surprising. What is surprising though, is that from 19 to old age typical Norwegian citizens have to pay the full cost of their dental work without any cap on the maximum or help from the state. I found this so difficult to believe that I emailed the relevant people and had it confirmed by a spokesperson from The Norwegian Health Economics Administration (HELFO) who I can (smugly) quote as replying to my email about the matter with “your observations are correct” (I should stress they were referring to the sentence before the last rather than the jellyfish metaphor).
It is not just the UK to which Norwegian dental provision compares poorly. Almost all of Western Europe covers a significant portion of their adult population’s dental health costs. Norway’s rivals and neighbours Sweden for instance pay 50% of their citizens bills after the first 3000 SEK and 85% after 7500SEK. They also provide 150 to 300 annual subsidy specifically for dentist workto encourage check ups. In Denmark, under 25s have to pay just 35% of their costs while over 25s pay 60% of their costs.
The pattern becomes even stranger when you take Norway’s economy into account. In a study of 9 European countries’ dentist costs (including Denmark, Germany Netherlands, in 2008 found that there was a solid correlation between the amount of the government subsidy and the GDP per capita of the population (interestingly all had at least some government intervention, it was merely a question of degrees). A higher GDP per capita usually translated into a greater proportion of the dental costs being covered by the state. Considering this pattern, together with Norway’s wealth and famously comprehensive welfare provisions, Norway’s dental policy is beyond bizarre; it is negligent.
I only discovered all this recently when I began to suffer excruciating toothache and went to my local Norwegian dentist to get it looked at. I balked at the bill for the check up, but mostly at the astronomical quote for the work that needed to be done. Knowing that I could pop back to England and get it done for one tenth of the cost I reasoned I shouldn’t complain too much. Besides, as a non Norwegian citizen already lucky enough to have my masters degree subsidised by the Norwegian people it would be a bit unreasonable to expect them to do the same for my teeth. It was only when I mentioned it to some friends that I found out that Norwegian adult citizens, save the unemployed, have to pay the same as me for dental work that I became shocked. And so were my Norwegian friends when I told them the cost in the UK. They had obviously assumed they had the best or at least parity with the rest of the world on welfare public provision. To save time I will paraphrase the conversations that followed.
No! British dentists don’t use a hammer and pick axe or any violently unsuitable household tool (ha ha), the bad teeth thing is (these days) largely a myth but if it does exist its nothing to do with dentists lack of training but a poverty related habit thing so making jokes about it is essentially just the same as laughing at poor people. And yes that’s very good, under 18 Nordmenn might get free dental treatment but so does almost every under 18 in almost any semi developed country, it’s hardly something for the world’s second richest country to crow about. Seriously? Do you really think that if you didn’t have to pay for the dentist you would stop brushing your teeth?
Anyway, with my interest piqued I asked all the Norwegian’s I know about their lack of public provision for dental work. There was almost complete consensus that it was both strange and unpopular. Amongst the 20 somethings in the bar where I work, hardly any had gone for a check up since they were 18 (and the end of free treatment). Meanwhile, the businessmen I teach English, mostly in their 40s an 50s all agreed that it was absurd and began exchanging stories about how they travel abroad if they need any work done. When you have a substantial number of citizens going abroad for treatment, even rich ones, it would appear to be symptomatic of a failing system. What’s interesting is that even parties normally opposed to government intervention in the market favour inclusion of dental cover in state health care. I spoke recently with a friend who is on the Liberal party policy board about the issue. She told me that it had been on the agenda for the manifesto this year but after discussion they concluded that it was too costly. This would suggest there is a consensus of left and right in Norway and the only obstacle is economic rather than ideological.
A sensible policy could be to start incrementally with affordable practical measures targeting those the current system leaves most vulnerable. There would seem to be sense in the Danish system of helping out young adults and the Swedish idea of annual voucher system to encourage check ups. Why not provide subsidised or even mandatory annual check ups to Norwegian citizens under 30 for example? To this section of society, squeezed by high rents and lower wages, the 800NOK cost of a health check up is unlikely to ever feel affordable or necessary. Yet the costs of waiting until they get a toothache, are much more severe. One feature of dental problems are that they are eminently preventable and certainly cheaper to treat if caught early enough. This is a classic example of how average an citizen often does not necessarily behave in a rational way. Instead, short term cost aversion overrides long term common sense as my colleagues at my bar would appear to demonstrate. Equally, there seems to be wisdom in the Swedish system; incrementally reducing the percentage paid by the citizen as the cost escalates. This would avoid bankrupting any poor fellow who has the misfortune to require two root canals while working in a low paid job. This situation highlights obvious regressive nature of dental fees. They are only a really a significant worry for the low paid workers but merely an irritant for the rich. Given the progressive nature of the rest of Norwegian society this facet of the problem makes it yet more bewildering that it hasn’t already been addressed.
My HELFO contact explained that the “why” question is “a political one” they could not answer. They suggested that “the ministry of health would be the correct address for this question”. Currently, different costing models for a government scheme for dental cover are under review, but this embarrassing jellyfish problem has been on the agenda for a long time now without any change in policy. Endless talking has produced nothing but hot air. If you agree it’s time to take the sting out of Norwegian dental costs, then help it happen, and send a tweet to the to the ministry of health @helse_og_omsorg and give them a a little kick in the right direction.
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