Those Damned Pencil-Pushers At the State Capital!

To echo what Krugman says here, I recently had to get a new Social Security card. This led to an absolutely harrowing experience where I filled in a form online, went to the local federal building, waited for about 90 seconds, handed the form to a friendly bureaucrat, left, and received my new card in a week This allowed me to fill out a single form and get my driver’s license renewed at the DMV in about 15 minutes. It was immensely painful being strangled by all that red tape.

Conversely, my wife has a painful dental issue, which wouldn’t normally be a big deal since she’s been continuously employed as jobs that provide dental insurance. Alas, she switched jobs last week, which means that there’s about a 3-week period in which she lacks insurance although she didn’t take a day off and her insurance comes from the same company. So either we’d have to pay for COBRA, which would be as or more expensive than just getting treatment out of pocket (which we can’t really afford), or just suffering for a couple weeks. The glories of private, employer-based insurance!

And the thing is that we’re very privileged to have dental insurance; what for us was bad lack meeting a completely irrational insurance system is for many Americans always true, and dental issues are in fact serious health issues. In other words, when revolting plutocrat Mitt Romney sneers about how absurd it would be for basic dental care to be included in universal insurance packages, he can cram it with walnuts.

98 comments on this post.
  1. USMarCorp70:

    Methinks Monsieur Romney would like the walnuts in the butt!

  2. Dan:

    Are you going to write about about the adventures of Canadian in America?

  3. commie atheist:

    The commenters on the Chait piece apparently think he’s being serious. Please, nobody tell them about the Onion.

  4. c u n d gulag:

    Even WITH Dental Insurance, it’s brutally expensive.
    American dental care is one of the biggest rip-off’s on the planet.

    To get a bridge I needed, which the insurance would only pay a relatively small portion of, I had to borrow against my 401K Plan, and repay that for years (then, when I left before I’d paid it off, they subracted that from what I cashed-out the plan for).

    Then, since I had to borrow against my 401K for something else, I had another expensive dental problem, which, again, only a tiny percentage of which would be paid for, since I had almost maxed out already that year, and I had no choice but to take out a credit application with the Dentist – and paid over 20% on interest for years.

    Dental Insurance is fine for preventative care – but for anything more than that, it’s a help, but not really good “insurance” in any sense of the world. It’s like your house burned down, and they said, “Well, we’ll cover 20%, YOU get to cover the rest! Good luck!”

    You want people’s health to improve?
    Give them comprehensive, low cost, dental care.
    I paid less for new cars, than I paid for that feckin’ bridge!

  5. CZHA:

    The idea that teeth are somehow not part of the same person who is covered by medical insurance has never made sense. The inside of the mouth is vital to health as the rest of the body.

    Similarly, separating out mental health care from other health care is absurd. Regular health insurance covers care for the part of the brain that generates Parkinson’s, but not that which produces schizophrenia.

  6. Davis:

    Another anecdote. I recently applied for Medicare online in a matter of minutes Easy. Same for renewing my passport. It’s an article of faith on the right that government is always wasteful, and the private sector is always efficient. As I said, an article of faith.

  7. John Protevi:

    10 minutes online to renew my auto registration. 3 day wait for the envelope with the paper and sticker to arrive in the mail.

  8. John Protevi:

    I am not complaining about the 3 day wait, mind you.

  9. somethingblue:

    I look forward to–but don’t expect to see–the day when every private-sector business I have to deal with is as efficient as the DMV (or that other favored whipping-boy, the USPS).

    To be fair, I have had the kind of DMV experience right-wingers like to complain about. I had it once, over twenty years ago.

    I’m not sure why they can’t update their whining. The TSA, for example, would make a perfectly good target, but no, it’s always the DMV.

  10. Uncle Kvetch:

    It was immensely painful being strangled by all that red tape.

    Here in NYC it’s quite common to find oneself standing in a long, slow-moving line at a fast food joint or drugstore, only to be treated miserably by surly, decidedly unhelpful staff when you finally reach the end of the rainbow. But for some reason no one stomps out of McDonald’s or Duane Reade after a bad experience grumbling about the “goddamn private sector”…

  11. Njorl:

    I did momentarily envision you sitting by the mail slot cursing the bureaucracy for three days.

  12. WeWantPie:

    Dude – Damn. Effing Dental Insurance. Dental, really??? I’m old, I’ve been working jobs that provide “benefits” since I was 20-something, and I’ve never even heard of anybody who had dental insurance.

    Meanwhile, the last time I had to deal with a damn Gubmint Byoo-Rockracy, I had to wait on line almost 4 whole minutes to submit a HIPAA authorization for SSD records on a plaintiff for my law office!

    (Yes, I am gainfully employed by a law firm, and no, my firm’s health plan does NOT include dental care.)

    Mitt Romney needs to crawl into a deep, dark hole in the ground and stay there for almost as long as Paul Ryan – who needs to stay there until the heat-death of the universe.

  13. WeWantPie:

    OMG, I messed up all the HTML tags. Sorry!

  14. ploeg:

    And Democratic politicians use the methods of Saul Alinsky, with whom everybody is well familiar.

  15. Sly:

    The idea that teeth are somehow not part of the same person who is covered by medical insurance has never made sense.

    It makes a bit of sense once you consider that (a) deaths due to poor dental health fell sharply upon the advent of antibiotics and fluoridation and (b) dentistry was relatively late in its professionalization and was a service typically offered by barbers, pharmacists, and even blacksmiths until the early 20th century. In other words, it was a form of health care that became somewhat superfluous in the public consciousness (wrongly, of course) and that was dominated by charlatans and amateurs well into the modern era. That’s not a good recipe.

  16. WeWantPie:

    Dude – Damn. Effing Dental Insurance. Dental, really??? I’m old, I’ve been working jobs that provide “benefits” since I was 20-something, and I’ve never even heard of anybody who had dental insurance.

    Meanwhile, the last time I had to deal with a damn Gubmint Byoo-Rockracy, I had to wait on line almost 4 whole minutes to submit a HIPAA authorization for SSD records on a plaintiff for my law office!

    (Yes, I am gainfully employed by a law firm, and no, my firm’s health plan does NOT include dental care.)

    Mitt Romney needs to crawl into a deep, dark hole in the ground and stay there for almost as long as Paul Ryan – who needs to stay there until the heat-death of the universe.

  17. Richard:

    DMV are state agencies. Some are good, some are bad. California used to have a uniformly bad system but it eventually went on-line for almost everything and now is pretty good (except for the recent situation I had where I couldn’t get my wife’s registration renewed since the system showed, erroneously, that we didn’t have insurance and there was no way to talk to someone.)

  18. Eli Rabett:

    McDonalds, for sure, stomp out about once a week headed for the Indo-Pak place across the street (the portions are too big), but Duane Reade? that’s the price of good stuff

  19. Scott Lemieux:

    {To be clear, I mean “medical insurance that covers some basic dental procedures.”)

  20. Happy Jack:

    You can always turn to charity. I don’t recall Dr. Szell charging Babe.

  21. Sly:

    Szell simply recognized the intrinsic psychological rewards of dentistry.

  22. Malaclypse:

    This led to an absolutely harrowing experience where I filled in a form online, went to the local federal building, waited for about 90 seconds, handed the form to a friendly bureaucrat, left, and received my new card in a week This allowed me to fill out a single form and get my driver’s license renewed at the DMV in about 15 minutes.

    Admit it – you used these forms to be one of the dozens of black people who voted in Maine!

  23. howard:

    when i first lived in boston in the mid-’70s, the downtown dmv office was as bad as the right-wingers claim: you could spend a long time waiting in what looked like the correct line only to discover, when you got the window, that it wasn’t and you had to start over.

    but that was 35 years ago and the situation improved tremendously in the interim and the last time i still had to go into the very same dmv office, in the early ’90s, i was in and out in 5 minutes, no muss, no fuss.

  24. Clark:

    I ordered a new needle for my turntable recently on a Friday and had to wait until Monday to have it delivered by the horrible, inefficient USPS to deliver it.

  25. somethingblue:

    See, there ya go. And I believe the person who brought it gets some kind of retirement package as well. What is this, 1962?

  26. Mudge:

    The Repugs have, perhaps to their credit, forced many bureaucratic agencies to focus themeselves and provide efficient service. Every agency I deal with is better than 20 years ago. The health industry, on the other hand, has no real incentive to be efficient or universal. Maybe it will now.

  27. dougR:

    I don’t think it’s the repugs that have done that, I think you give them far too much unearned credit. I think good, smooth-running, efficient state DMVs are considered a benchmark for how good Governor X’s administration is, and therefore, Exhibit A for why Governor X SHOULD be re-elected. (In the same way that assessments of the quality of Bloomberg’s mayoralty are partly dependent on how fast and effectively he mobilizes snowplows after a blizzard.) DMV lines are a sure expression of whether a governor can run a state or not (of course they’re not really, but as a signifier of same, they’re damn important).

  28. anniecat45:

    I just had a similar experience with bureaucracy in San Francisco. I needed written confirmation that I had shown up for jury duty. I phoned the jury commission office, explained what I needed, gave them my summons number, and got my written confirmation in the mail two days later.

    Can’t attribute this to Republicans, by the way –we haven’t had a Repub mayor since Alioto left office in 1976.

  29. Warren Terra:

    The California DMV in person is slow and bureaucratic (wait in line in order to wait in line, etcetera). But the people are friendly and the system does work; a lot of the problems come from underfunding and from serving the needs of many lower-income, lower-education people and many recent immigrants.

    Basically, if you can arrive early in the morning or can use a computer to pre-prepare your paperwork and to get a reservation the California DMV isn’t half bad. But if you just wander in, it will seem awful.

  30. Warren Terra:

    Eh, not so much. The R’s have gotten this narrative down where Government Doesn’t Work, and so they need to be put in charge of it, not so they can whip it into shape (this being impossible) but so they can rule it badly to express the people’s hatred of it. A badly run DMV can reinforce the narrative driving the campaign of the anti-government governor.

  31. adolphus:

    Not to mention more accurate, since the DMV is state run. If they want to make the point of unwieldy federal bureaucracy shouldn’t they compare it to an existing federal bureaucracy?

    Wouldn’t an unwieldy state bureaucracy be a good argument against federalism?

    Just asking.

  32. BertieW:

    I too share that frustration and pain. Once I had to get the birthday on my social security card changed. The horror of each of the five minutes I had to spend filling in the form and handing it in haunts me still.

  33. DocAmazing:

    I recently built myself a pistol. Interesting project; got everything I needed from online auction sites, notably Gunbroker.com. Fun fact: gun nuts love the USPS. They may vote Republican, but they understand what parts of gummint do right by them.

  34. Corey:

    I obviously get where you’re going here, but complexity of government service provision/”red tape” issues are serious distributional ones, particularly given that some populations rely on government services more than others.

    In other words, the public-facing bureaucracy should be simplified but not for Glenn Reynolds’ sake, and the periodic progressive outbreaks of “X government interaction went smoother than Y private-sector interaction” are, well, sort of weird.

  35. BikeCrasher:

    I’m so old, I can remember a time when our record players used lasers, instead of these new fangled, hi tech “needles”

    Damn kids and their music…

  36. Chad:

    Well, see, your brain is in parts

    That’s why you’re schizophrenic! ;-}>

  37. Chad:

    Romney has long been in his own entropic black hole, hence the problems in his philosophy.

  38. Jeremy:

    Well, you have to admit that Slate has spent years blurring the line between really dumb and counter-intuitive. There’s no guarantee that something that stupid isn’t getting presented as a “serious” idea somewhere.

  39. Joe:

    Basic dental care is covered by Medicaid to my knowledge. As to bureaucrats, I had mixed dealings with them, repeatedly really no problem. My trips to the DMV, that proverbial menace, were generally pretty painless, if a matter of waiting 1/2 hr once. Of course, often it is private parties that screw people over in health care and if your kids or wife gets it, some red tape is worth it anyhow.

  40. Joe:

    At least in NY, it’s covered.

  41. Holden Pattern:

    And conservatives have displayed their hatred of red tape and bureaucracy by requiring poor people to wade through metric fucktons of the stuff in order to access those services,

  42. PSP:

    Through the 80s, the Mass Registry of Motor Vehicles had centralized files in Boston, reportedly all on index sized cards in massive file cabinets. If you went to any other office, they teletyped Boston to check your information, waited for Boston to find your file and teletype back, then teletyped the new info. It took forever…. And the guys that gave drivers tests carried guns. One thing that Billy Weld totally deserves credit for fixing.

    Mass has gotten better, but a visit to the NJ DMV has a high probability of a 2 to 4 hour wait. Shockingly, privitization in the 90s didn’t fix anything.

  43. James B. Shearer:

    … So either we’d have to pay for COBRA, which would be as or more expensive than just getting treatment out of pocket …

    How is this possible? It appears that 3 weeks of COBRA dental would cost me about $45. Perhaps I have a lousy dental plan but COBRA would have to be a lot more to be comparable to paying the full freight.

  44. Joel:

    California’s DMV in the late nineties was horrible. Long lines, unclear directions, few bilingual agents to deal with the many Spanish or Chinese-speaking residents. However, my active life has led to a fair number of orthopedic and emergency room visits and in many cases, such as the time I waited for three hours in the exam room for an orthopedic surgeon to tell me absolutely nothing of importance, made those DMV visits look like cake.

    Since moving to Washington, I’ve had uniformly good visits with the DMV. The registry, which was privatized some years ago, works OK, but the inability to take care of both things in the same place is a huge pain. Also, the RMV “offices” tend to be shacks in low-rent districts. Recently went to the public health office – about as dreaded a government service as many could think of – for some rare vaccines, and it was surprisingly nice.

  45. Joshua:

    I live in New Jersey, and the DMV was nightmarish when I first encountered it during Christine Whitman’s term. Since McGreevey, though, it has been just fine.

  46. Joshua:

    For my most recent registration, my registration didn’t come. So I called up the DMV – talked to a live person within 3 minutes and she helped me out in another 5. I got my registration a week later.

    We all know, though, that a call to any big company’s customer help line goes the same way.

  47. Erik Loomis:

    Coming from you, cramming anything with walnuts is a notable insult.

  48. Bill Murray:

    updating from the Julian calendar?

  49. PBF:

    Last time I renewed my car registration I went to AAA and end up waiting longer than when I make an appointment at the DMV. I could of course mail the payment in but both AAA and the DMV are about a mile away from the smog check place I use so I just take care of it at the same time.

  50. @ DMV:

    Making an appointment is key

  51. bobbyp:

    +++.

  52. Pestilence:

    Wow .. when I needed one, I was living in the UK, and it cost me, um, lets see… nothing. Well, 2 dentist visits at #35 I think it was.

  53. Pestilence:

    win

  54. Pestilence:

    I dont know about periodic – my dealings with federal and state government have been mixed but mostly positive, relatively smooth and speedy. By comparison, my dealings with private enterprise at anything more complex than simply I-give-you-money-for-this-item, have been hideously hostile, unhelpful and deliberately obstructive. Getting a refund from (say) Walmart, straightening out why Terminix is sending invoices I need to pay to an address in Venezuela, wrestling with the immense prickly hostility of AT&T’s T/O, it has been a constant reminder of the evils of private bureaucracy gone mad: and most of it is quite deliberately instilled by senior management as a perceived method of improving profitability.

  55. RhZ:

    You are lucky the insurance company won’t deny the claim (assuming she can hold on long enough, and I sympathize with her plight) as a pre-existing condition.

    Or, just refuse to continue the insurance at all for the same reason.

  56. Manta:

    Serious question: does it really make sense to use insurance to pay for dental care?
    One way or the other you will pay the dentist anyhow (either via increased insurance rates, or out of pocket).

    The rationale for health insurance is that at any time there is a low probability that you will get some serious disease and will have to spend a lot of money for it. So it makes sense to pay a bit of money every month/year to insure against that eventuality.
    But does the same apply to dental care?

  57. ajay:

    No, Bill, he was born again.

  58. ajay:

    Manta: yes, it does, because you don’t spend a fixed predictable amount on dental care. One year you might just have a checkup. The next year, wisdom tooth extraction. Then just checkups for the next five years until suddenly you need a bridge.

    This really shouldn’t be difficult to understand.

  59. Manta:

    I had exactly that (wisdom tooth extraction) and no dental insurance: the amount of money I spent on it was not so large that would have justified paying a cut to the insurance company for peace of mind.

    If that’s your best (actually, worst) example…

  60. Manta:

    What I mean: in those 5 years you can put the money in your bank account, instead of paying the insurance.

  61. ajay:

    Manta, do you just not understand the entire concept of insurance, or what? Because if you don’t this is going to be a long hard war.

  62. Manta:

    I start from the assumption that people have a “rainy days” fund for emergencies.
    Paying an insurance company makes sense if in a “bad case” scenario your funds would be insufficient.

    The scenario YOU offered would not be such a case.

  63. Malaclypse:

    I think Manta’s point is that dental insurance, which does not cover catastrophic loss, is unlike medical insurance, which, in theory, does. Dental insurance is, in many ways, like an auto policy that pays for oil changes, but not for collisions.

    But I’m not sure if that is what s/he is trying to say.

  64. John Protevi:

    The mail delivery is the highlight of my day, after all.

  65. Uncle Kvetch:

    Is stand-alone dental insurance that rare? Both my job and my partner’s offer it, completely separately from medical, and provided by a different insurer.

  66. ajay:

    If you start from the assumption that everyone will always have enough saved up to cover all their dental costs, then I can see you might be puzzled about why dental insurance makes sense.

  67. DrDick:

    Exactly this. I can only wish that private enterprise was even 1/4 as efficient, friendly, and effective as that dreaded government bureaucracy.

  68. DrDick:

    Your experience is dramatically different from mine (and I expect most people’s). The truth is that the cost of treatment for many conditions is several hundred dollars and insurance premiums are quite low. It really does make the difference between going to the dentist and not.

  69. DrDick:

    Do you also assume unicorns and leprechauns?

  70. DrDick:

    My dental insurance, at least, does pay for catastrophic loss (though not as well as my medical insurance).

  71. Malaclypse:

    You are lucky. My policy does not cover the braces that I’m pretty sure MiniMal will need one day, for example. But we can all get annual cleanings.

  72. ajay:

    In fact, if you start from the assumption that everyone always has enough saved up for emergencies, you must be really puzzled about why anyone bothers to ever get insurance for anything.

  73. Bruce Baugh:

    Lots of states are cutting back dental coverage for anything except immediate emergencies and maybe very basic cleaning and such under Medicaid. :(

  74. DrDick:

    I am now officially shocked, since my university medical plan (separate from my dental plan) has generally not been all that great at this kind of thing (toward the low end of normal, based on my prior experience).

  75. Manta:

    If your emergency savings cannot cover “several hundred dollars”, you have serious economic problems: as in essentially broke.

    And in that condition, I am not sure the assertion that premiums are “quite low” (absent some help from the state) would still be true.

  76. Malaclypse:

    If your emergency savings cannot cover “several hundred dollars”, you have serious economic problems: as in essentially broke.

    I’d guess that this standard leaves about 80% of the population essentially broke.

  77. Jon H:

    Chait’s not at Slate anymore.

  78. Jon H:

    And then there’s the way dentists always seem to be pushing you to buy shit and I’m always suspicious that it’s more about making their boat payment rather than actual need.

    They kinda remind me of shady auto service shops.

  79. Linnaeus:

    If your emergency savings cannot cover “several hundred dollars”, you have serious economic problems: as in essentially broke.

    Like me. When I was laid off and my health insurance expired (along with dental) that was pretty much it for me in terms of being able to go to the doctor or the dentist. I might be able to do both by the middle of next year. Maybe.

  80. Hogan:

    I can’t remember now why I needed rustproofing for my gums, but it seemed pretty convincing at the time.

  81. Anniecat:

    You must not have needed an impacted tooth extracted under general anesthetic, which I’ve had to have twice. My co-pay, each time, was 2 months of premiums. the insurance paid — well, let’s just say the dental insurance was HUGELY worth it.

    Just out of curiosity — what do you do if you have two emergencies in a fairly short time and use up your rainy day fund?

  82. Jon H:

    USPS is “so bad” UPS has a service that uses it for final delivery:

    “The UPS SurePost services provide the convenience of UPS shipping and USPS-delivery to customers’ mailboxes.”

  83. john:

    I actually had to renew my license and return something at WalMart recently. The DMV was a solid hour-plus experience. I actually risked it and went to lunch because the wait time was so long.

    Returning a very expensive TV to Walmart for no other reason than I changed my mind and wanted a different one — about 5-10 minutes.

    So, for me at least, that’s private sector 1, government 0.

  84. john:

    The reason for that should be rather obvious. And it has nothing to do with how good or bad the USPS is.

  85. Substance McGravitas:

    Hey, by any chance are you the John from the Smith family?

  86. djanglermust:

    He’s certainly some kind of hole.

  87. djanglermust:

    You’re very fortunate to have been able to save so much, you must be very grateful for your good luck.

  88. Jon H:

    Well, since I get packages that way in the middle of Connecticut, in a location that has UPS trucks driving by every day, it apparently isn’t because I’m in a remote place that UPS doesn’t want to deal with.

  89. Yosemite Semite:

    And then there’s Massachusetts. Maybe it has changed since I last was there, but when my employer moved me from Irvine, California, to Chelmsford, Massachusetts, the DMV was intolerable. When I applied for a MA drivers license, I got sent into a back office with a uniformed and armed police officer, who very carefully scrutinized my CA license, to ensure that it met some standard or other. Everywhere else I had done that, some clerk looked at my out-of-state license, and gave the OK for a new in-state license. How much does that officer cost the state of MA? The rigamarole for getting a vehicle registered was so bad that the insurance companies did the legwork for their customers. You had to prove insurance coverage. By custom, in the office in Lowell, each gofer for an insurance company could do six registrations each time he (or she) got to the window, and then he went back to the end of the line, to wait to register his next six. There were guys whose job it was to wait in line all day long. The only other place that I’d seen like that was Spain in 1970s, where dealings with bureaucracies, like getting a drivers license, were done as a matter of course by companies that specialized in that work (tramitaciones); Spain of that era set the standard for the stereotype of intolerable European bureaucracy. In MA, when I naively went myself to register my car, the line came out the front door of the DMV office, down the block and around the corner. (Apparently still no better, judging from the comments on Google: “Thi [sic] is the typical Mass RMV, EXTREMELY Rude and Unprofessional”; “Croweded [sic], rude, RMV [five months ago]“) By contrast, though, CA was heaven. The state made appointments and kept them — in and out in minutes.

  90. Halloween Jack:

    That reminds me: even though I’m sitting out the SPEND SPEND SPEND YOU FUCKERS part of Black Friday, I might toddle down to the P.O. to send back a defective machete. Happy holidays, eh?

  91. Halloween Jack:

    See also: FEMA and Katrina.

  92. Hogan:

    How do you screw up a machete?

  93. RedSquareBear:

    I think you can agree with me that springing for ground-effect lighting was probably unnecessary.

  94. RedSquareBear:

    Gum Effect Lighting?

  95. RedSquareBear:

    It fixed the dangerously low bank balance of the guy who got the concession.

    He was down to his last 10 million dollars.

    Have a heart.

  96. mpowell:

    To me the primary benefit is pre-negotiated rates. Otherwise it would probably cost twice as much.

    When we had our first kid the hospital bill was $14K. The insurance company paid $4K and we paid $400 and that was it. It’s a crazy system we have.

  97. mpowell:

    I think his point is slightly different, but it’s a closely related concept.

  98. Links 11/25/12 | Mike the Mad Biologist:

    [...] the Macro Wars The other kinds of expertise Is this the death of the Republican party? No chance Those Damned Pencil-Pushers At the State Capital! Why Were Pundits All In on ‘All In’? How the “Takers” Voted Coercion Maybe Nate Silver Was [...]

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