The Feasibility of Medical Loss Ratio for Dental Insurance for Patients and Consumers


WASHINGTON, D.C. – Today, the global consumer advocacy group Consumer Choice Center launched a policy primer on the feasibility of enforcing medical-loss ratios and rebates for dental insurance in order to benefit patients.

The primer examines how medical-loss ratio is used in other medical categories, international comparisons, and how it would lead to a more open and competitive dental insurance market that would unlock savings for patients.

Yaël Ossowski, deputy director of the Consumer Choice Center, explains:

“Medical-loss-ratio requirements of the Affordable Care Act for general health insurance were a welcome first step to a more competitive industry. Yet more should be done to contain costs, open markets, and subject healthcare and health insurance to real competition, and that should be translated to the dental insurance market as well,” said Ossowski.

“Efforts are ongoing across states to hold insurers accountable by removing state barriers to competition, and to enforce medical-loss ratios and rebates so patients can actually get the care they pay for and deserve.

“Large scale reforms aimed at decoupling insurance from employers, providing more direct-to-consumer options that eschew insurance, and removing red tape at both the state and federal level would be long overdue reforms to empower consumers within a competitive and thriving market for dental care.

“On that path, we believe medical-loss ratio requirements and rebates would be a quick and easy measure to keep insurance accountable, promote competition, and ultimately unlock savings for patients,” concluded Ossowski.

By passing state-level medical-loss-ratio requirements for dental insurers, legislators could ensure that consumers and patients profit from a competitive and affordable market. This would serve the following benefits:

  • Keep dental insurance accountable
  • Unlock benefit spending for patients
  • Promote competition among insurers



Yaël Ossowski, Deputy Director


The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva, Lima, Brasilia, and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org.

Democratic Debates: Healthcare in the US is twice as expensive as in Europe – But is this really due to high drug prices?

Watching the #DemDebate in Iowa was an interesting lesson on how something becomes true if enough politicians repeat the same twisted fact over and over again. 

Once all candidates had agreed that Iran having a nuclear bomb would be a problem, the debate shifted towards healthcare reform and the fact that the U.S. is the world leader in healthcare spending as a share of GDP (whooping 17.7% of GDP compared to a typical 8-12% when looking at countries such as the UK, France, Canada, Switzerland, or Germany).

Hedge-Fund-Manager-turned politician Tom Steyer opened by saying that the US spends twice as much per person on healthcare than any other developed nation and that’s why we need a stronger role of the government in healthcare. Steyer forgets to mention that the United States is already the global leader in government healthcare spending:

According to the World Health Organization at least 49% of all healthcare expenditure in the United States is paid by the government (state and federal). That gets you close to 9% of the US GDP and is more than public and private health spending in the United Kingdom combined. 

This should make all of us skeptical and get us to question whether a bigger role of government in healthcare spending would actually bring costs down.

Vermont Sen. Bernie Sanders talked about “greed and corruption of pharmaceutical companies“ and lambasted them as the main reason for high health expenditures in the United States. And while it is true that the US is the largest market for drug sales, they account (including retail and inpatient use) for merely 14% of total health expenditures.

Simple math shows us that even if Bernie Sanders becomes POTUS and brings all drug prices down to $0.00, the US’ healthcare spending would still equal 15% of its GDP, and still it a world leader in healthcare spending. All of this while effectively killing any new medical innovations in the country.

These 2-2.5 percentage points in savings could (according to PWC) also be realized by cutting through red tape and the billing madness of the US health system(s). An unknown but significant amount of efficiency gains could be realized by opening up insurance markets nationwide and giving patients in every state more choice when it comes to their insurer.

High salaries for medical professionals (doctors and nurses) are definitely the elephant in the room that political campaigners don’t touch. Even purchase power adjusted medical professionals make easily twice as much as in other (very) developed countries. By opening up the US medical labor market to more immigration, mutual recognition of medical degrees and training, the US could counter ever-rising salaries for professionals. More competition among medical and nursing schools could also tackle student debt of medical professionals.

While merely 0.3 percentage points could be directly saved by reforming medical malpractice laws, a much bigger amount could be saved by doctors reducing their fear of lawsuits. So-called defensive medicine is the behavior of doctors that are worried about getting sued by patients. Some studies estimate that over-prescribing and over-treatments can make up a quarter of total health costs in the United States. While I think that that number is too high, even if it’s just 5% of total health expenditure, we would be able to shave off another percentage point getting us closer to the Switzerlands of the world.

In short: The Democratic candidates don’t have to worry: The US is already the global leader in government health spending per citizen. If they really want to bring total spending down, they should advocate for legal (liability) reform, opening up the medical and nursing job markets to more immigration, and more choice and competition in the insurance market. Nationalizing all pharmaceutical companies and handing out drugs for free won’t do the trick.

How Can We Improve Healthcare Today?

As 2019 wraps up, there is plenty of ample opportunity to discuss what should be the priorities for Congressional lawmakers in 2020.

What is top of mind for many Americans, of course, is healthcare.

It’s as much about the cost as it is about services and the ability to choose what works best for you and your family.

On the Democratic side, many presidential candidates are endorsing Medicare For All as an answer. We’d be inclined to disagree.

Others have focused just on repealing Obamacare (The Affordable Care Act). A challenge to its constitutionality is once more making its way through the courts.

Here’s a quick breakdown that we believe would empower consumer choice, affordability, and make people better off today.

👉Allow health professionals to practice in every state (reciprocity)

👉Reduce barriers to entry for health professionals, and create more streamlined license recognition for immigrants

👉Promote price of care transparency

👉Keep pharma competitive and protect IP to offer the best treatments

👉Digitize records to upgrade our systems

👉Emphasize the role of catastrophic insurance

👉Allow portability of insurance between employers

👉Allow additional tax benefits for those who save money for health costs (HSAs, etc.) and let them use where necessary

👉Allow insurance companies to offer plans and compete across state lines

Trump’s Medicare executive order

CONSERVATIVE GROUPS SEND LETTER ON VAPING — A coalition of 25 conservative groups is urging Trump to keep flavored e-cigarettes on the market, arguing the products are “essential to the success of vaping as an alternative to cigarette use long-term.”

Groups such as Americans for Tax Reform, Consumer Choice Center and FreedomWorks argued the administration’s envisioned flavored vape ban would go against the White House’s deregulatory agenda and “destroy thousands of small businesses.” This comes as the White House abruptly organized, and then canceled, a meeting with conservative groups over vaping, which it said at the time would be rescheduled.

Read the article from POLITICO here.

For more facts on vaping, read our research on the Myths and Facts on Vaping: What Policymakers Should Know

The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at 

Should I Stop Vaping?

Over the past few weeks we’ve seen a surge of headlines that say vaping may be more harmful than we might have initially thought. Seven deaths have been linked to the use of e-cigarettes. In response, some states have banned vaping products. However, naysayers — including experts — argue that a knee-jerk reaction by health agencies is premature, overlooks the harm reduction that vaping achieves, and could cause a potential public health disaster

If smoking is the de facto predecessor of vaping, then e-cigarettes should be examined within the context of nicotine delivery systems as a whole. Smoking is the leading cause of preventable death in the United States. Should the risk associated with vaping be a deterrent when the alternative is smoking cigarettes?

Some in the recovery community say that it shouldn’t. Many former cigarette smokers have replaced their “analog” smokes with e-cigarettes, using vaping as a means of harm reduction that swaps out cancer-causing tobacco with a safer means of nicotine delivery. Recovery purists and some clinicians, however, argue that smokers are trading one addiction for another and express concerns that, lower risk or not, most vapers are still ingesting large amounts of highly addictive nicotine. They also point to this recent rash of deaths as evidence against vaping.

Before we address the question of harm reduction, though, do the alarming headlines have any merit in science? And given that e-cigarettes have been around for 15 years, why are we only seeing deaths now?


The American Medical Association (AMA) recently labeled vaping “an urgent public health epidemic,” and physicians have urged the Food and Drug Administration (FDA) to act. The AMA claims that research has shown that the use of e-cigarettes and vaping products is unsafe and causes addiction, however the statement does not provide the supporting research. The AMA also says they “applaud steps to remove flavored e-cigarette products from the market.”

The Centers for Disease Control and Prevention (CDC) issued a statement that together with the FDA, local health departments, and other clinical and public health partners, they are investigating a multi-state outbreak of lung disease associated with e-cigarette products. The FDA echoed the CDC’s concern, calling the outbreak “a frightening public health phenomenon.”

Dr. Dana Meaney-Delman, who is leading the CDC’s investigation, said in a statement, “The recent rise of acute lung illnesses linked to vaping has deepened concerns about the safety of the devices.” 

But why now? People have been vaping for over a decade. The CDC’s Meaney-Delman says, “We’re all wondering if this is new or just newly recognized.”

Here’s what we know: As of this writing (9/21/19), the CDC states that 530 cases of lung illness have been reported from 38 states, and seven deaths have been attributed to vaping. Most affected patients also reported a history of using vaping products that contain THC. 

The CDC does not yet know the specific causes of these illnesses: “The investigation has not identified any specific e-cigarette or vaping products (devices, liquids, refill pods, and/or cartridges) or substance that is linked to all cases.” Regardless, for those who are concerned with these issues, the CDC recommends refraining from using all vaping or e-cigarette products until they know more.

Elsewhere on the website, the CDC still states that e-cigarettes have the potential to benefit adult smokers as a substitute for regular cigarettes.


Because of the media coverage and caution by public health agencies, we are seeing increasing action across the US: New York’s former mayor, Michael R. Bloomberg, has committed $160 million to ban flavored e-cigarettes, Governor Gretchen Whitmer issued an executive order to ban the sale of flavored vaping products in Michigan, San Francisco has banned the sale of e-cigarettes, and President Donald Trump says the FDA will ban flavored e-cigarettes. 

Is this a knee-jerk reaction? It seems that some of the pressure is a result of parents and politicians who are concerned that flavored vaping products are responsible for the surge in teen use. That’s understandable, given the potential for nicotine to harm the developing brain. According to the CDC, one in five high schoolers and one in 20 middle schoolers vape.

For adults, however, there appears to be conflicting statements by researchers, doctors, and health officials. 

In a September 2019 article, Dr. Robert Shmerling at Harvard echoed the CDC’s bottom line: Experts are unsure if vaping is causing these lung problems, and lung disease has not been linked to a specific brand or flavor of e-cigarette. A more likely culprit, they claim, is a chemical contaminant within the inhaled vapors that is causing an allergic reaction or immune system response. 

This belief is supported by a study that came out last year linking the chemical flavors within e-cigarettes to an adverse effect. Dr. Sven-Eric Jordt, PhD, one of the authors of the study, recently told The Guardian that “the liquids vaporised by e-cigarettes are chemically unstable and form new chemicals that irritate the airways and may have other toxic effects.” These new chemicals are not disclosed by the manufacturers to users. 

Dr. Michael Siegel, a professor at Boston University, claims that health officials and physicians are not telling the full story: In every case in which a specific e-liquid has been identified, that e-liquid has been found to contain THC — a fact corroborated by the CDC. He states that the e-liquids in some of these cases were oil-based and typically purchased off the street; therefore, their ingredients are not strictly regulated. It is these oil-based THC liquids that are known to cause acute respiratory illness. 

Similarly, the Washington Post reported that the FDA investigation found the same vitamin E-derived oil in cannabis products that were used by those found to be suffering vaping-related illnesses throughout the country. 


While Siegel acknowledges we aren’t in a position to draw conclusions about THC oils or to say that street products are definitely to blame, he believes the CDC’s recommendations are unnecessarily broad and consequently harmful, since people who vape may think it’s safer to go back to smoking cigarettes. 

“I cannot overemphasize how insane this policy is,” he says. “From a public health perspective, it makes absolutely no sense to ban these fake cigarettes but to allow the real ones to remain on the shelves.”

Instead, Siegel suggests, the CDC could offer more specific and useful guidance to the public, specifically: Do not vape THC oils (including butane hash oil), do not use any oil-based vaping e-liquid product, and refrain from buying products off the street or using any e-liquid that doesn’t disclose its ingredients. To reduce risk, people should “stick to products being sold at retail stores, especially closed cartridges where there is no risk of contamination or the presence of unknown drugs.”

Switching from smoking tobacco to e-cigarettes is a proven harm reduction strategy supported by health officials and used by individuals in recovery. 

Lara Frazier, a person in long-term recovery, explained, “I am in abstinence-based recovery and quit smoking cigarettes over four years ago, thanks to e-cigarettes.” Regarding the recent deaths associated with vaping, she says: “There is mass hysteria about vaping, with people not being properly educated on what is actually occurring.”

Frazier is concerned about the consequences of recent official warnings: “Nicotine addiction is like any addiction, and banning flavors will likely not result in less nicotine being smoked. This could cause more harm because the teenagers will have to find black-market cartridges, make their own juice, and/or switch to smoking cigarettes.”

She continues, “I think it’s ridiculous that they are going to ban all flavored juices that aren’t tobacco-based on five (now seven) deaths and illness without properly looking at the data or researching the cause of the illness.”


There is world-wide support and evidence for vaping as harm reduction. A study conducted by the New England Journal of Medicine found that vaping was nearly twice as effective as conventional nicotine replacement products for smoking cessation.

In the UK, Public Health England also supports vaping as a harm reduction strategy. Even in light of the recent concerns, their position has stayed the same: “Our advice on e-cigarettes remains unchanged — vaping isn’t completely risk-free but is far less harmful than smoking tobacco. There is no situation where it would be better for your health to continue smoking rather than switching completely to vaping,” they said.

Yaël Ossowski, deputy director of the Consumer Choice Center, urged President Trump to consider the facts before reacting hastily and pushing for a ban, arguing that vaping is a less harmful alternative for consuming nicotine. Ossowski cites a 2016 report by the UK’s Royal College of Physicians, which reviewed the science, public policy, regulation, and ethics surrounding vaping and concluded that e-cigarettes should be promoted widely as a substitute for smoking. The report also sought to clear up misinformation about vaping and long-term harm, stating that while there is a possibility of harm from e-cigarettes, it is unlikely to exceed five percent of that associated with tobacco products. 


According to the Centers for Disease Control and Prevention, more than 16 million Americans are living with a disease caused by smoking. We have abundant evidence that smoking leads to disease and disability, harming nearly every organ in the body. It causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease. It also increases the risk for tuberculosis, eye diseases, and autoimmune conditions. 

Worldwide, the use of tobacco products is responsible for more than seven million deaths each year. In the U.S., 480,000 people die every year from smoking, and 41,000 people die as a result of secondhand smoke. Economically, smoking has a huge impact on the United States: it costs $170 billion a year in direct medical care, and $156 million in lost productivity. 

Smoking remains the leading cause of preventable death. 

At this point, the evidence supports vaping as an effective means of harm reduction, thus outweighing the limited risks. Further, public health officials have yet to complete their investigations into these risks so they can conclusively identify the cause of the deaths attributed to vaping. It seems foolish to enforce blanket bans on e-cigarettes, as that may cause further harm by pushing people toward buying black-market vaping products or resuming smoking cigarettes.

Read more here

Five reasons to rethink Britain’s public health spending

By Fred Roeder and Chloe Westley With a combined budget of over 100 million pounds, taxpayers in the United Kingdom are some of the largest contributors to the World Health Organisation’s (WHO) budget. Britain also spends nearly 1 billion pounds on various other bilateral public health initiatives around the globe. Unfortunately, many of these projects are not improving […]

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