The Affordability Myth: Why Patients Say “Yes” to What Matters — and “No” When Value Isn’t Clear

Dentists: Your patients don’t have a money problem. You have a value-communication problem.
When voters in America’s biggest city chose a mayor based on feelings over qualifications, it proved what behavioral science has been telling us for years:
 People make decisions emotionally — and justify them rationally.

And yes — that includes your patients.

The Myth Takes the Mayor’s Office

I hate to admit this because the guy scares the hell out of me.  I fear how he might permanently change the City I love.  But there’s a lot you can and should learn from his campaign.

When an unknown 33-year-old, self-described socialist and wannabe rapper is about to become mayor of the largest city in America, everyone should take notes. He won not because of a résumé filled with accomplishments, not because he projected statesmanship or stability, and certainly not because his ideas resonated with traditional American values.  He won despite promoting Communist ideology and espousing antisemitic rhetoric.

He won because he shouted one phrase loud enough and often enough:

“Affordability crisis.”

People heard that phrase, and it hit a nerve, more Vagus than Long Buccal. They excused the lack of experience, the questionable rhetoric, and the radical ideology. Their emotional pain point — the feeling that life was becoming too expensive — overrode everything else.

That emotional override has been documented time and again in political science.
The Research says: Voters prioritize emotional resonance over factual qualifications in a ratio of roughly 3:1.

Source: Harvard Kennedy School Misinformation Review (2020).

And here’s the twist that’s relevant to dentistry:
The people who voted for him and embraced the “affordability crisis” narrative are not the poor. Exit polls reveal they were largely young, college-educated, six-figure earners living in one of the most expensive cities in the world.

Exit polls reveal they were largely young, college-educated, six-figure earners living in one of the most expensive cities in theThese are the same people…
…who dine out 130% more than the average American
…who frequent trendy restaurants
…who spend $17 on avocado toast
…who buy $6 coffees without flinching
…who order delivery with $30+ service and hidden fees

Research Annotation: Households earning $100k–$150k spend an average of $7,502 per year dining out — more than double lower-income households.
Source: U.S. Bureau of Labor Statistics Consumer Expenditure Survey, 2024.

And they are the same people sitting in your dental chairs.

Not impoverished.
Not destitute.
Not unable to pay.

But they feel financially stretched … when value isn’t clear.

This is where most dental practices get it wrong.

Patients Rarely Have a Money Problem — They Have a Meaning Problem

People spend freely on what matters to them emotionally.

Research Annotation: Healthcare economists have shown that consumers cut spending on entertainment, travel, and apparel before they cut spending on health — meaning price resistance is almost always driven by unclear value, not inability to pay.
Source: PwC Health Research Institute, 2023.

But dentists and their teams often assume every patient is financially fragile.
That assumption is poison.
It leads to:

The “affordability mindset” is a self-inflicted wound.

Let me illustrate this with two stories that changed the way entire teams thought about value.

The Barney’s Lesson: People Pay for Identity, Not Items

When I took over as Director Columbia University’s Midtown Faculty Practice, I inherited a faculty who believed that patients “couldn’t afford” ideal care.

So one day, during a staff meeting, I simply said:
“Follow me.”

We walked out of the building, crossed Madison Avenue, and entered the iconic luxury store, Barney’s.

I picked up a shirt and asked,
“What do you think this costs?”

No one came close.
I revealed the price: $450 — more than double the cost of a hygiene visit and more than double the average one-surface restoration at the time.  Even I gulped!

We walked to the tie rack.
“Find one under $100.”
Not a single one existed.

Then I had them look around.
Crowds.
Shopping bags.
People happily paying premium prices for items no one needs.

Back in the conference room, I said:

“We just visited where your patients shop.
They aren’t looking for the cheapest option.
They’re looking for something that feels like the best.”

What they were witnessing was not financial irrationality — but the Price–Quality Heuristic in action.

The Research Says: People equate higher prices with higher quality, especially in categories where they cannot personally judge technical performance — like healthcare.
Source: Carmon & Ariely, Marketing Science, 2000.

People weren’t buying shirts.
They were buying identity, confidence, and self-expression.

Just like patients aren’t buying crowns.
They’re buying certainty, confidence, function, esthetics, and a better version of themselves.

The Nordstrom Lesson: Exceptional Experience Justifies Exceptional Value

Years later, when Nordstrom opened near my New Jersey office, I took my team to witness something different: world-class service.

Nordstrom was famous for it.

We watched how associates greeted customers, anticipated needs, communicated enthusiasm, and made people feel seen.
We didn’t go for the merchandise.
We went to observe a value-creation engine.

Because patients — like Nordstrom shoppers — make decisions emotionally and justify them rationally.

The Research Says:

When the experience is exceptional, the value is clear, and the outcome is emotionally meaningful…

Price fades into the background.

The Science Is Clear: Patients Buy Feelings, Not Features

Across six major studies (Cleveland Clinic, Healthgrades, Gallup, Press Ganey, ADA HPI, Beryl Institute), the top drivers of healthcare decisions remain consistent:

Top 5 Factors Patients Actually Care About:

Cost doesn’t appear until somewhere between #13 and #19.

The Research Says:  Patients rely on emotional trust cues due to their inability to evaluate clinical “quality.”
Source: Cleveland Clinic Journal of Medicine, 2021.

This explains why the Mamdani voters, the Barney’s shoppers, and the Nordstrom loyalists all behave the same way your patients do:

They make decisions emotionally first.
Price is an afterthought — but only after value is clear.

The REAL Reason Price Becomes a Problem

When patients object to cost, it’s virtually always because:

The Research Says:  Patients object to pricing when the “Outcome Expectation Gap” is unclear — meaning the emotional benefit is not fully understood.
Source: Journal of Dental Education, 2019; JAMA Network Open, 2022.

It’s not a money problem.
It’s a meaning problem.

And meaning is the doctor’s job to communicate.

The Mindset Shift That Changes Everything

Once you and your team stops assuming patients are financially fragile, everything changes:

Because when patients understand the emotional, functional, and long-term meaning of your care…

They spend freely — enthusiastically — just like they do everywhere else in their lives.

The Liberated Takeaway: Value First, Price Last

Patients don’t wake up wanting a crown.
Or a sleep appliance.
Or a veneer.
Or a graft.

They wake up wanting:

When you communicate that, the price becomes the least interesting part of the conversation.

Price becomes a problem only when value isn’t communicated masterfully.

And that is entirely within your control, if you can control your mindset.