Yes, shrinking reimbursement has put the pressure on dentist and patients.  The quality of treatment goes down because people can't afford it, some opt to go to Mexico and some opt to extract the tooth rather than save it due to high cost.  It is unfortunate when a patient comes in thinking they have insurance and can have everything fixed, only to realize their limit doesn't cover much.  Employers have plans but most of them are not great, and many of them cover fee guides that are from previous years.  Dentistry isn't what it used to be.