Kevin MD excerpted a NY Times article that reported wait times to see a dermatologist were shorter if your need was cosmetic.  Just so you know, I'm way to cheap to pay to read the whole article.  I quote from what Kevin quoted:

Since I didn't read the article I cannot judge the tone that it was written in.  I wonder if it was critical of this?  The assumption that is made is: cosmetic = elective = no worrying about insurance reimbursement.  My practice is admittedly insurance driven but we see occasional patients wanting cosmetic/big reconstructive work done and they're willing to pay for it.  Do we treat these patients extra special?  Yeah, I guess we do.  But we don't make anyone wait to get in because our capacity is such that we can see an emergency same day. 

There's an "insurance-free-every-patient-pays-for-and-appreciates-the-wonderful-service-that-we-give" dream that most dentists aspire to on certain days.  It's a pipe dream for two reasons:

1. Most people still associate the dentist with pain and misery (not saying it's right, just being realistic)
   
2. There's an overwhelming belief that "I can't go to the dentist, I don't have insurance."  (definitely
   

I know there are dentists out there who claim to be wildly successful doing "wants-based" dentistry and bully for them.  Most patients are firmly grounded in "needs based" (my face is swollen out to here and I NEED to have this tooth taken out) dentistry. 

Bottom line...if someone comes into my office wanting pretty teeth and they want to give me cash dollars for it they're a VIP.  Maybe that makes me an evil, money-grubbing dentist but I think it makes me a realist.