Universal Dental Care, Anyone?

"on some level delivering everyone a basic standard of health care is a fairly simple moral imperative"

I thought you were supporting Richardson or Obama, not Edwards...

This is awful but sometimes I hear stories like this and wonder if these people were really too poor to come up with $80 for a tooth extraction or that we are so conditioned to think we shouldn't be paying for care that we don't recognize that the seriousness of some medical problems can justify doing some damage to an already difficult financial position.

Yeah, it's hard to peel away all the many layers of horror involved in that poor kid's death. But to my mind one of the salient atrocities is that this happened right in the belly of the national capital area -- one of the wealthiest regions of the planet.

It doesn't help to wade through the reader responses to the WaPo article. A fair number of comments seem almost gleefully smug...

"This is awful but sometimes I hear stories like this and wonder if these people were really too poor to come up with $80 for a tooth extraction or that we are so conditioned to think we shouldn't be paying for care that we don't recognize that the seriousness of some medical problems can justify doing some damage to an already difficult financial position."

Well, if you had actually read the story, you might have noted that the family was struggling to pay for six tooth extractions for a sibling that they (sensibly) rated as a higher priority in the no-insurance triage life than taking care of just one bad tooth in the now dead kid.

But thanks for your deep sensitivity to their plight. May all of your teeth fall out.

i had the same reaction

and MS, jeez...

I've often wondered why dental care is rarely discussed when health care policy is debated--even good dental plans have ridiculous deductables and restrictions, and that assumes one can afford a dental plan on top of regular health insurance...why are teeth treated differently from the rest of the body?

"or that we are so conditioned to think we shouldn't be paying for care that we..."

Who's this "we" you're talking about, MS? Are YOU so conditioned to think healthcare should be free that YOU won't go to the dentist for an abcessed tooth? (I hear they can be pretty painful.) Or are you projecting yourself into some fictional Reaganesque entitlement-queen-persona?

Like Petey says, I hope *all* your teeth fall out. Or at the very least, that you someday learn what it's like to not have access to medical care.

Some of the readers' comments are really shameful. It appears that many conservatives have skid marks for souls.

"May all of your teeth fall out."

In all seriousness, let's let this article be a reminder of why elections matter, and why it's important to vote for candidates who are serious about universal health care rather than candidates who are afraid to discuss it. And yes, that's intended as a shot at Hillary Clinton.

On an unrelated note, one of the US attorneys purged is one euponyous David Iglesias...any relation?

"...even good dental plans have ridiculous deductables and restrictions, and that assumes one can afford a dental plan on top of regular health insurance."

It's odd you bring that up. As a freelancer in New York, I buy my own insurance, and the cost of my dental plan is actually fairly reasonable--about $30/month (vs. $350/month for medical.) The dental work I've had done under this plan has been also reasonable in terms of deductibles and restrictions. Maybe it's different for other cities and situations.

Of course, if one doesn't have eighty bucks for a one-time tooth extraction, one probably can't afford $360 a year for coverage.

Don't worry, Matt. The Democrats are on track to move us toward universal single payer health care by the year 2619. Hang in there just a while longer, toothache sufferers!

Just as a matter of interest, precisely what policy change would any of you make to prevent this sort of tragedy in the future?

why are teeth treated differently from the rest of the body?

Ever seen a poor dentist? (Rachel's jilted fiancé in Friends was a completely outlandish caricature.)

This is a real problem: dental and eye exams are valuable early-warning signs for other serious health problems. But dentistry and opthalmology have always demanded special treatment, regardless of the system. On some parts of the UK, it's impossible to get onto the books of an NHS dentist, because the profession negotiated greater freedom to practice privately back in the day.

Why treat poor black kids when there's lucrative tooth-whitening or porcelain caps to be dished out? Oh, and here's to high fructose corn syrup, and the corn lobby's role in the Iowa caucuses.

Medicaid dental coverage is a complete mess in many states. The trouble is that Medicaid rates simply haven't kept up, and so many dentists don't accept Medicaid patients, because they lose money on every service. One thing everyone could do is boycott dentists who don't. Call them up, ask, and if they don't, tell them you're taking your insurance payments elsewhere. This goes for all sorts of medical care providers, but is a bigger problem with dentists.

If it's a moral imperative, why aren't you practicing dentistry?

I've often wondered why dental care is rarely discussed when health care policy is debated--even good dental plans have ridiculous deductables and restrictions, and that assumes one can afford a dental plan on top of regular health insurance

Poor organization and lobbying on the part of dentists? Most insurance plans have very generous coverage of chiropractic care, and chiropractors are famously well-organized and powerful - they make the AMA look anarchic by comparison. Dentists might be in the opposite position.

We have dental coverage for Medicaid recipients in Missouri. But the reimbursement rates are so low that very few dentists accept it. It's a horrible situation for those who are on Medicaid.

But look at this from another point of view: Many working people, who don't get Medicaid, are not able to afford dental care either. If you go into a rural WalMart and look at the customers, you see lots of missing teeth. So as a question of justice, why should working people have to sacrifice for dental care they can't afford, while Medicaid recipients get carte blanche?

Nick Kasoff
The Thug Report

Hardly the first time this has happened.

Ah, they're just dead poor kids. Who cares? Dental care is a luxury, like Prada bags.

Obviously this is very bad, but who can help but cringe at the miserabilist tone this *news* (as opposed to opinion) article uses? It does disservice to its cause.

First, I'm very sorry to hear about what happened to Deamonte Driver. It's a tragedy for him and all who knew him, and it must have been a terrible way to die. I wish that I could offer condolensces to Alyce and the rest of Deamonte's family.

One thing that's notable is that, to true economic conservatives, this story is an example of the medical system working.

Usually, with most extreme, emergency medical problems, like, say, gunshot wounds, strokes, heart attacks, or the like, you're treated to some extent even if you don't have money or insurance.

To economic conservatives, this is one of the problems with the U.S. healthcare system: that there is already too much free healthcare, and individuals already have too little responsibility in procuring their own services. If only the system could be further privatized, so that people bought what they paid for, were responsible for their own health, and paid market prices, then the huge problems of adverse selection in insurance, massive service-denying bureaucracies, and other problems with our health care system would be greatly ameliorated.

Well, here's that working in practice. This is a story of a well-functioning healthcare market, working just as it should, without all of the problems and moral hazard usually associated with the health care system as conservatives see it.

Right-wingers are always going off on health care and the magic of the market. Well, guess what, normal people aren't doctors, and have no idea whether they should spend the money or not. It's not like buying shirts or peanut butter. An honest conservative would say in this case, "The system worked! They saved $80 after all. It all averages out. People gotta die sometime anyway."

And yes, your mouth is part of your body. And if you've got poor dental health and chronic inflammation in your mouth, it's compromising your immune system, and may even contribute to heart disease:

http://www.google.com/search?q=chronic+inflammation++mouth+heart+disease

So hell yes, let's cover dental (and mental -- the brain is an organ too)!

Or rather, Mr. Driver's fate was an example of the system working as conservatives say it should until it was too late to save him. Then he got very expensive emergency care and two operations, which is presumably the part that hardcore economic conservatives would find objectionable.

If it's a moral imperative, why aren't you practicing dentistry?

Because being a chickenhawk is just fine for everything except the Iraq war.

This is clearly the fault of those damned Republicans who have controlled the State of Maryland for such along time now. I mean, when was the last time the Democrats controlled the Maryland legislature? 1640? Clearly it is time to elect some Democrats in Maryland to raise taxes there so the State can spend more on Medicaid.

By the way, one reads through the entire article, but the reader is never told WHAT THE DAMNED PROBLEM WAS. The article says that the family's Medicaid had "temporarily lapsed". HUH? Why? What a shoddy piece of reporting that tells you there's not enough coverage for these kids and then doesn't even tell you what the issue was that caused the kid to be uncovered. Grrr - the media in the country utterly sucks.

$$$$ equals rights. Thinking otherwise is naive. Having money allows you to purchase fair treatment. Having lots of money allows you to demand fair treatment. The moral? Don't be poor. Here, have a piece of cake.

That's not a good idea, Steve. Cake will rot their teeth.

It used to be that if you lived near a dental school you could get basic dental work done there by the students (it was part of their formal training oncet hey reached a certain level) for a nominal fee. Growing up near Ann Arbor (with the U of M's dental school) I knew quite a few people who had no dental insurance and availed themselves of this resource instead. Nothing fancy of course, but simple extractions and fillings were certainly done. Are there no dental schools in the Washington area, or is this no longer an option at dental schools?

The problem here seems to be that people are using too much dental care. If everyone wasn't running around engaging in unneccessary dental care program related activies then dental care would cost less. Its economics 101, people!

/snark

"Medicaid dental coverage is a complete mess in many states. The trouble is that Medicaid rates simply haven't kept up, and so many dentists don't accept Medicaid patients, because they lose money on every service. One thing everyone could do is boycott dentists who don't. Call them up, ask, and if they don't, tell them you're taking your insurance payments elsewhere. This goes for all sorts of medical care providers, but is a bigger problem with dentists. "

This is what we want from universal health care right?

I don't understand why people don't use dental schools. I had all sorts of poor friends in my 20s who who get work done through dental schools.

JonF, Bush era legislation affecting Medicare/Medicaid requires reporting the projected savings from using such dental schools as income. Extensive dental work results in lifting recipients into higher taxable income brackets, thus they possibly end up losing eligibility for other benefits. They may even end up owing additional taxes on their yearly earnings.

Poor organization and lobbying on the part of dentists?

To the contrary, I'd suggest. Having dental plans separate from regular health insurance creates a smaller risk pool, and I suspect that it's one that favours the dentists. Outside that, it's pay-for-service, and no middleman which again favours the dentists. So you have an even bigger split between Medicaid recipients and private patients.

Fortunately, Al doesn't need dental care, given that the last time he opened his snarky hack mouth in the presence of a decent person, he got all his teeth knocked out.

By the way, one reads through the entire article, but the reader is never told WHAT THE DAMNED PROBLEM WAS. The article says that the family's Medicaid had "temporarily lapsed". HUH? Why? What a shoddy piece of reporting that tells you there's not enough coverage for these kids and then doesn't even tell you what the issue was that caused the kid to be uncovered. Grrr - the media in the country utterly sucks.

Yeah, well, a little reading comprehension goes a long way, Al. If you'd bothered to read the whole article, you'd find this passage:

But she had to cancel after learning Jan. 8 that the children had lost their Medicaid coverage a month earlier. She suspects that the paperwork to confirm their eligibility was mailed to the shelter in Adelphi, where they no longer live.

It's just a conjecture, but it's a very plausible one.

It's just a conjecture, but it's a very plausible one.

I'm not sure what that sentence means. Is that the mother had to provide some paperwork to somewhere, and she didn't do it? If so, then why is the article about how little coverage the government provides, rather than the mother's error?

BTW, in looking back at the article now that you pointed me to that, I also see the following: On Oct. 5, DaShawn saw Arthur Fridley, who cleaned the boy's teeth, took an X-ray and referred him to an oral surgeon. But the surgeon could not see him until Nov. 21, and that would be only for a consultation. Driver said she learned that DaShawn would need six teeth extracted and made an appointment for the earliest date available: Jan. 16.

Hey, Medicaid is a government-provided healthcare program, and it turns out there's GIGANTIC waiting list for treatment. Who could've ever predicted that??? Hey, I've got a great idea, let's do the same thing for EVERYBODY!

"Just as a matter of interest, precisely what policy change would any of you make to prevent this sort of tragedy in the future?"

National health insurance paid for by repealing the Bush tax cuts and increasing the capital gains and estate tax. Seems simple enough to me.

I'm not sure what that sentence means. Is that the mother had to provide some paperwork to somewhere, and she didn't do it? If so, then why is the article about how little coverage the government provides, rather than the mother's error?

Jesus Christ, fuckwit. The passage I cited said that the mother surmised (that's the conjecture -- get it, idiot?) that she missed paperwork that had been mailed to an address, a shelter, where she was no longer living and where she figured it might have been lost.

The article describes the mother doing a variety of things most reasonable people would describe as sensible and responsible. Undoubtedly she made some errors. Modern life is full of encounters with all sorts of bureaucracies (public and private), and I've yet to meet the person who's never encountered a snafu when dealing with them. But I have seen the sort of shit that you routinely spew, Al, and you're in no position to criticize anybody for stupidity or laziness. You didn't even comprehend the newspaper article that this whole thread is devoted to, you twit!

"Hey, Medicaid is a government-provided healthcare program, and it turns out there's GIGANTIC waiting list for treatment. Who could've ever predicted that??? Hey, I've got a great idea, let's do the same thing for EVERYBODY!"

Al:

ALL healthcare programs will have huge waiting lists and onerous restrictions on treatment if they are underfunded. Medicaid is underfunded. If the private sector worked with similar funding, they couldn't fully insure those people either.

On the other hand, Medicare is fully funded. And there aren't big waiting lists for treatment.

I doubt the reporter has gotten her fact right, not that she might have cared, one obvious truth about the newspaper business is that newspapers rarely let reality get in the way of a good story.

An abcess is a medical problem, not a dental problem, though they're caused by dental problems. The way to fix an abcess is to just cut it open and let it bleed out. It also will kill you rather quickly if left alone (I doubt that the older brother with the six rotten teeth had an actual abcess for weeks without dying). Cutting an abcess is a short procedure too.

If you ever get one, go to the emergency room, and abcess is like a rattlesnake bite, hurry up! I bet the mother didn't realize how urgent the problem was and well, it's a sad enough story without the extras.

f so, then why is the article about how little coverage the government provides, rather than the mother's error?

Shorter Al: when I'm not being a shameless hack, I do good duty as a heartless cunt.

Al:

I'm not sure what that sentence means.

It is difficult to get a man to understand something when his blog-commenting persona depends on his not understanding it.
--Upton Sinclair

O for petes sake. If j mct had got their facts right, they might know that not all abscesses are caused by dental problems, and that many of the ones that are can be treated by a dentist. Yes, your local ER might drain your abscess and pack it with gauze- and then they would tell you to go to a dentist!

This whole situation shows what's wrong with "incremental reform" and "means testing". Either of these results in agencies denying care, trying to steer clients away from care, and creating bigger problems for clients and the kind of poor market environment that makes it hard for dentists to operate.

A big reason that dental care has never been included in Medicare is that so many Americans have bad teeth that the initial bill would be astounding. Of course, had we "bitten the bullet", so to speak, in the past, most of us would now have fairly healthy mouths and the inital expense would have become manageable.

Health Policy is my business, and there are a lot of different levels to this terrible story.

First, Medicaid payments for dental care are usually very low and few dentists will accept Medicaid patients.

Second, dentists do not feel a cultural responsibility that comes with a profession. Docs frequently have some sense that they are under an obligation to provide some service as a social good. (okay not always, but sometimes) The dentists don't have this inculcated in any way during their training. On the contrary, they are taught to operate their practices solely as a business: no cash, no service, even when it's life-threatening for the patient.

Third, Dental Society's are a huge guild and they have stopped any attempts to change scope of practice which would allow dental hygienists to practice independently. Breaking the restrictions on dental hygienist's practice would be the single biggest advance we could make to make dental care available to the underserved.

Take a look at what's going on in Alaska: It's very hard to get dentists to practice in the Alaska wilderness and frontier areas. The Dental Society and the ADA have sued in an attempt to stop a Dental Health Aide program there. This isn't a choice between getting great care from a dentist and mediocre care from an aide. It's a choice between no care and any care at all, and the ADA is on the side of no care.

ADA Sues To Halt Alaska Dental Aide Program

(AP) Anchorage, Alaska Alaska dental health aides who perform extractions, surgeries and other irreversible procedures in rural communities without proper credentials are in violation of state licensing laws, the American Dental Association said in a lawsuit filed Tuesday.

The lawsuit, filed in state Superior Court in Anchorage, Alaska seeks to halt the unique program run by Alaska Native organizations that allows dental health aides to perform services usually done by licensed dentists.

Much of the work is done in rural villages, where there are no dentists and the rate of tooth decay for Alaska Natives is 21/2 times that of the rest of the nation.

This isn't just an Alaska story. Every State has restrictions meant to help Dentists make money, and if you've ever read any of my other posts you know I'm no libertarian, but the Dental Societies stink and we could help by loosening restrictions on hygienists.

In lieu of a trackback, let me note I have a post on this topic (one that takes off from this one) at my blog here:
http://stephenfrug.blogspot.com/2007/02/deamonte-driver-is-dead-and-you-can.html

Serial catowner:

Let's see, the story says or implies that the mother was yelling abcess and no one did anything. Maybe she never said abcess. Or one could believe that the reporter got the story wrong, or more likely didn't want to let reality get in the way of her desire to be more Dickensian than Dickens. I think the second far more likely.

You're right, abcesses are medical problems sometimes treated by dentists, but unlike rotting teeth, abcesses can kill you. The doctor will send you to the dentist not primarily about your teeth though that does matter, but because if one doesn't deal with the dental problem one might get another abcess, which again will kill you.

Last but not least, any health care system is something that the patient uses to take care of himself, and like anything that one uses, not knowing what you're doing can lead to bad result, irrespective of the particulars of the health care system. I think that coming up with a health care system that takes care of you rather than being something that one uses to take care of oneself is more than a bit Quixotic and as likely as you owning a cat that barks.

Re: JonF, Bush era legislation affecting Medicare/Medicaid requires reporting the projected savings from using such dental schools as income.

???
First off, how would anyone even know? And if you pay, say $20, for a filling how is that "income"? It's money going out not coming in. Also, if there's some flap-doodle here about "fair market value", remember that this work is not done by dentists; it is done by dental students; hence in market terms it won't and shouldn't cost as much as work done by a degreed and licensed dentist. And beyond that the dental patient is actually providing a service (as practice subject) to the dental students.
Anyway, the people I knew who I was talking about were not on any form of public assistance; they were simply uninsured working people and so would not run the risk you cite. (And the IRS does not require dental schools to issue 1099s to their subjects so thiswould fly beneath tax radar).

Anyone who, like Al, thinks that the story is that the mom screwed up the paperwork might want to read this post and some of the links. The first post linked is about the Canadian welfare system, but the point is basically the same: The system makes you jump through a lot of hoops to get the care that you're legally entitled to, and if you're denied that care it won't always be your fault.

Ironically, j mct ends up being the person saying you should run to the ER for every litle thing.

Let's review- on the surface, an abscess can very much resemble an inflammation, presenting as a swollen tender area that may be warm to the touch. Anyone with deep cystic acne gets dozens of abscesses each year, most of which will spontaneously resolve themselves.

Most abscesses are dealt with naturally by the body- the collection of 'pus' is actually dead bacteria and disolved body parts that, with a little luck, and proper nutrition and rest, will be resorbed by the body and excreted. Abscesses that are near the surface will usually erode and burst outwards. As unpleasant as this may be, there is usually no danger as long as the abscess does not impact some important body structure, such as a nerve ganglion or major blood vessel.

If, however, your abscess is so painful that you seek medical treatment, you will either be prescribed a big dose of antibiotics, or the doctor will cut it open to see what's inside. Sometimes there is nothing inside but inflamed and impacted tissue, and naturally this is not as satisfying as draining a large pocket and getting fast relief from the pain of the inflammation.

Most lay people paying out of their own pocket would find it hard to decide when to seek care. For example, when I was bitten by a brown recluse spider, I decided not to seek care because in Seattle doctors usually cut out the necrosed tissue, and I didn't want to be laid up like that. As a nurse, I was able to monitor the progress of the necrosis, but most people would have no way to do that safely.

One thing I can definitely advise against is putting a hot pad on a swollen inflamed area. If it is an abscess, it may burst inward and put you in septic shock, that is to say, an overwhelming amount of infection conveyed to every part of the body by the bloodstream.

As for whether the mother was crying abscess, who cares? Unless there was actual drainage, neither she nor anyone else would have any way of knowing what it was until it was cut open. The real questions involve where the problem is, the severity and duration of the problem, and the liklihood of subsequent complications if the problem is not treated, or treated improperly.

It seems pretty obvious from the death of the child that somebody did not make the right call somewhere in this process.

And this reminded me of a terrific essay I read several years ago from the director of the Center for the Health Professions at the University of California, San Francisco.

Centering on …Dentistry as Canary?

The United States faces a hidden health care epidemic of near-crisis proportion. But this epidemic has not received the attention it needs or deserves. The crisis is in oral health... the Surgeon General's report (1) on oral health care illuminated the problem. Despite advances in dental science and practice that have resulted in great improvements in our nation's ability to provide oral health care, dental disease of all varieties has reached epidemic proportions. More significantly, however, disease is becoming localized with greater intensity among populations that have limited access to care because of inability to pay, age, cultural dissonance, and/or physical isolation...

First the dentistry profession must ask itself whether it wants to be the leadership profession for the nation's oral health concerns, or the leadership profession for bungalow solo private practices in the nation's suburbs... If dentistry chooses the status quo, it will likely continue its recent advances, but will find that its success has waning relevance to the country's oral health needs. Soon, many dental professionals' nightmares that oral health care will be provided outside the dental professional model will become a waking reality.

It's pretty clear which path the dentists took. Now it's up to us to make sure they don't stand in the way of people getting needed care.

Just my 2 cents. I have had an on going problem with a Dental Society here in NYC. They claim to settle disputes with consumers and dentists. After I took my case to the society PEER Review they gave me a check for $8oo.00. The actual bill was $4,900. I have been to their their unbellievable peer review in which five of their dentists found 7 errors with my two front implants that were placed improperly. The dentist never bought in x-rays or records of my work which is a REQUIREMENT for the Dental Society Peer Review. I also had an advocate at the review who did nothing to help. Also mismatched color and other horrors of the dentists dental work. When I poliety complained to the dental society they refered me to the office of the professions."I was stalled" untill the statute of limitations ran out ( please excuse my spelling). I contacted the District attorneys office and they have refered me to the Attorney Generals office. I absolutely refuse to let this problem go!!!. The District Attorney's office found 82 COMPLAINTS against this particular dentist. This has all been going on for 3 years of crazy referels to agencies. The dental society knew his unbelievable camount of complaints and felt they could get rid of me with $800.00. The Attorney general's office is sending me all my records on my case and I am going to take the dental society to court for either "Simple or Gross negelegence" if they won't settle out of court. The dental profession needs much more "watchfull dogs" with the profession. Attorneys would not take my case because there's "not enough money in it". Believe me I have better thing to do. The dental profession makes me sick with much, not all, of their price gouging and incompetence. Thanks for reading this far and I wish you all good luck.

I am coming very late to this discussion, but my brother has an oral cancer, must have all of his teeth extracted on Tues. at a cost of $3500 to the dental surgeon and who knows what for the hospital bill. He is on permanent disability with a low income and many bills to look forward to that will be unpaid by Medicare for cancer treatment.

There is no Missouri Medicaid assitance for any dental care, even in a catastrophic situation like this. The doctors can't start radiation until his teeth are pulled so this must be done asap.

Congratulations to the Republican-run Missouri legislature for making the lives of poor people ever less easy.

There is no dental school, no dental clinic, no dental surgeon who can afford to donate the cost of this surgery, and there is no such thing as catastrophic dental care. The hospital that is treating him is making an attempt to set up a clilnic program for indigent people who need dental care, but I would doubt that this will come any time soon.

I'm sorry to hear about your brother. Your brother's dentist should, out of professionalism, tell you of your brother's alternatives. I personally would contact malpractice attorney or contact the American cancer society for guidance. Please be more assertive for his sake. Rebecca

The Canadian Universal Health Care system doesn't cover dental costs, UNLESS it is a medical emergency. The same with plastic surgery, it's only covered if it is required for the health of the person, and is not just cosmetic. Just about all other medical treatment is covered in Canada.

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