Health Care Bill?

[ponkatart42]

Hello Dr. Bornfled,

What, if anything is included in the upcomming health care bill concerning dentistry?

Dentistry always seems to get the short end of the stick. most general health insurance plans, like the ones we get at work, usually don't include dental and not even Canada's singel payer sytstem includeds dental, except in the case of a disease related issue. It's odd that dentistry isn't seen as import.

Also, if it does include denistry, what type of impact would it have? The Repbulicans say that, in general, this bill would lead to rationing, and that certian proceedures/medicines would be banned if they cost too much. I'd hate to see that happen in dentistry. The Democrates say all that is false and its just fear munggering.

Fox news had a report on Great Britians "free" dental care that now the government has ordered that all problem teeth be pulled to save money so no more root canals, etc. Rush Limbau said jokingly, we could become a nation without any bite (no teeth) and Mike Savage (radio) said one guy in England pulled his teeth out because he couldnt wait any longer (waiting list). I don't know how much stock to put into all that, but I certinly don't want these kind of things to happen here, if there is anything negative in this bill concering dentistry. What's your take on this?

[mbornfeld]

Dear ponkatart42,

The following is taken from the Academy of General Dentistry web site:

Impact on General Dentistry: Several items in the bill are important to general dentistry. Most importantly, all qualified health benefits plans sold on the state-based exchanges must cover pediatric oral health services, although the term “pediatric” is not defined. Adult oral health care services are not mentioned in the legislation. The bill permits dental-only health plans to be sold on the exchanges.

The bill establishes several new oral health-related public health and prevention programs. It would establish a new national oral health care prevention campaign developed and operated by the Centers for Disease Control and Prevention (CDC), fund research-based dental caries disease management projects, require the CDC to provide funding to all states for school-based sealant programs, fund oral health infrastructure programs, and update and enhance several oral health surveillance programs.

Additionally, the legislation creates new school-based health clinics which must provide oral health care services. It also puts in motion a new requirement that all medical equipment (including dental examination chairs and x-ray equipment) is accessible to disabled individuals.

The bill updates several health workforce programs authorized by Title VII of the Public Health Service Act, many of which impact or are relevant to dentistry and oral health care. Most importantly, it creates a new “dental cluster” for dental training programs under Title VII that includes general, pediatric, and public health dentists as well as dental hygienists. Of grave concern to the AGD is that the legislation authorizes funding for up to 15 demonstration projects to test the ability of various mid-level dental providers to address oral health disparities.

You can draw your own conclusions. Suffice it to say that the great expectations for health care reform have been dramatically scaled back with the recent (presumed) abandonment of the Public Option and the 55 to 64 opt-in for Medicare. The insurance lobbyists are working overtime to make this reform a windfall for them, rather than a safety net for the American public. Now that the insurance industry does not need to worry about competition, they can happily endorse whatever vestiges of reform come out of this process, secure in the knowledge that every uninsured person will now be compelled to buy a policy at whatever price tag they ask. A travesty of dashed optimism, to be sure.

In any case, I won't be disappointed by any crumbs thrown in dentistry's direction. Although I am a dentist, and a fervent advocate for oral health, I will be the first to admit that medicine should get priority. If you don't understand this now, you will after you hit age 50.

Don't worry about health care rationing, as if it doesn't already exist. Health care will always be available to those who can afford it-- here, in the U.K, and in Canada. Nobody is compelled to go through the National Health Service if they can afford to pay out of pocket. The whole reason for health care reform here in the U.S. is that it is already out of reach of a substantial part of our population. Of course, the people over at Fox are not very much concerned about those people.

Even the likes of organized dentistry are to blame-- witness the epilogue in the above quoted text:

Of grave concern to the AGD is that the legislation authorizes funding for up to 15 demonstration projects to test the ability of various mid-level dental providers to address oral health disparities.

The ostensible "concern" is that rural or other populations under-served by the dental profession will have inferior dental care if non-dentists provide dental service. Do you smell the hypocrisy? If dentistry was serving those populations, there'd be no need for mid-level providers. You see, nobody holds the moral high ground here...