by Richard Mounce, DDS
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President Obama is correct that our health–care system needs change. People need affordable and quality medical care. Small businesses (like ours) need to be able to purchase affordable medical coverage for employees. The American people ideally need to change their habits to eliminate what are entirely preventable diseases that result from smoking, obesity, alcohol and drug abuse, etc. Physicians need tort reform. The list of who needs what from reform is extensive.
It is unclear exactly what will be in the final health–care reform legislation, or if the delivery of dental care will be affected. Here are several questions we should ask as clinicians and small business owners:1 President Obama has stated that taxes will not be raised to pay for this program. Is this credible? Could not requiring people to purchase medical insurance be construed as a tax? 2 The Obama administration has touted waste and fraud elimination from Medicare as a means to pay for a significant portion of health–care reform. How can Medicare continue to function at its current level and reduce costs so dramatically? If there is such waste and fraud now, how can the same government that has allowed this to happen now fundamentally be entrusted with a larger future stake in the delivery of health care in this country? Why is the federal government not aggressively rooting out fraud, irrespective of the health–care debate? 3 With fees that are regulated in one fashion or another, why would people want to take on the responsibility, years of study, and hundreds of thousands of dollars in educational debt to be physicians or dentists, only to be told how much they can charge or earn, or how they can actually practice (as a result of regulations that will be an incentive for some procedures and not others)?4 Without tort reform, doesn’t government–run health care or the “public option” (in one form or another) have the potential to drive clinicians out of health care very rapidly? Is it not counterintuitive to ask health–care providers to do the same amount of work for less money with the same liability (optimistically assuming that paperwork and regulations are not substantially greater in a government–run program)?5 With reduced fees, can there still be the same degree of innovation in the dental industry? Why would anyone buy a surgical microscope or invest in optimal technology (whether warm obturation or bonded obturation, RealSeal*, Twisted File* technology, etc.) when their reimbursement cannot change or will be reduced? In this crucible, why would anyone improve service? What incentive would manufacturers have to advance dentistry from a technology and methods and materials viewpoint?
These are the challenges. What are the answers?
There are solid first steps that could be taken now to improve access and quality and lower costs. Medical and dental offices in this country might be subject to random chart and site inspections to identify substandard clinicians, hospitals, and practices before larger problems emerge. Tort reform and medical insurance purchases across state lines would certainly increase competition and decrease costs. Higher taxes on unhealthy products, such as cigarettes, alcohol, and soda pop, would offer people an incentive to make healthier choices.
Comprehensive preventive health education in schools, public service health announcements, product safety, and enhanced environmental protection, among many changes, would be a vast improvement over the present reality of rampant obesity, nutritional deficit, and the medical establishment spending precious resources treating preventable disease states. Finally, the federal government should eliminate the waste and fraud from Medicare now to prove to the American people that it is capable of managing greater future involvement in health care.
With all due respect to President Obama, he has never injected an anxious patient in order to perform a root canal on a 25–mm long, irreversibly inflamed lower molar with severe bayonet apical curvature. From our side of the chair, things look different than they do from the Oval Office. I will never get the chance to sit down with the president to express these things face to face, but collectively as a profession, we can tell President Obama and Congress what we believe and what we need in order to provide the best care to our patients. If there ever was a time for the ADA and organized dentistry to stand up and speak out with one loud voice, this is it.
*SybronEndo, Orange, Calif.
Dr. Mounce is the author of the nonfiction book, Dead Stuck, “One man’s stories of adventure, parenting, and marriage told without heaping platitudes of political correctness” (DeadStuck.com). Dr. Mounce lectures globally and is widely published. He is in private practice in endodontics in Vancouver, Wash.