My, What Rotten Teeth Poor People Have: The Hidden Health Care Crisis and The Dems


On my deathbed, I will contend that the Clintons got a bad rap on their failed 1994 attempt at health care reform. An excellent piece in The American Prospect (hat tip: Washington Monthly) agrees and argues that this time, the Dems can pull it off. Here’s (partially) why:

First, the moment is more amenable to reform — in part because the reality has worsened. Fears abound that we are set to enter a deep recession, but even back when the macroeconomic indicators were fairly good, the health care numbers looked pretty bad. In 1994, 37 million Americans were uninsured. By 2007, that number had ballooned to 47 million. Between 1996 and 2007, the average employee’s spending on health premiums for his family shot up 85 percent — and incomes, of course, have not followed.

“My personal index,” says Len Nichols, director of the New America Foundation’s health policy program, “is the ratio of family premiums to median family income. In 1987, it was 7 percent. Today it’s 17 percent. That fundamental dynamic, that health care costs are growing so much faster than economic productivity, means that even though unemployment is so low and the macro-economic indicators are good, there’s still intense, acute anxiety.” In other words, the concerns that once appeared only during recessions are now an enduring fact of American life. The health care system is so expensive, so unwieldy, so unstable, that today’s participants feel much like the victims of the early-’90s recession.

Business also seems exhausted by the ceaseless march of health care costs and ready for reform. In 1994, when managed care was just beginning to squeeze cost growth, health spending grew by a mere 4.1 percent. It looked like the private sector might prove able to control costs just fine. But the gains from managed care dissipated as the 1990s wore on, and in 2005, health spending grew by 7.2 percent. Much of that cost was borne by the business community.

“It’s a global competitiveness issue,” says Charles Kolb, president of the Committee for Economic Development, a business coalition. “And even if it weren’t, it’s a cost issue. Health care costs are growing at a rate that’s simply not sustainable. [Our members] are in the business of business, not the business of health care.”

Unfortunately, while both Obama and Clinton are likely to at least try do something about health care both remain mum on a crucial aspect: dental care.

Sound silly? Go into the hood and check the choppers around you. I poll-watched last election in a Skid Row neighborhood, lucky me. Guys drunk, in donation barrel clothes with ropes for belts, at 8 am having been paid to vote. I was floored by all the toothless middle-aged and younger people coming in to vote. How could that be? At another community forum where inner city folks were confronting the local newspaper for better coverage—ditto. One woman complained bitterly to me that her neighborhood was red-lined such that she couldn’t get a job in reception at the paper. I didn’t want to suggest that it might be her exposed gums (among other things) that were the problem. The few teeth she had, all on the bottom row, pointed in every direction but up. We have a dental crisis in America and guess who’s getting bitten. From The Nation:

Last Spring, following the death of twelve-year old Deamonte Driver of Maryland whose untreated tooth infection spread to his brain, I wrote about the national epidemic of dental disease and the lack of access to dental care faced by the poor and working class. Last month, an article in the New York Times painted a horrifying picture of the state of dental care, where bootleggers sell dentures that would otherwise be unaffordable to many people missing teeth; where low Medicaid reimbursement rates perpetuate a dearth of participating dentists; where untreated cavities are a leading cause of kids missing school, people use Krazy Glue to reattach broken teeth, or swish rubbing alcohol to treat an infection, “burning the gums and creating ulcers.”

Currently, Medicaid only covers pulling teeth to treat infections — not root canals or dentures –- which can certainly dim the job prospects for someone trying to earn a living in our economy.

“Try finding work when you’re in your 30s or 40s and you’re missing front teeth,” Jane Stephenson, founder of the New Opportunity School in Berea, Kentucky told the Times.

We couldn’t find $80 to have a 12-year-old’s tooth fixed but found $300,000 for the hospital to treat him while he died of infection.

Lacking health care, I hadn’t seen a dentist in nearly four years. Halfway through, I broke a back tooth and couldn’t chew on that side. Nice, huh? Even once I got a job with benefits I had to pay 60% of the cost — approximately $600. Doc said I’d been heading for a root canal. What a system. Yet, neither candidate would speak to reporters about their plan for dental coverage. Maybe they don’t have one?

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