HealthLawProf Blog

Editor: Katharine Van Tassel
Case Western Reserve University School of Law

Sunday, October 14, 2007

Our Teeth and Our Health Care System

Frank Pasquale at Concurring Opinions has some observations about our teeth and the state of our health care system.  He writes,

What is the future of American health care?  Many believe that we need less reliance on government funding.  The current state of American dentistry suggests the likely consequences of such a move--along with the imbalances caused by "marketization" that focuses on the demand side while neglecting a cartelized supply side.

As social stratification deepens, ever more sophisticated cosmetic dentistry becomes the norm for the wealthy.  Meanwhile,

[M]any poor and lower-middle-class families do not receive adequate care, in part because most dentists want customers who can pay cash or have private insurance, and they do not accept Medicaid patients. As a result, publicly supported dental clinics have months-long waiting lists even for people who need major surgery for decayed teeth.

[E]ven as so many patients go untreated, business is booming for most dentists. They are making more money while working shorter hours, on average, even as the nation’s number of dentists, per person, has declined.


Even if more students wanted to enter the profession, states are not moving aggressively to expand dental schools or open new ones. Training dentists is expensive, because dental schools must provide hands-on training — unlike medical schools, which send doctors to hospitals for training after they graduate. Hospitals receive federal subsidies for the training they provide to medical interns and residents, but the equivalent system does not really exist in dentistry. Meanwhile, the A.D.A. does not support opening new dental schools or otherwise increasing the number of dentists. The association says it sees no nationwide shortage of dentists . . . .

So while the doctors' lobby has finally acknowledged the need for more medical schools, the dental lobby is holding a hard line.  One key question: is the problem that Medicaid underpays dentists, or the state's failure to assure the training of enough dentists? Consider the hard line the dental lobby takes against the allied health professions:

Despite the rise in dental problems, state boards of dentists and the American Dental Association, the main lobbying group for dentists, have fought efforts to use dental hygienists and other non-dentists to provide basic care to people who do not have access to dentists.


"What we’re extremely uncomfortable with is that they need to drill teeth and sometimes extract teeth,” said . . . the association’s president. Use of therapists would create a two-tier system where some people have access to dentists, while others must settle for less-qualified practitioners, she said.

The entire post is an interesting and thought-provoking read with a number of potential solutions discussed to the problem of physician shortages.

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