From the Financial Times and behind a paywall….my verdict on this…I’ll believe it when I see it.
Barbers went on pulling teeth long after doctors monopolised surgery on other parts of the body. The divide between dentists and the rest of the medical profession persisted into the 21st century where it is baked into the healthcare system. Insurers cover teeth separately.
The US Congress is contemplating adding dental benefits to its Medicare health programme for seniors, many of whom lack access to care for their dentition. This could improve health outcomes. General healthcare coverage in America is woeful relative to other industrialised countries. But the standard of dental care even worse.
Just under two-thirds of adult Americans visited a dentist in 2019, according to data from the Centers for Disease Control and Prevention. In that period, however, 85 per cent went to see a physician. As is naturally the case with private, employer-based benefits, the skew is also economic. Among Americans with household income at 200 per cent of the poverty level or below, only half were able to access a dentist.
The historical delineation between medicine and dentistry eventually led to the formations of separate professional schools for each. When private health insurance proliferated in America after the second world war, dental care was seen as preventive and routine. Risk-sharing with medical care has really only occurred as a safeguard against catastrophic emergencies. Health insurance excluded dental care.
US Senator Bernie Sanders and others of his centre-left persuasion say that the separation of health and dental care is largely a historical accident that is today harming seniors who are covered by Medicare. Build Back Better legislation championed by President Biden is set to expand dental benefits under Medicare receipts, albeit that progress on it is stalled for the moment.
Dentists, a wealthy and influential lobbying force, are fighting the proposal, which would cost the US government an estimated $238bn over a decade. They believe extra red tape and low reimbursement levels would mean their additional customer base would be a financial and operational burden.
They may succeed in derailing reforms. No matter. What has become glaringly apparent is that the US healthcare industry – and its substantial financial services hinterland – is expensive, inefficient and rent seeking. Expect insurers and benefits managers to come under increasing political pressure. But the American government, largely loath to socialise healthcare, will always be the provider of last resort.