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Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
We must hold the dental insurance industry liable for collecting premiums for years full well knowing that patients cannot afford the costs after benefits are determined.
This week has been an incredibly wild ride for politics in the United States. One former president is targeted by an assassin’s bullet, and one soon-to-be former president drops out of his campaign for reelection. History is unfolding, and fear about the future is rising.
One constant certainty for every person residing in the U.S. of the free and the brave is the extraordinary profits made by health insurance corporations and the providers who deny care to millions of Americans who don’t present themselves with enough coverage or cash to afford needed care.
Dental care access is one of the most vivid and disgusting examples of the profit-first motivations of the health and wealth care Americans seem to accept without much of a fight. Dental insurance is a highly consolidated segment of the industry, and dental care providers charge more than most people can afford out of pocket for dental health services. Credit companies have developed specific programs for dental costs that mirror our pet care and insurance options through collusion with dental providers and dental insurance plans, and patients (or consumers) who qualify for those credit plans are urged to pay often high interest rates to “charge” their care when cash is short.
When we all come together to demand that our mouths, our ears, our eyes, and our mental health is a part of the coverage we all pay for (whether through private insurance or taxes that pay Medicare and Medicaid benefits), we might just see our similarities as our power and our way out of so much division.
My dental journey is no different than so many millions of other people, and it makes me more angry and less hopeful every time I feel any need to see a dentist. I’ve always carried dental insurance, and I’ve gone years sometimes without seeing dentists while coverage premiums were dutifully paid each month. As I near my 70th birthday this year, I don’t understand why I don’t have many teeth left. Yes, of course, I do know the specifics of each decision to pull a tooth rather than do the root canal and crown treatment often recommended when one of my teeth was sick. That’s easy to trace and see how daily expenses and raising children won out over shelling out thousands for my own dental care. Yet in my heart, I’m confused about the whole mess.
Why isn’t it fraudulent to sell dental insurance that effectively cannot be used because benefits are too low in comparison to overall costs? And why should an insured woman like me lose all but eight of her natural teeth to a lack of money? Last week, I tried to distract myself with the bigger news in play while six more of my teeth were extracted at the local dental school. When I saw my teeth laid out on the tray, I wanted to apologize somehow to my late father who paid so much for my orthodonture and the cap on the front tooth knocked out by a “steelie” marble just after I got my permanent front teeth. I also thought about the flipper and the bridge I financed beyond my Delta Dental benefits allotment after an abusive partner long ago decided I needed a punch in the mouth to silence me. Why did I bother? And why was I now feeling so guilty for being unable to protect my own overall health—which, for me and most humans, includes oral health?
With no answers to my own questions, I do wonder why the health insurance companies allow so much care to go undelivered for so many millions of people they then must cover for oral health related illness. Of course it relates to the bottom line, I know. But then my larger questions for my fellow humans with teeth and eyes and ears and brains that sometimes need dental healthcare is how do we as neighbors, friends, relatives, and co-workers accept a system that denies us needed care for which we carry insurance?
Whether a MAGA devotee, a far-left liberal, a middle-of-the-road person without strongly held political leanings, our bodies need our attention and sometimes need the attention of trained professionals. Why do we allow ourselves to be separated from our shared humanness? The intentionality of the health insurance industry, the dental insurance cabal, the financial services industry, and the providers to make profits ever higher ought to draw us all together in a common struggle—and a common goal.
We must work more intentionally together to disrupt the collusion of the medical-financial-industrial complex we call a healthcare system. We must educate one another about the rip-offs we share and stop taking the blame for being human with teeth that need care despite flossing, brushing, and all the over-the-counter products we use to try to keep them healthy. We must stop allowing children and their parents and grandparents to die from cavities and dental injuries that could be simply treated. We must hold the dental insurance industry liable for collecting premiums for years full well knowing that patients cannot afford the costs after benefits are determined.
As for me, I have four teeth left on top and four teeth left on the bottom. All the rest have now been pulled. God willing (and apparently prayer is not enough for most of us), I will be able to find a way to cover the almost $2,000 after benefits necessary to have partial dentures. It’s humiliating and scary to think I must fundraise for teeth. When we all come together to demand that our mouths, our ears, our eyes, and our mental health is a part of the coverage we all pay for (whether through private insurance or taxes that pay Medicare and Medicaid benefits), we might just see our similarities as our power and our way out of so much division. Let’s hold each other accountable for our collective well-being. The rich are doing just fine doing just that while our teeth are pulled and thrown in the trash.
Despite the demise of Build Back Better, we should not give up on expanding traditional Medicare. Real change takes time and persistence.
President Lyndon Johnson signed Medicare into law 58 years ago Sunday—on July 30, 1965. Before Medicare, most American seniors could not obtain health insurance; they had to rely on charity or help from relatives with medical bills.
"Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness,” said President Johnson at the signing ceremony. “And the time has now arrived to help them attain that opportunity and to help them get that protection."
Medicare was modeled on a typical Blue Cross/Blue Shield plan in 1965. The average health insurance plan 58 years ago did not include hearing, vision, or dental coverage. As Kaiser Health News points out, “Back in 1965, life expectancy was lower and health care (including dental) was more affordable.”
“When Medicare was created, its architects assumed expansion… in terms of benefits. (But) they didn’t anticipate the shift in American politics to the right.”
Today, life expectancy is longer and healthcare costs have skyrocketed. But traditional Medicare still does not cover hearing, vision, and dental care—leaving beneficiaries to bear the full cost of care for their ears, eyes, and teeth. Hearing aids, dental crowns, and eyeglasses can amount to thousands of dollars in out-of-pocket expenses, which many seniors simply can’t afford.
President Joe Biden’s original Build Back Better plan finally would have added hearing, vision, and dental coverage to traditional Medicare. The White House ultimately dropped dental and vision care from its plan after objections from Democratic centrists, leaving hearing coverage as the only potential benefit expansion. Then, the entire Build Back Better plan was killed at the end of 2021 when Senator Joe Manchin (D-W.Va.) withdrew his support, effectively ending any real chance to expand traditional Medicare benefits while Democrats controlled the White House and both houses of Congress.
As Jonathan Oberlander, professor of health policy at UNC-Chapel Hill, observed, “Medicare is the kind of program where you’d expect the benefits to be expanded over and over again.” But other than the addition of Part D prescription drug coverage (administered by private plans) in 2003, Medicare benefits have not been expanded in the 58 years since the program was enacted.
“When Medicare was created, its architects assumed expansion… in terms of benefits,” Oberlander told Kaiser Health News. “(But) they didn’t anticipate the shift in American politics to the right.” This shift, which took root with the election of Ronald Reagan in 1981, emphasized tax cuts for the wealthy and corporations, increased military spending, and spouted a lot of bluster about reducing deficits (hard to accomplish given the first two items on the list).
What President Biden called “human infrastructure”—services for everyday Americans struggling to thrive in a global economy amid growing wealth inequality—became a tougher political sell after 1981. The ill-fated Build Back Better plan was an earnest attempt to begin investing more resources in “human infrastructure.” Despite the demise of Build Back Better, we should not give up on expanding traditional Medicare. Real change takes time and persistence.
In fact, there has been real progress on Medicare in other ways. The Inflation Reduction Act (the reconstituted version of Build Back Better) finally allows Medicare to negotiate prescription drug prices with Big Pharma—an historic reform that took some 20 years to enact. The Inflation Reduction Act will cap beneficiaries’ out of pocket drug costs at $2,000 per year (starting in 2025), limits seniors’ insulin costs to $35 a month, and penalizes drug-makers for raising prices above the rate of inflation.
While Congress was unable to enact a hearing benefit for traditional Medicare enrollees, legislation introduced by Senators Elizabeth Warren (D-Mass.) and Chuck Grassley (R-Iowa) required the Food & Drug Administration (FDA) to create a rule greatly expanding access to over-the-counter (OTC) hearing aids, which the FDA did in 2022. These OTC products (suitable for mild-to-moderate hearing loss) can be significantly less expensive than prescription hearing aids. And while the president’s proposed dental benefit for traditional Medicare did not survive the legislative process, the Biden administration has expanded the definition of “medically necessary” dental care under Medicare Part B.
A 2021 study by Kaiser Family Foundation indicated that MA customers “still generally end up with significant out-of-pocket costs” for hearing, dental, and vision care.
Some Medicare Advantage (MA) plans do offer hearing, dental, and vision coverage—but those benefits are extremely modest and don’t always make up for the disadvantages of Medicare Advantage. Many MA insurers are under investigation for overbilling the government, denying authorizations for reasonable medical procedures, and misleading customers through celebrity ad campaigns. Meanwhile, Medicare Advantage plans restrict beneficiaries to limited networks of providers and sometimes don’t cover medical care outside of a patient’s home region.
A 2021 study by Kaiser Family Foundation indicated that MA customers “still generally end up with significant out-of-pocket costs” for hearing, dental, and vision care. “It stands to reason there would be lower out-of-pocket spending in Medicare Advantage than in traditional Medicare, but the differences are not as large as one might expect,” Tricia Neuman, a senior vice president at Kaiser Family Foundation, told Kaiser Health News.
These privatized Medicare plans, which unfortunately are growing in market share under the power of their advertising (boosted by a pro-MA bias during the Trump administration), were not part of the original vision for Medicare when President Johnson signed it into law. Traditional Medicare is the bedrock program which has provided seniors with health security since 1965. It must be preserved—and expanded—in accordance with the real needs of 21st century seniors.
On this 58th anniversary of Medicare, let’s recommit to President Johnson’s promise of the “opportunity to achieve and enjoy good health” and provide “security against the economic effects of sickness.”
"In the midst of a broken and dysfunctional healthcare system, I will be doing everything I can to expand community health centers so that every American has access to the primary care that they need and deserve."
Sen. Bernie Sanders warned Monday that without swift congressional action, the $5.8 billion in federal funding relied on each year by community health centers around the United States will expire on September 30, resulting in a devastating "primary care cliff."
"Congress can and must avoid" such a scenario, says a statement from the Vermont Independent's office.
Sanders announced that the Senate Health, Education, Labor, and Pensions (HELP) Committee he chairs is scheduled to hold a hearing this Thursday at 10:00 am ET titled, "Community Health Centers: Saving Lives, Saving Money."
Millions of people in the U.S. currently receive lifesaving services from community health centers in thousands of neighborhoods nationwide.
“In America today, community health centers are providing cost-effective primary medical care, dental care, mental health counseling, and low-cost prescription drugs to 30 million people regardless of a person's bank account or insurance status," said Sanders.
"Not only do these health centers save lives and ease human suffering," Sanders continued. "They save Medicare, Medicaid, and our entire healthcare system billions of dollars each year because they avoid the need to go to expensive emergency rooms and hospitals."
"In the midst of a broken and dysfunctional healthcare system, I will be doing everything I can to expand community health centers so that every American has access to the primary care that they need and deserve," he added.
According to the senator's office:
Nearly 100 million Americans live in a primary care desert, nearly 70 million live in a dental care desert, and some 158 million Americans—nearly half the country's population—live in a mental healthcare desert. Today, 85 million people are uninsured or under-insured, over 500,000 people go bankrupt each year because of medically related debt, and more than 68,000 people die each year because they cannot afford the healthcare they desperately need. Expanding community health centers will begin to address this urgent crisis.
The following individuals are scheduled to testify at the hearing: Amanda Pears Kelly, chief executive officer of Advocates for Community Health and executive director of the Association of Clinicians for the Underserved; Ben Harvey, chief executive officer of Indiana Primary Health Care Association; Robert Nocon, assistant professor at Kaiser Permanente Bernard J. Tyson School of Medicine; Sue Veer, president and chief executive officer of Carolina Health Centers; and Jessica Farb, managing director at the Government Accountability Office.