October 22nd, 2005

Brad @ Burning Man

A Serious, Implementable (US) Health Care Political Proposal

Imagine that, at some party or event that I'm also at, some elected office holder who's interested in advancing from, say, local to statewide or statewide to national politics were to bring up the following problem. He's got the donors, he's got the staff, he's got the volunteers, he's got the experience managing a campaign. What he (or it could equally we be she) doesn't have is a signature issue. To get "brand recognition" as a politician, the kind of statewide recognition that it takes to stand out above other candidates on a primary election ballot, you have to be known for something, after all. It really helps if while you were in office, or failing that if at least while you're on the stump this time, you have a specific proposal that you and only you (or your coalition and only your coalition within the party) are known for. And if you can make it something that your party would pretty nearly all agree with, and a significant percentage of the other political party's members would approve of, then you've found the holy grail of politics, a perfect "wedge issue" that you can use to split the other party, not to mention carry a fair number of the independent voters. Well, I wish somebody in that position would ask me. Once I get back to having enough money in the bank to secure transportation, I probably will start going to local township club meetings again, in hopes of finding a candidate to advise. You see, after this last (fortunately, winding down) bout of grinding, crippling, near-homeless-level poverty, I've had time to think some more. And I think I've got the perfect political proposal for these times:

Single-payer universal preventative dental health care.

Remember that heart-wrenching column that bounced around LiveJournal right after Katrina made landfall, "Being Poor Means..."? One of them hit me right between the eyes, not only because I had been there in my previous bout of homelessness and poverty, but also because at the time the article was written, I had a friend and two acquaintances in exactly that position: "Being poor means hoping the toothache goes away." If you haven't been to the dentist in so long that a cavity has finally penetrated to the nerve ending, and the tooth has begun to rot from the inside down to the root, well, there's no pain on earth quite like it. And yet, in exactly that condition, we expect the poor and the working poor to continue looking for work; to show up to job interviews smiling, neatly pressed, enthusiastic, friendly, and on their best behavior; and then if they get the job to show up to work and do their best work, day after day, from then at least until they get their first paycheck and then can make an appointment with a dental surgeon to get a root canal or, if it's too late for that, to get the rotted tooth surgically extracted ... all the while, suffering the torments of the damned. Now, I know that you can say that about a lot of medical conditions. But the idea of free dental care has a long list of advantages that any other form of "socialized" medicine wouldn't have, and misses out on a lot of the shortcomings. I'll show you what I mean after I lay out the basic proposal, which is this:

Send every American with a Social Security number an annual coupon, mailed with the tax form that they file or on which they were claimed as a dependent last year, for one free tooth cleaning and dental checkup. Make those coupons reimbursable at a fixed rate, say around $100 (but negotiable in the legislative process, and of course reviewed at least as often as the minimum wage) via the Federal Department of Health and Human Services when submitted by any dentist or dental care clinic.

Why dental care and not any other medical procedure?
  1. It's cheap, and not getting any more expensive. There's not a lot of patented or trademarked or copyrighted research to be funded by the profits, nor even a lot of university research likely to lead to expensive new techniques, on how to clean teeth or diagnose dental problems. None of the equipment is really any newer than what, forty or fifty years? Long since generic, long since already equipped in even the most tiny, rural and/or third world dental practices. There's not any measurable risk of malpractice, because there really isn't anything that goes wrong with a basic tooth cleaning and a checkup. Which means that if you assume that there are something like 280 million Americans with SSNs, even if you could persuade all of them to use their coupons every year, the whole cost of the program would be $28 billion. That may sound like a lot to you, but trust me, to the federal government it isn't. It's even less when you consider that ...

  2. The payback is almost immediate. The first time you fill a cavity for someone for $40 that they promise to pay back out of their first paycheck instead of them waiting to find a way to finance a $400 root canal, you've put an American who otherwise couldn't work, back to work. Trust me, that person will pay a lot more than $100 in payroll taxes that first year, and from then on. What's more, a basic dental checkup catches a ton of other potentially very expensive illnesses in their early stages, not least of which cancer of the mouth or throat. Every time you're able to refer someone to early treatment, instead of them not catching the problem until their health disintegrates, ending up requiring several years' worth of expensive, extensive surgery and long-term or permanent hospital intensive care, you've saved Medicare, Medicaid, private insurance, or some hospital emergency room many tens of thousands of dollars. What's more, annual professional dental cleaning has been shown to do wonders, even more than lowering cholesterol and about as much as losing a ton of weight, for lowering stroke and heart attack rates; the current prevailing theory is that if a dental carries infection lasts long enough, it goes systemic, causing thousands of tiny wounds in the blood vessels that scab over internally, clogging arteries and throwing clots.

  3. It's so cheap that you don't have to get into fights over who "deserves" it and who doesn't. Maybe Bill Gates and Warren Buffett can afford their own dental checkups and cleanings, and maybe they might choose to use that coupon. But for crying out loud, it's only $100, who cares? And for that matter, what are the odds that they're likely to? You think that someone making the kind of money they do wouldn't rather choose get fancier service, with shorter waiting times and more personal attention, by paying their dentist more than $100? But since we're talking about glorified pocket change, the whole argument is moot.

  4. There are no arguments over who "needs" the service and who doesn't. Everybody needs it. Everybody needs the same amount of it. So you don't have to have an elaborate benefits determination bureaucracy somewhere deciding whose dental cleaning and checkup gets paid for and whose doesn't. Your program costs are limited to the cost of printing up the coupons and a few spot-check audits to make sure dentists are actually performing the services that they're submitting the coupons for. You don't even get into arguments about providing dental care to illegal immigrants if you tie the coupons to valid, on-file SSNs. No giant government bureaucracy. No heartless insurance company paper pushers. No plaintiff-friendly juries or plaintiff-hostile judges; no plaintiffs at all, really. And finally, ...

  5. Nobody is going to make the "moral hazard" argument about basic dental care. Nobody, not even the most strident right-wing conservative out there, is going to get on Tim Russert's show or on Hannity and Colmes and say, "If you make going to the dentist free, people will abuse the service, and go to the dentist over and over again just because it's free."

(Programming Note: Saturday night is a large party that I'm rather looking forward to. I rather expect to come home very late, completely exhausted, and moderately smashed. If I write anything on Sunday, don't expect to see it before late afternoon at the earliest.)