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good oral health is important
Good Oral Health Is Important
One of the old tropes used by the GOP and their complaint corporate media drones is that the Affordable Care Act (ACA) will 'destroy' a health care system that we were told wasn't that bad. Opponents to the ACA want us to forget why the ACA was proposed and passed in 2010. Even with the ACA taking full effect there are still examples where the health care system needs further reform for the poor due to lack of funding, red tape, and yes even high costs. Bob's story shows why this particular conservative argument against the ACA is full of crap.

Watching someone without dental insurance trying to get emergency care is exactly what it was like for all people without health care insurance before the ACA.

Bob (I've changed his name for privacy) had a tooth go bad a week before Christmas. He doesn't own a car but has Social Security Disability, Medicare, and has Medicaid with a high spend down (approx $500 a month). His city has several public health clinics that include a dentist. They charge $40 for a visit and a sliding scale payment plan for any procedures.

Medicare doesn't cover dental services and the spend down on his Medicaid is so high it would mean that Medicaid wouldn't cover the possible extraction of a tooth. Think of the $500 as a deductible - the amount you pay out of pocket before insurance pays anything. For a guy with only $200 after rent, food, and utilities each month, $500 is beyond his means unless his need is catastrophic. The Affordable Care Act only requires coverage of dental services for children.

Bob's tooth is hurting so he checks out the website of the public health dental clinic and learns they only take 3 emergency patients a day. Yes, only three a day. If you want to be seen as an emergency you have to be at the clinic by 7:45 AM and even then there is no guarantee you will be one of the three. Regular appointments are scheduled at the beginning of the month for slots in the following month.

Bob also has to have proof of income so that his sliding scale payments can be set. It's means testing. If you can afford to pay more you will. If you don't qualify for the sliding scale, the payments for service start at $279.

It's Friday afternoon so the next opportunity to go to the clinic will be Monday morning. His jaw hurts and is swollen. An abscess can kill you if not treated so he goes to a local emergency room. They won't remove a tooth unless your life is in immediate danger so Bob gets a prescription for an antibiotic and pain pills to get him through the weekend. He also gets a bill for $230.

On Monday, Bob gets to the dental clinic on time. This is when he finds out he forgot his proof of income and he knows by the time he goes home and comes back he will not be one of the golden three. He is told the clinic will be closed the next day for Christmas Eve and will reopen the day after Christmas.

Now Bob has to survive two more days in pain. Happy Holidays!

On the 26th Bob arrives even earlier then he did on Monday and has to wait for the door to be unlocked at 7:30 AM. He notices he is the only person in the clinic as he goes up to the front desk. The receptionist informs him the Dentist won't be in until January 2nd. Even though Bob was told on Monday they would see patients today now that has changed without notice.

As an alternative Bob decides to go to the major public University Hospital in town. He remembered years ago visiting their dental clinic on a Sunday when a tooth had gone bad. It was not free but reasonable. The only concern was the fact that dental school students do the treatments.

The University Dental Clinic accepts 10 emergency patients a day and when Bob arrived he was number 8 on the list. Great! He thought.

He spent thirty minutes filling out the paperwork and then is told he would need to pay $113 up front for something as simple as an extraction.

Bob doesn't have $113. That's why he's going to the particular places he's going to seeking treatment. If he had $113 in cash he would find a private dentist who could take an emergency case.

There are some charity dental clinics in the city operated by religious organizations but they don't have a regular five day a week schedule - more like once or twice a month early in the morning or in the evenings. Since it's the holidays there are no charity clinics open until after the New Year. Of course.

Now Bob has to try to survive until January 2nd.

Well on January 2nd his ride to the clinic overslept. The next day they had an emergency of their own they had to take care of in the morning so now there was another weekend Bob would go without seeing a dentist.

Early the next week Bob's city was hit by the Polar Vortex which shut down most of the public health system. The next available date he could go to the Dental Clinic would be the coming Friday.

He arrived at the clinic on Friday shortly before 7:30 and saw five people waiting around. "Oh, no," he said. "Not again." He starts thinking of plan to arrive even earlier the next day if he is shut out today.

Once at the front desk he learns that he is second on the list and four of the other people waiting there had scheduled appointments.

Bob also learns that his payment scale is 30%. His crappy basic health insurance he had in his twenties made him pay 20%. He now is expected to pay more than he would if he had crappy employer insurance - even higher than the basic ACA health plan.

Finally. After three more hours in the waiting room, he sees the dentist and the tooth is taken out.

Three weeks in pain, not able to fully eat, and having to go back to the clinic three times not to mention the failed visit to the University Hospital, Bob finally had the bad tooth addressed. He then told me the story of having a bad infection in his leg several years ago and having to wait 12 hours in an ER for treatment so the wait for the dentist rolled off his back. I was the one who was mad.

Before the ACA was passed 47 million people were without insurance. The only plan was the Emergency Room plan - need immediate care, go to the ER - the rest of the time you roll the dice and hope you don't get sick.

Charity care is still rationed and unless you are in danger of dying that day you have to wait. You also have to go through more hoops to get care just like Bob did for his tooth. We both had to laugh when we remembered the Republican's alternative to the ACA is the ER plan and churches. It's good politics for them but not good health care for the poor.

One change I would make to the ACA is to have dental insurance coverage for adults and add it to Medicare. Oral health can have a connection to our overall health. Some medicines and certain diseases can make oral health worse.

The Republicans and other cheap labor conservatives will continue to blow smoke up our collective behinds by claiming the health care system was great before the ACA. Bob's story makes that claim a lie.


Originally published on Doug's Views

Originally posted to Doug's Views: DK Edition on Mon Jan 20, 2014 at 08:01 AM PST.

Also republished by Community Spotlight.

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Comment Preferences

  •  Yeah, but having checked the dental plans in (4+ / 0-)
    Recommended by:
    Dvalkure, raincrow, La Gitane, beemerr

    the marketplace, I discovered that they don't cover a whole lot of stuff.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

    by zenbassoon on Mon Jan 20, 2014 at 08:55:40 AM PST

    •  Same experience here, ZB (1+ / 0-)
      Recommended by:
      linkage

      for about 50. $ per month I could get dental, but the only semi-local dentist in the network is not a good one.

       I'll look into it again next year and see if better is offered by then. ACA has been a very great boon to me, even in a state where the 'gov' has not supported it. We have a newly created not-for-profit health care co-op and it is wonderful.

      “Good things don’t come to those who wait. They come to those who agitate!” Julian Bond

      by Dvalkure on Mon Jan 20, 2014 at 10:26:25 AM PST

      [ Parent ]

    •  Like the ACA something is better than nothing (3+ / 0-)
      Recommended by:
      OleHippieChick, wasatch, JerryNA

      I surprised that the ACA even had what little dental coverage it did since Medicare doesn't have it

    •  Agree. We dropped our plan for 2014 (2+ / 0-)
      Recommended by:
      linkage, sillycarrot

      Still limited to $1500/yr maximum per covered individual, same as past 10+ years. In 2013 wife&I paid $888 total premiums, but reimbursed only $688 total after all the paperwork submission BS. We do have a superb and non-network dentist. Prior experience with dental HMO chain dentistry was horrible. Dental is just a big suck-it-up for many of us.

    •  That's noted here, but not nearly in (5+ / 0-)
      Recommended by:
      splashy, cadfile, wasatch, OooSillyMe, JerryNA

      enough detail:

      The Affordable Care Act only requires coverage of dental services for children.
      Adults get a crapshoot, and it's not even a good one at that! It doesn't only suck for "Bob" here, although it's a good example. WHY didn't they write emergency dental care into this for all? An abscess can kill you as a grownup, just like it can kill you as a kid!

      Jesus Facepalm...

      This all started with "what the Republicans did to language".

      by lunachickie on Mon Jan 20, 2014 at 10:53:33 AM PST

      [ Parent ]

      •  There are options to get dental in the marketplace (1+ / 0-)
        Recommended by:
        cadfile

        The policies are like $50 a month for individuals, but they don't cover a whole lot past regular exams.

        "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

        by zenbassoon on Mon Jan 20, 2014 at 11:08:55 AM PST

        [ Parent ]

  •  Everyone needs dental care (12+ / 0-)

    and a dental emergency is no different from any other health emergency.

    Fight them to the end, until the children of the poor eat better than the dogs of the rich.

    by raincrow on Mon Jan 20, 2014 at 10:24:34 AM PST

  •  Our Medicare Advantage plan includes dental care. (4+ / 0-)

    Everyone should have similar access to a dentist, whether through Medicaid or plans approved by the ACA.  I once found help for an immigrant student with a swollen jaw by sending him to a dentist I knew, who extracted a tooth for free. But he needed a specialist for another tooth, and that required having a religious charity send him to a publicly funded center where the operation was performed for $30.

    The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

    by ybruti on Mon Jan 20, 2014 at 11:09:23 AM PST

  •  Dental care needs to be manditory component (9+ / 0-)

    of all health plans, and not simply an afterthought, as oral health and somatic health go hand and hand.  The copays and deductibles need to also be reasonable, otherwise many people who do have insurance, like myself, will still forgo dental care.  Between inheriting my father's terrible teeth, some shoddy dental work from when I was younger and some periods of poor hygiene, at 27 years old I've already lost two teeth, and I have at least two others that are likely beyond saving and will need to be pulled, if I can ever afford to go to the dentist.  I have dental insurance at the moment, but the out of pocket costs for anything but basic care are extraordinary.  I'm afraid even to go in for a cleaning, because I'm both embarrassed and worry about the prognosis the dentist will give me.  I dread what my smile will look like in twenty or even forty years.  I can only hope I'll be making enough money at that point where I can afford implants.

    •  Skipping the care you can get b/c you're worried (1+ / 0-)
      Recommended by:
      cadfile

      about the care you can not afford is only hurting yourself. Please go. Talk to your dentist while you are there and explain your situation. Worst that can happen is you get a cleaning, right?

  •  EVERY piece of legislation needs work (4+ / 0-)
    Recommended by:
    bobtmn, cadfile, virginwoolf, JerryNA

    Even the most iron-clad, we-thought-of-everything piece of legislation needs some additional work, when ambiguous phrases or fuzzy words start creating loopholes never intended by the legislators who drafted it.

    Sometimes these problems are fixed in the administrative rules, which is where the practical application of laws gets addressed, and ambiguities are clarified and straightened out. Other times, a particularly intricate law might have contradictions between various subparts, or conflicting interpretations arise because one section defines some element differently from another section. In those instances, it's often remedied by legislation that amends the original bill.

    None of that has happened with the Affordable Care Act, an extraordinarily complex law with lots of moving parts. If Congress was capable of good-faith legislating, problems could be resolved and oversights addressed. Sadly, in today's political atmosphere, there's no way the ACA can possibly be made to work better, and at least one political party is blindly committed to make sure it works as poorly as possible.

    Thank the Republicans for boldly attempting to bring back coverage denials for pre-existing conditions, omitting dental care, and working their darnedest to be sure their campaign bankrollers in the insurance industry have lots and lots of money to give them.

  •  As usual, The Onion says it best. (11+ / 0-)
    WASHINGTON—With the Affordable Care Act now making it possible for a greater number of Americans to purchase medical coverage, the nation looked back this week and fondly recalled a simpler time when its health care system was broken beyond any hope of repair.

    Describing a more innocent period in the country’s history—before opponents of the act temporarily shut down the government, and before the disastrous rollout of the new insurance exchanges led to widespread public exasperation—citizens shared with reporters their warm memories of what they called a bygone golden era

    “Back then, if you couldn’t afford health insurance and got really sick, you went bankrupt, plain and simple,” said Dominique Otis, a Modesto, CA mother of three. “They didn’t have this whole mess of lower-cost options, or all these subsidies you might or might not qualify for based on your income. People didn’t have to deal with any of those headaches. They just went ahead and died of preventable causes.”

    “Those were the good old days, ya know?” she added with a sigh.

    More from The Onion article
  •  We are closed systems, everything's related, (8+ / 0-)

    and the teeth are really near the brain. Teeth are vital to our health yet stupidly excluded from care. We're barbarians.

    "He went to Harvard, not Hogwarts." ~Wanda Sykes
    Teh Twitterz, I'z awn dem.
    Blessinz of teh Ceiling Cat be apwn yu, srsly.

    by OleHippieChick on Mon Jan 20, 2014 at 05:09:23 PM PST

  •  Obamacare preserves the worst aspects US healthcar (2+ / 0-)
    Recommended by:
    cadfile, JerryNA

    It would be far cheaper and more popular to simply extend Medicare to everyone.
    http://www.healthcare-now.org/...

  •  I have lived Bob's nightmare. I tried to get (2+ / 0-)
    Recommended by:
    Russycle, cadfile

    dental insurance through the exchange as I am on Medicare now but that is a no go if you don't buy insurance on the exchange.  Dental insurance covers so little that it is almost not worth the cost.  There are plenty of health issues that go along with poor dental care and all the brushing and flossing in the universe won't fix that.  When will this country wake the hell up?

  •  Liste to these GOP cretins talk about all their (2+ / 0-)
    Recommended by:
    JerryNA, cadfile

    freedoms being taken away from them, and that they are living in a Marxist socialist country.  They're ludicrous lies that they can't even begin to explain, if you were to ask them.

    The only thing we have to fear is fear itself - FDR. Obama Nation. -6.13 -6.15

    by ecostar on Tue Jan 21, 2014 at 08:43:50 AM PST

  •  Well, it worked for me. And now it doesn't. (0+ / 0-)

    I had an very comprehensive policy and investments of time and money finding the best doctors in my networks. Now, along with hundreds of thousands of other sole proprietors/partnerships, the ACA has eliminated our ability to purchase group coverage, while at the same time making it extremely difficult to get coverage via the exchange because of income verification issues. So, I liked my policy and my doctors, and I will not be able to keep either my policy or my doctors. In every way, shape, and form, we are markedly worse off under ACA.

    So, screwed, tattooed, and lied to, to boot. Am I pissed off? You bet.

  •  My dentist extracted a tooth (1+ / 0-)
    Recommended by:
    cadfile

    (except wisdom teeth) for $75 the last time I had one out a few years ago here in Florida.

    Wisdom teeth are more difficult to extract. My dentist refers them out to a specialist who would have charged about $300/wisdom tooth a few years ago.

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