As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care. High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter.
Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth. Unable to afford expensive root canals and crowns, many simply have them pulled. Nearly 1 in 5 Americans older than 65 do not have a single real tooth left.
This is the problem with “free market” capitalism, in a nutshell. According to “free market” ideology, as long as government doesn’t interfere the Holy Free Market naturally finds the most cost-effective and efficient way to provide what people need. It’s like a natural law; water flows downhill, flowers bloom in the spring, free markets create abundance for everybody. But in the real world, that’s now how it works. Without government intervention, free markets let some people sink into genuine deprivation in favor of providing boutique, luxury services for the wealthy.
This is particularly true where it comes to health care. There are some things that can’t be done on the cheap, no matter how free the markets are. And I believe we are the only developed nation still trying to provide health care through a mostly private system, and which has little to no controls in place to stop price gouging.
The Affordable Care Act amounted to a system of regulations and subsidies designed to make the existing system fairer, which it did, although not perfectly so. It had several cost-control measures in place that seemed to be having some effect to slow the increase in health care cost, although that is disputed.
But the Republican plan primarily seems to be to lower insurance costsÂ allowing companies to cover fewer medical problems, without doing anything to tackle the factors that are driving up medical cost. This is like driving down the cost of home owners insurance by selling policies that don’t cover fires.
But getting back to dental work — modern dentistry is not going to make itself more affordable to the poor in the same way that consumer electronics companies might find ways to lower the prices on their gizmos. (See Why Your Dentist Costs So Much.)
The WaPo article describes a two-day clinic “event” in which a bunch of dentists volunteeredÂ to see people for free. Mostly they pulled teeth that were too far gone to save. People who hadn’t seen dentists for many years drove there from five states. Many people had jobs, but they had no dental insurance and no “leftover” cash to take care of dental problems as they came up.
Matello had both problems, adding to her frustration about being cut off from a world that many wealthier Americans take for granted.
â€œThe country is way too divided between well-off people and people struggling for everything â€” even to see the dentist,â€ she said. â€œAnd the worst part is, I donâ€™t see a bridge to cross over to be one of those rich people.â€
Matello voted for Barack Obama in 2008, thinking he offered the best option for working people, but she sat out the 2012 election. Last year, she rallied behind Trump after listening to him talk about â€œthe forgotten men and women of our country, people who work hard but donâ€™t have a voice.â€
â€œIâ€™m running to be their voice,â€ Trump said repeatedly.
What Matello heard was a promise â€œto restore pride to the working poor.â€
A big part of that promise was Trumpâ€™s assurance that he would build a â€œbeautifulâ€ health-care system to serve every American, a system that would cost less and do more. But nearly four months into Trump’s presidency, Matello sees Trump backing a Republican health care plan that appears to leave low-income people and the elderly worse off.
â€œI am hearing about a number of people who will lose their coverage under the new plan,â€ Matello said. â€œIs Trump the wolf in grandma’s clothes? My husband and I are are now saying to each other: â€˜Did we really vote for him?â€™ â€
We might argue that Ms. Matello and others like her were hopelessly naive to believe anything Trump said, but television news media were normalizing him way too much. Nobody on tee vee ever explained why Trump couldn’t possibly deliver what he was promising.
And here’s why we should be more concerned about dental problems:
George Acs, director of the dental department at Chesapeake Health Care, a clinic near Salisbury, said people with oral pain and infections are inundating hospitals. Last year, more than 2 million U.S. emergency room visits were attributed to neglected teeth.
â€œWhat I am seeing is absolutely horrifying,â€ said Acs, who recently testified about the problem before the Maryland state legislature.
Although those hospital visits cost an estimated $1.6 billion a year, the ER is generally not equipped to fix dental problems, Acs told lawmakers. So ER doctors just medicate people with â€œa perpetual cycle of antibiotics and opioids.â€
That cycle is feeding a nationwide epidemic of opioid addiction.
The business of keeping dentistry separate from other medical problems is stupid to begin with and needs to stop. But as some of the people interviewed in the article say, having bad teeth is a real social and economic impediment as well as a medical problem.
Over two days, 116 dentists treated 1,165 patients, providing $1 million worth of fillings and other care, according to the Mission of Mercy. Matello was grateful. She was told her panoramic X-ray and extraction would have cost $600 to $800 in a regular office.
She looked at some of the others who had come here, despite working for a living cutting down trees, building homes, minding a town library, running small businesses.
â€œWe are not staying home, not sleeping and living off the government,â€ she said.
She wondered why there wasnâ€™t a better system for people like her. She tried not to look at the 51-year-old truck driver lying next to her who had three teeth pulled, his mouth stuffed with bloody gauze.
â€œI am trying to think that this is not demeaning,â€ she said as she cleared the chair for the next person in line. â€œBut it is. Itâ€™s like a Third World country.â€
Yes, and it’s maddening that people like Ms. Matello support politicians who are making things worse for her, but in the recent elections, what did Democrats offer to do for her? If anything?