The politics of toothaches

Mr-ToothA couple of days into my recent trip to Mexico I developed a toothache. Not a please shoot me now! toothache, but the sort that makes you start avoiding one side of your mouth, like that neighborhood you stay out of after dark because it’ll be trouble.

I could tell this was going to be an expensive toothache — the pain was deep down in the bone — so I flossed and brushed and hoped it might just go away. But like the Packers, my immune system let me down. My white cells just didn’t leave it all on the field.

I went to my dentist, and after $250 of digital x-rays and a good cleaning he agreed that I had a real problem — one that he couldn’t fix. He referred me to a young endodontist at Root-Canals-R-Us.

Waiting nervously in the comfortable waiting room, I hoped I might just get away with a prescription for some 21st-century antibiotics. Didn’t DuPont coin the slogan better living through chemistry? Sure, they were thinking more about stain-resistant carpeting than rotting teeth, but… drilling seems so 1800’s!

Young Dr. Dan sadly reported that he would have to drill, and to his credit the entire procedure was painless and stress-free. At my request, he gave me a running commentary as he worked. Now that I know how it’s done, I might try to earn back Dr. Dan’s $850 fee by opening a discount root-canal business in my garage.

Eleven hundred bucks so far, and in a few days I’ll get fitted for a $500 cap — you can’t leave holes in your teeth, I guess. I could have had a decent-sized plasma-screen TV for what I’ve sunk into saving this tooth.

If I hadn’t had insurance or money in my piggy bank, my least expensive option would have been extraction. Which is why you see so many poor people with gaps in their smiles, like the young woman behind the counter at my local Burger King who smiles with her lips closed to hide her missing teeth.

Good teeth are one of the differences between the wealthy and the poor. We who can afford modern dentistry rarely give our teeth much thought. Others, like the young lady at Burger King, seem to think of little else.

In a new Pew Research poll cited here by Joe Carter of the Evangelical Outpost, Republicans and Democrats were asked to rank the top issues facing the country. I’ve listed 5 of the 21 issues raised and the percentage of Republicans vs. Democrats who see that concern as a “top priority”.

Providing insurance to uninsured: R – 27%, D – 65%
Improving job situations: R – 43%, D – 76%
Reducing health care costs: R – 53%, D – 81%
Dealing with problems of the poor: R – 34%, D – 62%
Securing Medicare: R – 47%, D – 66%

The disconnect between the concerns of Republicans and Democrats is widest, in this survey, around this cluster of worries about jobs and health care. What explains it? Are Republicans simply better insured and more secure in their jobs? Do they feel disdain for the problems of the poor, as some claim? As a class, do Republicans have more money than Democrats?

In an analysis of the Forbes 400 Richest Americans, Val Burris of the University of Oregon found that 29% of the “newly rich” supported Democratic causes vs. 52% supporting Republican causes. Among the “old money rich,” 19% leaned Democratic vs. 69% Republican. Those figures suggest something like a 2 to 1 ratio in America’s wealthy class between Republicans and Democrats.

Does that suggest the opposite is true among the poor? And if so, are Republicans perhaps out of touch with the day-to-day concerns of working class America?

To be clear, I don’t believe Dr. Dan overcharged me. He x-rayed my tooth with a $90,000 machine. His office employs a receptionist, two billing/records clerks, three endodontists and four technicians. He (thankfully) made use of costly anesthesia and antibacterial drugs. He is required to carry a very expensive malpractice policy and pays rent on a modest suite of offices in an expensive neighborhood. He employs a CPA to do his books and pay his employees’ salaries and taxes. He has to remain licensed by the state, taking expensive courses to keep his knowledge current.

If the government insured us all, they would try to save money by putting the squeeze on Dr. Dan. That sort of squeeze is why so many doctors don’t accept Medicare patients — government reimbursements fail to meet the doctor’s expenses.

That sort of reimbursement squeeze has forced many English doctors to abandon their careers, forcing England to hire less qualified doctors from the second world. In Canada and England, health care is rationed to save money, which means long waits to see a doctor.

We would like America to be a just society. A system that favors the rich over the poor is not a just system. Are Americans smart enough to figure out a way to provide adequate health care for the poor, while not crushing the entrepreneurial incentives that drive talented doctors, creative pharmaceutical researchers and top-notch hospitals to solve our worst medical challenges?

Can we call ourselves a just society if good health care is only available to the privileged?

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  1. This was a refreshing look into the government-provided health care debate. I particularly appreciate your second-to-last question: “Are Americans smart enough to figure out a way to provide…” I think this issue is confusing and complex, and simplistic answers will not solve the problem.

  2. Ouch! Last summer, I went for a routine dental exam (ha). The first hit was on my wallet – no dental insurance. Then I learned one of my teeth needed extensive drilling and repair.

    I don’t know which was worse – the financial pain or the physical pain. After numerous shots of novacaine, the dentist informed me he had nothing stronger and the next thing was hitting me over the head with a mallet. I seriously considered the mallet, but toughed it out.

    $500.00 later at least my tooth is happy and intact. Next time I go to a dentist, I’m shopping around.

  3. Hmmm, I’m intrigued. This isn’t a new debate for our family. Am I understanding it correctly to say that you are not in favor of more government-run health care, but that you do feel the need to get all Americans health care? If you are, I think we might finally agree on this issue. Now the only question is how to do this.

  4. Hannah: My ideal system would be a government-funded medical debit card (savings account) that gets loaded based on a person’s tax return statements of W-2 earnings and dependents. Singles might get $2,000 per year, couples $4,000 with another $1,000 per child. The government might also match additional contributions to give people an incentive to put their own money towards health needs.

    Taxpayers could either use the account to buy an insurance policy, or use it as cash to buy drugs, doctor visits, etc. as needed. It could be managed by banks as the current Health Savings Accounts are.

    Consumers could only buy insurance policies that have a certain basic set of benefits or better, so companies won’t rip off the poor. Money not used at the end of the year would roll over, not disappear. But the money could never be used for non-medical needs, and when the person dies the money in the account would go back to the government.

    Something like that would encourage market-driven, private health care solutions.

  5. Hi Charlie –

    I found your solution to the health insurance dilemma interesting, but inadequate. $2,000 is a drop in the bucket when it comes to medical expenses or even purchasing health insurance.

    For the privilege of having health insurance, it costs me close to $900 per month. If I just used the $2,000 for medical expenses, I would have chewed that up with one MRI never mind two major surgeries, physical therapy, doctor visits, X-Rays, etc.

    I wish I had an alternative suggestion, but I don’t. Maybe if U.S. companies would stop shipping all of our jobs overseas, we’d have more folks with benefits.

  6. I have 3 half-brothers in England that have dual British-US citizenship. All of them have been treated by dentists in both England and the US. They ALL asure me that there is no real difference in professional services between the two: the office waits are about the same, the services are about the same, and the equipment used is about the same.

    The one difference is the price of the services. Recently, the oldest endured a horrendous amount of pain the last couple of days before he flew back home to England, simply because he didn’t want to get trapped in the US medical mess. This is a very intelligent and educated man that I had to watch endure an ungodly amount of pain; and if he tells me that his government-provided healthcare is actually better then our expensively pampered doctors and dentists…

    I don’t want to spend a large portion of my life in indentured servitude because something went wrong in my body, I just want my damned tooth pulled!