Thinking about Teeth

New Orleans   Maybe it’s personal. Several weeks ago, I had a root canal. It’s shocking how much those bad boys cost, and talking to a friend in the northeast, he had to pop for another $500, so I guess it’s time to stop my whining.

On the doors last week though it wasn’t personal. One of my comrades cracked wise, as we were debriefing, that we needed to keep some kind of teeth-to-tattoo count in order to figure the ratios. I laughed then, but the next day in Akron the first three doors my team hit, the count was zero teeth on the first two (with some tattoos!) and ten or so in the front on the third door with three or four tats.

Why don’t we do better in making sure low and moderate income families have dental care?

Reading a newly published book by Mary Otto called Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America, provided chapter and verse while detailing one horror story after another of death and debilitation in lower income communities. Here are some startling facts from Otto’s book:

· For reasons including poverty, isolation, and the lack of private insurance and providers available to treat the poor, roughly one-third of the people living in America face significant barriers to obtaining dental care
· More than 35 million poor children are entitled by federal law to dental benefits under Medicaid, but more than half go without care. Fewer than half the nation’s roughly one hundred fifty thousand working dentists participate in the program.
· Approximately 49 million Americans live in communities that are federally designated as dental professional shortage areas.
· Private and even public dental benefits can help defray the cost of services. But more than 114 million Americans lack them entirely
· Among U.S adults who struggled with unpaid medical bills, 12 percent reported dental bills made up the largest share of the bills they had problems paying, a 2015 survey found.
· Medicare, the nation’s health care program covering roughly 55 million elderly and disabled Americans, does not cover routine dental services.
· Nationwide, a total of 61,439 hospitalizations were primarily attributed to periapical abscesses during the nine years between 2000 and 2009.
· In 2013, only 35 percent of private practice dentists reported treating any patients on public assistance, down from 44 percent in 1990, a separate ADA survey of dental practices found
· one-third (31 percent) of white toddlers and primary school–aged children (aged two to eight) have decayed teeth, the disease afflicts closer to half of black and Hispanic children (44 percent of black children and 46 percent of Hispanic children). And minority children are twice as likely as white children to go without treatment for the decay.

You get the message. Otto’s book makes it clear that the dentists bear a huge share of the responsibility here. They make more per hour than doctors. They have fought allowing dental hygienists doing more, including in public schools. They recommend costly procedures, rather than sealants. They opposed expansion of dental benefits in the original Medicare legislation. They drug their feet until the 1970s to integrate their state associations and, as you can see, they still do not provide service equitably to non-whites or those on public assistance.

How are they allowed to get away with this?


Why Deny the Poor Access to Telephone Service and the Internet?

lifeline solicitation-500x654Ocean Springs    We can say with confidence and without fear of correction that the coming year will see yet more full scale battles in the war against the poor.

Anyone can make that list.  Certainly it starts with the headliners right now as extended unemployment benefits are being terminated, food stamps are still on the chopping block in the farm bill, and vast hordes are still lined up nationally and state by state building obstacles to access to affordable healthcare.

And, just to pick one example, if you aren’t poor yet, look at the risks in front of you if you are a regular working stiff and don’t have health insurance according to reports from health actuaries.  The average American under 65 years of age will have a healthcare bill of $2700 this year.  5% of Americans will have really bad luck and equally bad health and end up with $47000 worth of health bills, pushing you lower down the economic ladder.  20% will have bills of $13,300 which would be devastating to many.  Yet, we have people saying, go naked with no insurance?  And, I’m not even talking about the problems of low wage jobs or unaffordable housing.  Pick your poison.

Nor do there seem to be limits on how many battles can be waged against the poor.

In Georgia, for example, advocates joined by the telephone industry itself had to sue to temporarily stop the legislature from trying to put a $5 per month fee on the bills for free telephones enabled by the FCC for 15 million lower income Americans.  These “lifeline” phones only give 250 minutes per month of time, but are what they claim, a lifeline for those who can’t afford them but need the ability to make doctor’s appointments, call ambulances, and handle the basic requirements of life.  Some of the howlers are so concerned that someone may have snuck one of these phones who didn’t qualify that they want to pretend that punishing the poor might be the way to stop it, as if a scamster wouldn’t be equally able to go for $5 bucks on that fraud.

Why slap the hand of the FCC on one of the few things they are doing right for the poor, especially given the spectacular failure of the FCC’s $10 per month internet access program for the poor with Comcast and other companies, who continue to promise the sky and deliver spit?  The fact that Cox and Times-Warner delivered even less is small comfort.  No sense pretending that there is a fair shot at the poor pulling themselves up by their bootstraps.  First, they don’t have boots, and then no internet either.

This is an issue throughout North America:

According to Statistics Canada, 54% of households in the lowest quartile of $30,000 or less do not have home internet access. This is roughly consistent with a report prepared for the U.S. Department of Commerce that finds 57% of homes earning less than $25,000 have no computer and that only 43% have home internet, compared with 93% with household income over $100,000.

That number was quoted in a piece  advocating support of ACORN International and ACORN Canada’s digital divide campaign.

About the only protection low income families have now is from the NSA and the spying machine since they aren’t on the internet and might not be on phones enough either. Small comfort.  Maybe it’s time to stop the war on the poor and do something different?


Enforcing Adequate Medicaid Cover for the Poor

Nmedicaid+comicew Orleans Reading the report was one of those Sports Center “come on, man!” moments.  This couldn’t be true.  The top Democratic were filing an amicus curia (friend of the court)  brief with the Supreme Court to try to overturn the Obama Administration’s efforts to allow cutting the standards of health protection under Medicaid for the poor by various states.  Furthermore, this was no rouge group but heavy hitters like Nancy Pelosi, Henry Waxman, Harry Reid, and Max Baucus.  They were joined in similar amicus briefs by former health officials, civil rights groups, the AARP, and others.  What the heck?!?
Here’s the problem.  The feds sent a truckload of money to the states and in California where this case arose the number is $20 billion.  The states have to pick up between 25 and 50% of the costs with the feds on the long end of the stick for 75 to 50% depending.  In the crushing domino fall of the USA economic meltdown not surprisingly the poor would be first in line for a beating.  States in dire straits whack down on their Medicaid spending to save money by cutting the standards of care giving themselves a break and finding a friend on the other side of the deal in the federal government which therefore also saves on its share, leading Obama, the health care coverage so-called advocate, to pop the poor hard.  Reimbursement rates get cut when this happens, so doctors feel the system and the poor not only have diluted coverage but no providers either.
Robert Pear of the New York Times is on this beat and cites the other problem which is the requirements of the law:

“Federal law says Medicaid rates must be ‘sufficient to enlist enough providers’ so that Medicaid beneficiaries have access to care to the same extent as the general population in the area.”

In other words the law is clear that you cannot discriminate in health care coverage, the decisions of life and death, against the poor.
The Obama Administration, seeking the cowards’ cave, argues that enforcement of that unambiguous standard should be the “exclusive responsibility” of federal health officials.  The Congressional caucus and anyone else caring two cents about the 55,000,000 who are covered under Medicaid, know that the feds simply do not have the resources or bureaucracy to police all of the standards in 50 states down to the nap, so they want poor people to be able to sue California and others when they are chumped and cheaped out.  In past presidential administrations such lawsuits were not greeted with universal cheer, but they were recognized as having a vital role in securing the standards of health care and protecting the poor.
What is the political equation which makes it acceptable for the Obama Administration to aid and abet discrimination against the poor and encourage by passivity killing them with neglect?


New Study: Health Insurance Saves Lives of Poor

Nhealthinsuranceew Orleans This should be the least surprising news since you learned that sugar tastes good, but now there is actually statistical proof from a drug-trial-like study that when the poor have health insurance by damn their health improves!  I’m not sure having hard proof will change any minds or votes among lawmakers but at least in the grand debate about health insurance there will now be no pretense that voting to limit or end health insurance for low income families will put blood on your hands, because it will be killing them.  Ok, maybe I’m overreaching, because that will only be clearer once the second phase of the study is completed, but it is pretty obvious where it’s going at this point, so be ready for that, too.

A study “The Oregon Health Insurance Experiment: Evidence from the First Year,” by a baseball team full of academics (Amy Finkelstein, Sarah Taubman, Bill Wright, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Heidi Allen, Katherine Baicker, The Oregon Health Study Group) was published by the National Bureau of Economic Research this week and reported by Gina Kolata in the New York Times. In 2008 the professors jumped on the once-in-a-lifetime policy disaster and statistical goldmine.  Oregon had approved a statewide healthcare Medicaid plan for low income families but did not have the dollars to put the whole show on the road.  In a novel, random solution, the state held a lottery and chose the 10,000 winners, who received the insurance, from the 80000 odd folks who were eligible and therefore equally poor.  The profs then surveyed the winners and measured the outcomes compared to the losers.  It is important to note that Oregon was able to provide insurance to everyone in 2009.

According to the Times:

“Those with Medicaid were 34 percent more likely to go to a clinic or see a doctor, 15 percent more likely to use prescription drugs and 30 percent more likely to be admitted to a hospital.   Women …were 60 percent more likely to have mammograms…20 percent more likely to have their cholesterol checked…70 percent more likely to have a particular clinic or office for medical care and 55 percent more likely to have a doctor whom they usually saw.”

There was also a 25% increase in the numbers who said their health had improved to good or excellent, and “they were 40 percent less likely to say their health had worsened….”

Bam!  Debate over about the benefits of the poor having full health coverage is over!  Yes, people will use it, get better, feel better, and have less medical debt.

Couple this study with the finding I discussed yesterday on the number of people killed annually by inequitable access to services, including health, and this ought to be open and shut on what is indisputably a life-and-death decision.

Who’s ready to have their vote counted now?


Let’s Really Investigate the Doctor Business

Newcroppedimage173106-Doctor Orleans A bi-partisan group of US Senators, led by Orin Hatch (R-UT) has asked for an investigation of physician-owned-distributorships (POD) and the lack of safeguards preventing docs from unnecessary surgeries utilizing devices that enrich them because they are distributors for manufacturers.  A study Hatch released indicated these PODs are legal in 20 states now and seem to be triggering a spate of risky and redundant spinal and orthopedic surgery.  I can only say, “Right on!” and then, “Don’t stop there!”

I am equally suspicious of doctors that display, advertise, and then recommend, i.e. prescribe, supplements and vitamins in their offices as part of treatment and care in order to fatten their pocketbooks even though there may be cheaper and generic alternatives.  When I hear that such doctors are not processing insurance claims for their patients to me that is a neon flashing warning light that these are pocketbook doctors rather than medical doctors and the only pain they are alleviating is whatever you may have had by sitting on a wallet with too many dollar bills.  They clearly know that their “vitamins” will not be covered by insurance nor is it likely that most of their care will be, and they are therefore simply involving themselves in predatory practices on their desperate patients.   Perhaps that example is too easy to stop, but the point is that no one is really regulating doctors now but their own medical boards and that is no regulation at all.

There have long been warning signs on doctor owned and investor owned hospitals and whether or not they are within miles of the Hippocratic Oath of “doing no harm,” especially when it comes to separating out the patient’s best interest from the doctor’s self-interest.  The problem remains that doctors are making the referrals to hospitals where they practice, so the patient becomes a “captive market” and anytime that happens, abuses are going to proliferate.

Even as future healthcare is being debated, there’s no reason for the Senators, feds, and states not to step up and do the jobs they should be doing of providing some public accountability and protecting the public from health care predators wearing white coats.  It’s a life or death matter!


Mr. President Don’t let Healthcare Coverage be Taken from Healthcare Workers

Obama signes Healthcare Reform Act

Obama signes Healthcare Reform Act

Tegucigalpa Before dawn in Honduras with the birds still loud and the sun still just a rumor, I was writing a petition for Local 100 members ( to be able to get out through our leaders and stewards throughout Louisiana, Texas, and Arkansas to demand that President Obama, DHS, Congressional Representatives, Senators and just about anyone who might listen would say no to the industry’s efforts to try and get a waiver from finally providing their workers healthcare under the coming law.  Reading the morning papers on-line, I was amazed at the gall and the bitter irony of healthcare industries trying to deny healthcare workers basic health insurance.

We represent a number of nursing home workers employed by different companies throughout Louisiana and Texas and community home workers providing similar health care support for the developmentally disabled in Louisiana, Arkansas, and Texas.  These are hard working, caring workers doing the jobs that families cannot do and that companies often pay little for them to do, despite the essential nature of the service.  It has long been an embarrassing blemish in our state and federal reimbursement systems that so much of these industries have been privatized under companies for whom profits are foremost and care is somewhere down the line, and the workforce often amounting to more than half of the care cost is always last on the list.

Reading the article in the Times of the nursing home association and the former governor of Kansas (is it a coincidence that the current head of DHS in DC is also a former governor of Kansas?) and its attempt to get a waiver from the President allowing them to not have to provide the now legally required healthcare for the millions of industry workers who currently provide healthcare but do not enjoy any healthcare themselves, was to put it mildly disgusting and enraging.  The gall!

Workers even in unionized homes such as hours are above minimum wage but still in sight of minimum wages with starting levels only a dollar or two above $7.25 and sometimes as little as $0.50 cents above.  When we first organized facilities in Louisiana almost 30 years ago they were all minimum wage, no vacations, no sick days, no holidays, no nothing, and certainly no health are or pensions.  Now with a union they are above minimum wage by a good number of steps, have regular raises and protections, do have vacations, do have sick days, do have holidays, but still don’t have any health insurance (or where they do have something it is so far out of their reach financially that it is almost an insult to claim it in the contract), and of course pensions courtesy of the Social Security Act.

It is unimaginable that the President or anyone recognizing the plight and paradox of healthcare workers without healthcare would even countenance for a minute giving a waiver, but in these days and times, nothing is certain.  As I write this, we are still writing the petition so we can post and circulate, but don’t hesitate to give a call and/or send a message to the White House and your elected representatives that doggone, don’t approve a waiver:  healthcare workers have to have healthcare, too!