When National Healthcare is Not Mean, but Vindictive, Not Policy, but Politics

New Orleans  Healthcare is a huge part of the overall US economy and, arguably, of critical importance to every American. Regardless of the cliché, it is in fact a question of life and death. Yet we are watching a horror show spectacle of a White House that is clueless about anything but whether or not it can claim a “win,” and a Congress that is cunning and calculating without any field of vision that can see past 2018 and the midterm elections.

Meanwhile the public is treated to media coverage that, rather than focusing on the complexity of the bill and its evisceration of any semblance of public policy, treats the whole affair as if this were an extra innings baseball game and the only real issue was whether or not Majority Leader Mitch McConnell can get enough votes to pass the Senate version before the totally arbitrary deadline of July 4th. Well, perhaps not totally arbitrary, since McConnell is worried that when his caucus goes home for the recess their constituents will kick their asses so badly his whole secret legislative architecture will collapse.

Remember Kellyanne Conway, so discredited as a Trump aide that we’ve been spared her doublespeak recently. Well, she was back on this bill with the outrageous claim that no one can support, that, oh, no, there are no cuts to Medicaid in the Senate bill, which everyone knows is wrong. Good try, Kellyanne, now go hide out again, because this time there weren’t even any headlines following such an outrageous claim.

How about we look at how the Senate went from mean to downright vindictive? Their bill restored funding for what is known as “disproportionate share” money to hospitals. Pay attention in class now, friends, this is important. In places like Louisiana where I live we know a bit about “disproportionate share” payments because in their heyday they figured so prominently in statewide political scandals. Ever popular, former multi-term Governor Edwin Edwards did court and prison time on the issue of having unduly helped some friends get such money to build hospitals in poorly served and lower income areas of the state. Indeed, disproportionate share payments were designed to subsidize health care costs in lower income and ill-served areas originally in order to assure communities that these institutions could survive, because a “disproportionate share” of their patient base was poor. Obama’s Affordable Care Act flipped the script here. By assuring that everyone would have to get insurance and providing subsidies for lower income families and Medicaid expansion, disproportionate share payments would be phased out to pay for Obamacare. In fact now is the time when $43 billion would be reduced between 2018 and 2025.

What did the Senate do in their bill? They buckled to the lobbyists and restored these disproportionate share payments, but, now get this, only to states that had not expanded Medicaid coverage. This allows them to punish those states and their people by cutting the subsidies to Medicaid in their bill and rewarding the scofflaws by restoring the disproportionate share payments.

Now it’s politics that inflicts real pain and terrible consequences. Need a vote in Alaska or Maine, then sweeten the pot on opioid money even though states throughout the country are reeling under such a crisis. Take away support for mental health coverage, but throw some dollars out here and there to get a vote. Cutback money for the elderly poor on Medicaid, but kick the can down the road past 2018 so that you can keep the votes with a wink and a nod until the oldsters figure out the con.

None of this is good policy, and, frankly, I’ll be darned if I even understand how it is good politics, when all of these repeal bills are wildly unpopular in every poll of the American people. The public wants to live, not die, at the hands of government. Why isn’t that news everyone understands?

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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?

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