A Better Way to Give Dental Care to the Poor

This article appeared in the Baltimore Examiner on March 13, 2007.

Deamonte Driver was just 12 years old when bacteria from an abscessed molarspread to his brain. By the time his mother realized he needed attention, itwas too late. Not even two brain surgeries and six weeks of hospitalization- at a cost of $250,000 - were able to save him.

Deamonte's tragic death demonstrates how our health care system so oftenfails the poor. And the way that policymakers have responded to his deathdemonstrates why that system so often fails the poor.

Deamonte and his siblings did not receive routine dental care, at least inpart because of the shortcomings of Maryland's Medicaid program, created toprovide health care to the poor. It's tough to get an appointment with adentist if you're on Medicaid. The program pays so little, only one in sixMaryland dentists participate.

Unfortunately, some policymakers are pushing legislation that would put evenmore people in the same situation. In Washington, Sens. Ben Cardin (D-Md.)and Jeff Bingaman (D-N.M.) responded with legislation that would increaseMedicaid payments to dentists. In Annapolis, Del. Nathaniel T. Oaks(D-Baltimore) and Sen. Thomas Middleton (D-Calvert County) used Deamonte¹sstory to argue for similar legislation.

Given that Medicaid offers paltry access to care, and that better accessmight have saved Deamonte, that approach holds some appeal. But Medicaidwould quickly swallow up the additional funding, and leave even morelow-income families in the same terrible bind.

Here's why. At any moment, only two out of three people who are eligible forMedicaid are actually enrolled in the program. Lousy access to care is oneof the reasons many eligible families do not enroll.

Spending more per enrollee would improve access initially. But it would alsoincrease enrollment by making the program more attractive to those currentlynot enrolled.

The added cost would leave lawmakers with two options: Increase taxes orreduce per-enrollee spending. Increasing taxes would just add fuel to thefire by making it harder for families to avoid enrolling. Eventually,lawmakers would have to reduce spending, and access would return to previouslevels. At the end of the process, the only difference would be that evenmore Deamontes would be dependent on a lousy government program for theirhealth care.

The politicians have thus far ignored another way that society failedDeamonte - one that actually offers some hope of expanding access to dentalcare.

In the name of "consumer protection," the state of Maryland reduces accessto the very type of early intervention that Deamonte needed. Twenty statesallow dental hygienists direct access to patients, which makes basic,preventive care more affordable. But not Maryland, which requires licensedhygienists to work under the supervision of a licensed dentist. That makesit impossible for hygienists to offer lower-cost basic and preventive careby striking out on their own.

The usual justification for that requirement is that it improves quality.The real reason for its existence is that it protects dentists fromcompetition. But it may not even live up to its stated purpose. Studies showthat over-regulation of dental hygienists increases the cost of dental care.If those higher costs prevent people from getting any care at all, thatreduces quality.

If Maryland officials want to improve access to dental care, they mustderegulate hygienists.

No one can say whether that would have made the difference for Deamonte. Butsuch laws do cost lives. Duke University professor Christopher J. Conoverestimates that health care regulations cost 22,000 lives every year. Some ofthose are lost because regulation cuts off access to affordable, basic care.

Given greater freedom, hygienists could educate more people about properdental care and catch problems like Deamonte's before they turn deadly.Unfortunately, most politicians seem genetically programmed to reject anyreform that would reduce their influence. There's a good case to be madethat improving access to care for the poor requires exactly that.

Michael F. Cannon

Michael F. Cannon is director of health policy studies at the Cato Institute, and co-author of Healthy Competition: What's Holding Back Health Care and How to Free It.