Saving Dentistry From the Jaws of Defeat

This article appeared on Amer​i​can​.com on March 12, 2007.

It is still just days since Deamonte Driver passed away. His tragic death demonstrates how our health care system so often fails the poor. But the way policymakers have responded to his death demonstrates why that system so often fails the poor.

Deamonte was just 12 years old when bacteria from an abscessed molar spread to his brain. According to The Washington Post, Deamonte’s mother had been trying to find a dentist for his younger brother, whose situation seemed more severe. By the time she learned Deamonte needed attention, it was too late. Not even two brain surgeries and six weeks of hospitalization – at a cost of $250,000 – were able to save him.

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

Most people respond to Deamonte’s story the same way: I don’t care how much it costs. Just don’t let this happen again. Unfortunately, some policymakers are pushing legislation that would put even more people in the same situation.

U.S. Senators Ben Cardin (D‑Maryland) and Jeff Bingaman (D‑New Mexico) responded with legislation that would increase Medicaid payments to dentists and funding for government clinics. In Annapolis, Delegate Nathaniel T. Oaks (D‑Baltimore) and Senator Thomas Middleton (D‑Calvert County) also used Deamonte’s story to argue for increased funding for government clinics.

Given that government programs offer paltry access to care, and that better access might have saved Deamonte, increasing funding for those programs has appeal.

But there’s another approach, besides increasing funding to a government program, that could yield more effective and efficient results. If society failed Deamonte, it may have been in trying to protect him too much. In the name of “consumer protection,” the state of Maryland discourages the type of early intervention that Deamonte needed.

If Maryland officials want to improve access to dental care, they need to deregulate hygienists.According to the American Dental Hygienists’ Association, 20 states allow hygienists direct access to patients, “which has been an effective model in increasing access to care.” Maryland is not among them. Like many states, Maryland requires licensed hygienists to work under the supervision of a licensed dentist. That makes it impossible for hygienists to offer lower‐​cost basic and preventive care by striking out on their own.

The stated justification for the requirement is that it improves quality. The unstated justification is that it protects dentists from competition. Indeed, the Federal Trade Commission has taken action against state boards of dentistry for pushing anti‐​competitive regulations.

Moreover, the requirement may not even improve quality. Studies have shown that regulating hygienists increases the cost of dental care. If higher costs keep some people from receiving any care at all, that reduces quality.

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

No one can say whether that would have made the difference for Deamonte. When politicians offer guarantees like Delegate Oaks’s claim, “that boy would not have died if this legislation had been in place,” they are selling snake oil. But such restrictions do cost lives. Duke University professor Christopher J. Conover estimates that health care regulations cost 22,000 lives per year. Some of those lives are lost because regulation cuts off access to affordable, basic care.

It is not hard to imagine the innovations that independent hygienists might devise to reach large numbers of low‐​income children. In the process, they would educate children about proper dental care and catch problems earlier. Given greater freedom, a hygienist might have bought Deamonte more time.

Increasing access to dental care for Maryland’s poor will require politicians who are willing to relinquish some of their power and to stand up to a powerful interest group that will try to talk them out of it. Unfortunately for Maryland’s poor, that kind of politician is in short supply.