An investigative report with teeth
And good election news
Welcome to a Tuesday night edition of Progress Report.
This is a quick one tonight, as I’m working on a new project that I hope to debut tomorrow night. We’ve also got a live stream interview with an exciting progressive Congressional candidate scheduled for Thursday evening — I’ll send an email out tomorrow with more information.
Oh, and some quick election news: Liberal judge Chris Taylor won the Wisconsin Supreme Court election tonight, giving Democratic-aligned justices a 5-2 edge on the state’s top court. It’s a remarkable 180-degree turnaround from the majority held by conservatives less than a decade ago, which allowed for gerrymandered legislative and Congressional majorities that are only now in range of reversing.
In fact, it was a great night for Democrats in Wisconsin, as they also flipped the mayor’s office in Waukesha, a longtime GOP suburban stronghold.
Note: The far-right’s fascist takeover of this country is being aided by the media’s total capitulation to Trump’s extortion. It’s never been more critical to have a bold independent media willing to speak up against the powerful. That’s what I’m trying to do here at Progress Report.
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As many readers know, I underwent my sixth open-heart surgery in November. I was fortunate to have it done at a top hospital and immensely lucky to have health insurance that covered the cost of the operation and 10-day hospital stay — all $448K of it, due to the Byzantine and bloated healthcare billing system. There were still thousands of dollars in ancillary expenses — flights to the hospital in Cleveland and back, a hotel room on campus for my wife, food, some tests, etc. — but in terms of medical care, insurance worked the way it was intended.
I cannot say the same thing about my dental insurance.
Over the past six months — with a long layoff for the heart surgery — I’ve been dealing with two troublesome molars, which have required a crown, extraction, and replacement. I’ve had maybe five appointments, adding up to about three or four hours in the dentist chair. And so far, the work has cost me $8400 out of pocket, a massive drain on my savings. My dental insurance has proven almost useless, even though it comes from the same employer as my health insurance.
The outrageous difference got me wondering why dental insurance covers so little, and more broadly, why it’s even separate from health insurance. After all, oral care is a huge component of healthcare, especially for somebody like me, who has to studiously avoid infections that start in the mouth and work their way down to the heart.
Fortunately, I have a job that allows me to explore these questions in service of the public interest, so I’ve spent the last few months working on the video below, which debuted today:
For all the triumphs of the early-to-mid-20th century, including Social Security and Medicare and Medicaid, the story of the American social safety net at that time is one of missed opportunities that would have led to a very different and far more equitable country.
FDR first suggested a national health plan in the 1930s, and his successor, President Harry Truman, nearly made it happen. That would have included both health and dental care, which had been considered separate ever since the 1800s, when John’s Hopkins medical school refused to admit dental students and they were forced to create their own separate track. The American Dental Association campaigned hard against comprehensive national insurance, working with the healthcare sector to invoke the specter of communism and insisting that practices remain “independent,” or not tied to any pay formula.
Dental insurance emerged in the 1950s as a bonus plan for the children of workers in the longshoremen union in Washington State, and dentists accepted it as the lesser of two evils. Ironically, antitrust exemptions allowed a few insurers to become so dominant — Delta Dental has 60% market share in many states, and even more in several — that they now essentially control the income of so many dental professionals. They have not increased payments rates in pace with inflation and out of pocket maximums for patients have remained stagnant for decades upon decades. As one long-practicing dentist told me, insurance used to cover a lot of care, and now it’s hardly worth having.
The other part of he video focused on dental service organizations. These are largely private equity-owned companies that roll up dentists offices and squeeze patients and doctors alike, often in unethical ways, as you’ll see in my piece above. Most infamous is Aspen Dental, while Heartland Dental is the biggest chain. Both are known for putting pressure on dentists to produce as much as possible, and as a Heartland dentist tells me in the piece, it often crosses over into financial executives essentially making care decisions for patients based on reimbursement rates and how much they can charge.
There’s more to the system, including ridiculously high — like half a million dollars easy — student loans from dental school and the soaring cost of dental tech, resulting in doctors who are forced to work for these huge corporations or go out of network. There are 72 million Americans without health insursnxe, and many millions more who can’t afford care despite having it.
Don’t worry: the video isn’t just a doomer piece, because we go over what states are doing to fix the situation. It’ll take national legislation (and Medicare for All) to ultimately repair our grievously broken dental health system, but reforms to how much of their premium revenue insurance companies must spend on care reimbursements (a key feature of Obamacare) and regulating and even prohibiting corporate ownership of medical offices are two solutions that are emerging in the meantime.
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