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Make dentistry cheaper
Can you see what is coming?:
But to the Alaska Dental Society and the American Dental Association, the clinic is a place where the rules of dentistry are flouted daily. The dental groups object not because of any evidence that the clinic provides substandard care, but because it is run by Aurora Johnson, who is not a dentist. After two years of training in a program unique to Alaska, Ms. Johnson performs basic dental work like drilling and filling cavities.
Here is much more. Get this:
The number of dentists in the United States has been roughly flat since 1990 and is forecast to decline over the next decade. A study last year from the Centers for Disease Control showed that Americans’ dental health was worsening for the first time since statistics began to be kept.
In Alaska, the A.D.A. and the state’s dental society had filed a lawsuit to block the program that trained people like Ms. Johnson, who are called dental therapists. The groups dropped the suit last summer after a state court judge issued a ruling critical of the dentists. But the A.D.A. continues to oppose allowing therapists to operate anywhere in the lower 49 states. Currently, therapists are allowed to practice only in Alaska, and only on Alaska Natives.
The opposition to therapists follows decades of efforts by state dental boards, which are dominated by dentists, to block hygienists from providing care without being supervised by dentists.
The dental associations say they simply want to be sure that patients do not receive substandard care. But some dentists in public health programs contend that dentists in private practice consider therapists low-cost competition. In Alaska, the federally financed program that supplies care to Alaska Natives pays therapists about $60,000 a year, one-half to one-third of what dentists typically earn.
The Alaska program is small, with fewer than a dozen therapists practicing so far. But the early results are promising, according to dental health experts who are studying the program.
As someone who has spent a lot of time at the dentist, I very much like the assistants and I think of the dentist himself as a kind of middle-level manager and salesman.
I thank Greg Rehmke for the pointer.
Posted by Tyler Cowen on May 1, 2008 at 02:06 PM in Medicine | Permalink
Comments
Straight out of capitalism and freedom...
Posted by: Eugene at May 1, 2008 2:15:36 PM
Straight out of capitalism and freedom...
Posted by: Eugene at May 1, 2008 2:15:36 PM
This is actually a big problem. Particularly for low-income people, dental care is either far too expensive, or simply unavailable. And the dental colleges are not increasing their student numbers with the result that the number of dentists continues to decrease.
Kudos to these folks in AK.
Posted by: Charles at May 1, 2008 2:39:43 PM
Apparently the natives are expendable.
Posted by: John goodman at May 1, 2008 2:43:28 PM
Can't the same be said about the AMA?
Among the multitude of Healthcare solutions I have seen, I rarely see the issue of supply control of medical care providers as a significant obstacle in tackling he Healtcare crisis.
Posted by: Mo at May 1, 2008 3:00:00 PM
This has been a major political issue in Alaska for years. The rural villages cannot support local dentists, and travel costs are high enough that few people are willing or able to pay for a traveling dentist. The result is that Alaska natives have some of the worst teeth in the nation.
The worst part is that the ADA is not offering alternatives or actual solutions to the problem of providing dental care in small, isolated towns, they're just suing to make suing on principle. If you think dental care is expensive where you live, you don't even want to know what it's like in rural Alaska.
Posted by: Sean at May 1, 2008 3:04:10 PM
I thought the money quote in the article was the matter-of-fact statement that over 100 million Americans
cannot afford dental care. The median income for married households in 2007 was approximately $80,000;
I'm not sure where the cutoff for 100 million would be (roughly the bottom third) but I'd love to know
where their statistics come from.
Posted by: anonymous at May 1, 2008 3:05:35 PM
Clinics rule in health care savings. Monopolies destroy clinics.
Posted by: Matt at May 1, 2008 3:12:22 PM
Reminds me a lot of a NYT article from October. I know people even in the DC area who save their basic dentistry work for trips to Latin America. And you can even find dentists who work evenings there!
http://www.nytimes.com/2007/10/11/business/11decay.html?_r=1&scp=4&sq=dentists&st=nyt&oref=slogin
Posted by: LB at May 1, 2008 3:25:48 PM
Perhaps you should change providers such that you could state "...the dentist herself" and see if that doesn't change your opinion?
On a more serious note, there is an acute shortage of providers, especially for those who rely on state or federal subsidized care. The cause is basic: when a provider accepts patients from the state healthcare pool, they accept very low reimbursement rates--often well below the marginal cost of the procedure. To make it work, the provider must become a volume business, and an efficient one at that. This can be physically and mentally draining. There is no financial incentive to do so. Typically only the new, the bad, or the genuinely altruistic ever try. Being a healthcare provider comes with a relatively high burden of liability, so opening markets for lower-cost providers of basic services may result in increasing educational, licensing and regulatory costs (hygiene, therapist) and a smaller-than-anticipated benefit for those basic services. And why on earth wouldn't newly independent hygienists and therapists chase similar margins from the same high-yielding patient populations that DMD/DDSs typically prefer? It's a complicated problem, but one worthy of creative thinking.
Posted by: anon at May 1, 2008 3:27:01 PM
Can't the same be said about the AMA?
Indeed, it has been. Famously by Milton Friedman, who told of a speech before the AMA where--thinking he had the perfect analogy--told the doctors assembled that occupational licensing laws were the same as saying only Cadillacs could be driven on our highways, because Chevrolets would not be up to standards.
He was stunned when he heard back: 'That's right, we can't accept anything less than Cadillac standards for the American peoples' health.'
Posted by: Patrick R. Sullivan at May 1, 2008 3:50:52 PM
First-person story: "How to get your teeth fixed in Mexico". (Man, there are a lot of Google ads if you search on [tijuana dentist].)
Posted by: Don Marti at May 1, 2008 3:51:29 PM
We would need even fewer dentists and more people would have healthier teeth if we would let the commies fluoridate our water.
Cf. http://www.filmsite.org/drst3.html
Cf. http://www.aafp.org/online/en/home/clinical/clinicalrecs/fluoridation.html
Posted by: Dave Barnes at May 1, 2008 4:08:21 PM
Ok, but why aren't there more dental shops with 1 dentist and 20 dental assistants, at least in urban areas? Shouldn't they be able to supply low cost care?
Posted by: Measure for Measure at May 1, 2008 4:37:17 PM
Exactly what I was thinking Eugene. Friedman would be proud.
Posted by: Scott at May 1, 2008 4:51:39 PM
This is actually a big problem. Particularly for low-income people, dental care is either far too expensive, or simply unavailable. And the dental colleges are not increasing their student numbers with the result that the number of dentists continues to decrease.
Perhaps, but I've also found that lots of people really overestimate the cost of a simple preventive cleaning. I know quite a few people who just will not go without insurance; this despite cleaning visits being $50-$100 (and the cost of major dentistry enormous.) They just assume that the cost would be too high.
Posted by: John Thacker at May 1, 2008 5:13:31 PM
Is it me, or are the ADA and AMA both evil?
I do feel I should mention that the use of airbags in cars has decreased the need for many types of dental work. I'm not sure if this has anything to do with a decrease in the supply of dentistry, however.
Posted by: Grant at May 1, 2008 6:09:59 PM
for good teeth and healthy gums:
1) first rinse in the morning: 20- 30 seconds, with hydrogen peroxide (cleans your mouth and whitens your teeth)
2) brush with an electric toothbrush, 2 minutes total, 30 seconds per "side", twice each day (after breakfast and before going to bed - sleep with a clean mouth)
3) use a good toothpaste (I like Colgate Total, ymmmv)
4) gargle and rinse with a generic tartar control mouthwash
5) have teeth cleaned by dentist/dental technician twice each year ($75 - $125), after which dentist inspects for other problems
You can floss if you want using regular floss or an electric flosser. I don't floss and after I started using the protocol above about 2 years ago my dentist told me (and continues to tell me) "You're doing a GREAT job flossing!"...
Posted by: chug at May 1, 2008 6:28:00 PM
Can't the same be said about the AMA?
Yes, we do need more medical and dental school seats to keep up with population growth. Either we build new schools or the Feds could mandate (with its purse strings) that medical schools operate on the year-round trimester system used in World War II- Four academic years completed in three calendar years. Alternately, as they do in Europe (and at some US med schools), combine college and med school in one 6 year program. http://research.med.umkc.edu/med_admissions/default.html
At least the AMA hasn't stopped (not for want of trying) the use of nurse practitioners and physician assistants. These Alaskan dental therapists are the dental version of a NP or PA.
Posted by: beowulf at May 1, 2008 7:08:19 PM
I can get the libertarian arguments, especially for people that are unserved.
You could say the same thing about physicians. However, I actually read the Flexner report and it was pretty persuasive. He was pretty upfront about raising incomes, and was concerned with a race to the bottom by grossly under qualified drs.
http://www.carnegiefoundation.org/publications/pub.asp?key=43&subkey=977
I found the actual report a lot more interesting then the endless arguments from secondary sources.
Posted by: Ziggurat at May 1, 2008 7:14:12 PM
-- Is it me, or are the ADA and AMA both evil? --
Don't forget the ABA. It might even be safe to say that organization styled A__A is going to be bad for consumers.
Posted by: 12345 at May 1, 2008 8:36:56 PM
If a service is valuable, it does not become less valuable because it is adequately provided by a more briefly educated professional. In the medical world, physician assistants and nurse practitioners have not flocked to serve the poor in any greater numbers than MDs. They tend to work in the surgery and radiology fields where they, like their physician counterparts, make more money. This should come as no surprise to any economist or, for that matter, businessperson.
Posted by: mrrunangun at May 1, 2008 9:48:50 PM
Actually dentistry is quite cheap if you have access to a pair of pliers.
Posted by: Gil at May 1, 2008 10:44:58 PM
"Is it me, or are the ADA and AMA both evil?"
Throw in the ABA for the trifecta. Every professional association, especially those that also serve as de facto licensing agencies, need to be culled.
Posted by: moises malone at May 1, 2008 11:26:54 PM
It seriously pisses me off that even someone as "revolutionary" as Michael Moore refuses to criticize the AMA.
For some reason beyond my understanding, the left feels squeamish voicing any concerns over the AMA and how their restrictive supply side policies impact those without health insurance.
Posted by: thehova at May 1, 2008 11:56:00 PM
