Archive | The Best Healthcare in the World

The cavity in health insurance coverage: oral health

2016.8.30 榮總看牙醫

By Susan Sered, Suffolk University

When we talk about the successes and shortcomings of the Affordable Care Act (ACA) – and health care in the U.S. in general – little attention is given to dental care.

While the ACA defines dental coverage as an essential benefit for those under 18, insurers aren’t required to offer dental coverage for adults. Medicare, the nation’s largest insurer, doesn’t cover routine dental work. And coverage for adults through Medicaid varies from state to state.

It is estimated that 108 million Americans have no dental insurance, and that one in four nonelderly Americans has untreated tooth decay.

Oral health isn’t just about nice teeth. As the surgeon general noted in a 2000 report, oral health is intimately connected to general health and can be implicated in or exacerbate diabetes, heart disease and stroke, and complications during pregnancy.

The absence of comprehensive dental care exacts a toll on millions of Americans in terms of poor health, pain and the social stigma associated with bad teeth.

People receive dental treatment at the Care Harbor/LA free clinic in Los Angeles, September 27, 2012.
Lucy Nicholson/Reuters

People desperately need dental care

In 2003 and 2004 (pre-Obamacare), I conducted a national study of uninsured Americans in southcentral Illinois, northern Idaho, the Mississippi delta, the Rio Grande Valley of Texas and in eastern Massachusetts.

I asked nearly 150 interviewees: “If President Bush were to declare universal health care for everyone starting tomorrow, what is the first problem you would take care of?” The most common answer by a landslide echoed this respondent’s: “I’ll be waiting outside the dentist’s office at 5:00 in the morning waiting for it to open.”

Many of the people I interviewed lived with untreated diabetes, asthma or even cancer, yet their oral health problems presented the greatest challenges to their quality of life.

Recently I returned to these communities to reinterview the people I’d met over a decade earlier. Very little has changed. While the majority of the people I interviewed now had health care coverage of some sort (for nearly 20 percent of them, it was as a consequence of becoming sufficiently disabled to be eligible for Social Security), very few had managed to secure dental coverage.

Then and now, people told me about visiting emergency rooms in hopes of alleviating pain or using addictive pain medications to make it through the day. People even told me that they had resorted to pulling out their own teeth.

Take Misty, for instance. When I met her 12 years ago in Mississippi, she was a “dirt poor” (her words) married mother of five, and she was living with diabetes, domestic violence and excruciating headaches. Despite all of these quite serious problems, she told me that she was more troubled by her bad teeth than by anything else. In fact, Misty told me that she’d had such bad toothaches that she pulled her own teeth. When I asked her how she can face the pain of pulling out her own teeth, she said:

[the infected tooth] hurts so bad… it’s a relief just to get it out of there.… I’ve gone two weeks with just being able to eat soup, because they are just so bad.

By 2016 Misty had left her abusive husband, moved to Arkansas and was accepted onto disability (SSI), which allowed her to get health care coverage through Medicaid. Still, however, she suffered because of her teeth.

It can be very hard to find dentists who accept Medicaid, and when Misty finally did, she had the rest of her teeth – 25 in all – pulled in one day.

Misty’s situation isn’t uncommon. I have met women and men of various ages who, like Misty, have pulled their own teeth. I’ve also met people who were able to get part of their dental needs taken care of during brief periods of Medicaid coverage but then were left with unfinished treatment when the coverage ended.

Teeth aren’t included in health insurance policies.
Dental x-ray image via

Insurance stops at the teeth

Even though the link between dental health and overall health is clear, insurance plans tend to ignore teeth.

As health insurance began to appear to appear in the U.S. – initially in the 1920s and then more widely during World War II and in the postwar era – dentistry wasn’t part of the standard package of covered services.

As the nation’s largest insurer, Medicare plays an important role in shaping health care coverage norms. Medicare does not cover dental care. Today, according to government estimates, 70 percent of seniors lack dental coverage.

Since Medicare doesn’t cover dental, Dr. David Kroll, senior program officer at the Robert Wood Johnson Foundation, argues that this “inertia spilled over into the ACA.”

Americans who purchase dental plans typically find that the plans aren’t cheap, and often don’t cover much beyond routine preventative care. Plans often require hefty copays for procedures beyond preventative care and no or very limited coverage for dentures, bridges or periodontic work.

And, in recent years, the cost of dental care has increased faster than the cost of other medical care. For those without dental insurance, there are few low-cost services available.

The ACA provided for an expansion of Medicaid eligibility, though not all states accepted the offer of federal funding to expand Medicaid coverage. Even in the states that expanded Medicaid under the ACA, strict limits on oral health care remain for most low- and moderate-income Americans.

There is one bright spot: children’s dental coverage is a required benefit included on all ACA compliant plans, and Medicaid as well. According to national calculations of the Health Policy Institute and the American Dental Association, dental care utilization among Medicaid-enrolled children increased from 35.3 percent in 2005 to 48.3 percent in 2013.

Not just about nice teeth.
Shannon Stapleton/Reuters

Oral health isn’t just about nice teeth

In the absence of coherent oral health services, too many Americans end up like Gina, a young Idaho woman who holds her hand in front of her mouth while she talks so that no one will see her rotted teeth. She can’t even get a job as a telemarketer because she cannot speak distinctly enough to be hired.

Many Americans incorrectly assume that rotten teeth are the product of bad decision-making; if someone had just brushed and flossed then they’d have nice teeth. But routine dental care – think of the twice-yearly checkups that are routine for people with dental insurance – keeps teeth healthy and can catch problems when they are easy to treat.

The reality is that tooth decay signifies poverty in pernicious ways. Without expanding insurance to cover oral health, millions of Americans will continue to live with pain, stigma and the risks of systemic diseases that could be averted through an accessible and integrated system of dental care.

The Conversation

Susan Sered, Professor of Sociology, Suffolk University

This article was originally published on The Conversation. Read the original article.

So sad

Equipo médico

And I think it had a lot more to do with being a woman than with her being a doctor. I heard stories like this all the time — and remember, many moons ago, my HMO primary doctor disregarded EVERY SINGLE SYMPTOM I had for Lyme disease, and put me on Prozac instead.

So it kind of irks me when I get these weird neurological and cardiac symptoms that may or may not be related to 20+ years of untreated Lyme. No point to asking doctors anymore — they don’t know, and can’t really test. Because once the spirochete digs into your organs, it doesn’t show up on tests and they can only tell with an autopsy. Whee!

A GP who died from a rare form of kidney cancer has warned of the difficulties doctors face in getting treatment for themselves, in an emotional blog published posthumously.

Dr Lisa Steen described her anger at colleagues for failing to go the extra mile to help identify the disease and for dismissing her as a hypochondriac, in the essay published on

The 43-year-old mother-of-two from Cambridge wrote of spending “two years wandering in the wilderness of the medically unexplained” before finally being diagnosed in July 2014, by which time the cancer had spread to her bones. She died in February.

Hillary comes out for a limited public option

Hillary thoughtful

Via the New York Times. Interesting:

“I’m also in favor of what’s called the public option, so that people can buy into Medicare at a certain age,” Mrs. Clinton said at a campaign event in Virginia on Monday.

Mr. Sanders calls his single-payer health care plan “Medicare for all.” What Mrs. Clinton proposed was a sort of Medicare for more.

The Medicare program currently covers Americans once they reach 65. Beneficiaries pay premiums to help cover the cost of their coverage, but the government foots the bulk of the bill. Mrs. Clinton’s suggestion was that perhaps younger Americans, “people 55 or 50 and up,” could voluntarily pay the full cost to join the program.

[…] Mrs. Clinton has been proposing a range of health policy overhauls to preserve and expand the Affordable Care Act. She has proposed expanding financial protections for people with high health care costs and expanding subsidies to help middle-income people buy their own insurance. She also has proposed a package of policies to lower the price of prescription drugs.

[…] Mrs. Clinton’s new Medicare plan, first reported by Bloomberg News, takes another step by proposing that Americans still in their prime working years be given the opportunity to obtain the exact same government insurance that is provided on a universal basis to their older peers.

[…] Moving more older adults into the Medicare program could have the effect of lowering insurance costs for younger people, as Mrs. Clinton suggested. But the exact dynamics would depend on the details of how the program was structured.

Medical errors now third leading cause of death in U.S.

Cheering patient

I watched the resident at one of the best hospitals in the country order Tylenol for my ex-husband. “Why are you giving him Tylenol?” I asked. For his fever, he explained.

“No, I meant, why are you ordering Tylenol for someone who is obviously in liver failure?” I said. “Have you looked at him? He’s bright yellow.”

“Oh, are we in the medical profession?” he said in a condescending tone.

“No, we’re in the legal profession,” I told him.

So yeah, I have no trouble believing their numbers:

Nightmare stories of nurses giving potent drugs meant for one patient to another and surgeons removing the wrong body parts have dominated recent headlines about medical care. Lest you assume those cases are the exceptions, a new study by patient safety researchers provides some context.

Their analysis, published in the BMJ on Tuesday, shows that “medical errors” in hospitals and other health care facilities are incredibly common and may now be the third leading cause of death in the United States — claiming 251,000 lives every year, more than respiratory disease, accidents, stroke and Alzheimer’s.

Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine who led the research, said in an interview that the category includes everything from bad doctors to more systemic issues such as communication breakdowns when patients are handed off from one department to another.

“It boils down to people dying from the care that they receive rather than the disease for which they are seeing care,” Makary said.

Paul Ryan wants to bring back pre-existing conditions

Speaker of the House Paul Ryan. 2/2 –Phil Humnicky

Paul Ryan is not working for his constituents, and neither are many of his cohorts in Congress. They are working to increase the profit margins of health insurance companies, period. Speaker Ryan wants to remove the provision of the president’s signature health care legislation that prevents insurance companies from denying care to those with pre-existing conditions.… Continue Reading →

So what happens next?


UnitedHealth Group, the nation’s largest commercial health insurer, made good on a six-month-old threat and announced Tuesday that it will pull out of Affordable Care Act exchanges in all but “a handful of states” after this year. The questions that raises are: Will that hurt? And, if so, who does it hurt? United had previously announced… Continue Reading →

Scientists rename thyroid tumor, say cancer is overdiagnosed

All About Papillary Thyroid Cancer Remedy And Treatments

The overdiagnosis of thyroid cancer has been an ongoing and steadily escalating issue over the past few decades. In 1992, six out of every 100,000 Americans were diagnosed with thyroid cancer. In 2012, that number was two-and-a-half times higher, at 15. Despite the increase in diagnoses, however, the rate of people who have died of thyroid… Continue Reading →

Zika virus ‘scarier than we initially thought,’ US officials say

Phát hiện Virus Zika có thể tấn công cả não người lớn - KQXS

And this is why we vote for Democrats. Unbelievably, Republicans are just planning to ignore this, like they did with global warming:

Washington (dpa) – Calling what they’ve learned since focusing on the Zika virus “not reassuring,” US health officials said Monday the illness brings a “broader set of complications” for pregnant women than first thought. “Everything we look at with this virus seems to be a bit scarier than we initially thought,” said Anne Schuchat of the… Continue Reading →

Site Meter