Practicing dentists do you guys know what the implications of medicare for all will have on dentistry?

[sleep_starterPack]

I will become a dental student this coming fall and I’m thinking ahead. What are the implications of Bernie’s medicare for all? Wasn’t there at some point a gold rush where Medicaid covered braces, and dentists were cashing in like crazy? I want to get an idea of what would happen to the profession. What would happen to the way insurance claims are conducted (currently a fking nightmare), procedure expenses, what procedures would be covered by the plan.

Also corrects me if I’m wrong, I do believe the plan has a dental component and is not exclusive to physician visits.

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[ToothJockey]

Bernie is not getting elected lmao

 

[sleep_starterPack]

Bernie is not getting elected lmao

Ok lol... But can you expand on “theoretical policy”

 

[Cold Front]

To the OP: Too early to tell.

Bernie will win the democratic nomination.

The presidential election will be fought over the rust belt states (PA, OH, MI, and WI). Bernie can win 3 of those states (based on the midterm election results and trend). The trade war with China irreversibly harmed the Midwest farmers and exporters. China tried to do a trade deal, but they were kicking the can down the road until the 2020 November elections.

Medicare for all is just a promise. All promises are meant to be broken in politics. Candidate Trump said he will release his tax returns, he didn’t. He said he will repeal Obamacare all together, he didn’t - by 1 vote (from John McCain). He promised to build a wall - as of today, there is no wall big enough to dent any illegal border crossings from Mexico. Trump can’t get anything big done in Congress because the House is blue, he couldn’t do much few years ago when Congress was red on both sides. So if Medicare for all has a shot, it will need a blue president and Congress to have a legislation that will come into a law. That’s how Obama did it with Obamacare. I think if the Bernie momentum holds until October, not only he may win, but the senate could be blue as well. Setting all Bernie healthcare agendas in motion to worry doctors and dentists.


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[sleep_starterPack]

To the OP: Too early to tell.

Bernie will win the democratic nomination.

Appreciate the policial analysis, but my question would be post election. What aspects of the medicare for all would be harmful/beneficial for dentists? There are currently physicians that are pro medicare for all I have yet to see the counter argument, but I’m sure there is one. I have heard speeches of dentists mentioning how the affordable care act was detrimental to dentistry in some aspects, but I don’t know what the implications of medicare for all would entail.

Also, I’m not meaning to make this thread political in any way. It’s only a hypothetical.

 

[yappy]

Appreciate the policial analysis, but my question would be post election. What aspects of the medicare for all would be harmful/beneficial for dentists? There are currently physicians that are pro medicare for all I have yet to see the counter argument, but I’m sure there is one. I have heard speeches of dentists mentioning how the affordable care act was detrimental to dentistry in some aspects, but I don’t know what the implications of medicare for all would entail.

Also, I’m not meaning to make this thread political in any way. It’s only a hypothetical.

Government fee schedules tend to be below market rates. Promises are made by politicians that are balanced on the backs of doctors, hospitals, clinics, labs, in the form of low reimbursement.

The net effect will be work harder for less money.

 

[Saddleshoes]

You do know that, presently, medicare DOES NOT cover dental treatment.

 

[P7898]

You do know that, presently, medicare DOES NOT cover dental treatment.

Yeah but doing work for free is better than doing no work for free.

 

[TanMan]

Yeah but doing work for free is better than doing no work for free.

Why would doing work for free be better? Overhead costs would eat me alive on free work, I might as well not work and incur overhead costs.

In dentistry, you can either opt-in, opt-out, or do nothing with respect to medicare. "Opt-out" is not the same as doing nothing. I did nothing, so I'm not part of the system. Opting out still puts you in the medicare system which is deceiving. This means that my prescriptions aren't covered by medicare, I can't try and bill medicare for anything, BUT I am not under the jurisdiction of government insurance, paperwork, or bureaucracy. I don't have to remain in "compliance" with CMMS rules and regulations because I'm not participating at ALL. Added bonus is that my demographic shift puts me into the demographics that are easier to work with and the procedure mix I prefer (not dentures, little medical issues, no severe xerostomia, long stories, etc...).

I will become a dental student this coming fall and I’m thinking ahead. What are the implications of Bernie’s medicare for all? Wasn’t there at some point a gold rush where Medicaid covered braces, and dentists were cashing in like crazy? I want to get an idea of what would happen to the profession. What would happen to the way insurance claims are conducted (currently a fking nightmare), procedure expenses, what procedures would be covered by the plan.

Also corrects me if I’m wrong, I do believe the plan has a dental component and is not exclusive to physician visits.

Dentistry is only implicated if they get rid of dental insurance too. This is why I advocate dentists to stop acting like physicians and separate ourselves from medicine as much as possible. Once you make it seem like dentistry is required and not optional, the government will feel the need to make it mandatory and classify it as a public good. What you're referring to is the medicaid braces gold rush (before I graduated, unfortunately). Usually, if there was "choice", reimbursements would be higher to attract providers, a rush would occur, people will abuse/overutilize, reimbursements go down, audits go up, reclamation/RAC goes up, number of providers go down and an equilibrium eventually settles. If there was no choice (if you got rid of all competing PPO/HMO insurances), government can do whatever they want, start you off with poor reimbursements and force you to participate if you needed to accept insurance in your practice. Eventually, standard of care will have to drop in order to stay in business (haphazard speed, cheaper materials), but because most everyone will be in the same boat, that new standard of care will be the accepted standard by the profession.

 

[P7898]

Lol I meant the other way around. NOT working for free is better than working for free.

 

[sleep_starterPack]

Usually, if there was "choice", reimbursements would be higher to attract providers, a rush would occur, people will abuse/overutilize, reimbursements go down, audits go up, reclamation/RAC goes up, number of providers go down and an equilibrium eventually settles. If there was no choice (if you got rid of all competing PPO/HMO insurances), government can do whatever they want, start you off with poor reimbursements and force you to participate if you needed to accept insurance in your practice. Eventually, standard of care will have to drop in order to stay in business (haphazard speed, cheaper materials), but because most everyone will be in the same boat, that new standard of care will be the accepted standard by the profession.

This is the answer I was looking for.
I’m still getting used to the jargon, I would appreciate if you could clarify. When you mention “reclamation”, are you referring to the insurance provider requesting proof of treatment. As in if the patient needs a crown, photos would be needed to be sent to the insurance provider before funds for the treatment could be obtained?

 

[wengerout]

Even if Bernie wins the white house, Medicare For All will not pass in the US House, let alone the US Senate.

 

[Cold Front]

Even if Bernie wins the white house, Medicare For All will not pass in the US House, let alone the US Senate.

Medicare for all or not, income taxes will go up under Bernie.


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[TanMan]

This is the answer I was looking for.
I’m still getting used to the jargon, I would appreciate if you could clarify. When you mention “reclamation”, are you referring to the insurance provider requesting proof of treatment. As in if the patient needs a crown, photos would be needed to be sent to the insurance provider before funds for the treatment could be obtained?

Reclamation means they want to reclaim their funds by trying to find reasons why they shouldn't have paid you. It can be as simple as declaring them as medically unnecessary to administrative mistakes (didn't check a box or something mundane).

If Medicare for all passes and taxes go up significantly/reimbursements go down significantly, we all probably have to get a second passport and diversify investments in non-FATCA countries. Otherwise, the taxman will hold your passport hostage.

 

[Gyuji]

Medicare for all is just a promise. All promises are meant to be broken in politics. Candidate Trump said he will release his tax returns, he didn’t. He said he will repeal Obamacare all together, he didn’t - by 1 vote (from John McCain). He promised to build a wall - as of today, there is no wall big enough to dent any illegal border crossings from Mexico. Trump can’t get anything big done in Congress because the House is blue, he couldn’t do much few years ago when Congress was red on both sides. So if Medicare for all has a shot, it will need a blue president and Congress to have a legislation that will come into a law. That’s how Obama did it with Obamacare. I think if the Bernie momentum holds until October, not only he may win, but the senate could be blue as well. Setting all Bernie healthcare agendas in motion to worry doctors and dentists.

Yeah, it's a promise but it's his flagship policy.

The thing about Bernie Sanders is that he's a politician with beliefs and convictions that makes him different from most politicians of today and recent presidents. If he gets into office, he's not only going to halt the neoliberal agenda but he will certainly campaign on Medicare-4-All once the 2022 mid-term election comes along by rallying up the People to vote against Republican and corporate Democrat Senators like Joe Manchin and Chuck Schumer. who are against the progressive movement. Basically, using public pressure to force politicians to either bent over to the will of the People or risk it at the ballot. Which is how things gets done in politics - e.g. passing of FDR's New Deal in the 1930's and Johnson's Great Society proposal in the 1960;s.

Mind you, the Democratic Party, meaning the politicians within the party, are not in favor of Medicare-4-All nor Bernie Sanders' platform as those policies are against their corporate paymasters' wishes. But things are changing as Bernie Sanders is reforming the Democratic Party back to its FDR roots single-handily.

Most Third-Way-New-Democrat-Clintonites know this as voters under 40 are less influenced by corporate media thanks to alternative media in the Internet that deconstructs political tactics.

 

[Gyuji]

Even if Bernie wins the white house, Medicare For All will not pass in the US House, let alone the US Senate.

Either be Nancy Pelosi or another corporate Democrat as Speaker of the House, Medicare-4-All will be pass in the House. It's political suicide to be against it as Speaker as no one in that position wants to get the blame. Of course, someone, a corporate Democrat, in the Senate has to take the blame for killing Medicare-4-All with his/her vote.

With a looming economic crash, Republicans will get the backlash and lose seats and will lose more if Sanders is president. So, they will be a non-factor.

 

[Cold Front]

Either be Nancy Pelosi or another corporate Democrat as Speaker of the House, Medicare-4-All will be pass in the House. It's political suicide to be against it as Speaker as no one in that position wants to get the blame. Of course, someone, a corporate Democrat, in the Senate has to take the blame for killing Medicare-4-All with his/her vote.

With a looming economic crash, Republicans will get the backlash and lose seats and will lose more if Sanders is president. So, they will be a non-factor.

Nancy already announced that her current term will be her last term. She is turning 80 next month. She can’t push herself beyond that. Since she doesn’t care much for a re-election, she doesn’t care much what people think of her or if she has hand on passing a Medicare-for-all in the House.


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[Big Time Hoosier]

neoliberal agenda

corporate paymasters

Third-Way-New-Democrat-Clintonites

Big Hoss

 

[luisfigo]

Bottom line, even in socialized countries Dentistry is still in many ways a private enterprise and expensive for patients

 

[DrJeff]

Real world numbers...

In my home state of CT, where apparently we're considered to have one of "the best" medicaid dental coverage plans and reimbursement rates in the country FWIW....

For adults, on average my medicaid reimbursement rates are 20-25% of what my normal fees are, and for kids that reimbursement rate is roughly 50% of my normal fees.

Add in the much greater number of restrictions that the medicaid coverage has vs either "private" insurance or straight fee for service, and the real world financial side of medicaid dentistry is certainly a challenge, and is often based on BIG volume.

Can it work? Yes. Is it a volume + speed race? Yes. Will you be doing a bunch of "bread and butter" type procedures (single crowns, endo's, etc) probably not. Like for example, with an adult, if they need an endo and a crown on a tooth, in CT, if they're missing any tooth on that entire side of the mouth, regardless of if it's in the same arch as the tooth that needs endo, that "disqualifies" the approval of the endo, at which point the patient can either pay full fee for the procedure themselves (doesn't happen very often IMHO since they're usually not flush with disposable income which is why they're on Medicaid in the first place), so then the tooth gets extracted, which if they don't up their home care game, the thing that often required them to need the endo that won't be covered, often eventually leads to more extractions over time on that side of the mouth due to the same Medicaid approval criteria.

Medicaid for all may sound great as a talking point, but do those who are championing it, REALLY understand what it actually means for their own personal healhcare? Often that answer is no

 

[Cold Front]

Real world numbers...

In my home state of CT, where apparently we're considered to have one of "the best" medicaid dental coverage plans and reimbursement rates in the country FWIW....

My state spent 15% of its total budget for Medicaid 20-years ago, today it’s about 50% and rising.

This obviously underfunds schools, transit and local governments. I believe this is the case for most states as well. Government Medicaid spending keeps rising - so will Medicare for the aging population. Healthcare cost will threaten the future of government spending and they will eventually have to increase taxes to keep up with those spending.


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[gryffindor]

I will become a dental student this coming fall and I’m thinking ahead. What are the implications of Bernie’s medicare for all? Wasn’t there at some point a gold rush where Medicaid covered braces, and dentists were cashing in like crazy? I want to get an idea of what would happen to the profession. What would happen to the way insurance claims are conducted (currently a fking nightmare), procedure expenses, what procedures would be covered by the plan.

Also corrects me if I’m wrong, I do believe the plan has a dental component and is not exclusive to physician visits.

The braces "gold rush" in Texas, from what I understood, was totally the fault of the administrator (Xerox) not following the guidelines that were in place to approve Medicaid cases based on severity of the case and instead just approving everything that came in. I have a lot of experience dealing with "medically approved" orthodontic treatment. Most of my patients don't get covered unless a very specific set of criteria are met. The criteria set by my state are actually way more generous than other states where basically nothing is covered except maybe cleft lip & palate cases. This is for braces covered by Medicaid and also several private plans as well that came about after the ACA was put in place. I don't forsee any dental component to Medicare being more than an exam, extractions, and maybe some cleanings. I'm sure there are studies out there showing you don't need teeth to have adequate nutrition and Medicare will cite that as the reason for covering only extractions and no restorative. They can add blenders to the list of Medicare approved DMEs.