Your ADA/ASDA $: do YOU know where its going?

I think you are missing a big key here: Last year, the Republican party held the majority of power, so it would be to our advantage to give more donations to those in power. The switch just occurred this year, so I'm sure things will change to be a little more even, but you have to give it time. The way it works, often times you contribute money to have "face time". So now that democrats are a majority, it will shift.

I know that you think the main purpose of ASDA is to lobby for the students, but I think you need to look at a longer term goal. The main priority should be on your future as a dentist (30 years of your life) vs. student (4 years). To me, and I'm sure to a lot of politicians, it just seems whiny to say I'm paying too much for school, please give me money for tuition. However, I personally lobbied with my state legistlature for more state funds for low income insurance (which was the main source of patients for our school.) This didn't lower my tuition, but it does help with my education, and provide a service to the community.

As for national board exams, this is a state issue more than a national issue. Think about it: the state decides licensure. So, it's a little more complicated, but remember to try to change it when you get out, because, you're right, you don't have as much sway when you are the test taker.

4. What is actually being done to maintain our independence as practicing dentists and how will it be affected by the coming movement towards nationalized/socialized healthcare?

As for number 4, talk to any ADA lobbyist. We can't predict the future, but that is exactly why every single dentist and student should be a member, so that we have more power for future challenges. A somewhat recent example: when HIPAA was being passed, it took lobbying efforts to change it so that every dental office in America did not have to remodel to put up walls between ops. (This was what it originally was going to do.)

If you REALLY want to know. GET INVOLVED. Go to your state lobbying day. My personal recommendation is not to focus as much on tuition, since although that sucks, you did make a choice, and I personally think it is tough sell to politicians to take money away from something (education, other programs, it has to come from somewhere) to help give us scholarships. If you were to ask for loan repayment programs in underserved communities, that would be a fair compromise, but would you participate? You have to think Win-Win, it's not just all about you.

 

But please, please, don't just sit back and whine that you don't know what ASDA or the ADA is doing with your money. GO DO SOMETHING ABOUT IT! The ADA supports politicians that support dentistry; they are bipartisan.

 

Lets answer a few here. first the Republican issue. For many of us, you'll be a small business owner in practice. The republican controlled gov't has put inplace (and is trying to retain a HUGE tax advantage for small business owners where you can rapidly depreciate(read as write off your income tax) upto $112,000 of capital improvements to your business per year - that new operatory you want, that new laser, that corporate vehicle weighing over 6,000lbs, that new office computer system, etc - tax deductable - BIG tax help!!!!!!! The Democrats want to take it away.

ADA and ASDA have both fought (and won) the right for you as dentists to be able to pick and choose which (if any) insurance plans you want to enroll with. Insurance companies wanted to have it where if you enrolled with 1 plan, than you were enrolled with all of that companies plans, including the horrible reimbursing managed care plans that they offer.

ADA and ASDA are very, very proactive about the amalgam issue, which if the fear touting junk science loving lobby has it, you as a dentist could be potentially libel for health issues, environmental issues, etc, etc, etc!

ADA and ASDA are very procative about the push to form a mid-level practictioner, and trying to prevent it! Do you want basically a glorified hygenist prepping and restoring teeth and doing extractions????

ADA and ASDA have been very, very proactive about getting a national licensure standards inplace and have made huge strides with ADEX.

The cost of school issue is more of a localized, school issue as opposed to a national one, many schools, especially the private ones can in this free market economy we live in set their tuitions based on what they need to cover costs plus what ever else the market will accept, if the price gets too far out of hand, then they'll see enrollment go down. State schools are subsidized by those individual states and set tuition as such. You'll rack up a big pile of debt, but you'll also in all likelyhood make enough to cover your repayments and then some.

On the nationalized healthcare issue, dental in general is a very small piece of the healthcare puzzle and in all liklihood won't be part of any early/initial trend towards a national healthcare. Plus, when it does come to a national healthcare situation, it will cost ALOT of $$, which means that politicians will have to do one of 2 things which they HATE to do, either 1) significantly RAISE taxes (just the thought of that gets politicians thinking about the negative campiagn adds that their challengers will use against them in the next election), or 2) drastically cut programs (many of them "pork barrel" expenditures that benefit their own districts) - (see fear of negative campaign adds above )

The best thing politcially that can happen to dentistry is that we stay on the political radar, but as a small blip (i.e. we're noticed, but not as a threat) Case in point, in my home state of CT, our medicaid reimburesment rates are attrocious (generally in the 20-40% of usual fees) and as such very few dentists participate since you essentially loose money due to the rates and just can't run a business and see a significant portion of the underserved. Roughly 1/3rd of all practicing dentists in CT have recently signed a pledge where if the state upped medicaid reimbursement fees to the 70th percentile range, that we'd see many more medicaid patients. Cost estimates have put the funding for this plan in the 70 million dollar per year range which out of a 9 Billion dollar or so budget is a real small amount. The bill to increase the funding died in committe since the politcians didn't think that we'd "step up to the plate" even though we had all the signed pledges And if they didn't think we'd step up to the plate at 70%, then even if they did raise the rates, it would cost them barely anything to implement To rope this though back, politicians notice us(especially since we tend to have the ability to donate to their campaigns), but don't really think we're an issue, so its move along in a status quo fashion right now.

Join ADA/ASDA it they really, really look out for the profession, and are more than just a monthly journal and a bi-weekly paper.

 

Dr. Jeff, do you happen to have any insight on foreign dental school accreditation? I'm starting D-school in 6 months and I'd be pretty upset if the ADA just starts granting foreign schools accreditation and does not limit the number of dentists that come to practice in the USA. I would think this could only be bad for dentistry, as more competition will mean insurance can step in somewhere to get a piece of the pie and possibly lead to the same thing that happened to medicine.........

I plan on being active in ASDA when I start school in the fall, I see it as a fantastic way to help preserve the dental profession I'm getting into. As you mentioned, belonging to ASDA/ADA is one way to start, as we are surely stronger together then divided.

 

My partner(he's on a couple ADA national taskforce committees) is a bit more upto date on the foriegn accredidation area, I'll ask him about it when he's in the office tommorrow.

In conversations I've had with him about this, it seems to be the sticking point, and what ultimately prevent its passage, is that when accredidation for a foriegn d-school is being looked at, its not an individual d-school that wins/looses accredidation but an entire country. Basically, lets take Canada for an example, you have some great d-schools, such as U-Toronto, McGill, etc which are as good as any in the world and you wouldn't question accrediting them, but if you also have a horrendous d-school(none come to mind off the top of my head) in Canada, then the all the schools may not win accredidation because of it. Thats the big issue.

One thing to remember is that the ADA as a whole is really looking out for its members and any perceived "bad" threat to the profession as a whole, they're all over it. Get involved, it's quite impressive to see what they do. Start in D-School with ASDA, get involved then once your out with your component society, and go from there!

 

Thanks for the reply Dr. Jeff. I didn't know about the whole country gaining accreditation. That certainly would be scarey, as what would stop a for- profit school from starting in a country that has gained accreditation that caters to american residents whom could not get accepted to US dental schools (similar to carib med schools). Then anyone who wanted to be a dentist in the USA could be one as long as they passed all the exams. The thought of that is certainly unnerving, esp. since I had to work my butt off after getting rejected the first time to get in on my second try!

 

The child that passed away due to the abcess is certainly a sad story. I read about it earlier today but also saw a clip of it on Nightly News in the evening. They certainly didn't bring good press to dentists.

As I posted in the pre-dental forum earlier, the only way, in my opinion to change the dental profession so everyone can have access is to start with tution. I will be graduating with $250k in debt as well, and this coupled with a future mortgage, kids, family and taxes will tremendously chip away at any salary I make in the future. How many new graduates with $200k+ debt are going to work for medicaid reimburstment when it pays very little?

If the government wants to kill the dental profession, then they can give universal dental care. Ultimately the government will pay pennies on the dollar reimbursment, while dentists have hundreds of thousands worth of debt. In turn, future pre-dents see this and turn away from the field. Eventually there will be less dentists for even more population, and dental care will suffer for EVERYONE, not just the uninsured. In fact it is very short sighted. Unless there is debt relief/subsidization of tution coupled with the governmental progams.

I think everyone wants as many people as possible to have dental care. But if the government doesn't address any other issue other then cheaper reimbursment, then they are going to be slowing killing dentistry.

Just my 2 cents.......

 

You all may be correct and what do I know however, consider the following:

Early periodic Screening, Diagnosis, and Treatment (EPSDT) benefit requires states to provide all Medicaid-eligible children, under the age of 21, with comprehensive, preventative, restorative and emergency dental services

In 1996, 22.9 million children were eligible for EPSDT

Clearly the issue is not paying for care, access to it. That being said, medicare/medicaid is a double edged sword. Think about how messed up medicine is. I thank God that dentistry is not messed up in all of that Govenment nonsense.

As for the kid that died. You have to remember that there is always another side to the story. You have no idea what that mother did/did not do. She may have ignored the problem, she may have underestimated the severity of the problem. It is human nature to not take the blame for your own mistakes. I find it hard to believe that she could find NO ONE to treat him. Not one dentist any where would help them. Seems kinda crazy to me. Which brings me to my next point.

Again, I might be wrong, but countries that have sucessful care to the poor do so by EDUCATION. Telling parents that oral health is VERY important. Counties like Sweeden show that education is the KEY to public health care. They have a much lower mean DMFT in children and still have a shortage public dentist, so how does it work. Again, education of parents of the value of oral health.

Everyone also have to remember that you can never please everyone and there will always be problems with any model.

Consider the following paper as a model. Do you really want MD's treating dental patients?
Lewis, CW et al. The Role of the Pediatrician in the Oral Health of Children: A National Survey, Pediatrics. 2000 Dec;106(6):84

 

Wrong. He died because his mother couldn't have find someplace the tooth extracted for free.

If you insist on blaming someone for that kid's death, blame the mother who chronically neglected both his & his brother's healthcare needs because she evidently didn't think they were important enough to pay anything for. Rampant decay doesn't happen by itself, and the tragic outcome in this case doesn't make us responsible for her decision to raise children who are/were afraid of their toothbrushes.

 

And here we have it: The crux of the issue and the most insidious result of the implementation of a welfare state (in any country) is that it instills a false sense of entitlement regarding all resources (not just healthcare).

Seventy years ago you would have been hard pressed to find an individual who would show up to a store expecting someone else (Food Stamps) to pay for their eggs and cheese. If a poor person didn't have the money, they would get it on store credit, and they would come back and pay for it as soon as possible!

Sevety years ago you would have had a hard time finding a poor person who would show up to the doctor or dentist expecting to have all their treatment paid for by someone else (Insurance, Medicare, Medicaid, etc.). Now days EVERYONE expects to have their health care "paid for" by someone.

This sense of Entitlement is sickening in so many ways. Think about it the next time you are working up a Patient and they proclaim, "Now I gotta check and see if 'they're' gonna pay for this, first."

Who the hell is "they"?!? Its YOUR OWN freaking body people!!! Where is the personal accountability anymore?

Of course, the bleeding heart liberals will act like its the spiralling costs of health care and everything else that got us in this mess, so Welfare needs to support those less fortunate. In reality, the Welfare state produced and now perpetuates this self-deprecating sense of entitlement throughout all levels of society.

Just my 4 cents. . .

 

As harsh and blunt as this statement is, it's very, very true. Just about everyone in the dental profession is quite altruistic in nature. The big problem is that this system as a whole is so broken, and people tend to have such a feeling of entitlement about what is theirs, that it can't be fixed to a majority of peoples satisfaction.

As somebody that's tried in my own practice to see a decent amout of medicaid patients (my goal is 1 per day, it doesn't sound like, but it makes a difference over the course of a year), the amount of logistical issues that you encounter dealing with third party medicaid payers, and the unfortunate high no-show rates of medicaod pateints, its real tough and frustraing, and you become jaded at both the system and the all to often failure of the patient to except responsibility for dental problems that they brought upon themselves. I can't tell you how many times over the last decade I've seen a medicaid mother bring in her child for a new patient visit, with a bottle of Kool-aid or soda in the hand of the child, a diet that is rich only in sugary foods, and a mouth that has a greater than 50% decay rate going on. I lecture them, at each visit about how diet is the main issue, restore them and less than 2 years later, I'm replacing a good quantity of what i did to clean them up and the Kool-aid is still in hand. I've basically given up on trying to find any reimbursement from medicaid for these pateints as the amount of paper work needed to be submitted for a ridiculously low reimbursement rate for way too few proceedures being covered isn't worth it. I've chosen to treat the medicaid patients that i see using what I call my "patient contract", which basically says that I'll treat them for free as long as they don't miss any appointments AND start some form of diet control. They are aware that if they miss any appointments, or if I continue to see a anything that resembles new onset decay that my agreement with them is terminated.

If you really want to make a difference, forget about some governmental help in doing it, but get your classmates ad future private practice colleagues to commit to seeing 1 medicaid pateint a day. Then you'd see some real change happening.

 

If you want to see another area about healthcare that is overlooked by many as part of the problem, lets look at the insurance industry. Everyone says that we make too much Even though the insurance companies like to control/limit treatment and reduce fees paid out.

Here is an excerpt from the financial releases for one of the insurnace biggies, Wellpoint for the 4th quarter of 2006 with soem year end summary too.

"WellPoint Reports Results for Fourth Quarter and Full Year 2006


Fourth quarter net income was $1.28 per share, which included net realized investment gains of $0.01 per share

Selling, general and administrative expense ratio continued to improve, declining by 100 basis points from fourth quarter of 2005

Full year 2006 net income was $4.82 per share, an increase of 22% from 2005

Operating cash flow was strong in 2006, exceeding $4.0 billion or 1.3 times net income

Company expects 1.4 million new members and net income of $5.53 per share in 2007

INDIANAPOLIS, Jan. 24 /PRNewswire-FirstCall/ -- WellPoint, Inc. (NYSE: WLP) today announced that fourth quarter 2006 net income was $801.1 million, or $1.28 per share. These results included $0.01 per share in net realized investment gains. Net income in the fourth quarter of 2005 was $652.0 million, or $1.04 per share, including $0.01 per share in net realized investment losses.

If you want to play the insurance game, all as dentists that we're really looking for is give us a fair playing field. Don't give us non expense covering fees, and you'd be suprised at how much can be done!

 

...and there lies the truth. Aside from being saddened by this recent, peventable event, I also thought this is definitely going to bring dentistry into the forefront, along with medicine, when, and if, a universal, national health care plan is eventually organizied and implemented.

 

I agree. All people need to see is a few media outlets showing stories like this claiming its the dentists fault, they are too greedy etc. The general public doesn't like dentists as it is, so its really just throwing fuel on the fire.

And who is going to pay for nationalized healthcare? It would cost billions upon billions of dollars. Like Dr. Jeff said, what politican wants to raise taxes when they are looking to get re-elected? In my opinion nationalized dental/healthcare would just make people more lazy and less accountable. Jaybe had some pretty good comments about this issue. I think it would just end up being worse then welfare/medicaid, with a certain percentage of people contributing $$ to the system via taxes, and a huge portion of people just sucking the system dry and never giving back. Why should these people try to get a job and contribute back to the system when they already have all the dental/healthcare that they need?

Like I said before, I really wish more people could get dental care. But by implementing a nationalized dental system, patients will be rewarded for being lazy.

A better plan IMO would be to establish free dental days in every state. Have a schedule published for every interested dentist to offer 1-2 days a year of free/reduced price dental care, and give them a total tax write off for all of the fees for that day. I'm sure every state has at least a few hundred dentists, so volunteering only 1 day a year each, there would be an entire year of free dental care. Make this schedule available at health clinics, hospitals etc. Then its up to the patient to make the effort to go see the dentist.

 

An even better way to get some participation of dentists to treat the underserved would be something as simple as the following, for every $1 of medicaid care you give, you'll have that equivalent amount deducted from the principle of your federal student loans, upto say $10,000 or so a year. Something as simple as that would get ALOT of participation since very quickly, most dentist loose the student loan interest tax deduction due to their income levels, and that way, with medicaid basically re-imbursing .25 to .50 cents on the dollar for real world healthcare dollars, that amount that would be written off of the federal loans would actually buy alot more federally funded healthcare dollars. Additionally, what loan ladened new dentist out there wouldn't want to do something that a) would reduce their indebtedness and b) has the ability to greatly benefit members of their community, and then c) would potentially encourage/instill a career length commitment to help treat the underserved.

The problem with something like that is its far to simple for a politician to grasp

 

Don't forget about the insurance companies cut to "manage" that insurance plan. Think about it, when's the last time you heard of an healthcare insurance company posting a quarterly LOSS?? You'll often hear PROFITS were below expectations, but almost never a LOSS

 

some awesome points. i agree with reasonable conditions dentists would be happy to treat the underserved.
by the way, i didn't hear any bad press about dentistry. every report i read/saw did make the point that dentists are fed up w/ the bureaucracy and ridiculously low reimbursements rates w/ medicaid.

 

That was my take too when i saw it on the NBC nightly news last night. Medicaid was more of the problem than the dental profession. although it was a nervous 20 or so minutes from when I saw it as the third lead teaser at the start of the news, behind the stock market crash and Afganistan Taliban violence. I had visions of a dental disaster being played aout across the nightly news!

 

Yeah, but would they be willing to pay an extra 10% in taxes? Doubtful. $500 wouldn't do jack. It would not be such a small increase. Anyone who wants the federal government to pay for health insurance should start filing for citizenship in Sweden. It's never going to happen here. Socializing medicine in a capitalist society? Not gonna happen...

Amen, brother...I'm in 100% agreement with that entire post...

 

Profound thought:

The reason insurance and medicaide/government assistance programs have so many problems is that they are a socialist idea trying to work in capitalist society. It just doesn't work out well.

 

If you take out that portion of healthcare expense that is assumed by the individual, then what incentive or consequence does the individual have to make choices that improve their healthcare or do things that are intelligent with regards to health care. My whole point is that individuals need to assume the majority of the responsibility for their health. It is their body, their life, and only they can control what they do with it.

What will they think of next, national pet insurance. What about national car insurance. I think we should raise taxes to pay for utilities too. While we are at it lets go dig up Karl Marx body and see if we can reincarnate him so he can run for president in 2008 and raise taxes on everyone to 99 percent... then we should join the EU.... then we should rename ourselves South Canada....

No country has instituted national health insurance and then moved forward as a economic and political power....

 

If you want me to find an encephalitis case from a bad tooth in a modern country with universal health care then I will. Universal health care can't and won't change poor personal decisions and exhorbitant health costs for those who don't take good care of their body. If you take a public health class you can look at study after study and see that access to care isn't directly correlated with improved personal health. You can't take the freedom of people away from them and make them be healthy and make them get health care. You are making everyone responsible for personal issues that are none of your and my business. Because of this single notion, you can't have national health care and expect it to get you better than what you have now. It will just be a different variety of "cluster [email protected]#$$" with less freedom for the common individual.

If you want to make healthcare less expensive start with Tort Reform, and insurance regulation/fraud and then see where that leaves health care....

Until we get to national health care, I suggest you sacrifice yourself, and treat anyone and everyone irrespective of money and lets see how far you get and how long you last.....for those who believe health care is a right, I suggest they dedicate their entire practices to treating everyone irrespective of cost and then return and report to the rest of us on your findings. As the old addage goes, "if you're young and not a exsanguinating liberal then you don't have a heart... if you are middle aged and not a conservative you don't have a brain...." another words, when you aren't the back bone of this country your head can be filled with all kinds of "great" ideas and then after some real world experience you can tell where your "lofty ideas" and the rubber hitting the road just don't jive especially when it has to jive on your back/blood/sweat.... nice thoughts though... especially about doing what is right for our fellow man.....such a liberal cop out. The latest studies show that conservatives are more philanthropic and charitable personally while liberals tend to be more philanthropic and charitable in "policy/posture" but not personally.... I find it interesting! Now tell me who really cares for their fellow man!

 

If you want me to find an encephalitis case from a bad tooth in a modern country with universal health care then I will. Universal health care can't and won't change poor personal decisions and exhorbitant health costs for those who don't take good care of their body. If you take a public health class you can look at study after study and see that access to care isn't directly correlated with improved personal health. You can't take the freedom of people away from them and make them be healthy and make them get health care. You are making everyone responsible for personal issues that are none of your and my business. Because of this single notion, you can't have national health care and expect it to get you better than what you have now. It will just be a different variety of "cluster [email protected]#$$" with less freedom for the common individual.

If you want to make healthcare less expensive start with Tort Reform, and insurance regulation/fraud and then see where that leaves health care....

Until we get to national health care, I suggest you sacrifice yourself, and treat anyone and everyone irrespective of money and lets see how far you get and how long you last.....for those who believe health care is a right, I suggest they dedicate their entire practices to treating everyone irrespective of cost and then return and report to the rest of us on your findings. As the old addage goes, "if you're young and not a exsanguinating liberal then you don't have a heart... if you are middle aged and not a conservative you don't have a brain...." another words, when you aren't the back bone of this country your head can be filled with all kinds of "great" ideas and then after some real world experience you can tell where your "lofty ideas" and the rubber hitting the road just don't jive especially when it has to jive on your back/blood/sweat.... nice thoughts though... especially about doing what is right for our fellow man.....such a liberal cop out. The latest studies show that conservatives are more philanthropic and charitable personally while liberals tend to be more philanthropic and charitable in "policy/posture" but not personally.... I find it interesting! Now tell me who really cares for their fellow man!