Commentary: Dental care must be part of health system reforms

A dentist’s program for veterans provided insight into the larger need for access to preventive care.

By Theresa Cheng

For The Herald

A local news article about an injured Iraq War veteran brought me to a deeper understanding of the struggle for access to dental care in my community.

I opened my dental practice to help other vets facing similar circumstances, which propelled me to a more comprehensive understanding about the systemic issues our country faces in providing consistent, high-quality preventive dental care.

Until then, I hadn’t fully realized how under-served our veteran’s community is when it comes to dental care, so I founded the non-profit organization, Everyone for Veterans, to connect a network of dentists to give back to those who’ve served in combat areas. I began to better understand that the gaps in service to our veterans are also reflected in the broader public and how this negatively impacts the health and well being of our communities.

Dental access is a complicated issue and there has been tremendous effort from the dental community to address gaps in service. However, the current system of compensation for urgent interventions such as extractions and fillings — instead of emphasizing compensation for preventive care to fight gum inflammation, infection and cavities, which address the underlying chronic issue of dental diseases — is unsustainable. Some policymakers have proposed creating additional types of dental providers to expand these urgent services, which is unnecessary as assistants and hygienists can already provide preventive care.

As our health care system moves toward an outcome-based model of care, preventive dental care should be more fully integrated into the health care system. This is especially true for veterans across the country, the majority of whom don’t receive dental benefits once disconnected from the service.

When the Affordable Care Act was passed in 2010, it meant a huge step forward for low- and middle-income families, who benefited not just from expanded Medicaid availability, but also more options in health care coverage from an open marketplace that was host to a diverse range of plans to suit different needs. Unfortunately, the spirit of these reforms did not translate into an increased emphasis on dental care.

We know that dental health is directly linked to overall health outcomes. Nationally, about 800,000 emergency room visits per year are for dental emergencies, and the risks for not properly taking care of dental issues can include sepsis, heart attack, stroke and Alzheimer’s disease.

Moving forward, policy makers must ensure the next round of health care reform emphasizes the prevention and elimination of gum inflammation and infection, which are the key contributors to larger, more costly health issues. This will directly benefit the veterans in our community and will also drive down the cost of the health care system as a whole.

We can’t afford to move backward at this key point for our nation’s health care system; 1 in 3 adults in the U.S. don’t have dental coverage, and repealing or rolling back parts of the ACA will only make getting access to health care more difficult. Due to an absence of dental coverage, Medicare patients in particular have a higher prevalence of gum disease, which negatively affects their overall health. Expanding Medicare into a single-payer or Medicare-for-All program won’t get to the root of the problem if dental care remains apart.

Finally, any policy changes that serve to reduce reimbursement rates for dentists or doctors would be harmful to the whole system. New practices take a lot of capital investment to establish and many providers already struggle with very low rate schedules. If we want to create better outcomes, we need to competitively reimburse providers for shifting their focus to preventative services.

We can and should do better to provide, high-quality, affordable care. But we can’t get there just by scrapping the health care market we have. As a country, we must work together so that all working families can have access to a more comprehensive slate of preventive services.

Dr. Theresa Cheng is a retired dentist from Issaquah and the founder of “Everyone for Veterans” a non-profit organization dedicated to helping low-income veterans access free dental care.

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