Dental care is health care, and dental care must be included in any real health-care scheme in the United States.
Medicare coverage would provide an option for elderly and disabled individuals to pay for their dental care, but there is no guarantee that all dentists would accept it. Almost every doctor and hospital in the country accepts Medicare, but dentists have grown their practices without relying on the program for the last 50 years. Many private-practice dentists refuse to accept Medicaid, claiming that the compensation is too low and the administrative burden is too great.
Dental disorders, as well as the inflammation and bacteria that accompany them, can exacerbate other chronic conditions such as diabetes and heart disease. In addition, missing or hurting teeth might make it difficult to eat a nutritious diet. Dental infections can be excruciatingly unpleasant — they are a leading cause of emergency room visits — and, in rare occasions, fatal.
Optimists, on the other hand, believe that Medicare dental coverage might do more than merely enhance recipients’ affordability. It may also challenge long-held beliefs about what health insurance should cover. Historically, health plans have tended to disregard health issues that are “in your head,” such as eliminating dental coverage, vision benefits, hearing aids, and mental health. About 15 years ago, Congress mandated mental health coverage, first in Medicare and subsequently in other types of policies. Access to mental health care is still inconsistent, although it is increasingly recognized as a component of health care.
Meanwhile, Medicare patients in Hardwick must continue to make difficult decisions. When Gina Brown, 66, came in for teeth cleaning recently, Dr. Rulon discovered a cavity near a root — one that could cost her the tooth in the near future. That afternoon, she was back in the chair for a filling. She had complete health insurance through her job as a caregiver for developmentally impaired persons, but her dental coverage was “extremely limited.” She could afford to repair her ill front tooth, but not a partial denture to replace the molars she had lost years before when money was scarce and dental care was out of reach.