Dr. Raul Garcia, your guest editorialist in September JADA, expressed one of the most unrealistic opinions since Hillary Rodham Clinton’s national health care plan ("Addressing Oral Health Disparities in Diverse Populations,"
JADA 2005;136:1210–2[Free Full Text]
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Perhaps the profession would do well to inform the welfare state that our services cannot ever be free, "without regard to ability to pay." Someone has to foot the expenses of delivery, and charitable work will never be able to fill the extensive need. Education is woefully negligent in the elementary and high schools, and parents contribute to the negative attitude and lack of preventive care.
I provide care for eligible Medicaid patients as a community service, because of the severe needs in our northern New York location. I can attest to the fact that, even though the service is free, many eligible recipients fail to show up after making appointments. In our area, the ethnic groups listed by Dr. Garcia are negligible, and there is no prejudice. In countries such as Costa Rica and Panama, which have a minimal military, their budget is heavily dedicated to health and education, with excellent results. Health care is also less expensive, due to a less litigious condition. When oral health care is respected and appreciated as a necessary part of general health maintenance from the earliest pediatric care, then the scene will improve.
Dr. Garcia advocates the need for more research, while I feel my thoughts expressed here are redundantly "preaching to the choir" and don’t need additional study. What we need are providers who are compensated and appreciated appropriately, along with an intensive educational effort, via Internet or recording of a gifted speaker in all schools. Unfortunately, at this time, Medicaid has been under attack in general, and is considered a stigma in describing a practitioner who accepts Medicaid. When the money is apportioned by government on a far more sensible priorities basis, then the populous will be far better off.
It should be noted that current Medicaid programs discourage participation by posing bureaucratic delays, irrational rules and tons of paperwork, equating to a poor insurance plan with a low pay scale. I propose a system of trust by government of the providers, backed by random inspection and review of cases to police the program. Is this too much to hope for?
