Medicine

Toothless in Appalachia

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The Washington Post is running an excellent video series called "The Healing Fields," about the Remote Area Medical Volunteer Corps in Wise County, Va.:

Hundreds of uninsured and underinsured Americans flock to Wise County, Va., every year to seek treatment at a makeshift field hospital operated by the Remote Area Medical Volunteer Corps. For three days in this isolated corner of Appalachia, a small army of health-care professionals offers medical attention to patients who are not likely to see another doctor or dentist all year. The annual clinic saves lives and alleviates suffering, but in the face of a growing national health-care crisis, it may not be enough.  

Be warned: The video features a kid with a mouthful of abcessed teeth and other horror stories.

Part of this crisis, as I argued in July, is the monopolistic licensing influence of the American Dental Association. The ADA has effectively discouraged lawmakers from licensing alternative dental practitioners in every state but Alaska, where the ADA lost its suit against the Alaskan Native Tribal Health Consortium. The consortium continues to send high school graduates to New Zealand for a two-year program in basic dental health care, which allows them to provide low-cost care in remote tribal areas of Alaska. Dental therapists, as well as denturists (who can legally practice in a handful of states, despite the ADA's smear campaign) could have a profound effect on health care in poverty-stricken areas, both rural and urban. Sadly, neither group can legally practice in areas like Appalachia, where they're needed most.

Why aren't politicians batting around the idea of comprehensive licensing reform, the quickest route to affordable health care? According to this excellent Cato paper, abandoning the medical rent-seeking model is "politically infeasible." The paper does, however, outline some intermediate steps towards reform, such as more skepticism on the part of state politicans in response to medical groups' requests for stricter legislation.

On the other hand, maybe foreign alternatives are the way to go.

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  1. Nothing is quite as horrifying as broken, rotting teeth.

  2. For a county named “Wise”….

  3. Yet more evidence of the elitist conspiracy against real Americans. When’s the last time you saw a Harvard grad with a mouth full of abscessed teeth? Yeah, that’s what I thought.

  4. We don’t need more “health care providers” and we especially don’t need cheaper health care; WE NEED MORE INSURANCE!

  5. “WE NEED MORE INSURANCE!”

    We need smart insurance!

  6. According to this excellent Cato paper, abandoning the medical rent-seeking model is “politically infeasible.”

    Perhaps we should work to make it politically feasible then. Oh wait, this is Cato, they don’t want to upset the elites who invite them to cocktail parties.

  7. We need insurance that gets used as insurance, and affordable options for common injuries and ailments. I don’t use my auto insurance when I get my oil changed.

  8. Sadly, neither group can legally practice in areas like Appalachia, where they’re needed most.

    Sneakiest Appalachians-are-toothless-hicks joke I’ve yet seen. Kudos.

  9. David, apples and oranges.

    If you don’t get your oil changed and wind up blowing your engine, your auto insurance doesn’t have to cover that.

    If you don’t get yearly checkups, on the other hand, and develop some awful condition as a result, your health insurance does have to pay for that.

  10. Are you suggesting …. DEREGULATION!!!11!!OMGWTFBBQ!

    Goddamn we’re burning people for doing that now a days. [not really, we’re shoveling money out with front-end loaders – but any day now we’ll get to the burning]

  11. in the face of a growing national health-care crisis

    What growing national health-care crisis?

    WE NEED MORE INSURANCE!

    Then buy some. Who’s stopping you?

  12. That depends. The oil change was meant to be a comparison to the sort of minor treatment that most people need every year. I don’t think that things like sinus infections and sprained ankles really need to be a $25 co-pay and a few hundred billed to the HMO. Insurance would be for things things like emergency care, surgeries, cancer treatment, etc.

  13. I don’t think that things like sinus infections and sprained ankles really need to be a $25 co-pay and a few hundred billed to the HMO

    Oh how I wish this was the case. HMOs do not reimburse well, generally speaking.

  14. I didn’t mean to imply that they did. But someone who intends to pay out of pocket is going to get billed at the HMO rate.

  15. I get bronchitus on a regular basis in the winter. I use to call up my old country doctor’s office and tell the nurse I got it again. They’d look in my chart and call in the script that I had the last time.

    Then the old doctor retired and a young guy came in. Now it’s a hundred-plus office visit for the doctor to look in the chart and then tell the nurse to call it the script I had before.

  16. “WE NEED MORE INSURANCE!”

    We need smart insurance!
    With the right people in charge!!

  17. We don’t need more “health care providers” and we especially don’t need cheaper health care; WE NEED MORE INSURANCE!

    You do understand, don’t you, that we ultimately pay for insurance. There isn’t a secret pot of gold anywhere that the government or the insurance companies or our employers can tap. Eventually taxpayers and consumers foot the bill.

    Part of this crisis, as I argued in July, is the monopolistic licensing influence of the American Dental Association.

    They aren’t the only ones. Nearly every piece of medical equipment, from CAT scanners on down, has to pass a government review saying it’s “needed.” Sort of like licensing cabs to keep the competition down.

  18. Nearly every piece of medical equipment, from CAT scanners on down, has to pass a government review saying it’s “needed.”

    It depends on the state. I think around half of them still have “Certificate of Need” programs, and most don’t apply to anything below the level of a CAT scanner.

  19. Yes, a massive overhaul of the American health system is urgently needed.

    Or this kid can brush his fucking teeth.

    You know… whichever.

  20. Why aren’t politicians batting around the idea of comprehensive licensing reform, the quickest route to affordable health care?

    When you remove a barrier, the freed person thanks you once and then gets busy helping those in need. On the other hand, liscensing is the gift that keeps on giving. The doctor owes his livelihood to your good graces and the patient has to ask you for finacial assistance to get medical help. Most politicians would rather have lots of people owing them gratitute for rubber stamping papers than to have a few freed humans get the credit for the lives those freed humans save.

  21. “Why aren’t politicians batting around the idea of comprehensive licensing reform, the quickest route to affordable health care?”

    Because then the demi-crats would loose their ability to keep the sheeple dependent on sugar daddy gub-nment if basic medical care was, you know, affordable. Geeze – if they don’t need me to hand out free care, they might not vote for me.

    Instead, we get continued resistance since all those making bank off the current system in all their forms want to keep sucking at the teat. See the article further up the blog on the so called free market.

  22. This is Buttkiss, Klahn’s bodyguard – he is tough and ruthless. This is Kwong, Klahn’s chauffeur – he is rough and toothless.
    –KFM

  23. I’m still wondering:

    What growing national health-care crisis?

  24. RC–

    Haven’t you heard? Eleventy hundred brazillion people have no insurance, and 128% of them are children. Don’t you care about the children?

    All you have to do is watch the AMA-sponsored ad where doctors bemoan the fact that there are lots of sick poor people out there and doctors are unable to help them because they can’t pay.

  25. You know what grinds my gears? Whiny smokers complaining about how much their health insurance is. I know someone who even wants “free” health care (hah!) because she thinks it’s too expensive. She would save doubly if she didn’t have to pay more insurance for being a smoker and if she weren’t buying several packs a week.

  26. Upper middle class children in Baltimore have free health care already.Obama intends to offer the stuff to even wealthier families.Why don’t poor sick children in Appalachia have it?

  27. SIV, what’s this about Baltimore? Too bad “The Wire” ended this year or they could have gotten onto that racket too.

  28. I agree with David for the most part, though the oil change analogy isn’t the most accurate ( I do use it myself to simplify things and get people thinking).

    However, I would have to add/correct that self-payers, you know people that just want to pay their bills without a third party, are billed at a HIGHER rate than the insurance rate.

    I have both attempted to be a guy that just wants to actually go to the doctor and pay his bill AND a guy with private high deductible insurance ( the kind David would like everyone to use). I can tell you the insurance is worth it just for the “discounts” even before it pays a single dime in claims. I enjoy opening my mail and reading ” You have not met your deductible so we are not paying your claim but the allowable contracted rate for this service is only 1/3 of the billed charge. You are not required to pay any more than the contracted rate. The provider may only charge you $XX.”

    I have also seen billing statements for a patient that has used Medicaid, Self-Pay, and Private insurance. For the same services, the self pay charge was 3X the insurance charge and Medicaid was billed 500%.”

    I have also tried to negotiate hospital bills as a self-payer and when it came down to it, it made a lot more sense to just apply for Charity because they don’t want to work with anyone who actually wants to pay out of pocket.

  29. And as far as dental health goes,

    Dentist access/checkups seems a minor part to it.

    The biggest problems are:

    1. Hygiene- Not brushing and flossing. I am amazed how many people do not. Most people I know at least brush semi-regularly. However many do not floss at all. I floss daily, and if I miss a day there is all kinds of crud in there. This how people get decay in between their teeth.

    2. Washing your teeth with sugar. Many kids and their parents regularly bathe their teeth in sugary drinks. Soda, gatorade, kool-aid, all that stuff. The drinks are the worst. It’s a little better if you are only drinking with food, but walking around with a Coke and nothing to chew is just terrible.

    Any dentist will tell you the above, and consider they make most of their money from working on bad teeth. But they will tell you, often for free, exactly how to avoid dental work.

    If you really need a dentist or some other dental/health professional to tell you to brush your fucking teeth, you have more problems than healthcare access.

    There is a 3rd consideration:

    Genetics. Some people probably just have terrible genes and some kind of extra sugar sensitivity and/or reason their teeth decay faster. I don’t know. Not trying to be mean, but do people in Appalachia have funky tooth decay genes? Or are they just nasty dirty people who don’t brush their teeth?

  30. Don’t forget water supply. Aside from artificial fluoridation, some regions just have water with more fluoride in it naturally.

  31. I’m late and I missed this fab post. Just wanted to say that my dentist did a couple of years missionary work in Africa. He taught the locals to do dentistry in about three months. There was no choice because there was nobody to replace him when he came back to the US. Some great stories and the best one is that those remote little villages in the hinterlands of Africa all now have moderately decent dental care. Without licensing or grad school.

    Secondly, I’ve been to Breezewood Pa and when you get over on the other side of the fast food joints the feet are bare and the teeth are missing. There’s plenty of people in the store, but no cars parked near by. Just a horse or two. Everyone else walked. You’re pretty sure you’ve left Kansas.

  32. New Zealand is good at providing a low quality of care for a low price. This is good for very poor people, who are not “left out”, as they are sometimes in the U.S. (if they can’t get government assistance). The problem comes when you want decent middling to good quality care and are willing to pay for it. Most Kiwis simply get teeth pulled when they risk being too expensive. I have been in both Appalachia and New Zealand, and they have better teeth in Appalachia.

    On dental nurses:
    http://www.grownups.co.nz/disc…../72/page/1

    Also see expatexposed dot com for more on the health care in New Zealand.

    http://www.3news.co.nz/Pulling…..fault.aspx

    They do in fact have a system for assigning human value in order to ration the health funding. This has some unfortunate results for the elderly, who have paid into the entitlement system their whole lives and then are bumped to the bottom of the queue by the time they are ill enough to need it.

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