dentistI did a little poll with my friends. Who among you has lost dental coverage? No hands went up. Then, finally, just when I began wondering if I should fish out a pack of breath mints for them, one person piped in. "I never had it," she offered.

If you're under 40, it's likely you're on your own when it comes to arranging your dental care. In your daddy's day, every self-respecting company included full benefits as part of its package. That cushy treatment is in the rear-view mirror. If you have a dental plan as part of your job, smile! You're one of the lucky ones.


Across America, dental patients are being brushed aside. In some states, Medicaid is trying to cut costs by having HMOs and provider networks take care of the care. Result: One in four primary care doctors had fled Medicaid in the past 18 months, according to the Associated Press. Meanwhile, as a Florida paper reports, one county has seen dental patients surge 40% since before Medicaid reform began. Another clinic in California's Bay Area is predicting six-month waits to see a dentist because their federal matching funds may not come through.

In other words, thousands of Americans are resorting to the very last refuge of dental health coverage: Medicaid. There's nowhere else for us to get our teeth care anymore, and since Medicaid is the bottom rung on the health-care ladder, there's nothing below it but an abscess-- er, abyss.

And that's just people whose income is low enough to qualify for Medicaid. Many millions more make too much money. Yet dental coverage, when it's offered at all by an employer, is usually offered as an add-on, and not as part of the basic plan. To cut costs (that is, to make sure there's some money left in the check on payday), people simply don't buy the dental portion of employer coverage. So even people who make a decent living are finding themselves tooth out of luck.

Freelancers (including the self-employed) face the same quandary. Lots of the "dental plans" offered on a non-group basis aren't insurance plans at all, but paid memberships (like Dental Care Advantage, Amacore Dental Program, or Vital Savings by Aetna) that entitle patients to reduced dentist fees. Faced with having to pay twice for a procedure, even one at a reduced rate, many people happily use the inconvenience as an excuse to procrastinate forever.

When Americans decide not to opt into their employer's dental plan, they usually do it saying, "I'll just pay for a cleaning on my own." But they don't. Forbes quotes a Kaiser Family Foundation poll that said that 34% of Americans had not gone for dental care last year.

Technological advances have made going to the dentist relatively easy, dramatically less painful, and quick. My dentist's office looks more like a spa than a den of torture, and I've never heard a drill in there. The stigma is gone. But just when dentists modernized their practices to become truly non-threatening, the financial end of the deal has driven patients away again.

And people oppose national health care why?

Even the Tooth Fairy is under economic strain. Two Minnesota dental insurers came out with their polls of how much the Tooth Fairy is giving kids for teeth these days. One had the average going from $2.09 to $1.88. The other saw a 23% drop, from $2.10 to $1.62.

Remember the "British smile"? The world used to laugh at the English for having mouthfuls of bad teeth. World War II was to blame. During rations, the country's dental care fell into a filthy state. The British have cleaned up their old habits, and nowadays, the only Brit I know with stinky snaggleteeth is Austin Powers. But at this rate, America is set to take the yuck-mouth crown back from Great Britain. Pretty soon, the British will be pointing at us and mocking our "American smiles."




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