From the Editor

Over 25 percent of the California population has untreated dental disease, which translates to nearly 10 million adults and children. There is an increasing shortage of dentists, particularly in rural communities and the inner cities of major metropolitan areas; also increasing is the number of adults without jobs, much less dental insurance. Hundreds of thousands of children are at risk of losing insurance under California's Healthy Families program due to the budget crisis.

The extent of the problem, the “tip of the iceberg,” was exposed this past August by the response to the eight-day free clinic in Los Angeles organized by Remote Area Medical, Inc., a charitable organization relying on volunteer health care providers. Thousands of adults and children showed up, many of whom were turned away for lack of capacity. According to RAM, 6,334 people registered. Of these, at least 3,182 were dental patients who received 2,274 extractions, 5,438 teeth saved [fillings], and 1,889 cleanings ― a $500,000 value. Sounds like a lot, but it is not even a drop in the bucket.

Much deserved praise was lavished on RAM and its volunteer doctors, nurses and technicians by those who received some basic care, and by the press, and by all those who feel good contributing to charity. Meanwhile, the vast majority, the millions of the poor and dentally neglected in California and throughout the United States, are still be in dire need of dental care. Charity is not a solution. It is hardly a band-aid. 

If we are really serious about addressing the oral health care needs of our population, what we need is not episodic charity, commendable as it is, but real, sustainable programs to provide on-going oral health care for our population. We need not reform but real change in our health care system. Single payer, which is singled out by liberals as the solution, is only the beginning. It would still pay fee-for-service that encourages overtreatment and outright fraud. Nonetheless, single payer universal health care administered by Medicare could save 20-25 percent in administrative costs; at least $400 billion (sic) of our $2 trillion health care expenditure. Perhaps an equivalent amount could be saved by eliminating unnecessary and ineffective treatment through improved health literacy and evidence-based practice.

Polls report that 60 percent of the public supports single payer, but 60 percent of our elected politicians do not. So much for representative democracy, which sometimes seems designed to protect the people from themselves. A good argument could be made that the United States is not a representative democracy but rather a representative oligarchy, e.g., an oligopoly. This would explain why a single payer health insurance system is “off the table” in Congress despite widespread public support. It would explain why the CEOs of commercial health insurance companies are paid millions in salaries, millions more in bonuses. It would explain why 46 million Americans (18 percent) have no health insurance, why many millions more are underinsured and nearly half the population, approximately 150 million people, have no dental insurance.

Time for a change? Yes ― to representative democracy.

Jay W. Friedman