I want them to take a better look at an interesting health care model that they’ve ignored for the last 40 years — the practice of dentistry.
Dentists and the American Dental Association are watching this current debate in Washington closely because they fear they will eventually be caught up in the swirl of health care reform — even though they managed to escape the humble beginnings. In 1965 when President Lyndon Johnson and Congress set up Medicare and Medicaid, they made interesting choices:
•They asked doctors how much they should be paid for the services and procedures they provide. This was done to get physicians’ buy-in for the plan, and it worked! Who wouldn’t want to dictate — without the threat of competition — the amount of money he is paid? We’ve been struggling ever since in an attempt to rein in the fees for medical services.
•The second thing they did was to exempt dental care from “health care.” Except in rare circumstances, dental services are not included in services paid for by Medicaid and Medicare.
Because rates are not linked to Medicare, we haven’t seen the same meteoric rise in the cost of services and procedures. You may also notice subtle differences in the customer experience at your dentist. They know that a few customers each year will be told by employers that their dentist is not part of the new insurance plan.
If they’ve had a good experience with their dentist, they might go out-of-network and pay a little extra. When a patient loves his dentist, he will remain a customer without insurance and pay for services out of pocket.
A great doctor might have similar luck with retaining non-insured patients, but it’s very difficult because out-of-pocket costs for medical procedures can be prohibitively expensive.
There is an interesting model at work when you look at how a dentist starts a practice. Fresh out of school, he or she will take any insurance company including HMOs just to get patients.
As the practice gets established, the dentist will begin to shed insurance companies based on how much they reimburse or how easy they are to work with. If a filling costs $120, some insurance companies might pay $80 for that procedure.
An HMO might pay $5. The dentist writes off the difference. Of course it’s their goal to deal only with insurance companies that are easy to work with and pay maximum reimbursement amounts.
This is why it’s sometimes impossible to find a dentist (or doctor) when a person is part of an HMO. Providers do not like the reimbursement rates, and so few sign on to take patients from HMOs.
It’s an important part of the story that’s about to play out with health care reform. There are only a couple of things that can happen when the money runs out to pay for your care: We either limit the services we’re willing to pay for or we limit the reimbursement that we give our service providers.
If the government becomes the insurance company, there will be downward pressure on reimbursement rates. Many doctors and dentists will seek ways to opt out of the plan.
What would happen if we forced doctors and dentists to take any patient? What if Congress dictated the amount of money they should get?
Because we live in free country, we would see medical and dental professionals simply get out of the business (and fewer young people get into the business). We cannot mandate a solution to this problem. Congress should consider models that do a better job at connecting the consumer of services to the cost of those services.
Dentists were not subject to Medicare, and their industry has done a much better job at containing costs while introducing technological innovations. Dental consumers are a little better informed on the cost of dental treatments, and this has helped to keep costs down.
Congress needs to focus on models or solutions that contain costs instead of focusing on the “getting a bill passed” as soon as possible.