Health Care Reform

	November 3, 2004

The Health Care Reform Debate:  What Happened?

	37 Million Americans lack Medical Insurance
	150 million lack Dental Insurance
	Millions are underinsured and the scope of coverage is declining
	Minorities, low income individuals, and those with limited education are particularly at risk and have the highest disease levels

The Health Care Reform Debate:  What Happened?

	20% of Medicaid eligible children actually receive care
	Over 50% of the homebound elderly have not seen a dentist in over ten years.
	Upon retiring, 85% of Americans have no dental insurance.

Reasons for Reform

	Problems with current system
				Private insurance cherry picks the healthy
				Medicaid mandates- states are seeking relief
				Employers need to be competitive; reduce costs, make employees pay more for premiums

Ginzberg: Health Swamp

	Satisfactory for most people so don’t tinker
	1/7 no insurance but they are children; rarely use physicians and hospital
	1/7 Medicaid; deficiencies in health care
	1/7 poor insurance; catastrophic illness can be devastating
	2/3 good coverage; 65 Billion annual tax subsidy benefits wealthy
	Affluent elderly get more benefits from Medicare than they contributed in taxes or premiums, particularly for Part B (pay only 25% of the annual cost)
	Physicians’ incomes average:$165,000
	Most of 5,200 hospitals operate in the black

ADA and AMA

	The AMA sees reform as inevitable so why not shape its future rather than fight it and ultimately lose with no influence on its shape and scope.

ADA

	The task force on access, health care financing and reform of the ADA-
		Dental benefit programs should continue to be treated separately from hospital-medical-surgical benefit programs.
	Comment: Dental plans standing on their own are convenient targets of budget cutters.

AMA

	AMA news 1990
		Lesson from 1964 AMA “wrote” Medicare legislation; placed itself at the center of the debate in 1964.
	A fault of the Clinton Health Care Reform plan was that it did not include the AMA and similar professional groups in the decision making process.
	Expand access to Americans who lack it
		Why? -more money dedicated to medicine more income for physicians.
	Health Access America; don’t destroy the entire system, fix Medicare pump more money into it with a trust fund reserve, don’t depend on congressional budgets.

AMA (Uniform Eligibility and Consistent Benefits, Throughout the Country)

	Reduce the cost of defensive medicine
			Expand Medicaid to cover everyone below the poverty level
			Health insurance coverage for all full-time employees
			State risk pools to confer the medically uninsurable
			Revamping tax treatment of employee health care benefits
			Developing practice parameters to assure the delivery of high quality care
			Reducing administrative cost to both physicians and patients

AMA: 9 Key Unresolved Issues
 Before Congress

			Bureaucracy
			Physical autonomy
			Patient choice
			Liability reform
			Antitrust relief
			Red tape
			Arbitrary caps
			Medical education
			Quality assurance
			Medicare/Medicaid cuts

Oregon: Rationing of Health Care

	Implemented 1994
	Control Cost and Increase Access to Health Care Low Income and Medicaid Population.
	Limited Covered Services to a State Approved List
	Services Ranked From Most Important to Least Important
	Covered Services Determined by Available Funding
	Merged Medical and Dental Services
	Many Dental Services Ranked Higher Than Medical Services
	Plan Previously Did Not Cover Any Adult Dental Care Now Has Very Generous Set of Dental Benefits

Oregon 1115

	Commission; five physicians, four consumers, public health nurse and a social services worker
			Effectiveness of treatment
			Cost and benefit of treatment
			Value of treatment by the public

Oregon 1115

	696 services on prioritized list
	#280 dental preventive services
	Note this is before #291 or treatment for non-insulin dependent DM or #300 cardiac arrythmia
	Obtained a waiver form HCFA

Oregon 1115

	Oregon experience show that dental benefits when meshed with medical benefits will not necessarily suffer, positive implications for national health care reform.
	Increased fees by 40% in 1994.

Health Right

			No ortho
			Yes, children’s services
			50% copayment for adults
			0% copay for preventive services
			Dentists pay 2% of annual gross income
			Must participate in all medical and general assistance programs as well as Health Right as a condition to provide services to state and public employees
			Dentists are required to accept new public assistance patients unless they exceed 20% of the practitioner’s family of patients.

Legislative Process

	Dr. Meskin’s editorial opposes Health Right in Minnesota
	“HealthRight guarantees coverage for Minnesotans who lack health insurance.  Limits for eligibility appear quite liberal-a family of four can earn up to $40,000 and still be included.  For those in lower income brackets, the state offers subsidized premiums based on monthly family income”
		ADA’s argument “ any increase in fees could drive away those patients who are marginally able to afford dental care”; doesn’t make sense; people who provide more services to these people not drive them away.

ADA

	ADA questions whether HealthRight will increase access or merely restructure the  payment system for  individuals already receiving care under public assistance.
		Then the most spurious argument
			“We must also consider potential of loss of substantial free or contributed dental care currently supplied by dental practitioners;.  Motivation to continue these charitable efforts could be severely limited..

Legislative Process

	Special Care in Dentistry 1992: Dentistry and National Health Reform: A call to action
	“We must stand up and be counted, the public is beginning to accept health care as a right and not a privilege.  I would suggest we make oral health care a right and not a privilege”
	“We should not make the mistakes our predecessors made nearly 30 years ago when the Medicare debate was undertaken.  We should, in fact, learn from our mistakes and establish a pro-active stance on the national healthcare reform debate”

Covered Benefits: Clinton Health Care Plan

	No lifetime limits
			Hospital services
			Emergency services
			Health professions care delivered in profession offices clinics and other sites
			Clinical preventive services
			Mental health and substance abuse services
			Family planning services
			Pregnancy related services
			Hospice care during the last six months of life

Dental benefits covered
(Clinton Plan)

	Dental Care for Those Under 18 Including:
			emergency care
			prevention, diagnosis, and treatment of caries and periodontal diseases
			prosthetics for genetic defects
			space maintenance(3-12 years old)
			interceptive orthodontic treatment after 2001, for 6-11 year old
			emergency dental care for adults
			dental care for 18-64 year old after 2001 including:
			prevention, diagnosis, and treatment of caries and periodontal diseases
			no endodontics or sealants

Legislative Process

		Mobil:  Health-care reform: Let’s not kill a good thing
		“It would be a promising beginning to breaking the legislative logjam on health care.  Let’s get it done and signed into law to provide some relief to those millions of Americans who have been living in fear of losing their health benefits if they leave their job.”
			Why support reform?
				Allows Mobil to play on a more even field

Delta Dental

	Advertisement in Newsweek 4/25/94
		“To see what health care reform could do to  your dental benefits, turn this picture upside down”
		Preventive care saves 4 billion a year
		Include basic dental benefits form the start,  Delta’s angle no business if no money! insurance industry is a business did not take out advertisements out of altruism.
	In 2/3/94 Roll Call
		“Dental health keeps Americans smiling. So why isn’t dental coverage a part of health care reform”

Legislative Process

	1199: On the Front Line of Health Care
		“If Congress doesn’t pass universal and comprehensive care, I’ll see more needless suffering, and more preventable deaths.  That’s not what the American people are expecting from health care reform.”
	“What’s the bottom line on healthcare reform”
		It is a loss of jobs that has 1199 concerned; once again where the money is so are the jobs and the salary increases.

Koop

	“We are in a crisis and not much will happen until we enter chaos”

Special Care Dentistry; 1992

	A call to action
	“The political rhetoric and public demand have finally caught up in magnitude with health care spending”
	Dentistry’s fear of Medicare was derived in part form the fear of government intervention and control.
	In 1992 as in 1964 politicians were asking “What is dentistry’s position on this issue”
	No coverage or little for special patient populations under current reimbursement mechanisms.
	Learn from the mistakes of 30 years ago and be proactive?
	Dentistry is a primary health care service and should be considered in any primary care legislation-do you agree?
		The dental profession has consistently proved that prevention is a significant factor in reduction of health care costs.