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1.2.12

Create cheap dental coverage to foster responsibility

An ounce of prevention is worth a pound of cure even when government provides it on behalf of those who can’t or won’t do it themselves. But if government gets forced into provision on cost considerations, at the same time it need not take its typical tack of providing anywhere from half a pound to a ton of prevention when faced with a social welfare issue, as a review of Medicaid oral health policy shows.

This federal-state program guarantees dental care up to age 18, and after that age states may add care as they see fit. Louisiana provides it up to 21 and for expectant mothers. As for other Medicaid recipients in this state, they’re on their own resources. Unfortunately, this leads a vast number of those with dental problems to emergency rooms, where Medicaid will pay for palliative care but not for dental procedures often necessary to fix an underlying problem.

As a result, the problem only gets obliquely addressed, often necessitating more visits than if directly addressed, which ultimately would cost taxpayers less money. Over the past couple of years, the cost to the state has been around the $1.7 million mark, which if focused on curing the disease rather than treating the symptoms may have been half or less.

So it appears that Louisiana could save some money by adding dental procedures to the vast Medicaid menu, despite the fact that almost all of these conditions were caused by abdication of personal responsibility by the failure to spend a couple of minutes a day brushing teeth or whipping out some floss from time to time. If Medicaid policy ultimately forces taxpayers to foot the bill for this behavior one way or the other, then it should happen in the most efficient, convenient manner for taxpayers.

Note that this does not mean for the convenience of the recipients of this largesse. Most dental problems addressed in emergency rooms stem from tooth decay. Thus, Medicaid could reimburse dentists for extraction, which in most instances solves the problem and is least expensive, and patients for medicine afterwards. No great lengths to save the tooth, no prosthetics, certainly no gold caps, just whatever is cheapest for the taxpayer and adequate to stop the problem. The few other, more complicated situations also could be covered.

However, one thing that should not be covered is periodic teeth cleaning. Good oral hygiene obviates this with any great frequency, but, regardless, it is not a relatively expensive procedure. With an average cost of about two months of cell phone usage, many dentists are willing to work out very generous layaway payments of just a few dollars a month over many months to enable this. A little less current consumption and a little more of an eye to the long-term, and almost all Medicaid recipients can afford this on their own at least occasionally, if they choose to do so.

Creating a barebones, no-frills Medicaid dental coverage will save taxpayers' money over the current policy, will achieve better patient outcomes, and will encourage client personal responsibility by signalling that unless the recipients of this generosity think ahead and take control of their own health, an effective but unappealing solution awaits if they let themselves into a problem. Louisiana needs to investigate this alternative.