The challenge in health care can be boiled down to two ideas: Improve the quality and cut the costs.
It’s a fact that the U.S. spends too much, both private and government money, on health care, nearly nearly 18 percent of all goods and services. The good news is that cost has been slowing, partly because of the economy, and partly because of the Affordable Care Act.
But this is just a first step. We have a long way to go. The reason is the country’s demographics:
We have smaller population of young people, a huge baby boom
generation, and people are living longer. Add this all up and the total
number is not sustainable by any metric. So math, not politics, ought to
determine the route forward and that means looking for innovation to
make health care less expensive. So when something comes along that does
just that, you would think that it would be worth a celebration. But
that’s not how change works.
As I have written before,
the Alaska Native Tribal Health Consortium’s Dental Health Therapist
Program is such a model. The Alaska program trains young people to
practice mid-level dentistry, something that’s common around the world.
This program expands access, improves quality, health, and is less
expensive. It’s backed up by rigorous studies, that show mid-level providers offer “safe, competent and affordable care.”
So where is the celebration? Well, that will have to wait until the fight is over.
Washington state is
considering legislation that would expand mid-level providers and the
Washington State Dental Association is opposed saying that “midlevel
providers will not make dental care more affordable, how dental
residencies are a superior alternative, and how dentists in private
practice are reimbursed 25 cents on the dollar for adult Medicaid
There is an interesting history here. The dental association in Alaska, and nationally, had long opposed the creation of
the mid-level providers or Dental Health Therapists, and even sued to
try and stop the program. Only now dental associations sort of praise
the program, saying that it might be “appropriate” because of Alaska’s
remote locations. The dental trade groups just don’t want that program
to expand again.
One of the reasons why the
Washington legislature is considering changing the law is that some
tribes in the state are keen on a mid-level provider as one way to make
it easier for tribal members to get better dental care.
But in Olympia, Alan Wicks,
general counsel for the Washington State Dental Association, testified
that “it’s not a question of tribal sovereignty; it’s a question of
federal law.” He pointed out that the Indian Health Care Improvement Act
authorizes the Alaska program and prohibits mid-level practice anywhere
else in Indian Country unless that state offers mid-level profession.
But what Wicks failed to say
is that the reason for this prohibition was that the American Dental
Association lobbied to make it so. This was a legislative attack on
And this is a prohibition that makes no sense given the challenges ahead.
As National Congress of American Indians President Brian Cladoosby recently wrote in Indian Country Today Media Network:
“Our population is still underserved. We do not have enough chairs and
dentists to service the people who come into our clinic. We reviewed our
charts and found that about half of our work could easily be done by
dental therapists, and it would take a huge burden off the dentists.”
Tribes are meeting later this
week at NCAI to talk about new steps to push the mid-level provider
issue forward. It’s clear that dental health therapy works in Alaska —
and the same idea could improve oral health across Indian Country. Plus
it meets the larger health care tests, improving quality and lowering
Mark Trahant is the 20th
Atwood Chair at the University of Alaska Anchorage. He is a journalist,
speaker and Twitter poet and is a member of the Shoshone-Bannock
Tribes. Join the discussion about austerity. Comment on Facebook at: www.facebook.com/TrahantReports
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