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What Should Dental Health Care Look Like in a Reformed Health System?

As government leaders set out to overhaul the nation’s health care system, one hopes that Hippocrates’ words, “First, do no harm,— will guide their decisions.

[IMGCAP(1)]While Congress wrestles with some intractable problems — chief among them 46 million uninsured and skyrocketing costs — our lawmakers should take note of the fact that one component of our health care system works relatively well: the delivery of oral health care. In fact, the mouth can tell us a lot in the health care reform debate.

Oral Health Is Vital

As a society, we have come to recognize that good oral health means more than bright white teeth and an attractive smile. Poor oral health, a lack of dental care and untreated oral diseases can adversely affect an individual’s ability to speak, smile, kiss, chew, maintain proper nutrition, attend school or go to work. In addition, the mouth is as important to overall health status as any other part of the body. Several systemic diseases, including diabetes, cancer, cardiovascular and chronic kidney disease, and HIV/AIDS manifest symptoms that can be detected during an oral exam. That means a dentist may be the first to spot warning signs during a regular checkup.

Over the past 25 to 30 years, we have gone from a nation where most Americans could expect to lose their teeth by the time they reached middle age to one where the average number of dental cavities has declined among most age groups. In recent years, in fact, we have seen major increases in the number of children ages 5-17 who have never had a cavity in their permanent teeth. The improvements we’ve seen stem from three sources: more widespread community water fluoridation, improved treatments such as dental sealants and greater access to dental insurance coverage.

While science gives us the tools to prevent and treat dental disease, dental insurance coverage affords 173 million Americans the means to access that care. As a matter of record, dental insurance is prevention-oriented, relatively inexpensive (the average dental policy costs $30 per month) and highly cost-efficient — all of the qualities Congress and the public would like to see in our health care system.

As we seek to expand the benefits of dental coverage to the more than 130 million Americans who do not enjoy it — as Congress should — we must be vigilant against reversing the progress that’s been made.

Taxing Dental Benefits a Step Backward

The vast majority of these individuals receive dental insurance coverage through their jobs, in large part because the federal government does not tax the value of health benefits offered through employment. Yes, that’s right, this is a government policy that’s working as it should to promote health insurance coverage.

How do we ensure that all of our citizens can access this highly efficient, low-cost benefit? First, we ought to take stock of what’s working. The government’s tax policy toward health benefits is arguably the biggest reason why people have dental insurance today. If health benefits were taxed, as some in Congress propose, millions of Americans could be forced to drop their dental coverage in order to protect their families against costly medical emergencies. This would undermine the good oral health so many Americans currently enjoy and create added barriers for those whom health care reform is intended to help.

Since that’s not the direction we want to go, lawmakers should preserve the current tax treatment of employer-sponsored health plans.

Secondly, we can reach the majority of those who lack dental insurance not by some broad-brush policy pronouncements, but by recognizing that dental care (and dental benefits, too) work differently than medical care. Physicians spend most of their time treating ongoing diseases and illnesses; dentists focus on preventing disease and restoring good dental health. Similarly, the primary function of medical insurance is to pay for treating sick patients, while dental insurance emphasizes regular check-ups and preventive services that avoid the need for costly treatments.

Government should take a page from its own playbook by instituting new incentives for reaching the 130 million who lack dental coverage. One way is to provide refundable dental benefits tax credits or a tax deduction to individuals and small businesses as an incentive to purchase dental coverage. Low-income individuals who still cannot afford to purchase dental coverage should be eligible for a government subsidy to pay for their premium.

There is still more work to do in oral health. But if we’re serious about giving all Americans access to good health care, including dental care, we should build on a delivery system that’s been proven to work.

Kim Volk is president and CEO of Delta Dental Plans Association.

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