Articles on the American Dental Association
Government Watch: For Whose Good?
I Urge You: Quit the ADA Now!”
Government Watch: ADA Encourages Washington to Impose Price Controls on Dentists
“For Whose Good?
Copyright Salvatore J. Durante, DDS, FAGD, 1993. Published in GP: The Journal of the New York State Academy of General Dentistry, September 1993.
President Clinton’s task force on health-care reform has decided that basic dental care should be included in any package of benefits that may be considered by Congress. What is “basic dental care”? Well, according to the task force, this includes emergency care, extractions and such preventive care as checkups, X-rays, prophies, periodontal services and fillings. Endodontics and fixed prosthetics are explicitly excluded. Additional special coverage would be included for children. Conventional “wisdom” would view this as a bonanza for dentists: “Just think of all the new patients who will walk through our doors, and how much more often our present patients will seek care if someone else is paying for it!” All good, no problems, right? Not quite.
If one looks beyond the next minute, or week, or year, or–dare I suggest it–the next decade, one will see that a right to dental care, which is what the task force proposes, must lead to the end of dentistry as we know it. Just as a right to medical care for the elderly, which was established nearly 30 years ago by Medicare, has lead to dictatorial control of physicians and hospitals, a right to dental care will lead to price controls and micro-management of our services. You think OSHA is a threat: wait till the Department of Health and Human Services, the Health Care Financing Administration, and whatever the new federal office of medical global budgeting is called start ringing your bell. And unlike OSHA, who must actually come to your office to ensure compliance, these bureaucrats will be alerted every time you perform a procedure for which you expect to be paid.
What is organized dentistry’s position on health-care reform of this kind? Unfortunately, in its Position Paper On Access, Health Care Financing, and Reform, the ADA parrots the lie about there being 37 million uninsured and pushes for a greatly expanded federal role in medical insurance. (In a previous “Government Watch,” I covered the fallacy behind the claim that 37 million Americans lack medical insurance.) In the same position paper, not seeing any contradiction, the ADA urges the government not to interfere with the private dental insurance system covering those over age 18–even though the National Dental Research Advisory Council estimates that 150 million Americans have no dental insurance. For those under 19 not covered by Medicaid or private dental insurance, the ADA supports issuance of U.S. Treasury vouchers for preventive dental services. This would certainly mark the end of the availability of private insurance for such individuals. (Which would you do, accept a voucher or pay for insurance out of your own wallet?)
Let’s sum up. The fact that 37 million are (falsely) claimed to be without medical insurance requires massive government intervention, but the fact that 150 million are claimed to be without dental insurance is not a problem. This from an organization that historically cried foul whenever it was treated as less important that medicine or not part of the total health-care team. Also, the ADA would have politicians believe that dental care is a political right, but only if you’re under 19. Sorry, it doesn’t work that way. The right to health care could not be limited to the elderly via Medicare, and the right to dental care will not be limitable to those under 19.
As so many times in the past, organized dentistry is awash in contradictions and we, its members, will suffer. The ADA agrees with the basic principles of those who would control us–but hopes to limit the damage through appeasement or by providing “input.” There is a right to dental care–but the government should not tell us what to do. Practicing dentistry is a privilege granted by the government–but “organized dentistry” should be allowed to do the policing. The Dental Society of the State of New York supports a mandatory child abuse recognition course and devises mandatory CE guidelines for the government–but is against mandatory CE. (This last has lead to a new infection-control course that we’ll all soon be required to attend.) Oh, and didn’t you know, certification of some dental assistants in NYS will soon be required, some now but I’d say eventually all–thanks to DSSNY?
All this raises a serious question: should you be paying dues to an organization that so clearly acts against your most basic interests? With the Clintons, we are talking about a fundamental change for the worse in the way dentistry is practiced–not immediately, but in principle and so eventually in every detail of your practice. And the ADA is helping to make this happen while claiming to fight it. Locally, thousands of Empire Dental Political Action Committee (EDPAC) funds, voluntarily contributed by New York State ADA members, are used to pass laws that further encroach on your freedom to operate your practice as you see fit. Whether the ADA’s and DSSNY’s actions result from naiveté on the part of many of our leaders or from power lust on the part of only a handful of them is irrelevant. The end result will be the same: you will have helped finance an organization that has demonstrated that it has no clue how to defend your interests and, in most fundamental disputes, actually acts to help have your freedom abridged.
“I Urge You: Quit the ADA Now!”
Copyright Salvatore J. Durante, DDS, FAGD, 1994. Published in GP: The Journal of the New York State Academy of General Dentistry, March 1994.
The American Dental Association is a threat to dentists’ most fundamental value–freedom. For further explanation, I refer you to “Government Watch” (ADA_Encourages_Washington) below. In that column, I cover the ADA’s efforts to have dental services included under Clinton’s plan, despite the fact that such inclusion would also bring price controls on our services.
The ADA’s policy toward Clinton’s health-care proposal is the best example of a fatally flawed policy that one could ever imagine. The ADA tries to combine two explicitly contradictory positions: 1) dental care should be guaranteed as a right for some Americans including all under 18 years, and 2) dentistry should be left out of the reform proposals, since the private delivery system has provided excellent care without driving prices into the stratosphere. National ADA officials just don’t seem to see any problem with these contradictory positions.
Our local leaders are no better. To quote the December 1993 New York State Dental Journal editorial, “Dentistry’s recommendations . . . . do include assurance by government of dental care for children, particularly by preventive measures. The profession’s proactive stance also calls for the inclusion of the working poor and the elderly. . . .” From this one might conclude that the author recognizes that the ADA’s position is to further involve government in our lives. But just a few paragraphs later one reads, “[A]t this point . . . . one may conclude that [Washington] planners have followed organized dentistry’s suggestions, for they seem to have omitted dental care for the general public. . . . Whether this omission represents acceptance of organized dentistry’s stand [that dentistry should be left alone] . . . .” And a few paragraphs later, “[a]lthough Washington’s contrivances may well accede to dentistry’s request for exclusion . . . .” Are readers thought to be so dim-witted that they will not be able to identify the contradictions in an essay that is one thousand words long? Perhaps. Recall that our state association backed Mrs. Cuomo’s child-abuse recognition course and has devised a state plan for mandatory CE–while simultaneously claiming to be against mandatory CE.
In all honesty, the ADA has no real policy aimed at keeping government out of our lives. They pay minor lip service to freedom, of which the cited editorial double talk of the NYSDJ is just one example, and then they lobby to bring the government bureaucrats down on us in force. And when an uncompromising argument against government interference is offered, it is not presented on their pages. A case in point: I submitted to the NYSDJ a letter criticizing the NYU College of Dentistry’s dean for an essay of his that appeared in the NYSDJ, February 1993. In his essay, which originally appeared as a letter to the editor in the New York Times, the dean urged President Clinton to propose legislation that would include oral health care in basic medical care. Dr. Kaufman’s views were published in conjunction with a conference at NYU, which the dean hosted. The aim of the conference was to reach a “consensus on the message we want to send to President Clinton’s Task Force on National Health Reform.” Concerning criticism of the dean, by me and others, the NYSDJ September 1993 editorial stated that “[w]e determined to exert our editorial prerogative and eschew publication of these vitriolic, even abusive attacks on the dean and his viewpoint, one he shared with . . . . a variety of prestigious dental organizations.”
I called the NYSDJ and learned the name of another who had written a letter critical of Dean Kaufman’s view. The letters on the facing page are the complete letters that NYSDJ would not print. In light of the regulations and price fixing that we now know Clinton’s plan would bring on dentistry, I’d say that the criticisms of Dean Kaufman were possibly too mild.
“Government Watch: ADA Encourages Washington to Impose Price Controls on Dentists”
Copyright Salvatore J. Durante, DDS, FAGD, 1994. Published in GP: The Journal of the New York State Academy of General Dentistry, March 1994.
As surprising as the above headline sounds, it is true. In fact, this latest move by the American Dental Association has finally convinced me that it is too late for reform at the ADA: I have canceled my membership in the Association. Here are the details of the ADA’s actions.
First, let’s look at the ADA’s recent position paper on national health care, entitled Position Paper on Access, Health Care Financing, and Reform. They came out in favor of “universal access” to health care, but also in favor of the private dental benefits program as it presently exists. That is, they support government guaranteeing health care for all, which regular readers of this column know means price controls and rationing, but they also claim to want dentistry to be left alone. Am I the only one in dentistry who sees the impossibility of defending such contradictory positions?
In the same paper, they argue that the federal government has an obligation to provide dental care for the indigent. Furthermore, they suggest issuing US Treasury vouchers for preventive dental care for children. That is, dental care is to be considered a right of those under 18. Well, Washington agrees that dentistry should be let into the system but has no illusions about what the final goal is. Washington views this initial inclusion of dental care as only the beginning. The originally released Clinton plan called for dental coverage for everyone by the year 2000. And remember once a service is covered under the government’s defined plan of basic benefits, the fees charged are under government control! Clinton’s plan would outlaw balance-billing.
The plan that Clinton eventually presented to Congress is even worse than the plan originally released. His latest version calls for more extensive preventive care and general treatment for children than did the original draft, and his proposal would immediately cover emergency dental services for adults. Other adult services would be mandated and come under government control in the year 2001. This change from the first version means price controls and major governmental oversight in more of our offices and for more of our patients sooner rather than later.
What was the ADA’s involvement regarding the expansion of Clinton’s plan to take control of dentistry sooner rather than later? After the original plan was released but before it was presented to Congress, the ADA lobbied to have the dental portions expanded, and they succeeded. Doesn’t this contradict the ADA’s position that dentistry should be left alone? Of course it does, but it furthers the conflicting ADA policy that dental care should be a right for children. Regarding the fact that the original proposal did not include fillings for children, Dr. Zapp, Executive Director of the ADA, says in the ADA News November 8, 1993 issue: “The ADA noticed this limitation in the package of dental benefits and immediately called it to the attention of high-ranking officials in the Clinton Administration and the leadership in Congress.” That is, the ADA urged Washington to mandate coverage–and, therefore, price controls–of routine fillings for all Americans under the age of 18. What about the fact that Clinton’s plan would mandate emergency coverage and fix fees for such care for all adults? The ADA never discusses the plan’s fee-fixing measures, just as Clinton seldom discusses them, but, regarding the plan’s changes from the first version to the next, the same ADA News article says: “ADA leaders said administration changes reflect a growing understanding of oral health issues and bring the plan closer to ADA recommendations on the delivery of health care.” Here’s another direct quote from Dr. Zapp: “The ADA certainly looks forward to working with both Congress and the Clinton Administration to shape the dental component of health care reform.”
The ADA is literally leading us into bondage while claiming to represent our interests.
Well, what about the things the ADA does correctly? Fighting OSHA, as the national ADA does (even if feebly), or fighting for the right to practice in other states, as DSSNY does, are good things, aren’t they? The problem is, as I’ve said in previous columns, that without a cohesive, principled and integrated approach, such isolated measures are meaningless and fruitless. One week the ADA aids government in its takeover of dentistry via national health-care schemes and mandatory CE, and the next week they oppose some government intrusion. They try to appear cooperative to politicians and bureaucrats, and, at the same time and often on the same issues, vigilant to members. The end result is just what we are witnessing: a government takeover. Think about it. Do you really want to financially support an organization that is fighting for the privilege to practice only under government price controls and guidelines–but in any state, not New York State alone? It’s ridiculous.
Over the next ten to twenty years, what might have been your ADA dues could easily grow to well over $20,000 if you invest conservatively. I certainly can think of better things to do with the fruit of my effort than hand it over to those who will use it to hurt me.