Author: James Campbell

The American Dental Association (ADA) is a dentist membership organization with a mission to “help dentists succeed and to advance the oral health of all individuals.” If advancing oral health for everyone is a crucial part of their mission, why does the ADA oppose expanding Medicare Part B to include a dental care benefit?

Medicare currently does not cover dental care, but after months of negotiations, the Build Back Better legislative proposal wanted to change that by adding a dental benefit to Medicare Part B. Doing so would bring dental coverage to millions of beneficiaries. Most people would expect the leading organization representing America’s dentists whose stated mission includes advocating for oral health to support this proposal, but the ADA is very clear in their opposition. The ADA wrotein a letter to the Chairman of the House Ways and Means Committee that they “cannot support the legislative proposal being considered by the House Ways and Means Committee to expand Medicare Part B to include dental care.”

The real question is why? The ADA has concerns that this proposal would not “benefit those low-income seniors who need dental care the most” and the proposal would not adequately reimburse dentists for the services provided. The ADA instead advocates for creating a separate Medicare program focused on dental care that is means tested, covering seniors up to 300 percent of the federal poverty level. In the end, it looks like the ADA has succeeded in blocking dental care for millions of seniors touting that “[a]fter intense ADA lobbying for a targeted benefit and strong grassroots efforts” the Medicare dental benefit was removed from the White House’s Build Back Better legislative outline.

For many, dental care is unaffordable and routinely is care that people forgo altogether because of cost. Deconstructing the ADA proposal makes clear that it prioritizes reimbursement for dentists over care for patients. Creating a separate program in Medicare is a mimicking of the Medicare Part D prescription drug benefit that is wholly privatized. Private insurance reimburses providers at higher rates, but is more expensive for patients and they are more likely to have instability in their coverage compared to public insurance programs. 

The ADA proposal would also means test their new program bringing out the same argument used by people opposed to public programs—that a universal benefit helps rich people more than it does those who are low income. Contrary to the austerity informed policies that the ADA advocates for, universal programs ensure longevity and protect low-income individuals with the security that their coverage will not be snatched away next Congress. Means testing a program like dental care extrapolates a larger issue within health care policy in the United States—that helping anyone above a certain income level is bad policy. 

In challenging austerity politics, it is important—much like Ginia Bellafonte did in the New York Times and Megan Day inJacobin—to posit, so what? So, what if people, including rich people, can receive dental care? Accepting austerity eliminates conversations about universal rights. It forgoes questions of whether everyone deserves dental care, and for that matter all health care. Organizations like the ADA, and issues like dental care are one part of a commodified health care system that accepts means testing, privatized benefits, and austerity as solidified—that is just the way things are. 

Health care policy is infused with this mindset, universality until recently was confined to progressive think tanks, academia, and a subset of progressive politicians but has burst into the mainstream. American health policy needs to expand its horizons to recognize that health care is a human right, and human rights should not be means tested. Austerity politics carves people up, separating people who are deemed needing of care and those who can obtain it themselves. Universal programs bring us together, it opens up a dialogue on the right to receive care not the ability to pay for it. Advocating for public health—like the ADA states it does—should not include privatization or means testing dental care, it requires shifting the debate on health care to focus on covering everyone. 

American Indians and Alaskan
Natives continue to have worse health outcomes and a wide mortality disparity
compared to the rest of the United States’ population. This includes higher rates of heart disease, cancer, diabetes,
alcohol addiction, suicide, sexual assault and a life expectancy of five and a half years lower than all other
racial and ethnic groups in the United States. Why is this, and what are the
possible solutions policymakers are proposing to address these disparities?

Historical trauma through colonization and
federal laws such as the Indian Removal Act led to generational trauma and
contribute to present-day health disparities. The United States Commission on Civil Rights has
attributed “the failure of the federal government to adequately address the
wellbeing of Native Americans over the last two centuries” to these health
disparities. These generational traumas are developed through continued
suppression of indigenous cultures and a long-term lack of resources dedicated
to addressing these disparities. The Indian Health Service, which is supposed
to fulfill the United States’ treaty obligations to provide
healthcare for American Indians and Alaskan Natives, is consistently underfunded. In 2013, only fifty-nine percent of the projected need for
the Indian Health Service was funded, demonstrating a severe lack of priority
for addressing Native American health disparities. The National Congress of American Indians has called
on Congress to commit an additional $2 billion per year to address this funding
gap.

The IHS needs to receive more
funding, but also needs to diversify where services are provided. The majority of Native Americans live in urban areas
because of federal government relocation policies following a history of
colonialism. Native Americans in both urban and rural areas need access to IHS
services, and the increase in funding can go to addressing the needs of these
geographically separate populations. Increased funding is only one part of the
solution—addressing mental health outcomes continues to be one of the most
persistent problems among Native Americans and Alaskan Natives.

Solving this problem not only
includes advocating for more mental health providers in traditionally underserved areas but also, as one study found, that “participation in traditional
cultural activities” is associated with positive mental health outcomes. The
United States can encourage positive mental health outcomes by respecting
tribal sovereignty and recognizing traditional cultural practices. Tribal
governments should be partners in addressing these disparities and respecting
traditional cultural activities and sovereignty must be part of the solution.
Tribal governments are leading the way with innovative solutions to
bring low-cost and high-quality healthcare to their members. Partnering with
state governments to create new and collaborative programs often combine the
expertise of tribal governments with funding from programs like Medicaid and
have the potential to lead the way in addressing these disparities.

Addressing these health disparities
also calls for addressing the persistent issue of sexual violence and missing
and murdered indigenous women. Even the IHS is facing allegations of sexual
abuse that resulted in a civil suit. The first steps to address this issue
include a presidential task force dedicated to studying and
producing a report as the full-sight of the problem has yet to be understood.
Additionally, Congresswoman Deb Haaland—one of the first Native American women
elected to Congress—has introduced multiple bills to address this issue. These bills
include the Not Invisible Act of 2019, the SURVIVE Act, the Justice for Native
Survivors of Sexual Violence Act, and provisions to address sexual violence
against Native women in the Violence Against Women Act reauthorization.

While
the federal government takes these important first steps, and leaders like
Congresswoman Haaland introduce bills aimed at ending sexual violence against
Native Americans, ending health disparities will take a coordinated and
deliberate effort. Tribal, federal, and state governments must work as partners
to draw down health disparities and coordinate their efforts to make sure
long-term gains are addressed. It will take acknowledgment of historical
trauma, new funding and innovation to ensure that Native Americans and Alaskan
Natives receive the high-quality care that they are owed through historic

Over
the past year, mergers and acquisitions across industries are seeing a spike
while appropriations to the antitrust division of the Department of Justice
have remained the same. Included in this most
recent spate of mergers are hospital systems. Hospitals are merging at record
rates and PricewaterhouseCoopers predicts hospital system mergers to continue to grow.
As hospitals continue to merge, they have started to form new conglomerates in
the healthcare industry. One recent example is the merger between Catholic
Health Initiatives and Dignity Health, forming CommonSpirit Health.

CommonSpirit Health has sites across 21
states, 150,000 employees and over $30 Billion in revenue. With 90 percent of
Metropolitan Statistical Areas considered highly concentrated for hospitals as
of 2016, these mergers beg the question of
whether patients are benefitting. Furthermore, what are the anti-trust
implications of highly consolidated regional hospital systems?

A
new study from the American Hospital Association
claims “hospital acquisitions are associated with a statistically significant
2.3% reduction in annual operating expenses at acquired hospitals.” The
American Hospital Association suggest that by combining administrative
functions among hospital systems they can pass these savings onto patients.
However, a recent class-action lawsuit against Sutter
Health disputes this notion. Sutter Health – a Northern California health
system – is accused of using its market dominance to drive up the cost of
services. With such a high level of regional market control, hospital systems
like Sutter Health use “all-or-none” contracting with insurance companies to
demand higher prices for services. These costs trickle down to patients with
higher premiums and co-pays.

Patient
advocates attribute the Sutter Health lawsuit to lax
anti-trust practices when it comes to hospital mergers. While anti-trust
officials have the time and resources to focus on blockbuster industry mergers
such as CVS-Aetna, smaller mergers among regional hospitals
and healthcare service providers go unnoticed. An example of such mergers is
Anne Arundel Medical Center and Doctors Community Health System merging to form Luminis Health in Maryland.
These regional mergers often evade the eyes of regulators and patient advocates
warn of their potential to drive up costs by dominating regional markets and rarely
if ever lower costs.

An
industry-funded study
[ST1] from Deloitte points out, however; that mergers and acquisitions in
health systems lead to investments and improvements on acquired facilities and
lower operating costs. This same study also pointed to specific improvements in
patient reducing patient mortality, reducing wait times and reducing
readmissions. These are all factors anti-trust officials should consider when
deciding whether to challenge a merger. Anti-trust officials simply don’t have
the resources to analyze these deals;leaving patients footing the bill for increased costs. Hospital costs continue to
remain the largest overall share of healthcare spending
in the United States. To lower healthcare costs and improve patient outcomes,
it is time for regulators to examine these regional health system mergers and
their vast implications on patient outcomes and pricing.