A Law Backing Tribal Sovereignty Is Answer to Expanding Oral Health
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 18 percent of all goods and services. The good news is that cost has been slowing, partly because of the economy, and most partly because 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 numbers are 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 patients.”
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.
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