256
Journal of Public Health Dentistry
Editorial Egalitarianism Or Eiitism? In the past year o r so a couple of distinguished senior public health dentists have burst out in print with some fairly establishment-shaking proposals. One suspects the reaction will register on the Richter scale on the high side of moderate. A quick distillation of their notions-and this interpretation risks doing them a disservice-is that both are calling for a reconsideration of the requirement of the very best in dental care for everyone who can pay for it and are suggesting that “standard” or “good” levels of care just might get more care t o more people at less cost. Frequently the analogy used is that “Cadillac” dental care is not necessary when “Chevette” care is sufficient t o do the job. Others counter with a n equally simplistic question: “But would you like your spouse t o have a second-rate root canal?” One suspects that both put forward their views because of a genuine concern for the dental health of American citizens-especially children. They likely are concerned that a n organized and comprehensive national program-either of health insurance or health services-will continue t o be postponed because the conventional wisdom isrhat the dental care component of such a scheme is “just t o o costly” and “might help bankrupt any national programs of health care.” They, therefore, are suggesting that society consider providing dental services that are “less than the best” but still “adequate.” They fear that the dental profession may well price itself out of the market-if it has not already done so. Examine if you will the denturist phenomenon and the response of organized dentistry-i.e., the establishment of dental society-sponsored clinics providing quality economy dentures or PAED (it is Publicly Acceptable o r Professionally Acceptable Economy Dentures or both’?). A third public health dentist in a responsible leadership position even dared suggest that dentists of the future might not be able t o maintain their relatively high income and high standards of living. Heresy! Sudden cries that there no longer is a dental personnel shortage Gust a maldistribution, if that) would tend t o bear out the heretical contention-if one accepts the laws of supply and demand. Certainly the use of EFDAs and their further training would appear t o have stalled. So, should there be less than highly qualified dentists (even auxiliaries) providing less than superior quality care (but adequate and acceptable) t o more people at less cost a n d perhaps even a t less income? Or should there be primarily highly qualified dentists providing luxury quality dental services to less than half the population at high fees t o earn a comparatively high income? This writer thinks that neither extreme will prevail and as so often happens in the United States a mix of the two extremes will result. The real questions are: “What will the proportion of the mix be? What should they be? What can I d o t o affect the mix?“
-DFS
Journal of Public Health Dentistry
Editorial Egalitarianism Or Eiitism? In the past year o r so a couple of distinguished senior public health dentists have burst out in print with some fairly establishment-shaking proposals. One suspects the reaction will register on the Richter scale on the high side of moderate. A quick distillation of their notions-and this interpretation risks doing them a disservice-is that both are calling for a reconsideration of the requirement of the very best in dental care for everyone who can pay for it and are suggesting that “standard” or “good” levels of care just might get more care t o more people at less cost. Frequently the analogy used is that “Cadillac” dental care is not necessary when “Chevette” care is sufficient t o do the job. Others counter with a n equally simplistic question: “But would you like your spouse t o have a second-rate root canal?” One suspects that both put forward their views because of a genuine concern for the dental health of American citizens-especially children. They likely are concerned that a n organized and comprehensive national program-either of health insurance or health services-will continue t o be postponed because the conventional wisdom isrhat the dental care component of such a scheme is “just t o o costly” and “might help bankrupt any national programs of health care.” They, therefore, are suggesting that society consider providing dental services that are “less than the best” but still “adequate.” They fear that the dental profession may well price itself out of the market-if it has not already done so. Examine if you will the denturist phenomenon and the response of organized dentistry-i.e., the establishment of dental society-sponsored clinics providing quality economy dentures or PAED (it is Publicly Acceptable o r Professionally Acceptable Economy Dentures or both’?). A third public health dentist in a responsible leadership position even dared suggest that dentists of the future might not be able t o maintain their relatively high income and high standards of living. Heresy! Sudden cries that there no longer is a dental personnel shortage Gust a maldistribution, if that) would tend t o bear out the heretical contention-if one accepts the laws of supply and demand. Certainly the use of EFDAs and their further training would appear t o have stalled. So, should there be less than highly qualified dentists (even auxiliaries) providing less than superior quality care (but adequate and acceptable) t o more people at less cost a n d perhaps even a t less income? Or should there be primarily highly qualified dentists providing luxury quality dental services to less than half the population at high fees t o earn a comparatively high income? This writer thinks that neither extreme will prevail and as so often happens in the United States a mix of the two extremes will result. The real questions are: “What will the proportion of the mix be? What should they be? What can I d o t o affect the mix?“
-DFS
