2012;114(3):333-337. 4. Nalliah RP, Allareddy V, Allareddy V. Dentists in the US should be integrated into the hospital team. Br Dent J 2014;216(7):391-392.
HEALTH CARE REFORM
The April JADA article by Dr. Marko Vujicic, “Health Care Reform Brings New Opportunities” (JADA 2014;145:381-382), ostensibly is not a viewpoint held by the American Dental Association. Dr. Vujicic claims that regardless of one’s political leaning, “health care spending in the United States is far higher than in any other developed country.” To that, I say “So what!” We spend more on all sorts of things than do other countries. Our health care system also provides state-ofthe-art methods and facilities that are available to a mere fraction of the population in other countries. In most European countries, which often are cited as a model, there exists, in fact, a two-tiered system of basic government care and more advanced (and expensive) private plans. Dr. Vujicic also alleges that “Obamacare” is here to stay, regardless of the political environment. In this he may be right, for if we have a government sufficiently powerful to rob Peter to pay Paul, it can always count on the support of Paul. The assertion that Obamacare has expanded coverage is dubious at best. If increased enrollment into Medicaid is their measure of success, we are destined to struggle in funding it. Dr. Vujicic also points to the fiscal sustainability of our present system. Although we do have issues of affordability, the answer is not the single-payer system our present administration is striving toward. We already are on a trajectory of unsustainability with Social Security and Medicare. Adding another massive entitlement to the mix is a recipe for disaster. What apparently doesn’t compute with academics is that once health care becomes just another line item as part of the federal budget, it falls under the control of bureaucrats and politicians far removed from
actual patient care. This can only lead to limitations in service or reimbursement in times of economic downturns. Decisions will have to be made, based not on patient need but on who most likely will benefit. Then there is the issue of taxes. Since government never has a need to make a profit, any shortfalls can and will be made up by raising taxes. We already are seeing an exodus of physicians from certain specialties with early retirement or a limitation in the scope of services, so more government regulation will only serve to accelerate that trend. Dr. Vujicic tries to bring dentistry into the discussion by saying we need “to nudge the health care system in this new direction.” When it comes to top-down regulation, the federal government doesn’t nudge. It intimidates, with threats of penalties for failure to conform. The answer to cost containment, which at the same time preserves the doctor-patient relationship, lies in tort reform and the ability to purchase insurance across state lines—namely, competition. The one-size-fits-all insurance options under Obamacare may create the illusion of universal coverage when, in fact, as we’re just beginning to find out, more people are hurt than helped by these changes. As in all other aspects of our lives, competition benefits consumers. Obamacare does nothing but limit consumer choices. Peter M. Muehleis, DDS, FAGD Plymouth, Wis.
HEALTH CARE REFORM II
In the April JADA article, “Health Care Reform Brings New Opportunities” (JADA 2014;145:381-382), Dr. Vujicic (managing vice president, ADA Health Policy Resources Center) makes a bold statement. Barely into the first paragraph, he states: “Whatever one’s political leaning, there is no denying that health care spending in the United States is far higher than in any other developed country, with little measurable benefit in terms of health outcomes,
access to care, affordability or patient satisfaction.” His sources for such an assertion are all members of The Commonwealth Fund, a liberal think tank headed by a former Democratic staffer. The Commonwealth Fund and its allies were responsible for a string of policy studies designed to discredit health care in the United States. They prefer a European-style, government-run system. No doubt, we have issues with health care spending and access to care. However, we fare far better than any other developed nation when it comes to cancer survival rates, heart attack survival rates and organ transplant success. In addition, our access to the latest technology and the newest medicines far exceeds that of other developed nations. Furthermore, no country outpaces the United States in cutting-edge research and development. In what other country would you rather be sick? Most dentists are small-business owners. We tend to be an independent, freedom-loving, conservative lot. We tend to feel overregulated. I, for one, don’t feel a government takeover will “fix” what ails our health care system. I certainly don’t support a partisan agenda disguised as academic research. Christian L. Culbreath, DDS, MS Jackson, Tenn.
Author’s response: I thank Drs. Muehleis and Culbreath for their letters. Their comments capture both the complexity and the passion surrounding the debate on health care reform in the United States. Regarding the performance of the U.S. health care system, there are volumes of scholarly work, including numerous reports from the Organization for Economic Cooperation and Development (for example, the most recent OECD Health at a Glance report1) comparing the United States with other developed countries. The evidence shows that for most well-accepted measures of health status, as well as quality of
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