If you have been paying attention, you will know that Australia follows the United States of America like a little brother with an older sibling. Our political leaders and parties look to the US for ideas and directions. Aussie businesses copy trends occurring in American marketplaces. America is seen as bigger and brighter and well worth taking a leaf from its best sellers. The US is, however, a far more extreme society than our own centrist and safe-leaning nation. Not all American narratives are healthy for all of its people and oral care is an example of this. Is the dental divide between rich and poor in fact America’s dystopian vision which is now unfolding in Australia? Maybe faster than we would hope.

Dentistry Uncovered In The USA

The US lacks a universal healthcare insurance scheme like Australia’s Medicare. Although not perfect, Australians love Medicare. More Americans are forced into bankruptcy through not being able to pay their medical bills than for any other single reason. Healthcare in the US is prohibitively expensive, as are pharmaceutical drugs and the sector is exploited by private health insurance companies, Big Pharma, and private equity ownership of hospitals. Profits come before the health and wellbeing of people in the USA. Dentistry is world class but only the better off members of the population can afford this top notch service.

Medicare Lets Our Oral Care Down

Unfortunately, Australia is in a similar position when it comes to dental care, as it is not included in Medicare. The Whitlam Labor federal government fought hard to establish Medibank/Medicare in 1974. It cost them a double dissolution and ultimately government. The Liberal Nationals kept on for 22 years trying to dismantle Medicare, right up to John Howard in 1987. Cries of the evils of socialism rang out in the Senate and elsewhere. Some would say that the LNP is still out to bring down Medicare, despite its popularity with the Australian people. Dentistry was not included in the scheme because of the perceived cost and the difficulty in establishing the scheme in the first place. Ideological and avaristic opposition ranged against socialised medicine here in Australia. Doctors and healthcare professionals are not saints despite their white lab coats. Many of them are committed to earning as much money as they can from their professions. These medical professionals train for many years and some work very hard as well.

Low Income Medicaid Dentists

In America, they have much more limited schemes called Medicaid and Medicare. These are primarily voucher based subsidised healthcare for those in extreme poverty. What you get in the US are dentists who specialise in servicing low-income families and children. Most dentists do not service this section of the population because they don’t see the money in it.

“David Heath of the Center for Public Integrity recently investigated a new breed of corporate dental care chains that cater to low-income adults and children. Heath collaborated with Jill Rosenbaum of PBS FRONTLINE on “Dollars and Dentists.” They found a high-volume business model that scored dentists on production and offered bonuses based on the revenue they brought in. Heath and Rosenbaum reported that Georgia-based Kool Smiles, the biggest Medicaid dental provider, has been accused by state regulators of giving shoddy or unnecessary care to some of America’s poorest kids.”
– Propublica.org

The Neoliberal Dystopian Vision For Poor Australians

Some political leaders in Australia have attempted to take Australia further down the neoliberal route to more privatised and corporatised healthcare and higher education. What you get from these ‘for profit’ and private equity pathways are widening gulfs between rich and poor. ’User pays’ as a model is OK if you’re wealthy and born into a well off family but not so great if you are neither of these. Australia has seen the top 3% of its population enjoy 90% of national wealth gains during the period 2010-2020. Dental care is fast becoming unaffordable for a growing number of our population. More Aussies are choosing to go overseas to get their dentistry done due at cheaper rates, especially for substantial procedures like implants, crowns and bridgework. Oral care is a high tech business in the 21C, with AI and digitalisation pushing up prices for materials and equipment used in dental clinics in Australia. Nothing comes for free in the high tech world.

Dentists Acting Badly For Corporate Profits

Sadly it appears the dental divide between rich and poor is just one of America’s dystopian visions for Australia. Extreme capitalism is rife in the US, where operators behave in ways rarely seen down-under. The culture in America, where welfare safety nets largely do not exist, produces bad actors capable of doing unimaginable stuff for profit at the expense of their fellow and sister human beings.

“Two Texas dentists and their large network of paediatric dental clinics and management companies settled with the United States Department of Justice for $3.1 Million to resolve claims that they violated the False Claims Act by offering kickbacks to certain patients and marketers by gouging the state’s Medicaid program by inflating dental bills and receiving payments for services never performed. The United States Department of Justice will pay one whistleblower $1.521 Million for reporting the allegations.”
– National Law Review

“PP: So, in some cases, you’re talking about pulling someone’s teeth unnecessarily?
Heath: There was a case where a woman went in who needed to have some teeth pulled, but they pulled all of her upper teeth, and several dentists told us she didn’t need that.”

These dental chains hire people, a lot of the time right out of dental school, and they pay fairly decent salaries and they have a bonus system where the more work you do on a patient the more you get paid. That’s true for a private dentist as well, but the difference is that these companies are owned by private equity firms, and they’re managed in a different way. You have people who are not dentists coming up with a business plan that’s based on metrics. They try to get new patients in who haven’t been to the dentist in a while, and they’ve already calculated how much revenue the average new patient should generate.”
– Olga Pierce, Pro Publica

In one instance a dentist in Ohio was strapping children into restraints against a backboard and performing up to 60 unnecessary procedures so he could charge large amounts via Medicaid.

“Two weeks later, in May 2013, the dentist put Gregory under and drilled his teeth. The Medicaid bill came to $1,273 – compared to the $61 that Medicaid would have paid for a checkup and cleaning. What Lancaster didn’t know then: Dental Express was part of North American Dental Group, a chain backed by private-equity investors.”
– USA Today

Factory Floor Dentistry in America

The far more common national practice is to have a single Medicaid specialising corporate dentist simultaneously servicing up to 5 low income kids. Picture the dentist in the centre with 5 treatment chairs ranged around him or her. Think about the quality of care when faced with these metrics driving the necessity of churning out 5 treatment sessions simultaneously. This is factory floor dentistry in the USA – we hope things work out better than in the Boeing plant. Wouldn’t want things falling off these poor kids or stuff accidentally left in their oral cavities by an overworked dentist. Australian dentists would be horrified at the outrageous stuff that goes on in America. We do not want to go there when it comes to the economic model defining our oral care sector in this country.

Dentists and the ADA are calling for greater government investment in subsidised oral care for Australian children. They are drawing attention to the latest medical research which identifies oral health as a key determinate of an individual’s overall health and wellbeing. The artificial separation between our teeth and gums from the rest of our Medicare covered bodies is a growing problem in Australia. It produces bad health outcomes, especially for low income families. We do not want the neophytes leading Australia further down the road to becoming the unofficial 51st state of America. Ex-prime minister Paul Keating in his colourful language has let us know the foolish direction we are heading with the $360 billion submarine deal sinking our sovereignty. In the past, Australia stood up for its independence and autonomy on the world stage, we seem to have lost our bite on this important topic in the 21C. Americans, as you can see via how they treat their own working poor, are not the unimpeachable good guys they make out to be. We may yet be the dupes in the AUKUS deal with no guarantees of ever seeing a submarine for our billions. This could be money much better spent on the inclusion of dental care in Medicare.

“Poverty is big business in America. The federal government spends about $900 billion a year on programs that directly or disproportionately impact poor Americans, including antipoverty programs such as the earned income tax credit, Medicaid, and affordable housing vouchers and subsidies. States and local governments spend tens of billions more. Ironically, these enormous sums fuel the “corporate poverty complex,” a vast web of hidden industries and entrenched private-sector interests that profit from the bureaucracies regulating the lives of the poor.’
– Anne Kim, Poverty For Profit      

Disclaimer: The material posted is for informational purposes only and is not intended to substitute for professional medical advice, diagnosis or treatment. Results vary with each patient. Any dental procedure carries risks and benefits. If you have any specific questions about any dental and/or medical matter, you should consult your dentist, physician or other professional healthcare providers.

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