nationalized heathcare and dentistry

[Strikeout13GB]

I know there was recently a similar thread to this but I would like to know in more simpler terms (if its possible) how Obamas nationalized heathcare system will affect dentistry. Ive heard many different answers and just wanted to find out some more information on the matter.

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[Daurang]

Nobody knows. They're rushing to force it down our throat before anyone get a chance to read/analyze the details in the 1000+ pages. Your mainstream medias like ABC, NBC, MSDNC, NYT are providing cheerleeding service instead of asking critical questions so we have no way of knowing until it's too late. Chances are your taxes will go up dramatically. Chances are they'll force doctors to accept money-losing government health plans as a condition for licensing. Chances are doctor will get pay one fee to take care of everything per patient rather than get pay by procedure. After they're done with the MDs, do you think they'll leave us dentists alone?

http://www.boston.com/news/health/articles/2009/07/17/pay_for_care_a_new_way_state_is_urged/













.

 

[UCSFAlumni]

There is already a thread here that discussed this, although now closed, probably because of the inferno of partisan flaming it inspired. For the purposes of this discussion, I will refer to the health reform plan under debate as an insurance reform plan, since that seems to be it's main concern.

I personally have no clue how it will affect dentists other than it's tax increases will likely include many dentists since they often earn more than the 200K limitation on taxation (esp. if combined with spousal income). However, if one extrapolates from the basic concept, insuring all people, if dentistry is included then that would mean you would have a larger paying patient base than you do today.

Since the uninsured also likely have greater dental needs, through years of neglect, that would suggest an insurance reform plan would benefit dentists in terms of increasing workload and therefore income. Of course, much of that new income may also be taxed at a higher rate, so from some dentists perspectives there may be a sense of diminishing returns.

Overall positive income but at a disproportional increase in work load... if you make more than 200K/yr (or whatever the limit is). Of course if a dentist doesn't make more than the point at which the new taxes kick in, then by the nature of a plan which insures all people, one would expect pure profit. And that would be a plus for some dentists.

Remember though, I don't know if dentistry is even covered by the insurance reform plan, so it may have no impact other than higher taxes for the wealthier dentists.

 

[Strikeout13GB]

Daurang....I think its great getting everyone access to healthcare but i think from what you said and what i've heard from other sources that this is going to hurt the quality of our healthcare system. IMO....i know money is not everything but if doctors make half of what they make now i think more and more people will not want want to go to school for 8+ years and be in tons of debt to become a doctor...or maybe even a dentist..

 

[Dentgirl09]

curious... is there a timetable for when this might come into affect? Obviously sometime during our careers since we are all just starting... but sooner or later?

Is there a chance it won't pass?

 

[DrReo]

Nobody knows. They're rushing to force it down our throat before anyone get a chance to read/analyze the details in the 1000+ pages. Your mainstream medias like ABC, NBC, MSDNC, NYT are providing cheerleeding service instead of asking critical questions so we have no way of knowing until it's too late. Chances are your taxes will go up dramatically. Chances are they'll force doctors to accept money-losing government health plans as a condition for licensing. Chances are doctor will get pay one fee to take care of everything per patient rather than get pay by procedure. After they're done with the MDs, do you think they'll leave us dentists alone?

http://www.boston.com/news/health/articles/2009/07/17/pay_for_care_a_new_way_state_is_urged/













.

When I worked (and was a patient) in the ER, they mentioned how a lot of tests, xrays, etc. are used as safety measures, so if misdiagnosed the patient doesn't sue the crap out of the doctor.

 

[UCSFAlumni]

Daurang....I think its great getting everyone access to healthcare but i think from what you said and what i've heard from other sources that this is going to hurt the quality of our healthcare system. IMO....i know money is not everything but if doctors make half of what they make now i think more and more people will not want want to go to school for 8+ years and be in tons of debt to become a doctor...or maybe even a dentist..

That's why most countries that have reformed health care, as in true UHC, also subsidize professional education. However, didn't Obama recently get some price and other cost concessions from the pharmaceutical and insurance industry recently? That would affect them, not the primary provider, and in effect give the doctor at the end more financial leeway. As mentioned before, increasing the number of patients with insurance would also reduce the financial reluctance of potential patients to seek treatment. Your profitability would go up if the pool of patients increased.

 

[Dentgirl09]

When I worked (and was a patient) in the ER, they mentioned how a lot of tests, xrays, etc. are used as safety measures, so if misdiagnosed the patient doesn't sue the crap out of the doctor.

Not only that but medicine is complex and your first hunch isn't always right. Not being able to run more tests because of a lack of funds seems like a bad idea. Will they be fighting over who gets the "healthiest" patients as they suggested in that article?
Will the government provide some sort of insurance to doctors in this case?

I'm not comfortable with this 'not knowing what in the world is going to happen' business.

 

[UCSFAlumni]

When I worked (and was a patient) in the ER, they mentioned how a lot of tests, xrays, etc. are used as safety measures, so if misdiagnosed the patient doesn't sue the crap out of the doctor.

That is called "defensive medicine", and IMO is more an excuse to artificially inflate the fees hospitals collect, but to do so for pseudo-ethical-legal reasons. From the stats I have read, actual malpractice costs in healthcare, including court and legal costs, as well as payments to plaintiffs, only represent anywhere between .5% to 1% of all healthcare costs. So defensive medicine is typically hyperreflexive, a sign of pathology, not one of reasonable response.

I recently attended a risk management seminar, and the figures given for general dentistry were that 83% of all malpractice claims were settled without any payment to the claimant. Moreover, 20% of the malpractice claims were simply retaliation for sending a patient's bill to collections.

 

[banana23]

Malpractice reform is essential to heathcare reform, the fact that is absent from Obama's plan, though not suprising, is totally inexcusable

 

[Strikeout13GB]

I agree that more people with insurance=more patients for doctors and dentist but what I’m scared of from reading articles and post is that the govt. will tell you how much you can charge for certain procedures. So you might have twice as many patients and working twice as hard every day but could still be making less because every patient you see only makes you half of what you were making with every patient..If that makes sense..(I do have to admit a lot of information I’ve read has just been post and threads from other discussions so they could be completely wrong)

 

[UCSFAlumni]

I agree that more people with insurance=more patients for doctors and dentist but what I’m scared of from reading articles and post is that the govt. will tell you how much you can charge for certain procedures. ...

That already happens. It's called "insurance". Private insurance already dictates how much you will get, if you accept it, ...and you must, since most people coming in will be on some form of it. Some doctors who are well-established and well-known can often drop insurance plans and just farm their cash-only patients, but that is a rarified population and not the norm, especially for graduates just starting out.

Many insurance plans don't let you set a price outside of their fee schedule, either. It's in the terms of the contract. So you can't try to collect the difference from the patient between an imagined "normal" fee and the insurance fee. So the situation already exists. The only worry you would have would be whether the level of reimbursement is better or worse than what private insurance already provides. Private plans can get pretty bad, so I wouldn't jump to the conclusion a government plan would be worse.

However, I am not even sure though what provisions the health care bill has, so I don't know if dentistry is even covered, or if it is, to what extent.

 

[Daurang]

When I worked (and was a patient) in the ER, they mentioned how a lot of tests, xrays, etc. are used as safety measures, so if misdiagnosed the patient doesn't sue the crap out of the doctor.

That's true. The AMA wanted Obama to help in with that problem when he met them last week; but of course he was against it so the problem continues.

 

[Cold Front]

Nobody knows. They're rushing to force it down our throat before anyone get a chance to read/analyze the details in the 1000+ pages. Your mainstream medias like ABC, NBC, MSDNC, NYT are providing cheerleeding service instead of asking critical questions so we have no way of knowing until it's too late. Chances are your taxes will go up dramatically. Chances are they'll force doctors to accept money-losing government health plans as a condition for licensing. Chances are doctor will get pay one fee to take care of everything per patient rather than get pay by procedure. After they're done with the MDs, do you think they'll leave us dentists alone?

http://www.boston.com/news/health/articles/2009/07/17/pay_for_care_a_new_way_state_is_urged/

There is a House bill to raise taxes on wealthy Americans underway. The bill would impose a surtax on individuals who make more than $280,000 a year and couples who make more than $350,000. But there is another talk going on to limiting the proposed surtax to individuals making more than $500,000 and couples making more than $1 million.

There will definitely be a tax raise, but it's too early to tell which income bracket will be effected the most. It's all suggestions at this point.

 

[UCSFAlumni]

I just read the AMA is backing the House health bill.

 

[Winter Lily]

Nobody knows. They're rushing to force it down our throat before anyone get a chance to read/analyze the details in the 1000+ pages.

Hmm. Didn't know it felt that way outside the Beltway.

 

[DMDreaming]

That's why most countries that have reformed health care, as in true UHC, also subsidize professional education. However, didn't Obama recently get some price and other cost concessions from the pharmaceutical and insurance industry recently? That would affect them, not the primary provider, and in effect give the doctor at the end more financial leeway. As mentioned before, increasing the number of patients with insurance would also reduce the financial reluctance of potential patients to seek treatment. Your profitability would go up if the pool of patients increased.

Not necessarily. If the number of patients increased but they were insured by government plans, your profit could potentially decrease. Current state and federally run programs in my state reimburse at approximately 40% of UCR. Most dental offices have overhead at higher % than this so you could actually lose money depending on how they address the reimbursement issues in the government run programs. This is why most dentists don't take Medicaid patients right now.

 

[UCSFAlumni]

Not necessarily. If the number of patients increased but they were insured by government plans, your profit could potentially decrease. Current state and federally run programs in my state reimburse at approximately 40% of UCR. Most dental offices have overhead at higher % than this so you could actually lose money depending on how they address the reimbursement issues in the government run programs. This is why most dentists don't take Medicaid patients right now.

UCR doesn't say anything about volume. An individual could have the highest prices in the world, but if no one wants to pay those prices, then he/she would make less. Private PPOs set prices for doctors as well, guaranteeing volume in exchange for price concessions. Also one has to wonder if a comprehensive health care program for the public at large would have the same reimbursement and service restrictions as a charity program for low-income families, like Medicaid. The comparison seems tenuous.

Also, patients have been increasingly resorting to "medical tourism" for their dentistry in recent years, so the notion of "where else would they go?" is not as much a barrier any more, even if your prices are average and ordinary for the area you live in. It is a well-organized service industry now, allowing people to price shop in geographic areas which may have prices far lower than the reimbursement rates for even Medicaid-based programs. That is not a good thing necessarily, since the work may not be up to the standard of care here. But people still do it.

Just because a health care program is going to be "federally run" doesn't make it the equivalent of Medicaid. Ultimately one has to wait and see what the exact stipulations are before rushing to the conclusion it will underpay ordinary reimbursement expectations, or subvert the standard of care.

 

[aphistis]

Having more patients is only a positive step if you assume that as a doctor see more patients, his/her income will increase correspondingly. Anyone willing to bet the government will honor that assumption?

 

[denner]

Having more patients is only a positive step if you assume that as a doctor see more patients, his/her income will increase correspondingly. Anyone willing to bet the government will honor that assumption?

If anyone answers yes to this question, can we permaban them?

 

[DMDreaming]

UCR doesn't say anything about volume. An individual could have the highest prices in the world, but if no one wants to pay those prices, then he/she would make less. Private PPOs set prices for doctors as well, guaranteeing volume in exchange for price concessions. Also one has to wonder if a comprehensive health care program for the public at large would have the same reimbursement and service restrictions as a charity program for low-income families, like Medicaid. The comparison seems tenuous.

Also, patients have been increasingly resorting to "medical tourism" for their dentistry in recent years, so the notion of "where else would they go?" is not as much a barrier any more, even if your prices are average and ordinary for the area you live in. It is a well-organized service industry now, allowing people to price shop in geographic areas which may have prices far lower than the reimbursement rates for even Medicaid-based programs. That is not a good thing necessarily, since the work may not be up to the standard of care here. But people still do it.

Just because a health care program is going to be "federally run" doesn't make it the equivalent of Medicaid. Ultimately one has to wait and see what the exact stipulations are before rushing to the conclusion it will underpay ordinary reimbursement expectations, or subvert the standard of care.

Stands to reason though that reimbursement may not go up much. Most states recently cut back on Medicaid benefits. The government money has to come from somewhere and we have a HUGE deficit already. The current administration's goal is to increase the number of insured. It has said nothing about raising the reimbursement levels to meet cost needs of the provider.

On top of that, nothing that I have read discusses the need for producing more providers to meet the demand levels that should be experienced if the current bill passes. You talk about not rushing to conclusions about standard of care but if this issue is not part of the program, standard of care and access to care could be severely compromised, IMO.

I do agree with part of your closing paragraph, however, in that we will have to wait and see. But, I am a little leary of any government run health program(s) since the current ones haven't had the best track record.

 

[Winter Lily]

Not necessarily. If the number of patients increased but they were insured by government plans, your profit could potentially decrease. Current state and federally run programs in my state reimburse at approximately 40% of UCR. Most dental offices have overhead at higher % than this so you could actually lose money depending on how they address the reimbursement issues in the government run programs. This is why most dentists don't take Medicaid patients right now.

Federally-run dental programs? Who shot who with a what now? That doesn't sound right: the federal government really, really hates running programs directly. It prefers paying for services and/or funding organizations to run programs. I was operating under the assumption that the only federally-run dental services were in the military. If I remember correctly, Medicare won't pay for most dental care. Most of the time Medicare funds dental care resulting from surgery, accidents, etc.

Medicaid dentistry reimbursement wasn't one of my issue areas, but I thought there was a teeny-tiny amount of federal funds given to state Medicaid programs to pay for Medicaid patients' dental treatment. As I understand it, this results in lower reimbursement schedules for dentists for a number of reasons. The two biggest that come to mind revolve around state deficits and...well, Medicaid's Medicaid. I don't even know where to start. It's hybrid nature makes it politically and economically untenable. It needs to be razed to the ground.

But I wouldn't worry too much. I'm willing to bet -- in fact, by changing careers I am betting -- that health care reform will be shot down on judicial review. SCOTUS will do so on a number of grounds, but it's ultimately going to come down to ERISA and the Commerce Clause. (What can I say? ERISA really is the Lucy Ricardo of the health care reform world.)

 

[UCSFAlumni]

...that health care reform will be shot down on judicial review. SCOTUS will do so on a number of grounds, but it's ultimately going to come down to ERISA and the Commerce Clause. (What can I say? ERISA really is the Lucy Ricardo of the health care reform world.)

And exactly how will health reform be ruled unconstitutional on those grounds? Even prior to the New Deal, the Court has generally accepted a broader interpretation of the Tenth Amendment, and there is a long history of more invasive Congressional regulation of commerce when there is an important public purpose at stake. Many aspects of the New Deal were challenged on the constitutional basis you claim, and those claims failed.

The Court at that time noted, "there has long been recognition of the authority of Congress to obtain social, health or economic advantages from the exercise of constitutional powers." The Court also stated Congress's authority over "commerce among the several States" empowers the national government to address all activity, "whatever its nature if it exerts a substantial economic effect on interstate commerce."

I think it's simply libertarian wishful thinking to presume a constitutional strike-down on health reform. There is not much precedent for it.

 

[UCSFAlumni]

Stands to reason though that reimbursement may not go up much...

I would agree there are plenty of ways for Congress to screw it up, though. Hopefully the retrenchment of the 1993 attempt at health reform has given proponents a time to come up with a good, well thought out plan this time around.

 

[Winter Lily]

And exactly how will health reform be ruled unconstitutional on those grounds? Even prior to the New Deal, the Court has generally accepted a broader interpretation of the Tenth Amendment, and there is a long history of more invasive Congressional regulation of commerce when there is an important public purpose at stake. Many aspects of the New Deal were challenged on the constitutional basis you claim, and those claims failed.

The (Interstate) Commerce Clause is in Article I of the Constitution, not the Tenth Amendment. Article I enumerates the powers of the Federal government; Tenth Amendment is about state's rights.

Frankly, that's just the pretty story that deludes us into believing there's a predictable method to the madness. If precedent really mattered, then how do you explain the Roberts court's first term? How many years of settled law have they blithely ignored since then?

Lower court judges reach their conclusions using precedents as a guide; SCOTUS justices don't. Their decisions are based on their politics, and then they reason backwards to force lower courts to follow their preferences as much as possible. And the court that decided the cases you allude to isn't the court we have now. Today's conservative wing was picked to explicitly to return the Commerce Clause to its 1880-1910-era interpretation. (Or in Scalia's case, 18th-century interpretation.)

The Court at that time noted, "there has long been recognition of the authority of Congress to obtain social, health or economic advantages from the exercise of constitutional powers." The Court also stated Congress's authority over "commerce among the several States" empowers the national government to address all activity, "whatever its nature if it exerts a substantial economic effect on interstate commerce."

I think it's simply libertarian wishful thinking to presume a constitutional strike-down on health reform. There is not much precedent for it.

Do I really sound like a libertarian hoping for it to get shot down? That's hilarious!

It's such a shame legal privilege and confidentiality prevents me from ever mentioning who I worked for. I can say that I worked on the Hill specializing in health care policy -- and that I'm as far from a libertarian as you can get.

The Obama plan is not my ideal plan, but it's one of only a handful of politically viable ones. It's also not ideal for those who are in medicine to be rich. In fact, it's specifically designed to weed out people in it for the money. I think that's a very, very good thing. (And believe it or not, I'm a Wharton grad.)

That said, the big flaw is that they're not adequately addressing student debt load, nor are they adequately addressing the opportunity cost of graduate school and residency. The ideal solution would be to eliminate debt for current students, strictly regulate school tuition to prevent future generations of medical professionals from being saddled with 100+k of debt, and transition to allow both MD as well as 6-year BM/BCh degrees. Get rid of the undergrad degree, and you save a lot of money. If you save a lot of money, you don't need $500k+ salaries.

To be fair, Obama's staffers are operating under the assumption that AMA and other NGO lobbyists will significantly increase the reimbursement rates. After all, that's how negotiations work: you start out absurdly low to get to the very low value acceptable to both sides. But even then, that's not what they should be doing. Medical lobbyists can't work towards an ideal solution because it involves knowledge of educational financial and options that are outside of their jurisdiction, so they'll ignore the possibilities entirely. (In fact, that's probably why Obama's people ignored these options, too. Health care policy people are trained to ignore educational policy in general, and especially as a solution to their problems.) As a result, they'll just argue for increases in money. There's such an elegant solution, but it's invisible to virtually everyone.

 

[ads1792]

I'm as far from a libertarian as you can get.

So are you saying you are an authoritarian? It sounds like it.

Statist, facist, totalitarian? Which one?

http://answers.yahoo.com/question/index?qid=20080709144110AAR86w7

http://en.wikipedia.org/wiki/Political_spectrum

 

[ads1792]

double post
http://en.wikipedia.org/wiki/Political_spectrum

 

[mirk3]

The AMA endorsed the house democrat's bill. That tells you that a very conservative group who always looks out for the interest of the doctors thinks this will benefit physicians, as they negotiated a higher reimbursement rate equal to private insurance from the public option. If anything, this will be a boon for dentistry, as although the bill does not include dental care as I understand, there will be that much more money left in the hands of the people some of which they can use for dental care.

 

[UCSFAlumni]

The AMA endorsed the house democrat's bill. That tells you that a very conservative group who always looks out for the interest of the doctors thinks this will benefit physicians, as they negotiated a higher reimbursement rate equal to private insurance from the public option. If anything, this will be a boon for dentistry, as although the bill does not include dental care as I understand, there will be that much more money left in the hands of the people some of which they can use for dental care.

Actually the ADA just sent an eGram to dentists updating them on what's going on with health reform as it relates to dentistry. It rambles a bit long on political maneuvering and legislative organization, but here are some more useful excerpts:

"Our most pressing concern is with the proposal for a government-run insurance plan that would compete with private insurers in the marketplace, and private plans [of the patient's choosing]. Both would be required to offer dental coverage to children, but that requirement needs much clarification for us to decide whether to support it.

...we hope to have at least two amendments offered. One would tack our Essential Oral Health Care Act legislation ... onto the bill, thereby providing federal financial support for states that choose to improve their dental Medicaid programs by increasing reimbursement and reducing administrative burdens.

...Even though we have concerns about the overall bill, and aren't prepared to take a position on it until things are much clearer, we are pursuing amendments to improve the dental provisions.

...Right now, the various versions offer the potential that most dental offices could be exempted [from providing health insurance for employees], depending upon how their practices are structured."

It also mentions Medicaid is not really altered much by the bill. They never really state how it will end up fitting in, however.

 

[UCSFAlumni]

The (Interstate) Commerce Clause is in Article I of the Constitution, not the Tenth Amendment. Article I enumerates the powers of the Federal government; Tenth Amendment is about state's rights....

The Health Reform Bill will be comprehensive, likely to affect all states in many ways, so why not a Tenth Amendment challenge? Why the Commerce Clause? Literalist arguments could be used similarly to challenge Medicare or Social Security, so why hasn't it happened?

Court conservatism alone is not reason enough to make your prediction given how little is known of the bill in it's current metamorphosis. My understanding is it has grown 400 pages since it was introduced. Only lawyers directly connected with its construction would be in a position to render a reasonable opinion on Constitutionality. Ultimately judicial opinion on the Supreme Court turns on legal, not political, ideology, - although I agree it tries to incorporate both when coincidental.

Do I really sound like a libertarian hoping for it to get shot down? That's hilarious! ... I'm as far from a libertarian as you can get.

Whether your thinking is wishful or simply fatalistic, it's still presumptive and too vague to be predictive. So far, the bill sounds like a glorified Medicare expansion, so it may well be tolerable for most practitioners and judges.

 

[Winter Lily]

So are you saying you are an authoritarian? It sounds like it.

Statist, facist, totalitarian? Which one?

Oh come now. You know what a libertarian means within the American political context. And the answer is: none of the above. It's fundamentally dishonest to refer to a term that was used in one context and pretend it's referring to a fundamentally different one.

I'm not your strawman. And I know that you know exactly what I mean.

 

[Winter Lily]

The Health Reform Bill will be comprehensive, likely to affect all states in many ways, so why not a Tenth Amendment challenge?

I'm sure there will be a Tenth Amendment challenge, specifically via ERISA. In fact, that's precisely why I mentioned ERISA in the first place. I just wanted to make it clear that state's rights and the Commerce Clause are, legally, two distinct issues. Conflating the two is like conflating cardiology and neurology. One system can impact the other, but for the most part, they're two different entities.

Why the Commerce Clause?

Because the conservative members on the court were specifically chosen to limit the scope of the Commerce Clause to prevent the federal government from the type of social engineering you see with the health care reform system. Roberts might surprise us because of his epilepsy, but I doubt it.

Literalist arguments could be used similarly to challenge Medicare or Social Security, so why hasn't it happened?

Because all of the D.C. legal health policy NGOs have spent the past two years marshalling their troops to challenge this. Once this is challenged, it'll pave the way to challenge Medicare and Social Security.

Court conservatism alone is not reason enough to make your prediction given how little is known of the bill in it's current metamorphosis.

You don't have to -- you just have to know the range of possibilities. If you know the range of possibilities, you know the range of possible legal issues. Then you just get a few people with relevant Hill experience to give you a good idea of how Congress will alter the bills, to give you even more possibilities. From there, you get your legal experts to issue spot yet again. And once you know the entire range of possible legal issues, you can begin writing internal memos that form the basis for the ultimate legal briefs. Once the final bill is signed, you just make a few adjustments to your legal briefs, and file the forms.

Fortunately, all of the presidential candidiates' health care proposals were subject to most of the same legal issues, the range of possibilities was smaller than it sounds.

My understanding is it has grown 400 pages since it was introduced. Only lawyers directly connected with its construction would be in a position to render a reasonable opinion on Constitutionality. Ultimately judicial opinion on the Supreme Court turns on legal, not political, ideology, - although I agree it tries to incorporate both when coincidental.

Ever hear of Critical Legal Theory? Ever wonder why legal scholars say that CLT is now the unquestioned norm, and, therefore academically dead (i.e., you can't publish papers on it anymore)?

Also, did you read my post about the Roberts' court's first term? If this is really true, how do you explain their decisions?

Whether your thinking is wishful or simply fatalistic, it's still presumptive and too vague to be predictive. So far, the bill sounds like a glorified Medicare expansion, so it may well be tolerable for most practitioners and judges.

Vague? How? I was the one that pointed out the difference between different Constitutional Articles and Amendments. I'm also basing my predictions on well-established legal principles and policy norms. While from practitioners' perspective it's a Medicare expansion -- and thus palatable -- from a legal perspective, it's a chance to advance the agenda of reducing the Commerce Clause. What's palatable to a gourmet chef isn't necessarily palatable to a baby.

 

[UCSFAlumni]

I extracted this from the health bill (H.R. 3200 as of 7-15-2009) as it had some info that might be of interest to this forum since it deals with dental education funding. I haven't read enough of the bill to know what sort of continuity or departure this has with existing law.

Pages 886-891
SEC. 2215. TRAINING FOR GENERAL, PEDIATRIC, AND PUBLIC HEALTH DENTISTS AND DENTAL HYGIENISTS.

(a) PROGRAM.
—The Secretary shall establish a dental medicine training program consisting of awarding grants and contracts under this section.
(b) SUPPORT AND DEVELOPMENT OF DENTALTRAINING PROGRAMS.
—The Secretary shall make grants to, or enter into contracts with, eligible entities—
(1) to plan, develop, operate, or participate in an accredited professional training program for oral health professionals;
(2) to provide financial assistance to oral health professionals who are in need thereof, who are participants in any such program, and who plan to work in general, pediatric, or public heath dentistry, or dental hygiene;
(3) to plan, develop, operate, or participate ina program for the training of oral health professionals who plan to teach in general, pediatric, orpublic health dentistry, or dental hygiene;
(4) to provide financial assistance in the form of traineeships and fellowships to oral health professionals who plan to teach in general, pediatric, or public health dentistry or dental hygiene;
(5) to establish, maintain, or improve—
.....(A) academic administrative units (including departments, divisions, or other appropriate units) in the specialties of general, pediatric, or public health dentistry; or
.....(B) programs that improve clinical teaching in such specialties;
(6) to plan, develop, operate, or participate in predoctoral and postdoctoral training in general, pediatric, or public health dentistry programs, or training for dental hygienists;
(7) to plan, develop, operate, or participate in a loan repayment program for full-time faculty in a program of general, pediatric, or public health dentistry; and
(8) to provide technical assistance to pediatric dental training programs in developing and implementing instruction regarding the oral health status,dental care needs, and risk-based clinical diseasemanagement of all pediatric populations with an emphasis on underserved children.
(c) ELIGIBILITY.
—To be eligible for a grant or contract under subsection (a), an entity shall be—
(1) an accredited school of dentistry, training program in dental hygiene, or public or nonprofit private hospital;
(2) a training program in dental hygiene at an accredited institution of higher education;
(3) a public or private nonprofit entity; or
(4) a consortium of—
.....(A) 2 or more of the entities described in paragraphs (1) through (3); and
.....(B) An accredited school of public health.

(d) PREFERENCE.
—In awarding grants or contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following:
(1) Training the greatest percentage, or significantly improving the percentage, of oral health professionals who practice general, pediatric, or public health dentistry.
(2) Training individuals who are from underrepresented minority groups or disadvantaged backgrounds.
(3) A high rate of placing graduates in practice settings having the principal focus of serving in underserved areas or populations experiencing health disparities (including serving patients eligible for medical assistance under title XIX of the Social Security Act or for child health assistance under title XXI of such Act or those with special health care needs).
(4) Supporting teaching programs that address the dental needs of vulnerable populations.
(5) Providing instruction regarding the oral health status, dental care needs, and risk-based clinical disease management of all pediatric populations with an emphasis on underserved children.
(e) REPORT.
—The Secretary shall submit to the Congress an annual report on the program carried out under this section.
(f) DEFINITION.
—In this section:
(1) The term ‘health disparities’ has the meaning given the term in section 3171.
(2) The term ‘oral health professional’ means an individual training or practicing—
.....(A) in general dentistry, pediatric dentistry, public health dentistry, or dental hygiene; or
.....(B) another dental medicine specialty, as deemed appropriate by the Secretary.

SEC. 2216. AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.
—Part F of title VII (42 U.S.C. 295j et seq.) is amended by adding at the end the following:

SEC. 799C. FUNDING THROUGH PUBLIC HEALTH INVESTMENT FUND.
(a) PROMOTION OF PRIMARY CARE AND DENTISTRY.
—For the purpose of carrying out subpart XI of part D of title III and sections 723, 747, 748, and 749, in addition to any other amounts authorized to be appropriated for such purpose, there is authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:
(1) $240,000,000 for fiscal year 2010.
(2) $253,000,000 for fiscal year 2011.
(3) $265,000,000 for fiscal year 2012.
(4) $278,000,000 for fiscal year 2013.
(5) $292,000,000 for fiscal year 2014.
(6) $307,000,000 for fiscal year 2015.
(7) $322,000,000 for fiscal year 2016.
(8) $338,000,000 for fiscal year 2017.
(9) $355,000,000 for fiscal year 2018.
(10) $373,000,000 for fiscal year 2019

(b) EXISTING AUTHORIZATIONS OF APPROPRIATIONS.—
(1) SECTION 735.—Paragraph (1) of section 735(g), as so redesignated, is amended by inserting and such sums as may be necessary for subsequent years through fiscal year 2019’’ before the period at the end.
(2) SECTION 747.—Subsection (f), as so redesignated, of section 747 (42 U.S.C. 293k) is amended by striking ‘‘2002’’ and inserting ‘‘2019’’.

 

[UCSFAlumni]

Also, did you read my post about the Roberts' court's first term? If this is really true, how do you explain their decisions?

I am fully aware of the Court's history and politics. I have relatives who are legal scholars who blather on incessantly about such things at every possible moment. So far there has been only minor retrenchment against earlier pragmatist interpretations of the law by the Court as far as I can see. That is the point I am making. Moreover, Scalia is already 72 or 73, so who knows how long he will be around. Also if this Health Bill is somehow to be a test case for the elimination of Medicare and Social Security by originalistic literalism, then you will see a public clamor for Obama to pack the Court to keep those programs alive. Despite the intimidating rancor of the opposing PR, these social programs are still very popular. Subject to Congressional approval, adding more justices is possible, as there is no set limit. And who owns Congress now? That is why the Health Bill is on the fast track, because as Obama said recently, "the stars are aligned".

Vague? How? I was the one that pointed out the difference between different Constitutional Articles and Amendments. I'm also basing my predictions on well-established legal principles and policy norms. While from practitioners' perspective it's a Medicare expansion -- and thus palatable -- from a legal perspective, it's a chance to advance the agenda of reducing the Commerce Clause. What's palatable to a gourmet chef isn't necessarily palatable to a baby.

Your claim is legally vague. There is no court case that yet successfully challenged the fundamental right of the existence of programs such as Medicare or Social Security. There have been specific challenges on parts of these programs but none on their fundamental basis yet. Simply saying people are looking for an angle of attack doesn't mean it will happen.

 

[OceanDMD]

Food for thought. Obama is a political infant.


Charles Krauthammer : Why Obamacare is Sinking - Townhall.com


WASHINGTON -- What happened to Obamacare? Rhetoric met reality. As both candidate and president, the master rhetorician could conjure a world in which he bestows upon you health care nirvana: more coverage, less cost.

But you can't fake it in legislation. Once you commit your fantasies to words and numbers, the Congressional Budget Office comes along and declares that the emperor has no clothes.

President Obama premised the need for reform on the claim that medical costs are destroying the economy. True. But now we learn -- surprise! -- that universal coverage increases costs. The congressional Democrats' health care plans, says the CBO, increase costs in the range of $1 trillion plus.

In response, the president retreated to a demand that any bill he sign be revenue neutral. But that's classic misdirection: If the fierce urgency of health care reform is to radically reduce costs that are producing budget-destroying deficits, revenue neutrality (by definition) leaves us on precisely the same path to insolvency that Obama himself declares unsustainable.

The Democratic proposals are worse still. Because they do increase costs, revenue neutrality means countervailing tax increases. It's not just that it is crazily anti-stimulatory to saddle a deeply depressed economy with an income tax surcharge that falls squarely on small business and the investor class. It's that health care reform ends up diverting for its own purposes a source of revenue that might otherwise be used to close the yawning structural budget deficit that is such a threat to the economy and to the dollar.

These blindingly obvious contradictions are why the Democratic health plans are collapsing under their own weight -- at the hands of Democrats. It's Max Baucus, Democratic chairman of the Senate Finance Committee, who called Obama unhelpful for ruling out taxing employer-provided health insurance as a way to pay for expanded coverage. It's the Blue Dog Democrats in the House who wince at skyrocketing health-reform costs just weeks after having swallowed hemlock for Obama on a ruinous cap-and-trade carbon tax.

The president is therefore understandably eager to make this a contest between progressive Democrats and reactionary Republicans. He seized on Republican Sen. Jim DeMint's comment that stopping Obama on health care would break his presidency to protest, with perfect disingenuousness, that "this isn't about me. This isn't about politics."

It's all about him. Health care is his signature reform. And he knows that if he produces nothing, he forfeits the mystique that both propelled him to the presidency and has sustained him through a difficult first six months. Which is why Obama's red lines are constantly shifting. Universal coverage? Maybe not. No middle-class tax hit? Well, perhaps, but only if they don't "primarily" bear the burden. Because it's about him, Obama is quite prepared to sign anything as long as it is titled "health care

This is not about politics? Then why is it, to take but the most egregious example, that in this grand health care debate we hear not a word about one of the worst sources of waste in American medicine: the insane cost and arbitrary rewards of our malpractice system?

When a neurosurgeon pays $200,000 a year for malpractice insurance before he even turns on the light in his office or hires his first nurse, who do you think pays? Patients, in higher doctor fees to cover the insurance.

And with jackpot justice that awards one claimant zillions while others get nothing -- and one-third of everything goes to the lawyers -- where do you think that money comes from? The insurance companies, who then pass it on to you in higher premiums.

But the greatest waste is the hidden cost of defensive medicine: tests and procedures that doctors order for no good reason other than to protect themselves from lawsuit. Every doctor knows, as I did when I practiced years ago, how much unnecessary medical cost is incurred with an eye not on medicine but on the law.

Tort reform would yield tens of billions in savings. Yet you cannot find it in the Democratic bills. And Obama breathed not a word about it in the full hour of his health care news conference. Why? No mystery. The Democrats are parasitically dependent on huge donations from trial lawyers.

Didn't Obama promise a new politics that puts people over special interests? Sure. And now he promises expanded, portable, secure, higher-quality medical care -- at lower cost! The only thing he hasn't promised is to extirpate evil from the human heart. That legislation will be introduced next week.

 

[OceanDMD]

And now I hear Pelosi is determined to have a vote next week, and Waxman has decided to Bulldoze the Blue Dog Democrats if they dont get in line. Irresponsible haste. These frickin politicians will ruin this country. Why must they rush such important legislation?

 

[jsmars03]

Although I am not sure how this awful legistlation is going to affect dentists, it won't be long until it does. If Democrats truly wanted to fix health care, they would get rid of the frivolous law suits that burden Doctors with thousands even tens of thousands in malpractice insurance. Something just tells me when a doctor doesn't have possible lawsuits hanging above his/her head, their will be a direct corrolation to uneeded tests going down. I love this country more than anything, but we are going down a path of no return, and Obama is doing his best to make everysingle person dependent on the government. We are going to pay dearly for ignorance in this country.

 

[Daurang]

Good news from the Sunday wire...

"Senate Democrats are going to need help from Republicans to get President Obama's ambitious plan to reinvent the health care system over the goal line, a top lawmaker acknowledged on Sunday. 'Look, there are not the votes for Democrats to do this just on our side of the aisle,' said Sen. Kent Conrad, the chairman of the powerful budget committee."

 

[mirk3]

Although I am not sure how this awful legistlation is going to affect dentists, it won't be long until it does. If Democrats truly wanted to fix health care, they would get rid of the frivolous law suits that burden Doctors with thousands even tens of thousands in malpractice insurance. Something just tells me when a doctor doesn't have possible lawsuits hanging above his/her head, their will be a direct corrolation to uneeded tests going down. I love this country more than anything, but we are going down a path of no return, and Obama is doing his best to make everysingle person dependent on the government. We are going to pay dearly for ignorance in this country.

A lot of the lawsuits are legitimate. I had two family members affected by medical malpractice (simply not giving much of a damn and pulling out a part of a gall bladder so hastily to tear the lining of the liver, nearly killing my relative). She did not sue him, but stuff happens and doctors must be threatened to be held accountable or else you'll see more sh$^ happen.

 

[jsmars03]

A lot of the lawsuits are legitimate. I had two family members affected by medical malpractice (simply not giving much of a damn and pulling out a part of a gall bladder so hastily to tear the lining of the liver, nearly killing my relative). She did not sue him, but stuff happens and doctors must be threatened to be held accountable or else you'll see more sh$^ happen.

Agreed, Doctors should be held responsible for when they do make mistakes. This is just one of those things were your screwd either way. I'm actious to see what happens in the next few weeks in congress.

 

[DrReo]

Agreed, Doctors should be held responsible for when they do make mistakes. This is just one of those things were your screwd either way. I'm actious to see what happens in the next few weeks in congress.

Then they should be able to play defensive medicine and the patient shouldn't complain about outrageous medical costs,right?

 

[DMDreaming]

Just a thought but wondering how many others find it interesting that the insurance companies are FOR the current bill that mandates coverage. They wouldn't be for it if it mandated changes to their current way of doing business or should I say if it altered their income potential. In fact, the number of insured has decreased over the last year due to the recession and the bill would increase the number of enrollees. Something to consider.

 

[robhmnt]

And now I hear Pelosi is determined to have a vote next week, and Waxman has decided to Bulldoze the Blue Dog Democrats if they dont get in line. Irresponsible haste. These frickin politicians will ruin this country. Why must they rush such important legislation?

Those who bring up the "why the rush?" issue, mostly republicans, are the ones who literally want to kill the bill. It's NOT like they want to take time to read the bill, make corrections, add suggestions, etc.

 

[OceanDMD]

Those who bring up the "why the rush?" issue, mostly republicans, are the ones who literally want to kill the bill. It's NOT like they want to take time to read the bill, make corrections, add suggestions, etc.

Maybe it has something to do with the fact it is a PARTISAN BILL. Not only are Republicans not involved whatsoever with writing this bill, EITHER ARE MODERATE DEMOCRATS. When you have Pelosi, Reed, and Waxman writing the bill without input from moderates I would kill it too.

GIve me a frickin break, you cant be serious thinking that a piece of legislation like this should be rushed at all. Wake up.

 

[robhmnt]

Maybe it has something to do with the fact it is a PARTISAN BILL. Not only are Republicans not involved whatsoever with writing this bill, EITHER ARE MODERATE DEMOCRATS. When you have Pelosi, Reed, and Waxman writing the bill without input from moderates I would kill it too.

GIve me a frickin break, you cant be serious thinking that a piece of legislation like this should be rushed at all. Wake up.

Oh, so you are simply saying you expect a bunch of republicans and about 4-5 corporatist democrats write a bill, which is detrimental to the robbery of the private inssurance companies who feed them?
A bipartisan bill would be nice, but I can't see that happen anyway, since the republicans trample all the facts, and have the balls to claim we have the best health care system in the world. I guess I would do the same thing if someone was paying me million dollars for it.

 

[OceanDMD]

Oh, so you are simply saying you expect a bunch of republicans and about 4-5 corporatist democrats write a bill, which is detrimental to the robbery of the private inssurance companies who feed them?
A bipartisan bill would be nice, but I can't see that happen anyway, since the republicans trample all the facts, and have the balls to claim we have the best health care system in the world. I guess I would do the same thing if someone was paying me million dollars for it.

Apparently you are liberal. Republicans agree there needs to be changes, and we dont have the "best health care system", but the "best quality of health care" in the world. And if we dont, who does? I myself understand there is a group of uncovered americans that need to be covered. However, many of these people are here illegally, are young and choose not to pay a premium, and thus this number is much smaller in reality. I do not think we should tear down the entire system, and SACRIFICE THE QUALITY of the current healthcare system, so some government payed employee can tell me I am too old to be treated for a condition. QUALITY WILL BE SACRIFICED regardless of what is said in one of Obamas BS sessions after you and your liberal buddies have had your daily kool aid.

Dentistry will come shortly thereafter. This is not good legislation, and as a student of the profession you really need to sit back and understand what this administration is trying to do. I cant understand how you could be in support.

 

[OceanDMD]

Oh, so you are simply saying you expect a bunch of republicans and about 4-5 corporatist democrats write a bill, which is detrimental to the robbery of the private inssurance companies who feed them?
A bipartisan bill would be nice, but I can't see that happen anyway, since the republicans trample all the facts, and have the balls to claim we have the best health care system in the world. I guess I would do the same thing if someone was paying me million dollars for it.

Obviously you forget to address the fact that moderate democrats aren't even involved. This bill doesn't have the support of a big portion of the democratic party, let alone republicans. Its one thing to be partisan, but this is a little too important to have so much politicking going on. Obama doesnt understand healthcare, its just about making a name for himself.

 

[DrReo]

Obviously you forget to address the fact that moderate democrats aren't even involved. This bill doesn't have the support of a big portion of the democratic party, let alone republicans. Its one thing to be partisan, but this is a little too important to have so much politicking going on. Obama doesnt understand healthcare, its just about making a name for himself.

Iz this why californua is goin under? Wif all dez illgalz (more than 5 mill). Costin cali more than 10 billion dollarz? Hmmmm

 

[OceanDMD]

Don't Be Fooled by Obama's '45 Million' Uninsured

courtesy of S.E. Cupp

When the numbers are crunched, it turns out that only 11 million legal American citizens who would like health insurance don't have it, and even that figure is likely high. If we take it at 11 million, that's less than 4% of the country.


There's that number again: 45 million.

That's supposedly the number of people in America who don't have health insurance. How do I know that? Well, for one, President Obama's said it, like, 45 million times.

Democrats also love to say it. Michael Moore quoted it in his last movie, "SICKO" which in hindsight may as well have been a commercial for Obama-care.

Enter "45 mil" into the Google search bar, and before you're even done typing it will fill out the rest for you: "45 million uninsured." Finish typing in the search term and Google will bring up 147,000 results. The figure is quite literally everywhere. And now it's being used by the Obama administration to convince average Americans of two things: the uninsured represent a sizeable group in America; and Obama's plan will make health care more affordable and accessible to everyone, especially those 45 million.

Both premises are patently false -- the number of uninsured is far fewer than 45 million, and the Congressional Budget Office finds that Obamacare will practically bankrupt us, while simultaneously penalizing citizens and businesses who refuse coverage. It will also probably mean that the quality of our health care system will plummet, countless patients will not receive the life-saving care they need, good doctors will be driven out of business, and fewer people will actually want to become doctors. But 45 million Americans will finally get health insurance.

Considering the scope of Obama's massive proposal for health care overhaul, shouldn't we be considering how the vast majority of Americans will be affected, as opposed to just a small minority? (And, even a smaller minority than is often suggested?) Indeed, isn't it the number of insured Americans that should matter, since they are the ones whose medical coverage is about to drastically change for good?

This number, the number of insured Americans, is not an easy figure to find. Just try Googling it and you'll navigate through a frustrating labyrinth of dead ends, most of which lead you directly back to that uninsured "45 million" number. Eventually I had to ask the Centers for Disease Control and Prevention and the U.S. Census Bureau to get an answer.

It turns out that 253.4 million Americans -- or a whopping 83% of the country -- have health insurance, whether it's through private insurers, employer-based coverage, a government program or Medicaid/Medicare. The majority, 202 million of the 253.4 million, pay for private insurance.

And as a number of clever skeptics have recently pointed out, breaking down the 45 million number reveals that far fewer folks are actually uninsured. Nearly 10 million of those 45 million aren't even American citizens, and nearly 17 million of them can easily afford insurance, but choose not to get it (these folks will be taxed under Obamacare for opting out.) When the numbers are crunched, it turns out that only 11 million legal American citizens who would like health insurance don't have it, and even that figure is likely high. If we take it at 11 million, that's less than 4% of the country.

Now, it's important that we get health care to those 4%, of course. But is it really necessary to rip apart the health care system we currently have to do it? Yes, we all want better coverage that's more affordable and easier to navigate. Obamacare doesn't solve any of these. All it does is help less than 4% of the country get health insurance, while putting the rest of us through a tangled maze of bureaucracy, for worse care that costs just as much, maybe more. The long-term effects are even more frightening, but in the short term do we really want to penalize the many in favor of the (very) few?

 

[robhmnt]

Apparently you are liberal. Republicans agree there needs to be changes, and we dont have the "best health care system", but the "best quality of health care" in the world. And if we dont, who does? I myself understand there is a group of uncovered americans that need to be covered. However, many of these people are here illegally, are young and choose not to pay a premium, and thus this number is much smaller in reality. I do not think we should tear down the entire system, and SACRIFICE THE QUALITY of the current healthcare system, so some government payed employee can tell me I am too old to be treated for a condition. QUALITY WILL BE SACRIFICED regardless of what is said in one of Obamas BS sessions after you and your liberal buddies have had your daily kool aid.

Dentistry will come shortly thereafter. This is not good legislation, and as a student of the profession you really need to sit back and understand what this administration is trying to do. I cant understand how you could be in support.

I am a rationalist who doesn't twist the facts for his own benefit.
Republicans agree there needs to be change, but never propose anything. Now, they are bringing up all this "why the rush?" Bull$hitical argument to kill any type of reform for the good of their boss, the inssurance companies. As I said before, there are about 4-5 corporatist democrats who do the same thing.
First of all, the administration is not really making a healthcare reform, but a health inssurance reform. They are going to offer a public option to encourage competition and and help the millions (talking about the 255, or 289) who are being ripped off by the private inssurance companies. Those who wish to keep their private inssurance will be free to do so.
Secondly, how is the health care quality going to deteriorate? Are they going to take away the advanced technology or the research studies away from the doctors? Oh, you mean doctors and dentists would be busy and not have enough time to provide quality care? But wait a minute, I thought there are so many recent grads struggling to find associate positions right now. See, everyone likes to get paid cash, but the problem is that the corporations (with the help of reps) have robbed people off so much in the past couple of decades that there is no more money left in people's pocket. Now, you have the choice to get paid by the inssurance companies, but the inssurance cost is also so high that many either can't afford it, or are opting out. Keep up with the status quo, and soon you will have the choice of, oh well, not getting paid at all.
By the way, many dental procedures are not covered by inssurance companies, and unlikey to be covered by the public option either. People who need to do prostho, ortho, surgeries, etc will still be coming in for you.
It's amazing how the propaganda of the republicans, who don't give a damn about anyone making less than at least a million dollars a year, easily deceives the average citizen to stand up and defend their bull**** (Check out the loser, Joe the Plumber). I assume you and many dentists here make less than a million dollars a year, and I probably won't make that much in the future either. Look at it this way. If something gets done for the good of the average U.S. citizen, you will eventually benefit from it. But if the inssurance corporations keep ripping people off, things will only get worse.
Btw, you said, "Obama doesn't understand health care." You are twisting stuff as if Obama is writting the bill himself. There are health care experts who write the bill, despite the fact you might be in disagreement with them. Who understands it then? The republican lobbyists? The way you say it sounds like, "Obama doesn't understand health care, but the RNC (Rush, Newt, Cheney) does."