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Clash of the Intentions
June, 23, 2018

For the sake of this short piece, we will assume the two state programs through which we provide care are the same.   These are Mass Health and Rhode Island Medicaid.  They are not the same but since the purpose of this essay is not to compare the two, considering them the same does not undermine my purpose or the integrity, or lack thereof, of the two state programs.

End of the story is I pay back what Rhode Island and Massachusetts has paid me in the return for providing dental care to their Mass Health and Medicaid program recipients.   I begrudgingly accept this as a marketing fee to the state.

How does the happen Dr. Swann?  Good question.  The state sends agents of correspondence to my office requesting patient charts.  With these charts they detail review what has not been done strictly according to my contractual agreement with them.  Most of these contractual agreements have not been amended to new technology in decades.  They advocate the use of materials which date back to the 1850′s.  Techniques that were used as early as  the 19th century.   Next, they say I’m using the wrong materials.    We don’t use wrong materials.  We use materials and designs that are less hazardous to human beings.  Simple as that. We use ceramics which call for better tooth preparation design that protect teeth and present less hazardous conditions for the dentition over time.  Then they report I’m charging patients for procedures already covered by the state insurance.   Under-estimating the intelligence level of patients are we?   Nine out of  ten patients who present with state insurance know for what procedures the state pays.   So why would the patient pay for it.  This is a non-sensical claim made by people who don’t practice in the dental field or have failed at doing so. They indiscriminately and neglectfully attach a value to each “error” found, come up with a total, and send me a bill in the form of legal mumbo jumbo.

In addition, they try to scare me with claims of criminal activity while making harassing calls  to my employees and patients.   If something looks like a gangster, smells like a gangster, talks and walks like a gangster,  its a gangster.

That amounts to what is in effect an incredibly inefficient scheme by the state  to minimize their losses in a program disguised as providing dental care to the exploited “needy”.  The “needy” class is growing and the state exploits it by harassing the vulnerable class.  More on this later.

By the way, who is the state?   In correspondence with these kooks, their constantly referring to “they do this” or “they want this”.   Of course, there is no accountability in these state programs.   We have made numerous calls to them and their representatives give different answers to the same questions.  We’ve tested this many times.

Who are the losers in this system?  I would argue those receiving the dental care at minimal to no cost.   This is quite easy to understand if you consider the public school education system.   If you pay nothing and gain complete access to it, you inevitably will get only what that system is designed to provide you.  Whether it is harmful or not.   In addition, you will demand it more, given its low cost of entry.  Resulting, as it also pertains to dental care,  are problems worse than those found in  the absence of such a system in the first place.  It reminds you of the question “Is the disease or treatment worse”?

The damage created by such a system is not amended by the sole system that caused it.  Hint, hint!  So, we are now beginning to see who the scapegoats are in the whole system.   The providers.  Private costs rise, laborers are limited, and access is limited to advanced systems.  These advanced systems are private and cost more and thereby inaccessible to most people without creating debt.

Just for fun, let’s create a system where there’s no accountability in information provided to providers and their customers,  no new technology,  paid for by everyone else.   This is Mass Health and  RIMA  (Rhode Island Medicaid).    Now let’s find a group of people who are inextricably knowledgeable about the product, dental care in this case,  and represent the only producers of that product.  These are dental care providers.  Dentists, hygienists, and assistants.  Now, let’s put the two together. At this point I will angle the topic to a morose but formational topic which hopefully will accent this essay.

The provider has an ethical, moral, professional and personal obligation to patients.  This includes voluntarily updating all of the aforementioned qualities which tie to a provider to a patient.  Ethically and morally, providers should make better decisions with experience.  Professionally, you learn what works and what does not and you transform into a more refined member of society and should have sought out better technology which produces less morbidity, reduces costs, and provides higher quality care.  Personally,  you have met goals and constantly create new ones for yourself that may have some positive effect on the people around you.   On the other hand,  the state has nothing of the sort.  They are present like a mouse is present on your kitchen floor.  You don’t want them there,  but they are, and getting rid of them forever is close to impossible.  No obligations to their customer, our patient, to be met. Literally.

So when the two come together,  there’s a clash of intent.  One points the finger at the other.  One side is spending other people’s money (the state) and the other side is subject to an involuntary hike in their moral, professional, and personal obligations to society.  This is includes giving more access to procedures which produce less morbidity and costs and more long-term effectiveness.

So the best way the state can react to this is effectively report that I have provided care which does not meet their sub-standard.  Yes.  You read it correctly.  We provide care that does not meet their sub-standard.  There’s too much access.  It’s not costly enough,  not hazardous enough, too fast and we don’t want to pay for that.  So they bill me.  Yes.  In effect, they are forcing me to pay them for the access to provide care to their forever-turning spool of patients who can’t reasonably access dental care in any other way.

Weird but that’s exactly what you get in most places if you receive dental care through the state.  I’ve known this for a long-time and the semi-reason for writing this is to promote a change in our dental care system.  From the educational level of dentists ( of which quality has diminished and become more expensive) to the private office setting of which by and large have artificially high and inflated prices,  the system of must change.

There is a reason why the dental profession is burdened by its history of anxiety-provoking procedures, pain, fear, occupational-related suicide, and weird journalistic stories about unscrupulous dentist and procedures.  Its all related to price and third-party influence.  In this case its the state.

We should remember the only reason a state dental care program exists today is the insufferable demand from self-interested lobbyists to policy-stakers to provide dental care to the poor.   As a result the poor and “working-class” receive sub-standard care  promoted and paid for by the state.

In our office, Direct Pay Dental Care,  we have natural prices reflective of the supply and demand for our services.  Our system of care provides results characterized by lower incidence of recurrent dental problems, less tooth loss, and less dental-related morbidity.   We do this by making decisions based on good information, new technology and honest prices.

Look forward to future post:

Why the state doesn’t like your teeth.

Dentists are a bunch of dummies.