According to the Center for Disease Control, between 27 and 30 percent of adults suffer from dental caries, the clinical name for tooth decay. Having inherited a lineage of tooth problems from both sides of my family, I’m unfortunately among that number.
I moved to Oregon in 1996 (unless you count the summer of 1993, which I spent naked and neck-deep at Cougar Hot Springs, along with two or three dozen close friends), and my bad teeth came with me. In those years the Oregon Health Plan was justifiably a point of pride for our state government. One of the most liberal health care plans in the country, OHP allowed me total medical coverage for just a few dollars a month, light-years away from private insurance policies, which, for single coverage, averaged $3,695 in 2004, according to the National Coalition for Healthcare’s web site. But the most impressive, and to me most important, aspect of OHP coverage was that it included total dental coverage.
That’s right. Imagine this: cleanings, fillings, root canals, maintenance, etc., all for a monthly pittance that added up to about one-tenth of what your average college student spends on the same month’s beer supply. This was an invaluable resource for me, providing me with care that, otherwise, would have run into the thousands of dollars.
However, over the last decade our state legislature has been downsizing OHP, and dental insurance, much like my wisdom teeth, was more or less extracted completely, with providers like Capitol Dental being closed to new patients. That means if you allow your OHP benefits to lapse, your “grandfather clause” access to dental care also lapses.
So, my dental hygiene had been languishing, and I went without care until a few months ago, by which point I had been taking ibuprofen in stomach-eroding amounts for weeks. I finally bit the bullet and arranged to see a dentist; we’ll call him Dr. James Johnson, the supercilious, Hawaiian-shirted replacement of my fiancee’s excellent former dentist.
What followed for me was emblematic of what many poor people in this country experience when we seek medical care, increasingly a luxury only to be afforded by the wealthy. Dr. Johnson was terse and dismissive. He mentioned that the severe pain in my lower molar might well have been the result of “referred pain” from an upper tooth, but perhaps knowing that I’d be back very soon when the pain was unceasing, filled the lower tooth.
Walking out with a mouth full of gauze, I came face to face with New American Medicine: “That’ll be $200, sir.” I’ll admit na퀨͌�vete, but I’d never heard of “a la carte” service like that. I hadn’t even brought any cash with me; I assumed I’d be billed. When I explained this to her, the receptionist, a lemon-faced, thin-lipped charmer, was clearly put out to be bothering with my picayune bullshit. She lashed me with a hissing sigh and told me the bill would find me within the week.
When it did arrive, it was ornamented with a personal message in an incongruously cheery feminine hand, missing only hearts over the lower-case i’s: “This amount is to be paid immediately!” There were three heavy lines under the last word, just in case I thought of recycling the bill and ignoring it.
I had hoped to find another dentist, but when the pain only worsened, as the dentist had doubtless foreseen, I was forced to return. When I did so, I was met with a steely eye from the receptionist. Her face darkened as I showed the temerity not only to approach her desk where she was busy playing Tetris, but also to try and secure a payment plan. I told her it would be in both our interests for me to be given a payment plan, as I would then have all my family’s dentistry done right there. She yawned at me and suggested that I go home and save some money, then sought to shut me up by saying that she “heard me,” because her daughter was in the hospital.
“Isn’t that all the more reason to allow me a payment plan?” I sympathized, but she was done with me and waved vaguely in the direction of the dentist. “He’ll decide,” she said, dismissing me.
I was strapped into the chair and had X-rays taken, sharp plastic plates jammed resentfully into my mouth. The whole office heard my audacious demands, apparently. When the dentist came in, he sat down next at my side and looked at me as though I were masturbating with my own excrement. It turns out he’d brought me all the way across town for a little object lesson. In his eyes, my paying my old bill two weeks after treatment constituted “walking on him.” He, in contrast to goldbrick turds like myself, was a “man of his word” and would have offered me a payment plan had I not “lied” and “taken advantage of him.” While my temper began to simmer at his gross insults, he smiled condescendingly at me and ripped the spit-bib off my neck. With my son in tow, I was literally thrown out of his office.
This is what happens when medicine becomes primarily a monetary pursuit and loses its inherent focus: to succor and heal. When avaricious scum like Dr. Johnson begin to infect the health-care system, patients become customers and the success or failure of a given procedure is based not on its medical effectiveness, but on profit-loss analyses. Johnson was so deep in his own coffers that my late payment, not the result of negligence, but of a payment scheme I’d never previously encountered, was a personal insult that demanded not only refusal of treatment, but a face-to-face reprimand, complete with egregious personal insult.
Like education, medicine is not possible without monetary funding. There is an element of both that is transactional in nature; there is always a bill. But when either institution loses its original vector and is reoriented towards wholesale pocket lining, we risk that our hospitals, and our schools for that matter, will become little more than expensive 7-11s. And the Big Bite?
That’s coming straight out of our asses.