I was reading some of the things in my pile of professional publications and such, and came across two letters in the ADA News, which is a biweekly publication of the American Dental Association communicating with its members. The first was a "My View" article that reads like a letter, actually, and in it the author/dentist tells the story of receiving a notification authorizing a transfer of dental records to another office. I know what this dentist was feeling when he got that in the mail - losing a long-time patient is never a cause for celebration. The story goes on, however, to give the reasons - the patient was an 88 year old man who had recently lost his wife, and getting to the office was very difficult, so he needed to transfer to an office closer to where he was going to be living now.

As a dentist you fully understand this sort of a transfer, and you just want to make it as easy on your patient as you can. And that made me think of what it is that we value in the relationship between us and our healthcare providers, be it a dentist or a physician or some other provider. It's the doctor who focuses on the care of that one patient in their treatment room at that time who ends up being valued. Who we honestly feel is looking out for our best interests. The business part of the practice is important, and as a provider you don't necessarily want people who don't value your services, won't honor their own financial commitments, but you can't focus overly much on that. When you do, you end up noticing the disappointments instead of the successes far too much and it changes you. Changes your attitude about the practice of your chosen healthcare field.

The other letter was titled "Insurance" and talked about how insurance companies come between providers and patients. In dentistry, it is different from medical insurance. First, insurance companies only cover a yearly maximum of $1000 to $1500 a year. Occasionally one will cover more, maybe up to $2500, but those are rare, exceptions. (Interestingly, in Illinois one of the only plans that covers $2500 is the one provided by our state government - yes, the state government that is pretty much broke.)

In the 1970's, when dental "insurance" came into being, it covered a yearly maximum of...you guessed it! $1000! They quit paying when you reach your maximum, no matter what you need done and how urgent it is. This forces the patients to make choices as to what they should do and what they should perhaps pay out-of-pocket for. It's incredibly liberating when a patient comes in and doesn't have insurance, and has the dental IQ to want the dental treatment that they need.

So while the risks of insurance companies has barely changed (oh, yes, a crown has gone up - in 1986, a crown was about $350 in my area, and now it's over $1000, and the insurance company, who generally covers half, is pays $500 instead of $175 - but they still will not pay more than the $1000 they are obligated to pay in a year...), the premium costs have gone up significantly. One stat quoted in the letter is that only 3% of dental policyholders reach their maximum benefit for a given year. The letter writer points out that there's an awful lot of money paid that is not going toward dental care.

And dentists sign UP for this, and act like they like it, being told how much they can charge and even what procedures "are reimbursable", the insurance companies calling them "preferred providers" and trying to steer their policyholders toward them and away from fee-for-service dentists, which I am, pretty much totally. Physicians have already been forced into line by these concerns, but I don't know a single physician making what most upper management makes at any insurance company. Meanwhile care is compromised and providers are squeezed.

Profit motive is damaging something that should be independent of such a concern. One's health shouldn't rest on what they can afford. When we as a society decide that this model is preferable to one where quality care would be accessed by all, and paid for by all as well, we've made a mistake, in my opinion.

Both of these letters made me think about the fact that what's important in medicine (and I include my own field in there) is the relationship between the patient and the providers. The fact that some smart but perhaps ethically challenged individuals have figured out a way to get really rich profiting from the sicknesses and misfortunes of others is perhaps the biggest problem. That goes for providers, too, who don't put patient care at the top of their list every day.

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