Why Are Dental and Vision Not Covered Under Most Health Plans?
A single night in the hospital costs upward of $11,000, and this patient needed three of them for the intravenous antibiotics to do their work. That’s not including, of course, the costs of the medication or the fee for the surgeon who removed the last bit of infected tooth. The rest of it the owner yanked in despair with a pair of pliers after the pain got too much to bear.
All in all, the bill came out to nearly $100,000 — for a procedure that could have been prevented with an $85 cleaning and $400 extraction. As the patient had no financial resources, Medicaid picked up the tab.
Why such waste? Because Medicaid doesn’t cover routine dental care for adults. Neither does Medicare.
Most health insurance in America does not — nor does it cover your eyes. But why? The reasons are steeped in history and the bizarre aversion people in this nation have toward common-sense solutions that smack of the dreaded “S” word (side-whispers “socialism” while looking over shoulder for the thought-police).
However, it’s long past time for this nation to pull its collective head from the sand and start covering this care, for practical reasons as well as humanitarian ones. Why are dental and vision not covered under most insurance plans? The bottom line is, they should be.
A Brief History of Dental and Vision Care
Imagine going for a haircut and having your barber lance your abscessed tooth in between trimming your beard. Once upon a time, such practices were common. After all, digging around in your mouth isn’t exactly like cutting into the body, and parents routinely used bedposts and doorknobs to extract pesky baby teeth.
As for your eyes, they either worked or they didn’t. Myopia posed little threat in the days before driving became a part of daily life.
If you’re seeking a big, impressive reason why most health insurance companies don’t cover dental and vision services, there you go. The answer isn’t profound. It’s simply history.
Of course, the current for-profit system offers zero incentives for such companies to expand their coverage options today. As is always the problem in an extreme capitalistic system, if an activity isn’t profitable, it often goes ignored, no matter how dire the need for that product or service.
However, continuing the present course is both an exercise in inanity and a waste of valuable resources. It’s also needlessly cruel to the economically disadvantaged. The present system needs to go the way of the dodo, and health coverage should be comprehensive, including dental and vision. Here’s why.
3 Arguments for Including Dental and Vision Coverage as Part of a Comprehensive Health Plan
Why should health insurance include dental and vision coverage? Here are three reasons, not necessarily in order of importance.
1. It’s Financially Irresponsible to Cover Some Services Separately
The example in the opening paragraph happened to a friend of mine. I can still feel the imprint of that uncomfortable plastic hospital chair on my bottom years after the fact.
My brain injury might have resulted in acalculia, but you don’t need a degree in mathematics to know that $100,000 is a lot more than $485. Let’s put the unnecessary pain and suffering aside for a moment, all those long nights lying awake, unable to sleep from the agony, resulting in a final, desperate act that didn’t address the underlying infection.
A routine annual dental cleaning would have revealed the initial cavity that led to the infection. Even if it had remained untreated until the first pain struck, a simple extraction would have prevented the bacteria from spreading into the jaw. There would be no need for a midnight hospital visit, surgical intervention or IV bags dripping with antibiotic solution.
The same problem that ended up costing nearly $100,000 could have been solved for less than $500 — if the patient in question had proper preventative care.
Nor is this example the only way that neglecting routine dental care costs the public big money. Consider these other serious health issues that could be prevented by annual cleanings:
- Heart disease: Poor oral hygiene worsens existing high blood pressure, increases systemic inflammation, which stresses your heart, and puts you at an increased risk for valve infections, a considerable risk for those with existing valve problems.
- Stroke: High blood pressure increases your stroke risk.
- Alzheimer’s disease: Oral bacteria can travel through blood vessels and nerve channels to the brain, where it increases your disease risk.
All of these conditions are costly to treat, often requiring multiple overnight hospital stays and sometimes, long-term palliative care. Many of them could be prevented with routine treatments, like cleanings to identify small cavities, which cost less than $200 to fix. Even paying $10,000 or more for multiple crowns is more cost-effective than the $1,000,000-plus bill that can result from a month-long stay in intensive care.
I’m a taxpayer. I’m not sure why my fellow taxpayers are okay with this degree of waste, but I’m not. It’s past time we hold our elective representatives responsible for fixing the system and delivering us value for our dollars.
2. It’s a Matter of Public Health and Safety
Let’s switch gears to vision care. For this exercise, it’s best if you close your eyes, but that does make reading problematic. Use your imagination instead and think back to when you were first learning to drive and your childhood caregiver refused to let you borrow the car for safety reasons. How many times did you hear, “It’s not that I don’t trust you; it’s the other drivers on the road,” or some variation of that statement?
Your folks had a valid point.
At least half of Americans admit to skipping their annual vision exam, even though nearsightedness is incredibly common and farsightedness is far from rare. Additionally, roughly 115 million vehicles take to the nation’s highways each day. That’s millions upon millions of drivers behind the wheel who might not be able to see clearly. Eek.
Admittedly, vision care is generally less expensive than other treatments, so it’s easy to say, “Well, people should be more responsible.” However, even a routine exam at a big-box retailer costs $80 or more. What if you’re one of the many Americans working for minimum wage or just above? It takes more than a full work day to afford an exam alone, and that’s assuming you don’t have other obligations, like paying for rent and food. Glasses create an even bigger financial burden.
What price tag can you put on a life? Losing someone you love dearly to a preventable car accident has a way of changing your perspective. All of a sudden, including an $85 eye exam and $200 corrective lenses allotment to a comprehensive healthcare plan doesn’t seem like too much to pay for, does it?
3. It’s an Integral Part of Health
Perhaps the best reason for including dental and vision as part of comprehensive health coverage — if the least convincing to the powers-that-be — is that your teeth and eyes are a part of your body. They play integral roles in your well-being, as anyone who has had trouble with either can tell you.
For example, even if you ignore the big health risks of skipping dental care, like Alzheimer’s and heart disease, avoiding the dentist can still harm you. When your mouth hurts, it’s a lot harder to meet your nutritional requirements, and food plays a much more vital role in total health than many people realize.
Those who lack teeth often have to resign themselves to soft foods, meaning they don’t get the right mix of fruits and vegetables to provide the phytonutrients and antioxidants necessary to prevent disease. Worse, they could indulge nearly exclusively in easy convenience foods like noodles made from bleached flour that increase their diabetes risk.
Lacking teeth also makes it harder to exit the poverty cycle, which is a daunting enough task for the intact and healthy. If your smile is riddled with missing teeth, you’ll have a hard time finding customer service jobs, typically the easiest to get. You’ll likely experience discrimination in other positions, too — even Zoom interviews make it hard to hide the gaps when you speak.
Vision problems likewise take an economic toll. Working on a computer is nearly impossible without proper corrective lenses — otherwise, you can end up with a blinding headache in no time. Errors follow, then job loss. Even if you have no compassion, this should concern you as a consumer. I shudder to think of climbing into an Uber with a driver who hasn’t had a proper eye exam in years.
We as a society have a choice. We can continue wasting money with the current system, an arguably stupid decision. Americans already pay the highest medical costs in the world while having some of the worst health outcomes.
Or we could evolve to something better, like much of the rest of the world. Such an alternative already exists, although it is not yet law — only continued pressure on your elected representatives can make it a reality.
Medicare for All Would Include Dental and Vision Coverage
One good thing to happen in the political world recently is that none other than Senator Bernie Sanders was appointed as chair of the powerful Senate Committee on Health, Education, Labor and Pensions. One thing he has announced in an email to his supporters is that he will reintroduce his Medicare-for-All bill in coming sessions.
The problem, of course, is that not a single Republican supports the plan. Even among Democrats, support remains mixed, with the progressive faction firmly in favor and blue dogs holding out for more of the same old, same old that sees 45,000 Americans dying without healthcare each year.
If you want to know why, just follow the money. The health insurance industry contains some of the biggest lobbyists, followed by organizations like CVS, who have donated tons of dark money to stop Medicare for All.
Medicare for All would include dental and vision coverage as part of the comprehensive care extended to all Americans regardless of their socioeconomic status. You’ve already seen how that can save significant money. Furthermore, eliminating much of the “middle administration” — aka, health insurance companies whose only job is to deny you care when you need it the most — would save trillions of dollars over the next ten years.
There’s not much of a chance of Medicare for All making it through the current Congress. But a slim chance is not zero. Remember that old cliche about squeaky wheels and grease? If you care about the issues above, it’s time to make a little noise.
It’s Time to Include Dental and Vision Coverage as Part of Medical Care
Let’s bring American healthcare out of the dark ages. Continuing to omit dental and vision from comprehensive health coverage is the ultimate myopia — it’s staggering how short-sighted it is in terms of costs and public health risks.
Expanding dental and vision coverage through a comprehensive Medicare for All plan would take America out of last place and improve our global standing in terms of health outcomes. More importantly, it would help millions of American citizens get the care they need and deserve so that they can lead more productive lives.
Note: This article first appeared on LivingWithHM.com
