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In “Financing and Reimbursement of Elders’ Oral Health Care: Lessons from the Present, Opportunities for the Future.”

Dr. Jones points to higher demand among the elderly, unequal access across socio-economic strata and insurance coverage gaps in retirement.  While acknowledging that dental care costs amounted to a minor 5.3 percent of total health care expenditures, she presses her case for Medicare and Medicaid to cover a larger share of these.

Absent unrealistic assumptions about universal health coverage and concern for the plight of minority elders, Dr. Jones does assemble a creative set of proposals for a mix of publicly- and privately-funded oral health care insurance coverage that will obviate the need for out-pocket payments from fixed retirement dollars precisely when seniors must conserve what purchasing power they have.

Discussion

Making a Strong Case

The author’s concern for the generational reality – the “baby boomer” cohort born in the post-war years – is bound to strike a sympathetic chord among others concerned with the “graying” of the U.S. population.  Similar worries plague health authorities in such disparate locations as Europe, Japan, and Singapore.

Hence, it is a timely concern.  Lamster (2004), Mertz & O’Neil (2002), and Ahluwalia (2004) share the conviction, reinforced by the observation that the rate of dental disease among the elderly is increasing.

Dr. Jones quantifies demand among the elderly, showing higher incidence of seeking oral care in recent years.  To create the straw man for her goal of universal oral health care, she also vividly demonstrates disparities across socio-demographic segments and points out that inconsistent state support for Medicaid means 41 of 50 states have unsatisfactory coverage for oral health care.

As to federally-funded Medicare, the Institute of Medicine recommendation to cover a very limited set of patient health problems (e.g. proximate cancers, prior to radiation therapy for leukemia) holds out little prospect for wider Medicare coverage in the near future.

One grants that Dr. Jones appears to have been thorough in assembling the options for financing oral health care for seniors.

Her present recommendations and those of colleagues writing in the same journal issue (circa 2005) include adding a personally-funded section D to Medicare, extending private dental insurance to the elderly who have the least coverage, inclusion in HMO package plans, and self-funded prepayment for retirement.

What Detracts from Scientific Rigor

This piece rests on the assumption that dental care is a universal right.  Believing wholeheartedly in the IOM principle that health care coverage ought to be universal, Dr. Jones argues that if working adults enjoy oral health care benefits, then retirees and the elderly are entitled to it, too.  She asserts that her plan presents options to “eliminate disparities in oral health access and outcomes”.

Such an overarching goal could not have been articulated at a worse time.  In an era when both Federal and state governments struggle to reverse recessionary trends, overcome budget deficits, cut back on nonessential services, and avoid imposing more taxes, the assumption of universal entitlement is specious at best.

In California, as in the rest of the country, Republican and Democratic legislators present a united front to address budget shortfalls (caused by the collapse of the housing market) through politically unnerving cutbacks in social services.

While there is general acceptance for Medicare and private health insurance, Dr. Jones has her work cut out for her arguing that oral health care is more than a quality of life issue.  Since life-threatening or debilitating medical and dental conditions are not involved, it can be difficult to argue for egalitarian access.

Missing in most discussions of social good is the fact that the middle-aged of America have comparatively robust personal incomes and that, after all, a good number of them are in nursing homes.  In the latter scenario, Preston et al.

(2006) and Steele (2006) suggest co-opting “carers” for what oral health care advise they could give.  Matear and Barbaro (2006) also remind us that caregivers and designated family members play a especially crucial role among the most elderly, who are likely to be cognitively impaired.

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