Facing Up to Dental Terrors

The only thing worse than toothache/jaw pain, to be cruelly specific, is toothache/jaw pain without insurance. Most of us are without such insurance. It has not even been on the radar of health reform advocates, which is just as well — if you add dental terrorism to abortion and public options we won’t see reform for another few decades.

Nevertheless, tooth reform, euphemistically referred to as full mouth restoration in some circles, is ahead for increasing numbers of Americans sooner or later. It comes down roughly to a choice between fixing the mouth or buying a yacht, but if your jaw aches, you forgo the yacht.

New York Times health writer Jane Brody traced the new path of dental repair journeys in a thoughtful article yesterday, explaining her own costly route from tooth decay to bridges to implants, and throwing out an estimate of approximately $3,500 to $4,000 per tooth for the now-preferred latter. Multiply this by at least three or four times if you have other issues, which most of us do once things start going south in the mouth, needing attention. That would be gum problems, repair to surrounding teeth or necessary attention to bone.

I write with authority. Some years ago, facing all of the above, I visited an assortment of dentists with an assortment of solutions that frequently had me in tears when contemplating the time, details (one would have had screws in my jawbone which I would tighten every few days for months as it rebuilt itself) and costs. Like Brody, I grew up before the days of fluoridated water and have had more repair work since childhood than the Bay Bridge. It was a mess in there.

Finally my husband, whose best wives have been born in 1933 but with bad teeth, said, “Just do it all. Don’t be going patch-patch-patch; do it all.” I proceeded to choose the most sympathetic and understandable (most of them were, except for the screws-in-the-jaw guy) dental professionals, assembled a team and went to work. Or rather, I scrinched my eyes shut while they went to work. Some 18 months and $40,000 later we were free at last.

(Out of this experience, during which I was doing a great deal of entertaining just to keep us happy and sane, came one of my finer unpublished books, Cooking for the Dentally Impaired: Recipes and Menu Suggestions for the Impaired and Unimpaired in Difficult Times. I think it’s a book whose time has come; my agent disagrees.)

Brody’s article is a must-read for anyone stewing over this issue. The following are abbreviated tips for anyone with teeth and plans to keep them:

1 – Consider early-decision. The sooner things like gum surgery, crowns, implants-v-bridges or bone issues are dealt with, the likelier all can be made well and kept that way.

2 – Get second opinions. You may even choose the screw-in-the-jaw route, but there are many different procedures and it is good to find one suited to your temperament and bank account.

3 – Ask questions. I asked so many that I was fired by one team; a polite letter said they did not believe they should take my case. It’s just as well. Those I wound up with answered my questions and seemed happy to do so.

4 – Ask for references. Brody suggests this, and I agree. Because I already knew several people who had been patients of the dentists with whom I eventually invested all that time and money, talking with them about their experiences helped keep me from any surprises.

5 – Talk finances. Several friends of mine have had major dental expenses that were far outside their budget, but worked out payment schedules with their dentists so that necessary work could be done sooner rather than later.

Meanwhile: floss.

Doctors oppose abortion cuts in health bill

The San Francisco Medical Society has come out in opposition to removal of abortion coverage in the health reform bill, pointing out the potential danger to women’s lives if they are denied access to such care. Charles Wibbelsman, MD, President of SFMS, writes in today’s San Francisco Chronicle that the board of directors will urge congressional representatives to find a compromise.

It is a shame that such a complex issue as health care reform has been hijacked in the form of the Stupak amendment, which would ban all public funding for abortion (“Amendment to House bill reignites abortion debate,” Nov. 10).

Experience has shown that denying coverage of abortion does not stop or even curtail it, but rather shifts the costs elsewhere, and threatens to delay a woman in seeking and obtaining this medical procedure, thus potentially endangering her.

The San Francisco Medical Society’s board of directors has voted to urge our elected officials, particularly Sens. Dianne Feinstein and Barbara Boxer, to find a compromise that will not ban such funding and keep women with unwanted pregnancies safe.

Women’s lives should not be held hostage to politics.

At last, a ray of sanity from the medical community. I, for one, am proud of SFMS for standing up for the uncounted thousands of women, most of them poor and disadvantaged, who will suffer harm from denial of access to care should the conservatives and the U.S. Conference of Catholic Bishops win the day on this matter.

via Stupak amendment hijacks health care reform.

Abortion, health reform and me: who is making our choices?

Am I the only person around who is squirming — make that fuming a little — over the concessions made to the anti-choice guys before the House passed its health reform bill? Does no one else find it offensive to turn from reading on page one of today’s New York Times about this sad state of events to page 14 for a large photo of President Obama shaking hands with Cardinal Sean O’Malley? They were meeting at the funeral for Senator Ted Kennedy in August, where reportedly the good clergyman told the president that the Congress of Catholic Bishops really wanted to support health reform ——– oh, but only if everybody caved to their wishes that abortion remain unavailable.

It is not as if we weren’t forewarned. I posted a brief note in this space a few days ago (see Abortion Foes Winning Health Concessions, 11/4, below) and tried to resume a position of calm.

It is hard to remain calm. Somewhere the lines about separation of church and state have to fuzz themselves back into reality. I believe in the right of the U.S. Congress of Catholic Bishops to tell Catholics how to behave (despite the fact that of my many Catholic friends I know almost none who pay any attention in matters of personal choice.) I even believe in the right of the Pope to tell the Bishops to tell their parishioners how to behave. I even believe in the responsibility of all individuals, including my Presbyterian self, to behave according to their conscience and their faith. I just hate being governed by someone else’s faith.

This is not a small distinction. My own church, admittedly starting with a small group here in woo-woo San Francisco, passed a fairly strong national resolution denouncing our country’s torturing folks and seeking justice. As far as I know, no one threatened the president about withholding support for these occasionally immoral wars we keep fighting unless the instigators of torture-in-our-name were sent to jail. However strongly I would like to see the latter happen, I believe there are limits to what faith communities should do.

I had personal experience with back-alley abortion, in the dark days pre-Roe v Wade. It was not pleasant. Is there any way a celibate Catholic bishop could even remotely understand the horrors to which he is condemning poor, desperate pregnant women with the relentless push to make abortion totally unavailable? No. I wish there were.

We still have got to have health reform. But what prices we are paying.

Abortion foes winning health concessions

Anti-abortion forces, sensing victory in the health bill, are happily using their clout. They will undoubtedly win big. David M. Herszenhorn and David D. Kirkpatrick report in the New York Times that staunch anti-abortion Representative Brad Ellsworth (D-IN) is likely to get what he wants, which means other leading opponents of a woman’s right to choose, including a few elected representatives and the U.S. Congress of Catholic Bishops, will also get what they want.

Struggling to finish their big health care legislation, House Democratic leaders signaled Tuesday that they were prepared to make several changes to the bill to satisfy abortion opponents, including many Democrats, who had threatened to block it.

The opponents are insisting that tax dollars not pay for health insurance that would cover abortion. That is a tricky proposition given that the health care bill would provide hundreds of billions in federal subsidies to help moderate-income Americans buy health insurance, mostly from private carriers.

But Democratic leaders have little choice but to make some concessions. As many as 40 Democrats have said they might oppose the health care bill without tighter restrictions on abortion – a potentially decisive number.

So okay. We desperately need health reform, and such concessions apparently have to be made.

I just wonder if any of these guys know anything about what it was like in the days before Roe v Wade, which is the scenario to which they wish to see us return.

And I find it interesting that they, who seek to exercise so much control over what a woman may do with her body, are mostly men.

Democrats Near Deal on Abortion Coverage – Prescriptions Blog – NYTimes.com.

Safeway carrot-stick plan a boon to reform

There was a little local pride in a key segment of the Senate Finance Committee’s health care bill reported today by Andrew S. Ross of the San Francisco Chronicle:

It’s not every day a local grocery has a congressional amendment named after it. Such an honor has been bestowed on Pleasanton’s Safeway Inc., whose stick-and-carrot health insurance program is the model for a “wellness provision” in a health care reform bill that passed the Senate Finance Committee last week by an unusually bipartisan 18-4 vote.

“Yes, it’s quite fair to call it the ‘Safeway amendment,’ ” said a spokesman for Sen. John Ensign, R-Nev., who co-sponsored the amendment with Sen. Tom Carper, D-Del. “He’s a big advocate of the Safeway program.”The provision, designed to “incentivize Americans to lead healthy lifestyles in order to lower their overall health care costs,” would allow companies with self-insurance programs to reward employees with bonuses and/or premium reductions of up to 50 percent if they follow health guidelines, like undergoing regular screenings, quitting smoking, losing weight, taking cholesterol-reducing medications and so on.

While some question the accuracy of reported cost savings, the measure has strong support among key politicians up to and including President Obama.

As a beneficiary of Kaiser‘s “wellness” program — a constant push toward healthy lifestyles and preventive medicine — I hope this piece of the legislation stays. As long as he’s not going to resign, Senator Ensign might as well be doing something useful over there.

via Safeway plan part of Senate health care debate.

Boomers & the high cost of dying

As health reform slogs along, a few critical pieces are already gone for good — or for now, at least. One of the saddest is coverage for end-of-life conversations; one of the saddest elements of our culture in general and healthcare mish-mash in particular is the tendency to treat death as a curable disease. Timothy Egan, in a recent blog for the New York Times, makes an eloquent case for injecting a little reality into all this.

In the last days of her life, Annabel Kitzhaber had a decision to make: she could be the tissue-skinned woman in the hospital with the tubes and the needles, the meds and smells and the squawk of television. Or she could go home and finish the love story with the man she’d been married to for 65 years.

Her husband was a soldier who had fought through Europe with Patton’s army. And as he aged, his son would call him on D-Day and thank him – for saving the world from the Nazis, for bequeathing his generation with a relatively easy time.

That son, John Kitzhaber, knew exactly what his mother’s decision meant. He was not only a governor, a Democrat who served two terms in Oregon as it tried to show the world that a state could give health care to most of its citizens, but a doctor himself.

At age 88, with a weak heart, and tests that showed she most likely had cancer, Annabel chose to go home, walking away from the medical-industrial complex.

“The whole focus had been centered on her illness and her aging,” said Kitzhaber. “But both she and my father let go that part of their lives that they could not control and instead began to focus on what they could control: the joys and blessings of their marriage.”

She died at home, four months after the decision, surrounded by those she loved. Her husband died eight months later.

The story of Annabel and Albert Kitzhaber is no more remarkable than a grove of ancient maple trees blushing gold in the early autumn, a moment in a life cycle. But for reasons both cynical and clinical, the American political debate on health care treats end-of-life care like a contagion — an unspeakable one at that.

Kitzhaber, having seen the absurdities of the system — Medicare would pay hundreds of thousands for continuing treatments but not $18 an hour for an in-home caregiver to help her die as she chose — was among the thousands of us who were distressed to see the debate get sidetracked by misinformation and outright lies. He knows the truth: that changing the way we treat dying people is the only way real economies and compassionate reform will happen. He is not only a politician, currently running for a third term as governor of Oregon, the state that has shown us the way, but a physician. And he’s smack in the middle of the Baby Boomer generation. Egan cites the recent Newsweek cover article by Evan Thomas, “The Case for Killing Granny,” and its on-target line about this being the elephant in the room, “Everybody sees it, but nobody wants to talk about it.

John Kitzhaber, M.D., politician, and son who watched both parents die in a dignified way, cannot stop talking about it. His parents’ generation won the war, built the interstate highway system, cured polio, eradicated smallpox and created the two greatest social programs of the 20th century — Social Security and Medicare.

Now the baton has been passed to the Baby Boomers. But the hour is late, Kitzhaber says, with no answer to a pressing generational question: “What is our legacy?”

The Way We Die Now – Timothy Egan Blog – NYTimes.com.

New Way to Count Old Poor

As if there weren’t enough bad news to go around, a new(ish) formula for calculating the national poverty rate could boost the number of over-65 poor from 9.7 percent — or 3.6 million of us — to 8.6 percent, or a hefty 6.8 million. Just like that, the poor get poorer; or in any event they get to be more of us.

It’s not really a new formula, it’s a revision of the half-century-old National Academy of Science’s formula…

which is gaining credibility with public officials, including some in the Obama administration. The original formula, created in 1955, doesn’t take account of rising costs of medical care and other factors.

If the academy’s formula is adopted, a more refined picture of American poverty could emerge that would capture everyday costs of necessities besides food. The result could upend long-standing notions of those in greatest need and lead eventually to shifts in how billions of federal dollars for the poor are distributed for health, housing, nutrition and child-care benefits.

Using this formula, overall poverty in the U.S. would rise to an estimated 15.3 percent, or 45.7 million.

The current calculation sets the poverty level at three times the annual cost of groceries. For a family of four that is $21,203. That calculation does not factor in rising medical, transportation, child care and housing expenses or geographical variations in living costs.

I’m not at all sure my current family of two could eat (OK, and drink too, with an occasional dinner out) on $21,203. It may certainly be time for a re-calculation. And a little more help.

via New measure doubles number of elderly poor.

Health Reform: The Mystery

Facebook friends of mine in the past few days have been turning up with a status line that reads, “No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree please post this as your status for the rest of the day.”

Well, I do agree. I haven’t posted it as my status yet, mainly because my True/Slant posts get posted as my status, and enough is probably enough. But I’ve been curious because friends who are not even Friends of friends have been posting it, some with additions (“I’m just sayin’…”) or (“E-mail your representatives!”)

So I just checked out Open Salon, and there’s OESheepdog’s blog reading “From my friend Leigh Bailey: “No one should die because… etc” followed by a long list of affirmative reactions. My personal favorite was John Blumenthal’s comment, “You’re right, of course, but I wouldn’t lose any sleep if someone took Glenn Beck’s insurance away. Pre-existing stupidity.”

But the question remains, Did OESheepdog’s friend Leigh Bailey start the whole movement? Kathleen Sebelius? Nancy Pelosi?

I’m just askin’.

Reforming US health care is not the end of the world – OEsheepdog – Open Salon.