Toothless: the Build Back Better Bill’s Dental Coverage

There’s a lot to be said about teeth. Like, that not having them can be a real problem.  Since one out of five American seniors has lost all their natural teeth, this is no minor statistical blip of an irritation. It is a BIG issue.

So that’s why, for months, Senator Bernie Sanders has told us Medicare must cover dental work. The notion is wildly popular with seniors, understandably, as many cannot afford to keep their teeth and would like to continue chewing with them. Medicare coverage would be a way to hang onto their molars and incisors. Now those voters’ hopes will likely be dashed, as the House bill that deals with this matter would postpone its implementation till 2028. In short, the House is kicking seniors in the teeth.

Federal officials, according to the Washington Post, cite as their excuse for this delay vetting new dentists for Medicare and instituting a pricing system to reimburse them. This is hogwash. When president Lyndon Baines Johnson signed the law establishing Medicare, on July 30, 1965, at the ceremony former president Harry Truman was instantly enrolled as Medicare’s first beneficiary and received the first Medicare card. Nineteen million people enrolled when Medicare officially geared up some MONTHS later. So now the Dems would have us believe that they can’t do in the 2020s what they did in the ‘60s? Who’s going to buy that nonsense? Something here just doesn’t wash.

What that may be is so-called “moderate” Democratic objections to Medicare expansion. So they kill it with a thousand cuts. What they sacrifice in the process is any political benefit of helping people save their teeth. Those facing imminent dental extractions would unquestionably cast their ballots for Dems if a new Medicare law kept their teeth in their heads. But not if they have to wait six or seven years. By then they’ll wear dentures and Dem promises to save their molars will just be a sour memory.

“Roughly two thirds of Americans over the age of 65 don’t have dental coverage and half haven’t been to the dentist within the past year,” wrote Jake Johnson for Commondreams on September 25, citing the Kaiser Family Foundation. Johnson also quotes an expert asking “Why, oh why do so many people consider the Democratic moderates the realists in this equation? Did no one learn anything from the long delay in implementing the [Affordable Care Act]?”

Meanwhile Sanders has prodded his erstwhile buddy, Joe Biden, to add dental, vision and hearing coverage to Medicare and to lower the general eligibility age to 60. This is a far cry from Sanders’ full-throated endorsement of single payer health care on the campaign trail and shows, once again for those obtuse souls who never learn from experience, that those on the left are lucky if they get crumbs at the Democratic feast, which is primarily a fete for donors, including health insurance companies and big Pharma. Nine times out of ten, progressives leave the gala hungrier than when they arrived, and so do their constituents.

“According to the AARP,” Jacobin’s Michael Lighty reported September 9, “about one in five Americans age 65 or older have untreated cavities, and two in three have gum disease; 50 percent of people over age 55 wear dentures, which require routine maintenance…Nearly 70 percent of older Americans currently have no form of dental insurance.” This stinks.

So how does the U.S. compare to other western countries in the dental department? Not well. Canada, Australia and Italy offer “deep public coverage for a subset of the older population,” according to Health Policy in September 2020. England, France and Sweden provide “universal but shallow coverage of the older adult population.” Germany has “universal, predominately deep coverage for older adults.” The U.S. is, you guessed it, at the bottom of the list with “shallow coverage available to only some subgroups of older adults.”

The Medicare Rights Center reports that under Build Back Better beneficiaries would have to pay a percentage of dental costs for preventive, screening and basic services. “The draft bill defines preventive and screening services as oral exams, dental cleanings, dental x-rays…and fluoride treatments. Basic treatments may include basic tooth restorations, basic periodontal services, tooth extractions, and oral disease management services,” and more. At least once every five years dentures would be covered.

The estimated cost over 10 years of these dental benefits is $238 billion, starting in 2028. So if you need dental work now, better plan for dentures. Currently Medicare does not cover dentition, an oversight in the original plan – a glaring one, considering that for most seniors, trouble with teeth is pretty predictable. The main senator opposed to this so-called entitlement, Joe “I Just Don’t Give a Shit” Manchin, is no spring chicken. But he doesn’t have to worry. He can hold up the whole bill and slash the dental benefits and still get his top-of-the-line, gold-plated congressional health care coverage. If Manchin has a cavity, he won’t have to pay to have it filled. But he thinks you should.

But who cares about Manchin? What I want to know is where does the gaudily infamous congressman and dentist Paul “MAGA Is My Mantra” Gosar stand on expanded dental benefits? Before he became a Trump-boosting fanatic, Gosar was actually a popular dentist back in Arizona. Indeed, many of his patients publicly expressed shock that this mild-mannered, expert cavity driller metamorphosized into a deranged MAGA moron. What dark spell, they wondered with dismay, had Washington cast on the self-effacing man who polished their molars? They found it hard to connect the fellow who numbed their gums with the raving right-winger who wanted to overturn a legitimate election. Many expressed hesitation at the thought of this frenzied conspiracist ever placing a tongue depressor no less his well-trained digits in their mouths again. So maybe he could try to regain his patients’ and constituents’ good graces by supporting Medicare-covered dental work. He could cite his years of experience fluoridating incisors and thus credibly pose as an expert on the subject of the many public benefits of voters keeping their teeth in their heads. It might actually redeem his tattered reputation. I, for one, would be happy to welcome a repentant Gosar back into the fold of sane, rational, boring politicos. Hey, it’s worth a shot.

Sanders’ dental provisions in the Build Back Better bill would make lots of voters happy, save lots of teeth and go a long way toward reassuring constituents that their concerns count, maybe not as much as donors,’ but in worthwhile ways. Ever ready to sabotage anything for the general welfare, moderate Dems and the GOP turn up their noses at expanded dental coverage. Will Biden? He already ditched a health care public option, thus burning through much of his medically deprived supporters’ good will. How much of that will survive till 2028, if that’s when they can get their first cavities drilled? The smart money’s on the obvious answer: not much.

Eve Ottenberg is a novelist and journalist. Her latest book is Lizard People. She can be reached at her website.