Saturday, August 4, 2018

Smile!

I have long had dental problems since age 16 when my braces were removed and I was found to have Juvenile Peridontosis.  The gum disease often associated with age and/or with negelct.  I was under the monthly care of an Orthodontist who spent no time realizing that I was having major problems during the course of my treatment and could have stopped and staved off the progression had he been an attentive skilled technician.  Well when you have three chairs in a room and are seeing teen after teen in succession care and attention to detail not possible.  This was the beginning of what we are now seeing with regards to medical care over all, a rotating door with a 15 minute cap of time dedicated to a quick fix or a misdiagnosis that leads people to go inadequately treated.

When the Affordable Care Act came into fruition it neglected other essential elements tied to health care - Dental and Vision.  The reality is that Medicare nor Medicaid treat these as well and in turn essential if not critical links to one's health go duly untreated or relegated to those who can afford private insurance.

Now let's talk about private dental insurance for a moment.  It will only take that as the American Dental Association has long held a tight leash on what care is covered and insurance has not kept up with modern technology nor advancements in treatment to adequately cover most individuals.  I have two policies with a 1000 dollar year maximum, two cleaning maximum and barely covers any of the procedures I have undergone in the last six years.   Dental insurance is utterly useless and serves few.

I recommend for those curious about this subject the book Teeth by Mary Otto.  In that she goes into detail the mark up, the misleading information, the lack of adequate treatment available and the overall stranglehold the ADA has over change with regards to insurance and costs.  Yes indeed the Patriarchy that governs the AMA is extended over to the other white coats in the same Medical and Dental buildings that align many towns in America.   Try going to a Dentist on a Friday? An evening? A weekend?  Good luck.  The ability to get care is becoming as challenging to find primary care physicians and just as costly.   This from the Floss Bar:
  • Over 80% of Americans have gingivitis, a preventable condition which causes our gums to swell and bleed and for us to walk around with open wounds as we eat, speak, kiss our loved ones, bite our finger nails, etc.
  • Our mouths have over 500 species of bacteria, which can enter the bloodstream through these wounds and cause damage over time to our pancreas, heart, lungs, immune system, and even unborn children. Remember, your mouth is the largest funnel for intake of all the harmful parasites in your environment.
  • It’s much more serious than the bad breath you can smell. Regular dental hygiene has been statistically shown to add 6.5 years to your life.
Given these risks, why aren’t we going?

Two key reasons: price and availability

  • Dental costs have been rising at over 3x the rate of inflation (5.6% a year). The price of a simple routine cleaning that we all need every 6 months or more, is higher in major cities than the weekly food budget for a family of four. The $150 average doesn’t even include the x-rays. This means that for a family of four on an annual basis basic dental care costs over $1000.
  • Insurance should help, but 50% of us don’t have it for dental, and 30% of those lucky insured people don’t even show up. Fear of sharp objects aside – it’s pure math. Insured Americans generally work full time, and the average full-time worker in America works 47 hours a week. That’s a lot. And the average American dental office is open for 33 hours a week. Guess how much those hours overlap? A ton. We don’t have time to leave work. So even the insured are going far less than 2x a year. I haven’t even mentioned the uninsured, 50% of which aren’t showing up to get the care they need.
  • As a result, 1 in 6 Americans experienced an expensive dental emergency in the last year, and the health risks continue.

I moved to Nashville as here (as in Pittsburgh my second choice) has remade itself with Med and Ed.  The proliferation of schools and thriving medical industrial complex here has enabled those like myself who can write a check to cover costs to get work done that in Seattle was cost prohibitive if even available.  The University of Washington Medical and Dental schools are dumps.  The UW runs most of the public and some private hospitals and in turn use them as tools in which to teach while the Dental college in a rich city has not stayed solvent for a decade and in turn is finally going under. And that is why Washington is one of the most expensive places in the country to get dental care.  But then again people go to the dentist in Seattle, in the South they don't so they have to make it affordable just to make it work at large for those even who have insurance.  Demand dictates cost.  The state rated 42 out of dental visits? Tennessee.   So here I am.  Odd you would think it would cost more.  Nope my dental policies here all two of them are less than the price of the sole one I had in Seattle.   And again the desirability of which to live and cost of living also affects dental costs

177,000 adults throughout the U.S. were interviewed for the Gallup-Healthways Well-Being Index, and asked if they had visited a dentist in the past 12 months. Overall, only 65 percent of adults said that they had, which leaves a large segment of the population without adequate dental care. And since the data was collected by state, the survey also reveals some telling regional differences in oral health:

Regionally, people living in states in the Northeast and upper Midwest are the most likely to say they visited the dentist in the past 12 months. Southern states, on the other hand, have the lowest percentages of people who say they visited the dentist. The nine states with the lowest incidence of dentist visits are in the South.

One of the major contributing factors to this trend has to do with access to health insurance. In the 10 states where the most people had visited a dentist in the past year, residents were — on average — more than 15 percent more likely to have health insurance that in the states that fell to the bottom of the poll.

When I read this man's story I thought this is my story and this is what it is like to feel so loathsome and so frustrated when you cannot get help, find reasonable solutions and treatments that will last in which to restore some type of normality and functionality.  I have faced all those issues that this man is facing, I am fighting to restore my health but also my sanity living in a City that I find utterly devoid of any sense.  Period, any sense.  I am determined to finish this next year and get the fuck out of dodge with new goals, new dreams and a book under my belt with more to follow. At least out of this something good can come from this. I am lucky not everyone is. 



Lack of Dental Coverage Hampers Medicaid Recipients, Suit Says


By Tyler Pager
The New York Times
Aug. 2, 2018

Frank Ciaramella has not been in a family photo in years, and he also cannot remember the last time he had good veal scaloppine.

Without any teeth, Mr. Ciaramella, a Staten Island resident, faces a host of challenges, but he said his most pressing concern is his inability to chew food. As a result, he said he cannot follow a prescribed diet related to his end-stage renal disease, and he’s at risk of being too overweight for a much-needed kidney transplant.

Though dentures seemed to be the solution, Mr. Ciaramella, who qualifies for Medicaid, said he has run into a litany of problems since he received them in 2016. He said his bottom dentures never fit properly because of bone erosion, a problem dental implants could rectify, but Medicaid does not cover that procedure. Then, a few months ago, he said his top dentures fell out and were run over by a car, and Medicaid will not pay for a replacement until 2024.

Now, Mr. Ciaramella, 57, is one of the lead plaintiffs in a class-action suit filed Thursday in Federal District Court in Manhattan against the New York State Department of Health for the Medicaid program’s categorical ban on dental implants and limits on replacement dentures. The Legal Aid Society and Willkie Farr & Gallagher filed the suit, saying the state is denying medically necessary treatments for thousands of low-income New Yorkers.

“I would agree that there are cases where getting a single dental implant for a particular person may not be necessary, but people like Mr. Ciaramella, that’s not the case here,” said Belkys Garcia, a lawyer for the Legal Aid Society. “For him, this is medically necessary, and it’s having a real dire impact on his health and really putting his health in danger.”

The federal government provides some funds to states that participate in the Medicaid program, and states have to follow certain federal rules. The Health Department oversees New York’s Medicaid program, and it has some flexibility to determine which care is deemed medically necessary.

The Health Department declined to comment on pending litigation.

“While this case is really about getting people like Frank the access to medically necessary dental care that they need, it’s also to continue taking on categorical bans generally in the hopes that the practice dies out eventually,” said Wesley R. Powell, a lawyer for Willkie Farr & Gallagher.

Mr. Ciaramella’s struggles with dentures have also exacerbated his other health problems, including hypertension, coronary artery disease, diabetes and protein malnourishment, according to the lawsuit. His biggest concern, though, is a kidney transplant. Already on dialysis three times a week, he is on the waiting list for a kidney, which can take seven to 10 years, but he said his doctors told him he could not weigh more than 270 pounds. He currently weighs 294 pounds.

“I’m supposed to be high on proteins,” he said. “You can’t break down lettuce. I can’t chew vegetables. It’s hard to gulp it down. Financially, I can’t afford all those food processors to make everything into liquid.”

Dialysis also limits the amount of liquids he can drink each day, Ms. Garcia said.

As a result, Mr. Ciaramella’s diet is carb heavy: pasta with butter or marinara sauce, mashed potatoes and white bread, but only after he removes the crust and softens it by soaking it in milk.

The other plaintiff in the suit, Richard Palazzola, 60, received lower dentures in 2016. However, they were stolen in 2017, and Medicaid denied his replacement request because of the eight-year waiting period that the state’s Medicaid program requires for new dentures.

Mr. Palazzola, a Long Island resident, has a number of medical and mental health issues, including bipolar disorder, depression, anxiety and diabetes, according to the lawsuit. Without a full set of teeth, he is only able to eat soft foods, and he worries about his appearance, which has worsened his depression, the lawsuit says.

Mr. Ciaramella, who formerly worked as a truck driver, similarly spoke of the social repercussions of not having teeth. In addition to missing years of family photos, he said he often stays inside for fear of being ridiculed.

“It’s embarrassing,” he said. “I’m not a vain man, but when you look like a clown, everyone thinks you’re making faces. It’s just not an appealing thing. It ruins your social life.”

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