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The Worst Part of the Terrible American Health System


Is there anything more nonsensical than dental coverage being separate from health coverage? As if your mouth is not part of your body. It’s just complete nonsense. And yet, here we are, with the world’s dumbest health care system. What this means is that if you are poor, good luck finding a dentist, as this New Yorker article explores.

Not long ago, a line of people stood on a corner in a North Philadelphia neighborhood surrounding Temple University. The sun hadn’t yet risen, and traffic was light. The few drivers who passed looked at the crowd with curiosity. The people waiting were hoping to be admitted to a free dental clinic for the poor and uninsured, hosted by Mission of Mercy in Pennsylvania, or mom-n-pa, a nonprofit organization. Some people were there for routine care; others needed essential procedures.

mom-n-pa has been putting on “dental fairs” across Pennsylvania since 2013. They’ve held a fair every year, with the exception of 2020, when the pandemic forced them to cancel. Typically, at a two-day clinic, the organization treats around two thousand people at a fairground or arena. But covid meant that the 2021 fair had to be smaller. Temple’s Kornberg School of Dentistry had agreed to host the event, and eight hundred patients was the likely ceiling.

Even before the doors opened, it was clear that mom-n-pa would hit that ceiling quickly. Bobby Jones, sixty-four, had arrived at 6:20 a.m., stylishly put together in a black outfit complete with a bolero. He told me that he wanted to get his teeth cleaned. Seeing the line, he wished he’d arrived at 4:30. Still, he said, “I’m too blessed to be stressed.” Miguel Villar, a young man with a neatly trimmed mustache and soul patch, walked the line, sharing a bag of soft pretzels. He, too, was waiting for treatment. He thought it had been ten years since he’d had a checkup. The pretzels were warm—a good thing, given that it was still dark and freezing.

Medicare doesn’t cover dental care except in certain specific circumstances—say, if a procedure is required during hospitalization. Medicaid coverage for adults varies from state to state. A person may have medical insurance but not dental insurance. Even those with dental coverage may struggle to get care. According to the Center for Health Care Strategies, less than half of dentists in the United States accept Medicaid or the Children’s Health Insurance Program, and getting an appointment with one who does can be a challenge; some counties in Pennsylvania don’t have a single dental provider who accepts Medicaid. “Eligibility doesn’t necessarily mean access,” Amid Ismail, the dean of the Kornberg School of Dentistry, told me, as he gave me a tour of the fair. Temple operates a clinic that provides care for those who may struggle to afford the typical costs of dental services. But even its care, Ismail said, is out of reach for many low-income patients. The pandemic has worsened the situation, since many clinics and dental offices have closed.

I’d ask again why we put up with such an awful system, but then I guess I know the answer.

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