Filling the Cavities in Missouri’s Dental Care

Posted on by Caitlin Hartsell

 

Missouri’s oral health is among the worst in the nation. The Centers for Disease Control ranked the state 47th in terms of the percentage of the population that visited a dentist last year, and 50 of Missouri’s 114 counties have a shortage of dental professionals. In response to this public health crisis, the Missouri Department of Health and Senior Services (DHSS) released its 2009 statewide oral health plan, which addressed the difficulty of recruiting dentists to rural areas. Although the plan points out that enabling improved oral hygiene and regular visits to a dental practitioner would narrow the disparity, it fails to address an underlying cause of Missouri’s dental predicament: the professional licensing law, and its restrictive definition of who can provide dental care in Missouri.

Alaska had a similar dental problem in its tribal areas, which had the worst rates of oral health in the country. Alaskan dental therapists — trained to do most basic dental work, like drilling and cleaning, but not oral surgery — became a much-needed solution to the problem. The American Dental Association (ADA) sued the Alaskan Native Tribal Health Consortium (ANTHC) as a result, and the two groups ultimately reached an agreement that limited the program’s scope. The ADA argued that dental therapists cannot adequately provide health care. However, a 2008 pilot study of the Alaskan program, funded by Texas A&M University, did not find any significant differences between the quality of care provided by dental therapists and dentists.

Other groups have argued that there are too many dentists already, and that opening the market to paraprofessionals is unnecessary. If dentists are so accessible, though, why are Missouri’s oral health outcomes so much lower than other states? Cost and access are both issues; even those who can conveniently reach a dentist may deem dental services to be too expensive when money is tight. Dental therapists, because they require less training, are able to provide comparable care for a wide range of dental services, at a more affordable rate. Those who need more than basic drilling and cleaning can be referred to a professional dentist. Dental therapists would not replace dentists; already, dental hygienists provide the majority of basic dental care before patients see a dentist. Also, in the same way that some people prefer to see a general practitioner rather than a nurse practitioner, some will always prefer a professional dentist to a paraprofessional. Dental therapists merely provide a less expensive alternative for those who cannot afford a professional dental checkup.

Dental therapists have been successful in England, Canada, and Australia at providing quality dental care. In Australia, dental therapists are proving their worth beyond the provision of basic oral care. A recent study found that nearly 94.6 percent of restorations performed by dental therapists were successful, and that patients were satisfied. Another study demonstrated that dental therapists can improve children’s oral health, especially in areas without proper coverage. Throughout the United States, new legislation is capitalizing on the international success of dental therapists; in the spring of 2009, Minnesota passed a bill creating a bachelor’s degree program in dental therapy.

Opening the market to dental therapists provides more than just quality, affordable health care. It also provides jobs, especially in depressed rural economies that have trouble attracting professional dentists on a permanent basis. A change in the law would benefit both those newly employed therapists and their patients, who would have significantly better access to dental care. This is an important contributing factor to general human welfare, because improving oral health helps to improve overall health. Recent studies have indicated that gum disease is correlated with increased risk — and is potentially a contributing factor — for other health problems, like heart disease.

Dental therapists provide an economical way to combat tooth decay, and public health officials have already suggested plans to implement training programs in the United States. The only obstacle to their introduction in Missouri — and to subsequent improvement in the oral health of Missourians — is the regulatory barrier of Missouri’s professional licensing law.

Caitlin Hartsell is a public health graduate student at Washington University and an intern for the Show-Me Institute.

 

Massachusetts Tells Preschools to Brush Kids’ Teeth

Posted on by Sarah Brodsky

In an article about Massachusetts’ new law requiring certain preschools and day care centers to teach children how to brush their teeth, the New York Times quoted a teacher who opposes the regulation:

“I don’t want someone’s hand in my child’s mouth,” said Sarah Brodsky, a teacher at First Path Day Care in Watertown and mother of 4-month-old Noah. “It’s a little too much” government intervention, Ms. Brodsky added.

I’m not the Sarah Brodsky in this article, although we do have the same name and her quote is basically what I would have said. She’s right; the decision of whether to incorporate teeth brushing into the school day should be left to preschools and day care centers.

The new law is an intrusion into preschool management, and the fact that parents can opt out is little consolation from a preschool director’s point of view. Every preschool now has to set up sinks and take time away from other activities in order to brush teeth, all while keeping track of which students’ parents opted out. Preschool teachers are sure to hear complaints from parents if one child sticks someone else’s toothbrush in his mouth, or if an opted-out child inadvertently gets into the toothpaste. Those kinds of mix-ups are unavoidable when you have a bunch of little kids brushing their teeth at the same time.

I hope Missouri won’t follow Massachusetts’ lead and mandate teeth brushing in day care centers. But now that I think about it, I don’t know whether the in-school dental care policy would catch on in Missouri — people would probably demand taxpayer-funded home visits!

Revisiting Parents as Teachers

Posted on by Sarah Brodsky

I’ve made my case against Parents as Teachers, and I suggested that the program limit eligibility to poor families. That idea was roundly rejected in the comments, on the grounds that Parents as Teachers would become another welfare program that taxpayers have to support but can’t benefit from. My answer to that is: It already is a program that many people have to pay for but can’t benefit from. Infertile couples and single people with no prospects of having children soon have to help pay the more-than-$1,000-per-family price tag for home visits to wealthy parents. And the Parents as Teachers educator doesn’t do anything your pediatrician couldn’t do just as well. You could spend a lot of time with a pediatrician for $1,000+.

This is a popular program that participants feel they gain a lot from, so I realize my opinions aren’t going to change how it’s run. That being the case, I wish people would stop making statements like this one in a letter published in the Post-Dispatch:

Studies have shown that parents who take part in Parents as Teachers are more involved in their child’s school once the child starts kindergarten.

Well-off parents who care about their kids will be the first to sign them up for programs like Parents as Teachers, and they’ll also be the most likely to be active in their kids’ schools. We can’t infer any causal relationship there as long as Parents as Teachers continues its current eligibility policy.

Feds Allocate $8 Million to High-Speed Rail; Missouri Gets a 0.39% Cut

Posted on by Christine Harbin

Yesterday, the Obama administration pledged $8 billion in federal stimulus funds to develop a high-speed rail system in the United States. This is no surprise. Congress set this money aside in February 2009, and the president described his vision for the project in April 2009.

California and Florida will receive $2.3 billion and $1.25 billion, respectively, which are the largest single awards. Obama’s home state of Illinois will receive $1.1 billion of this money, which is the third-highest amount. Missouri will receive much less money under this program: “only” $31 million, which equals 0.39% of the allocated funds.

In a recent study for the Show-Me Institute, “Why Missouri Taxpayers Should Not Build High-Speed Rail,” Randal O’Toole demonstrated that the president’s high-speed rail plan would result in high costs and few benefits:

If Missouri decides to build moderate- or high-speed rail, it may be responsible for cost overruns, operating losses, and the costs of replacing and rehabilitating equipment about every 30 years.

O’Toole has written several pieces for the Show-Me Institute about high-speed rail. He has a vision for transportation in Missouri that is more fiscally responsible than President Obama’s:

A better plan would be to use the state’s share of the $8 billion stimulus funds solely for incremental upgrades, such as safer grade crossings, longer track sidings, and signaling systems, that do not obligate state taxpayers to pay future operations and maintenance costs.

Alarmingly, the Obama administration emphasizes that this money is merely a down payment. This means that states, which are already cash-strapped, are left to pick up the rest of cost of these high-speed rail projects. For example, although the the Amtrak route from Chicago to St. Louis stretches 284 miles, the federal grant will cover only the 182-mile segment between Alton and Dwight, which constitutes only 64 percent. Illinois will have to find a way to pay for the rest of the project.

Although I understand that this money will pay for improvements to the existing rail in Missouri, I am concerned that this project will costly and will have low marginal benefits. Taxpayers are paying $31 million to increase the speed of the train that runs between Kansas City and Saint Louis by a mere five miles per hour. However, I will defer the analysis of the Missouri project and how it relates to O’Toole’s study to David Stokes, because he knows much, much more about transportation policy than I do. I look forward to reading his thoughts on this subject.

Can a Law End Bullying?

Posted on by Sarah Brodsky

Anyone following the cyberbullying issue should read this article in the Columbia Missourian. (Thanks to Combest for the link.) The article reports on a proposed bill that would require all public school districts to write policies about online bullying.

The bill’s sponsor doesn’t see any drawbacks to it:

“I feel like this bill has the support of everybody,” Wilson said. “It’s simple, and it’s the right thing to do.”

The sponsor’s intentions are unimpeachable, but her bill still deserves to be challenged and debated. In particular, I see one potential down side to it: Passing such a bill could make people feel like the government had fixed something, when in reality little would change.

For one thing, the bill would apply only to public districts. I wouldn’t suggest expanding its reach; the state should not tell private schools which policies to adopt. But what if a student from a private school bullies a student from a public school, or vice versa? Or, what if someone’s cousin comes for a visit from out of state and bullies the neighborhood kids? How would districts’ anti-bullying policies help in those situations? Many instances of bullying wouldn’t fall under any district’s policy.

Furthermore, the bill just tells districts to write something down on a piece of paper. It’s not guaranteed that districts will enforce their policies well enough to prevent online bullying. Bullying can be difficult to detect and stop, because bullies usually harass their victims away from adults’ supervision. A district can’t track down all the emails and text messages that students send to each other, so the new policies probably wouldn’t affect communications between students as much as districts might want them to.

A Country That Raises Corn and Cotton … With a Little Help From the Government

Posted on by Sarah Brodsky

I don’t have a precise answer to the Show-Me Institute Question of the Week, which asks which lifestyles are most heavily subsidized, but I agree with David Stokes that rural communities should be high on the list. The first rural subsidies that come to mind are agricultural ones, like the cotton subsidies that appear in this Southeast Missourian article. Here’s the rationale behind them:

Michael Milam, an agronomy specialist with the Missouri Extension in Kennett, Mo., said that underscores the important role subsidies play in the survival of farmers.

“The subsidies have kept farmers in business,” Milam said. “The help from the government allows the farmers to compete on a level playing field with the rest of the world’s cotton producers. If the farmers that produced not only cotton but other crops dropped out because they didn’t receive the subsidies, I believe you’d see a domino effect of higher prices passed onto the consumer.”

The effect of ending the subsidies wouldn’t be as disastrous as this specialist imagines. Everyone could enjoy a lower tax burden if the government stopped paying Missouri farmers to grow crops that could be grown more cheaply someplace else. And there’s no reason to assume farmers who grow both cotton and more profitable crops would drop out of farming altogether. More likely, they would concentrate on raising crops that the market will pay for.

We shouldn’t try to level the playing field between Missouri and other places, because it’s a waste of money. We could pay farmers to grow oranges and level the playing field between us and Florida, but what would be the point? We can just ship in oranges with less trouble and expense. It’s the same for cotton and all the other crops that don’t bring in a profit when grown in Missouri.

Here Is an Example From Oregon Illustrating Why I Prefer a Representative Republic to Direct Democracy

Posted on by David Stokes

Oregon, a state that we talk about a lot on this blog because it seems to be in the forefront of a lot of good and bad ideas, just raised taxes through a ballot initiative. Meaning, the good people of Oregon used the power of initiative petition to just jack up the tax rates on business and the “wealthy” in Oregon. A famous anonymous quote (often misattributed to Alexander Tytler and Alexis de Tocqueville) observed, “A democracy cannot exist as a permanent form of government. It can only exist until the voters discover they can vote themselves largess out of the public treasury.” Luckily, the people of America have mostly proven that prediction wrong. However, votes like the one in Oregon, as well as the inevitable entitlement crisis we’ll face in about 20 years, may prove it right one day.

And, yes, I am aware that the entitlement crisis is just as much to blame on the elected officials who put the programs in as on the people who support them with their votes.

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