| March 30, 2003
In lean years, state
fill budget holes, not cavities
By REBECCA COOK
Associated Press Writer
OLYMPIA (AP) _ Jeff Hanby's yellowed and crooked teeth give his face a
lopsided slant and make him look, in his own words, "like the mule from
Hee-Haw."
Now
that's all about to change.
Hanby sits tensely in a dentist's office, waiting to have his teeth _
all 13 of them _ pulled out and dentures put in. He's so nervous he
barely slept an hour last night.
But Hanby, a 37-year-old former mechanic disabled by a back injury,
believes the ordeal will be worth it.
"I'll smile more," he says. "Now when people talk to me I see them look
right at my teeth. Yeah, I'll feel better about myself. I'll be happy in
an hour and a half."
A
dental assistant opens the door to the waiting room.
"Jeff?" she says.
Hanby hesitates, and looks toward the exit. Then he stands up.
"Let's do this," he says.
___
Hanby will get his new teeth courtesy of Medicaid, the joint federal and
state program that serves about 300,000 poor and disabled adults in
Washington and millions nationwide.
But
as states face their worst financial crises in two decades, many are
deciding that filling budget holes is more important than filling
cavities.
Last year, 12 states reduced or eliminated Medicaid adult dental
services. This year five states, including Washington, are considering
similar cuts.
"It
wasn't easy," said Marty Brown, chief budget-writer for Washington Gov.
Gary Locke, whose budget recommends saving $52 million by eliminating
dental, vision and hearing services for adults on Medicaid.
Washington faces a $2.4 billion budget shortfall. Locke took his cue
from voters, who have passed a string of anti-tax initiatives, and
proposed a no-new-taxes budget.
"What we tried to do is sort of the Titanic approach," Brown explained.
That means women _ specifically pregnant women and mothers _ and
children first.
Adult dental, he said, just didn't make it into the lifeboats.
Poor oral health can cause serious problems: increased risk for heart
disease, low-birthweight babies, and infections spreading from the gums
to the rest of the body, for example.
Yet
bad teeth signify more than just bad health. A mouth full of rotten
teeth can destroy someone's self-esteem, social life and employment
prospects. The gaping smiles of Medicaid patients could provide a stark
picture of the human suffering caused by state budget cuts.
"When you try to show someone is poor, you show missing or blacked-out
teeth," said Dr. Mary Marazita, a University of Pittsburgh professor who
is studying oral health in Appalachia. "It's almost a shorthand."
The
symbolism isn't lost on Locke, a second-generation immigrant. When the
governor wants to illustrate how far his family has come from the
poverty of rural China, he sometimes tells the story of meeting his
grandmother in China when he was a boy.
She
had, the governor says gravely, only one tooth.
___
Just up the road from the governor's office in Olympia, Hanby opens his
mouth wide for Dr. Prasith Kim-Aun, one of two dentists at the Sea Mar
Community Health Center.
"All you need to do is relax," Kim-Aun says in the tone dentists use
when they're trying to be soothing. Hanby, who drank three beers with
lunch to take the edge off, can't stop talking and cracking nervous
jokes.
Hanby arrived in this dentist's chair through a combination of bad luck
and bad choices. At times he's gone a week without brushing his teeth _
just got busy with other things, he says.
He
used to support himself by fixing up old cars and selling them for a few
hundred dollars. That work ended when he slipped three discs in his back
and became permanently disabled. Now he relies on monthly $570 Social
Security checks and health care from Medicaid.
If Hanby lost Medicaid, he could probably find someone to pull his teeth
at a hospital emergency room or a low-cost clinic. But he would never be
able to afford $700 to $1,200 for dentures.
Kim-Aun injects Hanby with several shots of Novocain. General anesthesia
is unnecessary, he tells the patient _ also, Medicaid doesn't cover it
for adults.
"This is going to be a little more uncomfortable," Kim-Aun says as he
leans over Hanby with another injection.
"NNNNNGGGGHHHH!"
Hanby protests.
Kim-Aun pauses while his assistant checks Hanby's blood pressure.
"I should have drank a six-pack," Hanby mumbled through numbed lips.
"Now I know why they say brush."
___
Dental pain is excruciating, as anyone who's had it knows. The nerves in
the mouth lead directly to the brain, so you feel pain there more
intensely. Toothaches were one of the leading causes of suicide before
advances in dentistry in the mid-20th century.
"Middle class people do not realize how devastating it can be.
Politicians have no idea what's going on," said Marita Inglehart, a
psychologist and associate professor of dentistry at the University of
Michigan who wrote a book about oral health.
She
has seen poor and uninsured patients with rotted, broken teeth and huge
infections in their mouths. "You think, 'I'd rather shoot myself,'" she
said.
Adult dental services in Medicaid are "optional," as are vision and
hearing care, meaning the federal government doesn't require states to
cover them. In a 2000 survey of 50 states and the District of Columbia,
according to a General Accounting Office report, 15 covered full dental
benefits under Medicaid, 18 covered partial benefits and 18 covered
nothing.
The
state of Maryland eliminated the last of its adult dental benefits in
1993. Dr. Bob Johnson, a dentist with the Washington County health
department in Hagerstown, Md., sometimes extracts up to 200 teeth a day.
"I see horrible things," he said. "I don't see how some of the people
have been able to bear the pain. I see teeth that have rotted right off
at the gumline _ they've been hurting for years, just haven't had the
money."
His
clinic, the only remaining option for the county's poor and disabled
adults, charges sliding fees based on income. They do extractions but
not dentures. For that, Johnson directs patients to one of two places: a
clinic about 60 miles away in Pennsylvania that does good work cheaply,
or state prison.
"If
they don't have any money, I tell them to go commit a felony and they
can get everything they need," Johnson says.
He's only half-joking.
The
Medicaid adult dental program is politically vulnerable for two reasons:
in lean budget years, children take priority over adults, and general
health care takes priority over dental.
"Dentistry just doesn't seem to sit high on the totem pole," said Dr.
Shepard Goldstein, president of the Massachusetts Dental Society, where
adult dental services were eliminated last year.
Goldstein said dentists are trying to provide more free care, but
patients who lost their Medicaid dental benefits aren't showing up in
their offices.
"We've worked hard to try to help these people," he said, "but there's
only so much we can do."
___
"You will feel a lot of noise," Kim-Aun tells Hanby. "You will feel
pressure, but no pain."
Hanby's head rocks back and forth as Kim-Aun starts tugging with dental
pliers at his teeth. Kim-Aun hands the bloodied teeth one by one to his
assistant. Hanby flashes a thumbs-up.
It's all over in about an hour. Kim-Aun carefully fits the dentures into
Hanby's mouth. Hanby grabs a hand mirror and twists from side to side,
checking out his new face from every angle.
"Oh, that looks good," Hanby says, watching the orderly row of white
teeth appear when he smiles. "I haven't seen that in a long time."
As Hanby admires his transformed mouth, state legislators are weighing
the need for dental care against dozens of other programs targeted for
cuts. In the coming weeks and months, they will decide whether
Washington can afford to take care of everyone's teeth. To Hanby, the
answer seems simple.
"A
toothache is the worst pain in the world," he says. "Whether you make
zero dollars or you're the richest man in the world, you deserve teeth." |
