Why Dental Care is Healthcare
A person’s oral health speaks volumes about their overall state of health, and for this reason, dental health should not be neglected. Just like healthcare procedures, going for a single dental visit is expensive, and most people cannot afford to pay without overstretching their resources or sinking into debt. Health insurance is a method of cutting costs to more sensible and inexpensive figures, and the same measures apply to dental care. Efforts are afoot to overhaul the healthcare system and expand coverage to help millions of people forced to forego healthcare procedures, and the same attention must be given to dental care to ensure overall body health.
What is the Link Between Dental Health and Overall Health? 
The mouth is laden with bacteria secreted when the food we eat is consumed into sugars, and most of these bacteria are harmless. There are more than seven hundred (700) species of bacteria that form colonies in the mouth, such as gingival crevice, oral mucous, and dental plaque. All types of bacteria inside your mouth and their respective genes are referred to as the oral microbiome, and they enter the mouth each time we consume food and drink or by kissing. As Dr. Purnima Kumar of Ohio State University explains, only a few bacteria remain in the mouth and colonize while others are removed each day, such as through daily oral hygiene practices.
While it remains unclear how oral microbiome is created, their makeup is directly linked to the maternal oral health, which means if an expectant mother had gum infections, the child is likely to have more pathogens in the mouth. Higher levels of pathogens predispose children to gum infections and cavities at any stage of their life. Harmful bacteria in the mouth – biofilm or dental plaque – are responsible for causing dental caries and other dental-related ailments.
The mouth has many species of bacteria that are harmless. However, when there is an imbalance between healthy and unhealthy bacteria in the mouth, bad breath, dental caries, tooth loss, and gum disease often follow. If pathogens grow and colonize in the mouth, they can transmit to the rest of your body through blood vessels, and this process starts with inflammation that damages the small blood vessels inside gums. Oral bacteria seep through these tiny holes and make their way to distant parts of the body wreaking havoc on their path. While we have complex systems that fend off bacteria, some organs can become overwhelmed, thus lending the body to ailments such as diabetes, heart disease, Alzheimer’s disease, and pregnancy complications.
Apart from oral problems affecting the rest of the body, the reverse is also true. Specific ailments can have adverse effects on your oral health such as diabetes which makes one susceptible to contracting a periodontal disease. The American Academy of Periodontology surmises this happens because diabetes patients are more likely to suffer from various infections and not just related to oral health.
Doctors recommend taking foods that promote oral health such as black raspberries as they are laden with phytochemicals that protect against inflammation. Black raspberries are great for preventing the development of oral cancer in the onset stages. Eating healthier foods must go hand in hand with adhering to proper oral hygiene practices like brushing your teeth twice per day, flossing once per day, and swishing antimicrobial mouthwash. In addition, it is recommended to visit a Downey dentist for regular checkups and screenings.
US Healthcare System in the Lowest Performer
The Commonwealth Fund ranks healthcare systems of industrialized nations using specific indicators, and the US has consistently ranked last in the past two (2) decades, despite having the most significant budget. As per this ranking, countries with the best healthcare system are Canada, Sweden, the Netherlands, Australia, Switzerland, New Zealand, Germany, the United Kingdom, France, and Norway. The Commonwealth Fund does this research based on seventy-two (72) indicators spread across five (5) domains as follows:

1. Care process
2. Accessibility to care
3. Administrative efficiency
4. Equity of care
5. Healthcare outcomes

Researchers compute performance scores of each field and then assign a rating for each country. As per Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better US Healthcare, the US took the last place in overall performance and then ranked last or near the bottom in the five domains. The UK, Australia, and the Netherlands came out shining in general ranking, which means America could use some of their strategies. Given the dismal performance of the US healthcare system, it is no wonder its citizenry is unhappy with the big spending that fails to provide universal healthcare to every American.
To illustrate how the US became an outlier in the delivery of healthcare despite spending three (3) times the budgets of comparable countries, we look at the opioid pandemic and how pumping money doesn’t always deliver results.
Case Study of Inefficiency: The Opioid Crisis
Life expectancy has improved for several decades and then took a massive hit due to the ballooning opioid crisis, particularly fentanyl that is trafficked illegally from Mexico. In 2017 alone, the CDC estimated seventy thousand (70,000) people died from a drug overdose, with most of these deaths linked to a prescription opioid. The most severely affected states were West Virginia, Ohio, Pennsylvania, District of Columbia, and Kentucky in that order. In response to this devastating pandemic, the government is funneling billions of dollars into prevention programs, treatment facilities, and recovery efforts like improving access to evidence-based treatments, and fighting distribution cartels. The goal is to save addicts while keeping the rest of the population free from this pandemic that is crippling lives and causing widespread fatalities.
While the government is lauded for facing the opioid epidemic head-on, it is also criticized for acting too late and not focusing efforts in the right manner, just as it does with healthcare. Allocating billions of dollars each year to these efforts does not automatically translate to reaching the desired outcomes. To illustrate this point, the government focuses mainly on the causative factors of the opioid epidemic, but there is an inadequate focus on whether these funds are strategically targeted to the most affected communities. Policymakers should routinely measure progress through Monitoring and Evaluation (M&E) programs and use findings to curtail duplication of efforts and maximize the efficiency of available resources that include the workforce.
The Bipartisan Policy Center (BPC) sought to examine how federal appropriations and fifty-seven (57) federal programs that are dedicated entirely or in part to combating the opioid crisis. BPC found that the federal government spent almost eleven billion dollars for these programs in the fiscal year 2017/2018 unrestricted appropriations bills. There was a one hundred and twenty-eight (128%) percent increase in this discretionary funding from $3.3 billion in 2017 to a staggering $7.4 billion in 2018 for prevention, treatment, the continuum of care, and recovery. This money is also used for opioid research, public health surveillance, fighting drug-related crimes, and curbing the distribution of illicit substances, including the unauthorized sale of prescription opioids.
The government failed to prevent the entry of highly addictive pain medications like OxyContin into the market, and this situation was exacerbated by cutthroat marketing by drug companies and overprescribing. The Drug Enforcement Administration (DEA) concluded that ninety (90%) percent of prescribers of pain medication were based in Florida where they enjoyed little to no regulatory oversight until the cracking down on “pill mills” started in 2010. How the government is handling the opioid pandemic correlates to how the healthcare system is managed: too many funds funneled, poor focus and mismanagement, and thus dismal results.
How Accessible is Dental Care in the US?
One of the five domains used by the Commonwealth Fund to rank health systems is the accessibility of care by all. Just like other healthcare needs, access to dental care is limited as the report found many patients go without care due to the prohibitive costs, high out-of-pocket costs, dental insurance shortfalls, or constrained resources that hamper paying medical bills. There are stark disparities in accessibility, timeliness, and affordability of care, and these problems are even more amplified when you look at health and dental insurance coverage.
In the fiscal year 2016/2017, the number of people covered rose by 2.3 million, reaching 294.6 million, and based on 2018 statistics, 28.5 million people (8%) did not have healthcare insurance. Among the 91.2% with coverage, the majority of them (67.2%) have private health insurance while the rest rely on government coverage. The breakdown of insurance types is as follows: employer (56%), Medicaid (19.3%), Medicare (17.2%), direct purchase (16%), and military (4.8%).
Dental insurance, on the other hand, is not as forthcoming as seventy-four (74) million (23%) Americans lack this coverage, the National Association of Dental Plans finds. This figure is more than twice the percentage lacking healthcare insurance, which goes to show that dental insurance is not usually given the weight it deserves. Many employers have a provision where staff can sign up for dental coverage when they are signing up for other benefits. Other ways of getting dental insurance are by purchasing it through the Affordable Care Act’s marketplaces or Medicare Advantage coverage.
There are many reasons for the widespread lack of dental coverage, but the overarching one is restrictions in government health programs, for instance, Medicare caters to people who are sixty-five (65) years and above, but it doesn’t include dental insurance. Those who wish to purchase dental cover turn to Medicare Advantage plans, which are privately-operated and do not come cheap. Medicaid, the federal and state health insurance program for the less privileged also excludes dental insurance, and this population’s financial status does not leave much room to pursue private dental insurance.
What is Generally Included in Dental Insurance Cover?
Those who are lucky enough to obtain dental coverage through their employer or other means can expect it to cater to preventative measures like teeth cleaning and X-rays whenever necessary, but that is it. Additional dental needs like filling cavities usually come with co-insurance so you will have to foot a portion of the bill which can get prohibitively expensive. For instance, restoration procedures like installing crowns and bridges, dentures, and implants could attract up to fifty (50%) percent of co-insurance, thus disqualifying patients of modest means. Depending on how badly damaged their teeth are, they may result in the extraction of the ailing teeth instead of pricey restoration work.
Many dental plans cap their annual limits at one thousand five hundred ($1,500) dollars or less for any form of dental care per person, which means exceeding this amount takes money from your pocket. The same tightfisted measures apply to braces for children as some plans cap the annual limits at one thousand ($1,000) dollars per person over a lifetime, which is not much depending on dental needs. When asked why dental insurance covers have such low caps, the executive director of the National Association of Dental Plans – Evelyn Ireland – noted expanding coverage would make insurers raise premiums. The effect would undermine national goals of encouraging more people to mind their oral health by getting routine checkups that eliminate the need for expensive procedures down the road.
The association also noted that more than ninety (90%) percent of people with dental insurance don’t reach their annual limits, but as Marko Vujicic of the American Dental Association’s Health Policy Institute challenges this summation. According to his research, this economist found that most people stop seeking dental care before reaching the set limit to avoid having to pay the additional fees once their plan is used up.
Apart from hoping your Downey dentist is benevolent enough to issue discounts, patients can utilize tax-advantaged health savings to pay dental bills, or they can use flexible spending accounts if that is an option. When contemplating taking out a dental plan, the best starting point is examining how your total expenses match up to monthly premiums. The next step is determining if you have enough funds to cover additional costs if called upon to do so, and don’t forget to ask your insurer to negotiate discounts with your dentist as deemed applicable. Please note, these discounts are only available to people who sign up for coverage.
America’s Path to Reaching Universal Healthcare (UHC)
Universal healthcare coverage (UHC) is a focal point of meeting the aims of the global health agenda as agreed upon by members of the United Nations. This strategy was further reinforced by the World Assembly’s promise to implement a range of health interventions and technology evaluations. The research paper “Making Choices on the Journey to Universal Healthcare Coverage: From Advocacy to Analysis,” UN countries defined UHC as the access to preventative, curative, and rehabilitative healthcare at a reasonably priced price range for all. The US and other UN countries have a standing directive to reach the highest standards of mental and physical health, and the latter, I suppose, should encompass dental health. Providing social insurance entitlements, benefits packages, and copayments were other goals of this UHC resolution and meeting these objectives requires identifying healthcare priorities and removing barriers to access.
As seen with the case of US healthcare trailing behind its industrialized counterparts, there is a dire need for proper institutions to facilitate informed decision making and dissemination of information to the masses. We must also find equilibrium between public and private entities in the healthcare system and organize federal and state funding in line with global metrics.  Countries that have realized the goals of universal healthcare have applied instruments like Pharmaceutical Benefits Advisory Committees and Essential Medicines List. The former tool has yielded enormous success in Australian helping with economic evaluations and other UN members such as New Zealand, and Canada adopted it.
Another useful tool is the International Decision Support Initiative (IDSI), which is a mutual strategy guiding lawmakers in setting priorities for reaching UHC. For example, the UK provides universal care that specifies treatments and circumstances but its benefits package comes with broad definitions that lessen benefits packages. The US needs to apply an “intelligent” benefits package that is defined by measures of performance, regulations, and modes of payment that works for everyone. Finding an amicable balance between clarity and flexibility in healthcare is vital, and these efforts must include dental care, so it is not perceived as a luxury but a necessity. As explained previously, there is a strong correlation between oral health and the rest of the body and vice versa, so ignoring dental care or making it unattainable counteracts UHC goals by the UN.
Dental Care is Inextricably Linked to Healthcare
As the debate of how the current administration is solving this gnawing problem of insurance coverage, some on the right wing argues healthcare and health insurance are not correspondents and that expanding coverage does little in enhancing health outcomes. Nevertheless, extensive research on insurance coverage indicates that availing insurance to more people is akin to a public health intervention as it keeps incidences of the disease down. People living in the UK, France, Australia, and other nations listed by the Commonwealth Fund don’t have to fret over their state not expanding Medicaid, their immigration status, or how deep their pockets are. These populations enjoy comprehensive coverage at a fraction of our budgetary spending per year. Therefore, we must be more vigilant in not separating dental care from healthcare.
Since insurance plans usually cover varying treatments and procedures, doctors are forced to spend too much time coordinating with insurers, and this leads to administrative inefficiencies that consume funds. Standardizing elementary benefit packages would significantly reduce bureaucratic bottlenecks, and what’s more, patients will benefit from predictable copayments and will be able to enjoy a comprehensive healthcare which includes regular visits to a Downey dentist. The US will also have to revamp its unsystematic, fragmented, and under-funded primary care system, which makes it difficult for physicians to give seamless and harmonized care.