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The Health Care Reform That Has Yet to Happen

square726A plague is sweeping the nation. Three out of four Americans suffer from it. It is virulent and contagious. It destroys living tissue and bone. Bacteria at the point of infection inject their poisons into the bloodstream, exporting the destruction to other parts of the body. Cardiovascular disease, joint problems, pancreatic cancer, diabetes, asthma, osteoporosis, and even Alzheimer's disease have been associated with it. Yet normal insurance does not cover its treatment. It was not part of health care reform. Most Americans are covered only to the tune of a couple of thousand dollars a year or less.

Bacterial plaque of the mouth is vile.1 Most people think it only causes caries or gingivitis. But recent studies show that the bacteria dump their waste products into the blood stream — a phenomenon called bacterima — causing problems in other parts of your body. If left untreated, the acids and other waste products will erode the bone of your mouth. This cannot be replaced. You will lose your teeth and if the condition is serious enough, you won’t be able to replace them with dentures or other dental appliances.

Healthy, mentally stable people think it is a simple matter to keep your mouth clean. Consider the third of the population who suffer from major depression though. When you twirl and fall into the morass as I did, you see your mouth as a hopeless cause. Why brush? Why floss? The commercials all say that your teeth must be white.2 You look into the mirror and fail to see the brilliant flash that advertising and employers say must be there. Even professional polishing fails to brighten your grimace. As conditions worsen, the costs of repairing the damage increase. It becomes more difficult to chew. Your jaw aches. So you give up.

Clearly, this is yet another symptom of the psychiatric disorder. But despite the broader health implications of the biofilm, insurance companies and the public in general view dental care as cosmetic — about as important a medical concern as shaving or getting a haircut.

Insurance treats your mouth as an alien camper in your body. If you turn your lungs into a cancerous sac by smoking, your costs are covered to $750,000. If you become addicted to alcohol or other drugs, your rehabilitation is paid for. But most people are covered only to the tune of $1,500 or less each year. Beyond that low bar you have to pay out of your own pocket.

Do you see the discrepancy? Diseases caused by smoking and alcohol are equally caused by a lack of self control, yet they are covered. You can get your oxygen paid under Medicare3 and a heart bypass covered under most insurance, but there’s nothing out there for a dental implant if you need it. It cost me $40,000 to fix my mouth. Most of this came from my family and a large contribution by my Quaker meeting’s sharing fund. It has taken us years to recover from my melancholy-induced negligence.

In 2008, Congress mandated mental health parity. This meant that my bipolar disorder — which had indirectly caused my dental disaster — was now covered. Barring changes by this Republican Congress, regular care for this life-threatening condition of mine was now possible.

Given the wider damage wreaked by bacterima, it’s about time that there was parity for dental work.



  1. Plaque occurs in layers. It looks like a thick off-white goo. As it builds up, the most destructive bacteria migrate to the bottom where they exist in an environment that is without air, light, or food. The longer you don’t brush your teeth, the thicker these colonies will be. And it is important to brush regularly: the bacteria growth or pellicle can reestablish itself in only twenty minutes! []
  2. Their natural color is yellow. []
  3. At least for now []