There have been a number of unrelated news stories in the past few months each of which has a special implication for the future of dentistry in this country.
Not too long ago, the Federal government announced a plan to eliminate medical deductions on income tax payments. The government position is that the effect of this would be to add several billion dollars in tax payments and help finance a national health plan. The immediate effect of such a move would be to raise the cost of health care for those who purchase their own health care directly. The ultimate effect will almost certainly be to remove those people from private practice and move them into socialized practice.
More recently, the President signed a bill allotting $375-million for pilot Health Maintenance Organizations (HMO) throughout the country. It is encouraging that the government set up this five-year pilot study program first, rather than committing the country to a universal plan from the start. However, the handwriting is plainly on the wall.
Under the terms of a new contract signed last Fall between Chrysler Corporation and The United Automobile Workers, Chrysler will pay for a comprehensive dental program for its workers. There is an additional provision that if a national health insurance program is enacted, Chrysler would pay the full premium. Under most national health care proposals, the employer pays a part and the worker pays a part. Under this agreement, the employer would pay the whole premium. It is contemplated that the premium for a national health insurance plan will be smaller than the outlay now called for in the Chrysler contract, which means that the difference will be used for additional fringe benefits for employees. This gives automobile workers an incentive to push for passage of national health insurance legislation. If the Chrysler agreement were to be the pattern for the industry, 1.7 million workers would be covered in this way, and it is predicted that the idea will spread to other unions.
Another recent report outlined the participation of a dozen insurance companies in the ownership, management, and financing of HMOs and other group medical practices. If HMO is the way to go, then insurance companies want a piece of the action which they hope will be more profitable than writing insurance contracts on fee-for-service care. The switch in this format is that the insurance companies finally cross the barrier and hire the doctor to perform the service.
The American Dental Association Board of Trustees published a statement on unionization and followed it with an information bulletin on the same subject. It recognized that there has been a growth in the number of professional unions in response to the threats to private practice which professionals have begun to feel in dealing with "big government, big business, big unions and the third-party problem in general." Nevertheless the Board concluded that unionization is inappropriate for health professionals. Among other reasons, it was pointed out that collective bargaining by self-employed health professionals is in restraint of trade and, therefore, illegal. The Board statement concludes that "there is nothing that a union can accomplish, for the benefit of dentists and their patients, that a professional association having active, united support cannot do equally well . . ."
The most remarkable news to come out of the ADA Meeting at Houston in 1973 was that the House of Delegates voted 60% against reciprocity in dental licensure between all states. The reason that the vote is remarkable is that through years in which this subject went through consideration by the Board, referral to committee, report of committee, decision to poll the membership, polling the membership, studying the results, reporting the results, referring them to committee, it has been well known and established by the poll that 70% of the membership is in favor of reciprocity.
If in union there is to be no strength, if in organized dentistry no responsiveness to the membership, if in government a movement toward socialized dentistry, if in insurance companies a movement to go into the dentistry business while, paradoxically, dentistry through Delta Dental Plans is in the insurance business, the dentist is to be excused if he is alternately baffled and frustrated by current events. The orthodontist, perceiving that all this may happen first to medicine, then to dentistry, and only more remotely in time and in a limited way to orthodontics, might be tempted to ignore the whole thing. It would be a pity if orthodontics did not use the time to develop a system of delivery of orthodontic care which would maintain high standards of treatment, leave all the professional prerogatives with the orthodontist, and make orthodontic treatment available to anyone who might need it at a cost that would assure fair compensation to the orthodontist, but which the public would recognize as fair and reasonable to them.
