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  "Corrido al Dentista"

Some may wonder why an American would dedicate a portion - even an hour - of a wonderful Mexico vacation to dental care.

Just peruse the yellow pages: there are so many local dentists available in the United States. So why would anyone travel to Mexico for dental care?

To answer this question, the investigators at Dentimundo completed a bit of research.

We at Dentimundo discovered that the annual percentage of uninsured persons in the United States in 2004 was 14.7%, slightly higher than 14.2% in 1999.⁽¹⁾

The rate of uninsured over a five-year period has remained relatively static, with more than 43 million uninsured citizens in the United States today.

If these 43 million people visited the Mexican border for a $25 dental cleaning, few would refuse. After all, $25 is at least one quarter of the fee charged in the United States without health insurance.⁽²⁾

But why should the insured cross the border for dental service?

Medicaid, the government-subsidized health insurance program for the poor, is currently under review. The federal government may make severe budget cuts, as Medicaid has grown into the largest insurance program in the nation and a primary resource for many.⁽³⁾

Although Medicaid was designed to supplement other forms of health insurance for the lower income population, 40 million citizens⁽⁴⁾ rely on Medicaid as a primary health and dental program.⁽⁵⁾

From state to state, Dentimundo discovered a range of benefit limitations: four states do not cover dental services at all through Medicaid, while the rest require a fee for service.⁽⁶⁾

Along with Medicaid's other limitations, 22 states grant dental service only in cases of emergency treatment for relief of pain and infection or trauma care. Even in these circumstances, some states have cost limits.

Arizona is a border state with more than 300,000 children receiving Medicaid's health and emergency-only dental coverage. Fortunately, parents of these 300,000 children live close enough to the border to purchase affordable dental care.

California, another border state, offers only these specified services: periodontia, crowns and root canals, pre-denture services and services for nursing facility residents. That is, biannual dental cleanings must come out of one's pocket.

The fact that the poor must pay for their dental cleaning, is reasonable. Afterall, why should one dependent on Medicaid receive dental services free of charge? Why should your hard-earned tax money pay for someone else's oral hygiene?

However, for one to recieve Medicaid, one must subsist at the bottom of the United State's socio-economic hierarchy - earning below 10K per year with two dependents. So even a co-payment for dental cleaning might be a financial burden and a full payment for a cleaning is far beyond their economic means, since a cleaning easily begins at $100. Therefore, the poor raised in a society that idealizes clean white teeth are left with no recourse but to head south of the border.

As Dentimundo researched why citizens of the most powerful and advanced nation in the world have to travel beyond its borders to receive dental care, we learned of obscene fraudulence by U.S. dentists. These U.S. dentists were indulging in types of behavior that some Americans assume of Mexicans, and could never imagine happening in the United States.

A July New York Times story (indeed a questionable source, but in this case verified) reported that Brooklyn dentists Dr. Dolly Rosen and Dr. Alex Silman, reaped $5.4 million from Medicaid billings in 2003. On a single September day Dr. Rosen billed for 991 procedures, or more than 100 per hour of a typical workday."⁽⁷⁾

Medicaid, once a "Great Society" vision, has become a bureaucratic labyrinth. It's susceptible to fraud, which makes the program too costly for the federal government.

Mexican dentists provide equal, if not better, dental care than that available in the United States, and at a fraction of the cost. Hence, a mutually beneficial economic and health objective is realized on the border. Dentimundo recommends that you put aside the stress of high expenses for dental care and merely schedule your dental treatements into your next Mexican vacation. DENTISTAS FRONTERIZOS LUCHARAN!

Footnotes

1. "The 2004 National Health Interview Survey," National Center for Health Statistics, The Department of Health and Human Services, Center for Disease Control and Prevention (CDC) http://www.cdc.gov/nchs/about/major/nhis/released200506.htm
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2. The range of cost for a dental cleaning along the border popularly ranged from $25 - $35. For $25 I received a full cleaning and had a retainer cemented to the back of my lower teeth removed. This is a retainer that had been in my mouth for 18 years and would have cost $300 to have removed in the United States.
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3. "Fixing Medicaid's Myriad Problems" by Julie Rovner, National Public Radio, Politics & Society, 7 July 2005 "Morning Edition, July 7, 2005 · An increasing number of officials and analysts are saying that Medicaid cannot be fixed. Medicaid is the nation's largest health insurance provider for the poor and its budget is straining local and federal governments." http://www.npr.org/templates/story/story.php?storyId=4732872
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4. "In December 2002, total Medicaid enrollment in the United States reached over 39.6 million persons... The total excludes over 2 million individuals enrolled in Medicaid for limited benefits under family planning waivers. The total enrollment also excludes more than 200,000 senior citizens enrolled in Medicaid under a Pharmacy Plus waiver, who only receive Medicaid coverage for prescription drugs. This report excludes more than 1 million Medicaid enrollees from the U.S. territories." The Kaiser Commission on Medicaid and the Uninsured, December 2003
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5. Title XIX of the Social Security Act requires that in order to receive Federal matching funds, certain basic services must be offered to the categorically needy population in any State program: inpatient hospital services; outpatient hospital services; physician services; medical and surgical dental services; nursing facility (NF) services for individuals aged 21 or older; home health care for persons eligible for nursing facility services; family planning services and supplies; rural health clinic services and any other ambulatory services offered by a rural health clinic that are otherwise covered under the State plan; laboratory and x-ray services; pediatric and family nurse practitioner services; federally-qualified health center services and any other ambulatory services offered by a federally-qualified health center that are otherwise covered under the State plan; nurse-midwife services (to the extent authorized under State law); and early and periodic screening, diagnosis, and treatment (EPSDT) services for individuals under age 21.
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6. The Kaiser Commission of Medicaid and the Uninsured has a searchable state-by-state information on Medicaid dental benefits. http://www.kff.org/medicaidbenefits/dentalservices.cfm
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7. "New York Medicaid Fraud May Reach Into Billions" by Clifford J. Levy and Michael Luo, New York Times, 18 July, 2003
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