The expression “Don’t look a gift horse in the mouth” exists because the quickest way to gauge overall health is via the teeth. In that vein, a quick look at America’s teeth is disturbing.
While overall dental health is improving, poor and rural citizens have dramatically worse dental health than does everyone else. So, state legislators have been promoting various creative solutions. One popular idea under debate in legislatures in Florida, New Mexico and North Dakota is to legalize a new breed of dental professional — dental therapists — which would function as a sort of intermediary healthcare provider between dental hygienist and dentist. It’s well-intentioned, intuitive and — unfortunately — bad policy.
Most of the dental procedures that patients undergo are relatively simple and, in theory, don’t necessitate the lengthy educations required of most dentists (who typically take three to four years to complete their dental degree). Yet, in the majority of states, the only way of accessing these simple procedures is by way of dentists who, owing to their education and expertise, are a small, pricey bunch.
Therefore — the argument goes — if an intermediary class of professionals requiring slightly less education (a master’s degree) could offer these simple procedures, costs would decrease, and poor and rural folk would consequently have better dental health. This is the basic argument that dental therapist advocates, like the W.K. Kellogg Foundation, usually use to support the notion.
Sadly, in the few states where dental therapist laws have been enacted, the profession attracts astonishingly few people: in Minnesota, for instance, only 86 dental therapists have signed up (about a third of which flocked directly to cities) and in Maine, not a single dental therapist has materialized even though the profession has been legal for half a decade. Further, while there’s some data to indicate that dental therapist legislation may have yielded increases in levels of access for residents in Alaska’s native communities, there’s no data demonstrating that dental therapist programs elsewhere have substantially improved costs or access to dental care for the rural poor (to the contrary, costs have been steadily increasing).
None of this is surprising. Dental therapists avoid rural areas and flock to cities for the same reason that dentists do — cities have more clients. Likewise, it makes sense that there are few dental therapists: the sort of people who would become dental therapists are largely the sort of people who do become dentists. Since prospective dental therapists would be working in the same environment and performing many of the same procedures as dentists, there’s almost no incentive for them to forgo the extra income, prestige, and education offered by simply becoming full-fledged dentists.
This is especially so because — as with other professions — prospective dentists typically take out loans that will be paid back over the course of their career to finance their schooling and therefore don’t quite heavily weigh upfront the cost of an additional year or two of training when choosing between career paths.
Further, even if more people did inexplicably choose to become dental therapists, it would require a truly massive number to drive down costs, because otherwise there’s little market pressure to lower prices considering that dental therapists typically rely on private insurance, Medicaid and Medicare to cover the average price of a basic procedure. In other words, because people typically rely on some sort of insurance program that features a preset amount of coverage, the market for dental procedures is a lot less responsive to small changes in the supply of providers.
Interestingly, dental therapist legislation represents an especially unique type of bad occupational licensing policy. Usually, bad occupational licensing laws put up needless obstacles to practicing relatively risk-free professions like hair braiding or floristry. In this case, however, legislators are cultivating a whole profession as a top-down solution.
This sort of bad occupational licensing policy is probably less harmful than the former, however, it still cultivates a situation where, for instance, legislators are sidetracked from improving costs and access, and are instead focused on increasing the number of dental therapists — often by spending hundreds of thousands of taxpayer dollars on fruitless grants to dental therapist programs.
In the words of Edmund Burke, “Men little think how immorally they act in rashly meddling with what they do not understand. Their delusive good intention is no sort of excuse for their presumption.”
Instead of cultivating a profession at taxpayers’ expense, legislators should consider less invasive, free-market policy solutions like empowering dental hygienists to perform more procedures, encouraging mobile dental clinics through deregulation, and recognizing dental licenses from other states. Essentially, legislators should be wary of expansive market interventions and focus on policies that free up folks in the dental healthcare market to provide care to more patients at lower costs.
