Just two more appointments, if all goes well, and by the end of February I will be finished at last with a long, complicated dental procedure that began in 2014.
About a year ago, I told you about growing new bone in my upper and lower jaws (a medical miracle in my book), the insertion of titanium posts into the new bone when it had fused with my natural bone and then the attachment of an “overdenture” that has allowed me, as I explained then, to bite into an apple again for the for the first time in a decade.
At that point we were finished with my upper denture and now we are rounding the corner to the finish line on the lower one.
I chose the overdentures because I want a better eating and living experience than the traditional denture but I could not afford a full set of implants that would have allowed me to have teeth as permanent as real ones. Overdentures almost do that except that, like traditional ones, they must be removed every day for cleaning.
The implants and overdenture are an engineering marvel but there is no doubt they are wildly expensive. In total, I spent about $33,000.
Even after more than two years to become accustomed to it, that number causes me almost to stop breathing. These fancy new teeth took a great, big, giant chunk out of my end-of-life fund. (I guess I'll just have to die faster when the time comes.)
As hard as it was to make that decision, I am luckier than most elders; at least I had the money to fret over. Most old people do not. And Medicare, by law, cannot help.
When the Medicare legislation was implemented in 1965, it was a deliberate choice to leave off dental coverage (and prescription drug coverage).
According to a 2016 study from Johns Hopkins Bloomberg School of Public Health, just 12 percent of Medicare recipients (almost all old people) have dental coverage.
In contrast, according to the report of this study in Medical New Today,
”Eighty percent of Americans under the age of 65 are covered by employer-sponsored programs that offer dental insurance, which covers routine cleanings and cost-sharing on fillings and other dental work. Many of them lose that coverage when they retire or go on Medicare.”
No kidding, said she with $33K worth of dental work in her mouth. I'm going to quote this story at greater length than usual because I think these next paragraphs are important for you to know. The researchers
”...analyzed two separate proposals for adding dental benefits to Medicare, estimating how much each would cost. One was similar to the premium-financed, voluntary Medicare Part D benefit that was added to Medicare a decade ago to help cover prescription drugs for seniors.
“The other was similar to a proposal that has been introduced in Congress that would embed dental care into Medicare as a core benefit for all of the program's 56 million beneficiaries, which is not expected to pass before Congress recesses. [RB: It did not.]
“The first proposal, which would cost an average premium of $29-a-month and would come with a subsidy for low-income seniors who couldn't afford that, would run an estimated $4.4 to $5.9 billion annually depending on the number of low-income beneficiaries who participate.
“The second, with a $7 monthly premium and subsidies for low-income people, would cost between $12.8 and $16.2 billion annually. The packages would cover the full cost of one preventive care visit a year and 50 percent of allowable costs for necessary care up to a $1,500 limit per year to cover additional preventive care and treatment of acute gum disease or tooth decay.”
That wouldn't help much – actually, implants and/or overdentures and even traditional dentures would not be possible at all in that scenario. But it would be a start for basic care and here is why that is important:
”Poor dental hygiene not only contributes to gum disease, but the same bacteria linked to gum disease has also been linked to pneumonia, a serious illness that increases the risk of hospitalization and death.
“It can also contribute to difficulty eating, swallowing or speaking, all of which bring their own health challenges. Nearly one in five Medicare beneficiaries doesn't have any of his or her original teeth left, according to the Centers for Disease Control and Prevention.”
The study's author, Amber Willink, PhD, an assistant scientist in the Department of Health Policy and Management at the Bloomberg School, says that
"'...a staggering 49 million Medicare beneficiaries in this country do not have dental insurance. With fewer and fewer retiree health plans covering dental benefits, we are ushering in a population of people with less coverage and who are less likely to routinely see a dentist. We need to think about cost-effective solutions to this problem...'
“'Older adults are struggling and the current benefits structure of Medicare is not meeting their needs. We need to find the right solution,' she says. 'Otherwise, it's going to end up being so much more expensive for everyone.'"
Reading this report a few weeks ago as I was writing the final check for my dental work, gave me both a shudder (I am unaccustomed to writing checks with mid-four figures and will never get used to it) but also a strong sense of gratitude.
As much as I still carry concern about taking such a huge chunk of money out of my end-of-life fund, at least it was there for me to make the choice. How lucky is that – so many elders are not.
But why do I think incorporating even limited dental coverage into Medicare won't happen for at least the next four years?
In related news, during the election campaign, then-candidate Donald Trump pledged to let Medicare negotiate discounts for prescription drugs as the Veterans Administration does. Then, early this week,after he met with lobbyists and executives of pharmaceutical companies, reports Matthew Yglesias at Vox:
"...he abandoned that pledge, referring to an idea he supported as recently as three weeks ago as a form of 'price fixing' that would hurt 'smaller, younger companies.' Instead of getting tough, Trump’s new plan is that he’s 'going to be lowering taxes' and 'getting rid of regulations.'"
Yglesias further reports that according to Herb Jackson who was the designated pool reporter that day, Trump told the pharmaceutical attendees:
"I'll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing their product to a vibrantly competitive market. That includes price-fixing by the biggest dog in the market, Medicare, which is what's happening. But we can increase competition and bidding wars, big time.
"So what I want, we have to get lower prices, we have to get even better innovation and I want you to move your companies back into the United States. And I want you to manufacture in the United States. We're going to be lowering taxes, we're going to be getting rid of regulations that are unnecessary."
This is chilling when you extend similar thinking to Social Security and the Medicare program itself that the Republicans in Congress are planning to privatize. Recall that during the campaign, Trump repeated many times that he would not touch those two programs. Riiiiight.