“Botax” in Senate Health Bill Could Hit Cosmetic Dentistry

Cosmetic dentistry could be hit by Senate health care reform taxThere’s a new addition to the Senate health care reform bill that could have massive consequences for dentistry: a proposed 5% tax on cosmetic surgery and procedures that has been dubbed the Botax.

While it’s not entirely clear what this would include, cosmetic dentistry will probably be included.

The Senate bill doesn’t define cosmetic surgery, but it seems likely it would be similar to New Jersey’s tax.

In New Jersey, cosmetic procedures are subject to a 6% tax. (In effect since 2005, it’s the only state with such a tax.) It defines “cosmetic medical procedures” as those that are performed to improve appearance without providing significant health benefit.

The state’s Treasury website provides a specific example:

“For example, charges for teeth whitening will be taxable, while charges for breast reconstruction or for vision correction by laser treatment will not be subject to the gross receipts tax.”
New Jersey State Treasury

New Jersey has netted about $11 million annually from the tax — half of what was expected.

One of the unintended consequences of the tax? Patients heading to neighboring states for aesthetic procedures.

Senators hope the proposed national cosmetic tax could raise $5 billion annually to help pay for providing health coverage over the next decade.

I’m not comfortable with trying to distinguish “cosmetic medical procedures” from ordinary medical procedures — at least not when it comes to dentistry. Presumably porcelain veneers will be taxable and root canals won’t be… but who’s to say a dental implant with a beautiful dental crown won’t be considered a “cosmetic” procedure?

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Dentists’ Opinions on Health Reform

Health care discussion among dentistsWhen I shared my opinion that health care reform could be good for dentistry by providing government-sponsored prophy exams, dentists flooded my blog with comments.

Even if the Botax is out, there’s still a lot to talk about here!

Last week I ran some comments from doctors, most of which suggested that dentists oppose health reform. This week, I’m continuing along the same vein.

Wouldn’t it reduce the standard of care?

“It is unbelievable there is anyone out there that thinks government health/dental care in any form will be better than what we have here today in this country. I donate many hours each year to needy patients in our area. I will be forced to stop if the government gets involved. Stop this train before it gets out of the station!”
– Gordon Rye

How much is much at stake?

This is the end of dentistry as we know it. I get a fair bit of Medicaid patients and work pretty diligently to make a profit. With the high overhead of current dental staff (hygienist, assistants, etc), it is not is not practical to maintain a well-equipped office. It is very difficult to sell these types of insurance patients treatment plans with the attitude ‘just do what the insurance covers.’

“Just try doing $60 amalgam fillings, $45 extractions and prophys and see how much it takes to make a decent living. I have to average about five fillings or extractions an hour just to make a decent living.

“If the government expects the bankers who are responsible for making billions in profits to accept $500k salary, I shudder to think what they have in mind for the healthcare practitioners. Too bad we can’t buy our way out of this healthcare bailout.”
– doctooth

Will it really change your bottom line?

“We have a high percentage of indemnity patients who get free cleanings and a big percentage of them do not avail themselves of this unless there is pain involved. Therefore I feel that government-run health care for cleanings will not change our practice’s bottom line. But the bottom line in taxes and inflation will be great.”
-Kirk Lundell

Do the poor have a fatalistic outlook?

“You really don’t know the people you are talking about, do you?

“Poor people in the US are fatalistic in outlook. Prevention is a hard sell, because they don’t believe it it. They generally believe they are predestined to have good or bad teeth, depending on their ancestry.

“That’s why compliance for preventive Medicaid procedures is so low. All you would end up with if people got free cleanings would be a bunch of no-show appointments.”
– Kim Henry DMD

How do Medicaid patients behave?

“When I first got out of school I worked for a Medicaid practice. We had at least a 75% no-show rate when the patients were getting $1000 in free dentistry from the government, and that was in 1977, so today that would be like getting $6000 in free dentistry today.

“Even if we were successful in getting them on the phone when they no-showed, we’d usually hear ‘Momma’s at the hairdresser,’ ‘Momma’s getting her new Cadillac,’ or some other excuse for not bringing their kid AGAIN.

“That blatantly says people don’t value what they don’t pay for. The welfare worker would have to threaten the mothers with losing all their welfare money if they no-showed again.”
– Loyd

What about CA’s Denti-Cal program?

“Here in California, we have had a system where folks who didn’t have resources got care, called Denti-cal, before the budget crater. Take operating costs from the early 90’s, subtract your office staff, and then you MIGHT break even. Or you can run the Dental/Medical Clinic thing-Every person, every tooth, 50% of surfaces restored with alloy or SSC’s all that day, with indentured servants(I was a new grad once also, just not willing to compromise my ethics to this level)whether they need it or not.

“Just think, you only need to see 10 patients, and place 40 SSC’s and restore 200 surfaces of alloy to make 45% of your existing salary. Or you can Sell, Sell, Sell to the credit patients on inflated contracts, and bait and switch non-precious to ceramic crowns on HMO patients, regardless of appropriate restorations, made in Tijuana from lead glaze, and take Halcion to sleep at night.

“Or you can continue to do what you do now, morally, ethically, and hope the government health plan shift won’t dump all your patients onto the public option. I definitely am not looking forward to 50% of the indemnity patients not having coverage except for cleanings, and at $4-8 per patient reimbursement-monthly cap payment.

“How much will the care have to be discounted to keep people buying? 20-40%. Don’t they call that operating at a loss? Guess that means joining the ranks of those corporations who do not generate a profit(GE, GM) but a loss. I just assume that there will be no bailout money from the Govt.

“Sorry about the rant… just venting…”
– socaldds

Is health care a right or a privilege?

“The government, especially this administration, never does anything on a limited basis. Once they get in, we’re going to be just another frog on the stove.

“It pisses me off when I hear you or other dentists trying to find an angle on how to make bad public policy work for them. That’s why the medical profession is where it is today. Physicians get paid a quarter of what they charge and anyone inside our border can walk into an medical facility and get treatment for nothing.

“People value what they pay for. Healthcare is not a right, it’s a privilege. We earn it by going to school, getting a job, and paying for out of our back pockets.

“Get control of your expenses and dump those insurance plans and losers who steel your time, your skill, and your money. If you want to donate your services to the under-served, fine, do it. We don’t have to screw up the whole system to accomplish that.

“And for those of you who think that there is no difference between dealing with insurance companies who are still responsible to their policy holders and dealing with Washington which is no longer responsible to anyone, you are incredibly uninformed or just a idiot.”
– wrbattarbee

Are they just getting a foot in the door?

“Government intrusion into currently private dental practice is just a foot in the door… When was the last time you saw any government entitlement program get smaller. The recipient pool always expands and more ‘free’ services are promised as those in power need to buy more votes every few years.

“With regard to health care reform, don’t forget about tort reform, portability of health insurance, free care to millions of illegal aliens, etc. In dentistry, don’t forget that we are not getting a bailout. We have relatively high-wage employees, high educational debt, expensive facilities, expensive equipment and with such we are able to provide a very high level of quality care.

“As far as providing care to the under served – many of the under served are that way because they do not seek care until a problem escalates. Many have the resources to pay for the care yet they choose to put their money elsewhere (priorities). There are many free clinics around the country, dental schools, and throngs of private dentists who provide treatment for reduced rates and even at no charge on a case by case basis.

“Dentistry is known for being a resourceful industry and generally rises to the occasion – we do not need the government to tell us how to do it. No system is perfect and there will always be those who fall through the cracks – but the system works pretty well now, even if there is some room for improvement.

“Look at the deterioration of our country’s infrastructure – it is falling apart. Health care is next. Don’t let it happen to dentistry.”

Dental Care Reform: Senate To Require Dental Veneers

Cosmetic Dentistry USA: dental veneers for all AmericansIn an unexpected bipartisan move, Democratic and Republican senators will announce on April 1st that they will supplement the health care reform bill with a comprehensive reform of dental care in the USA.

“Americans are typically considered to have perfect teeth,” said Senator McGrin (R-CA) at a press conference Tuesday. “What is at stake is nothing less than our country’s international reputation.”

“We will do whatever it takes to stay #1 in the world,” agreed Senator Smilestein (D-NY), also speaking at the press conference. “Our plan will guarantee dental veneers for every man, woman and child in the US.”

Under the proposed plan, dental veneers would become mandatory for all Americans in 2014.

Well-known for having a perfect smile himself, President Barack Obama is expected to support the bill.

Cosmetic dentistry is a right!” declared Sen. McGrin. “For too long, dental makeovers have been limited to those who can afford them. It’s simply not fair. Mandatory veneers will level the playing field, teeth-wise.”

Those who have had braces or who have naturally perfect teeth may be able to apply for a special waiver. However, these individuals would be required to undergo yearly exams from a cosmetic dentist. At the first sign of decay or yellow teeth, porcelain veneers would be immediately required.

But not everyone is thrilled with the new legislation. In fact, Tea Party conservatives and ACLU liberals have joined forces to protest the bill. “Requiring cosmetic dentistry is un-American,” declared Glenn Beck of Fox News. “I can’t believe I’m saying this, but I completely agree with Glenn Beck,” replied the president of the ACLU.

“Who is going to pay for universal cosmetic dentistry?” asked Beck. “The Congressional Budget Office has projected that mandatory veneers or lumineers for all Americans will cost the country half a trillion dollars over the next five years. High-income Americans are taxed enough already. And don’t think that higher taxes to pay for this will be limited to people in the upper income brackets. You’re going to see tax increases for middle-income Americans also, if this goes through.”

While the National Dental Organization supports the measure, opponents have loudly challenged the measure. “What’s next?!? Dental implants and dentures for children? Braces for seniors?” demanded one protester. “Why should fat-cat dentists get a special break?”

James Du Molin, president of dental website TheWealthyDentist.com, replied, “Dentists, like other small business owners, are the backbone of our economy. Why are we bailing out banks and other megacorporations? It’s small businesses, like the privately-owned dental office, that create 80% of the new jobs in America.”

Overall, Senators McGrin and Smilestein remain unfazed. “Government-sponsored veneers are the perfect blend of socialism and capitalism,” said Sen. Smilestein. “We’re confident that this solution will satisfy everyone… and cement America’s position of having the best-looking teeth in the world!”

Orthodontic Braces: Taxpayers Spent $424 Million for Children in Texas

Orthodontic Braces: Taxpayers Spent $424 Million for Children in TexasIn June of this year, The Wealthy Dentist published a story about Taxpayers footing the bill for orthodontic braces in Texas.

In Texas, Medicaid pays dentists for orthodontics per procedure, instead of a lump sum for the “finished mouth” of straight teeth.

This has made Medicaid orthodontia a lucrative dental business in Texas.

WFAA-TV of Texas has been investigating this story for the last six months and has uncovered hundreds of millions of dollars of questionable Medicaid spending on dental braces for children in Texas. Their news reports prompted federal investigators to now audit the Texas Health and Human Services Commission, which controls the Medicaid funds.

According to the WFAA website –

In a letter to the state, the Inspector General says it will examine the “authorization process for orthodontic treatment” under Texas Medicaid. “The objective of our audit,” the letter continues, “is to review the State’s controls to ensure that only medically necessary orthodontic cases are paid.” The time period covered by the audit is September 1, 2008 through May 28, 2011.

The new station’s investigation revealed that during that period, Texas taxpayers spent $424 million on orthodontic braces for children under Medicaid. Taxpayers spent $100 million in 2008, $140 million in 2009, and $184 million in 2010, state records show.

Texas dentist, Dr. Christine Ellis, who teaches at UT Southwestern Medical Center, has twice traveled to Washington in an attempt to convince lawmakers to scale back Texas Medicaid orthodontics payments and divert funds for more pressing dental needs.

Her attempts fell on deaf ears. According to the WFAA-TV article, Ellis said, “There’s no response. No one is putting the brakes on this thing.”

Billy Millwee of the Texas Health and Human Services Commission is now telling WFAA-TV that if taxpayers money has been lost, the Attorney General might take action to get it back. He went on to say that Texas will have a new managed care Medicaid dental program beginning next spring.

For more on this story see: Feds Investigate Texas Dental Medicaid Program and Taxpayers Footing the Bill for Braces in Texas.

Dental Insurance and Obama Care: Who’s Right?

Dental Insurance and Obama CareThe National Journal is reporting that the National Association of Dental Plans is spending more than $1 million on a campaign to change a provision in the health care law that they feel will require some people to buy duplicate dental insurance coverage.

Let me repeat…The dental benefits trade organization is spending $1,000,0000 to hire a lobbying firm to convince the Obama administration to fix the provision by the end of 2011.

Is this a good thing? Click here for a 92-page white paper “Road Map” with Delta Dental as a co-sponsor.

The NADP is concerned that, starting in 2014, the almost 44 million people who receive pediatric dental coverage through small business employers will also have to buy coverage through the new health insurance exchanges. It is asking regulators to clarify that their existing coverage meets the law’s requirements.

“Truthfully, this is the No. 1 issue for our industry,” said NADP executive director Evelyn Ireland. “It is the most crucial thing for us to get done.”

NADP wants to ensure that people will be allowed to keep their existing dental insurance coverage under the new health care, a promise President Obama repeatedly made during the heath insurance reform debate.

For a multitude of reasons I have never been a big fan of Delta Dental. However, after reviewing the 92-page white paper I think there may be some merit to this $1,000,000 argument.

Before, I make up my mind, I would like some pro or con feedback from our readers.

Please post your comments below.


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