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Medicare-for-all is already lacking by @BloggersRUs

Medicare-for-all is already lacking

by Tom Sullivan

Several times over the last decade, I have visited the Remote Area Medical free clinic held each July at the Wise County fairgrounds in southwest Virginia. (Stan Brock, RAM's founder and patients' patron saint, passed away last August.) Most of the free care people camp out in cars to receive is dental treatment.

With that in mind, let's move on to Catherine Rampell's consideration of Medicare-for-all. Despite the idea's broad popularity, don't make it a litmus test for progressive candidates, she cautions:

Here’s the problem. The things Americans are apparently envisioning when they tell pollsters they support Medicare-for-all turn out to be a different, vaguer and more varied set of ideas than the specific thing that Sanders, Rep. Alexandria Ocasio-Cortez (D-N.Y.) and others in the progressive base are proposing.

Sanders, et al. want all Americans enrolled in a single, generous, government-run — or single-payer — plan with no private insurers offering their own similar, competing policies. Sanders said he envisions the role of private insurers only for “cosmetic surgery, you want to get your nose fixed.” (To be clear, this is not how Medicare currently works; the program relies heavily on privately run insurance plans.)

Complicating creating such a system, Rampell suggests, is the fact that while the public strongly supports the idea in theory, inform people that Medicare-for-all involves killing off their private plans and support plummets from 56 to 37 percent. There may be multiple ways of avoiding policy landmines in arriving at “affordable health care for every American,” Rampell cautions. The principle should come before the policy. Fine.

But getting back to dental care.

The reason RAM does such a brisk trade in pulling teeth, treating oral infections, and making dentures is because the U.S. government treats dental care as separate from the rest of a person's heath needs.

"If you've got a mouth full of bad teeth and you can't see to function, to get a job, for you it is a disaster," Brock said, advocating that any kind of universal health care program had to include dental.

Nicole Karlis explains at Salon that about 74 million Americans in 2016 had no dental coverage, roughly three times the number that had no medical insurance. Congress created Medicare without including comprehensive dental coverage for a variety of reasons, some of them historical. That continues now, in part, out of institutional inertia:

However, if doctors knew back then what they know now, perhaps the course of history would have been changed. Dr. Gary Glassman, an endodontist, told Salon in an email that the mouth “is a window into what's going on in the rest of your body, and can often serve as a helpful vantage point for detecting the early signs and symptoms of systemic disease.”

“Like many areas of the body, your mouth is overflowing with bacteria, most of them harmless, but with daily brushing and flossing the bacteria can usually be kept under control by way of the body's natural defenses,” he said. “However, without proper oral hygiene, bacteria can reach levels that might lead to oral infections, such as tooth decay and gum disease.”

And Alzheimers disease, suggests a recent report:
Researchers say they've found more evidence linking bacteria found in a common type of gum disease to dementia. A new study, published in the journal Science Advances, found a key pathogen associated with chronic periodontal disease in the brains of people with Alzheimer's disease. The study authors say these results, plus additional testing in mice, provide "solid evidence" of a link between the two diseases and may offer a potential new way to treat Alzheimer's. The devastating illness affects 47 million people worldwide, and there is no cure.
The usual caveats apply. The work is preliminary. Correlation is not causation. Nevertheless:
A 2017 study out of Taiwan found that people with chronic gum disease lasting 10 years had a 70 percent increased risk for developing Alzheimer's. Another small study published in 2016 in the journal PLOS ONE found gum disease was associated with a six-fold increase in the rate of cognitive decline in people with mild to moderate dementia.
Rebecca Edelmayer, Ph.D., director of scientific engagement for the Alzheimer's Association, reminds CBS News that "diet, exercise, a good management of cardiovascular health, getting good sleep" could help prevent cognitive decline. Maybe good oral care may one day be recognized as a factor, she adds.

Does bacteria migrating from the mouth to the brain cause dementia, or do people with dementia just tend to have bad oral hygiene? Show of hands. Who wants to volunteer to find out?

The point is, Medicare-for-all, while popular, is still ill-defined in public debate. The gaps in the way the U.S. handles medical insurance are less so. In concept, universal coverage is likely to be historically selective about what a federal program might cover universally. As a trip to any RAM clinic will make plain, those coverage gaps swallow up Americans left behind not just by the economy and existing programs, but by class.

Before we ask candidates to sign on in blood to a program that still leaves out important care for tens of millions of Americans, we might want to spend some time considering just who and what Medicare-for-all should cover.