I was intrigued by an article in today's Des Moines Register about Dr. David Nash, who advocates training “oral health therapists” to handle simple procedures for children's teeth.

My cousins who are dentists probably wouldn't like this idea, but Nash made a compelling case:

Nash, who spoke at a conference in Johnston, framed the problem as an issue of justice and fairness. He criticized fellow dentists for concentrating on profitable treatments, including cosmetic procedures. He said they should spend more time on public-health needs, including care for poor children insured under Medicaid.

Dentists often say they limit their Medicaid work because the program pays them too little. But Nash said states that have dramatically raised reimbursements have not seen corresponding increases in dentists willing to accept more Medicaid patients. “Many dentists just do not want to see these people in their offices,” he said.

[…]

The professor has made waves nationally with a proposal to create a new class of “oral health therapists,” who would receive two years of training in the treatment of children. They could perform typical dental-hygienist duties, plus simple fillings, crowns and extraction of baby teeth. They could be posted in schools, pediatricians' clinics or mobile clinics, he said. Such therapists provide safe, economical treatment in 53 countries, including New Zealand, Britain and Canada, he said.

I have a friend whose family is on Medicaid, and I know she has struggled to find a dentist to fill her daughters' cavities. The family dentists or pediatric dentists recommended by me and other friends do not take Medicaid patients. She wants to avoid getting mercury amalgam fillings, and the only dentists in the Des Moines area she can find who take Medicaid patients use mercury in the fillings.

I'm sure there are arguments to be made against Nash's idea, but it seems to merit serious consideration. 

While most of us are focused on insurance or universal care, the Bush Administration has been incrementally shredding Iowa’s existing public health safety net in ways that have yet to become apparent.  The most recent assault on our public health care infrastructure is escaping the notice of mainstream media and citizen journalists alike, probably because it is not easily explained. I am referring to a proposed set of arcane regulation changes by the Center for Medicaid and Medicare Services (CMS) which, if enacted, will result in $15 billion dollars in cuts over five years to service providers, closing or scaling back emergency rooms, medical education and school based services in Iowa communities.