Free dental clinic in Duluth swamped; our state’s dental denial

PHOTO: Partha S. Sahana, Flickr CC

PHOTO: Partha S. Sahana, Flickr CC

Yesterday hundreds of low income or underinsured people flowed into the Duluth Entertainment and Convention Center to lay on folding tables to receive free dental care from the nonprofit Minnesota Mission of Mercy. John Lundy describes the event, which continues today, in Saturday’s Duluth News Tribune.

One way of looking at a story like this is to say that it’s good that some kind of service is being provided for patients who need dental work. And it is. But I see an issue that has been around for decades now, and one that illustrates the continuing folly of our health care system, even with improvements in health coverage due to Obamacare.

Issues related to teeth so often follow people with other health problems and are more pronounced in families experiencing poverty. I grew up in what would now be called poverty and we saw the dentist only to fill painful cavities, which were paid for out of pocket or later on when we were on MinnesotaCare during dad’s stints of unemployment.

The cost of private dental care is prohibitively high, even for middle class families. Because dental plans are often held separate from traditional health insurance plans offered by employers or purchased privately, a person can often have decent health insurance without adequate dental coverage. As the cost of insurance has gone up, along with the actual cost of service, over the past 25 years, the problems has gotten worse. Only a small number of people are eligible for programs like MinnesotaCare (my family would not have been eligible today as we were when I was under 18). Those that are have a devil of a time finding dentists who will take the low reimbursement rates MinnesotaCare offers.

So that’s why programs like the Minnesota Mission of Mercy are so important and so popular. But for every person they serve there are many others who are unserved, or who simply don’t have a painful tooth problem right now.

This isn’t how the rest of the developed world handles these kinds of problems. The reason health care reforms were so difficult (and left so incomplete) is because more than half the country has what they need under he status quo. The same is true of dental care. As long as that’s true political barriers make reform difficult, even if the demand for reform is so blatantly obvious.


  1. Even with a job that provided health insurance, dental was not included. That would have been a separate policy and up until recently would have been totally out of pocket. When I hear what friends of mine with families pay for dental, it makes me shudder, (then it reminds me of The Simpsons episode when Homer leads the plant workers on strike over potentially losing their dental plan, which he did not care about until Lisa needed braces).

  2. John Ramos says

    Just another sign of Duluth’s fantastic turnaround.

    • Gerald S says

      Unfortunately this is not at all limited to Duluth. You could probably turn out hundreds for free dental in Edina and Eden Prairie. As Aaron and others point out, most employer plans do not include dental unless it is an expensive add on, and co-insurance and deductibles can still be killers. Medicare does not cover dental. Medicaid and various children’s programs do cover dental, but there is often a problem finding dentists who will accept the programs because of low payments.

      This is a major hole in health coverage in the US, but for a change we are not alone. Even in Canada dental is not covered for most people under most of the Canadian Provincial health plans.

  3. Paul Pascuzzi says

    Even with employer provided dental insurance the annual coverage caps and copays can make anything besides a simple cleaning and exam cost prohibitive. People often look and say why go in for another yearly exam I still can’t afford to do the work they wanted last year.

  4. I think it is wonderful when people help people out of their sense of making this world a better place. Dental care along with health care is prohibitive due to cost. Running a private dental clinic is becoming increasingly more difficult with all the new regulations thrown at the business. A good friend of mine saw this coming 5-6 yrs ago and sold his private dental practice, he figured it would be impossible to be profitable without charging outrageous prices. I don’t see it getting better any time soon, sadly the middle class will be left out again in our over regulated society.

  5. I know a few middle class people, the rare few, who have employer covered health insurance that includes dental and eye coverage with reasonable, affordable cost in co-pays, etc. Most people with jobs earning similar incomes can only dream of and envy having employer covered health insurance that allows them to get essential dental or other care done without agonizing what other non-frivolous, vital expenses will have to put off yet again, new roof, a more reliable vehicle, a medical surgery, a badly needed vacation or if they can even afford it at all.

    My dentist sees a lot of patients with cracked molars which he said has increased over the last decade or so. He says people are more stressed now and he has seen a big jump of teeth grinding. Even a temporary cap is expensive and just buys some time. A permanent cap can cost $2,000 or more. If a couple who each needs two molars capped and that’s not unusual from what I hear from friends and relatives, that’s at least $8,000. If they also have kids that need braces, wisdom teeth pulled, it’s a financial nightmare.

    If middle class Americans somehow do manage to travel outside the US, they were no longer be easily identifiable as American by wearing their fanny packs or baseball caps, it will be the condition of their teeth. We are becoming the Appalachia of the developed world.

  6. Gerald S says

    One last, and perhaps interesting, point about dentistry.

    As the Cecil the Lion story is illustrating, a lot of dentists are making a lot of money. This probably does not apply to those on the Range, but certainly applies in the Twin Cities and elsewhere.

    One of the key reasons is something I mentioned above: Medicare does not pay for dentistry.

    Medicare, which sets prices based on central decision making, acts as the default set point for prices for medical care in the US. Large health care organizations are able to push back against this price point by using market power to demand significant multiples of the Medicare rate from private insurers, but small practices and individual practices are usually paid just small increments above the Medicare rate.

    Dentists, however, without the brake of Medicare set points on pricing, are free to charge whatever they feel like. And often do. Recent data shows that dentists actually make more money per hour than physicians.

    Consequently, although medical care spending increases are mostly due to increased utilization (more tests and procedures) while actual payments to doctors per procedure are often declining, dental spending rises are due partly to increased prices by dentists, although the “fluoride bonus” (older baby boomers keeping their teeth and consequently requiring high cost interventions like crowns and root canals) plays an important role as well.

Speak Your Mind


This site uses Akismet to reduce spam. Learn how your comment data is processed.