The April 2 MultiBriefs Exclusive article "Why doesn't Medicare cover dentistry?" emphasized that cost was the major obstacle to dentistry's inclusion in Medicare. However, the cost was not the main obstacle in the beginning.

In the mid-1960s, the American Dental Association (ADA) decided to not join the American Medical Association in accepting a position in Medicare, the federally funded healthcare program for the elderly. The ADA opted to engage Medicaid, the program for the poor and underserved which is operated by state governments. We now believe this decision may have been a mistake and a significant reason for dentistry's exclusion from healthcare.

Nevertheless, cost — and more importantly value — is seen by consumers and payers as a significant concern confronting the healthcare industry, and specifically dentistry. Marko Vujicic, chief economist and vice president of the ADA Health Policy Institute, summarized these two concerns in his editorial in the March JADA.

"We will not see major expansions in dental care use and sustained improvements in oral health in the coming years, especially among those with the highest needs, under the status quo model," Vujicic wrote. "The dental care system needs major reforms."

This concern about value opens up an opportunity for dentistry to not only join healthcare but also to assume a leadership role by improving its value position. All of the concerns confronting healthcare as a whole — inefficiency, ineffectiveness, inequality, inequity, etc. — can be effectively improved if healthcare can better manage the predictable impact of social determinants on chronic diseases.

Dentistry can provide information to healthcare that can shed light on how well consumers are managing their health. These insights could provide a path for "patients" to become "partners" with healthcare, which will significantly reduce cost.

Guiding patients along a path to partnership takes effort and continuous monitoring. But patients being partners is a critical step to helping healthcare to move from a reactive to a proactive culture.

Being proactive is the best way for healthcare to counter the effect of social determinants, which are at the core of poor health management. Proactive healthcare must start at an early age, provide continuous feedback to consumers about how well they are managing their health, and share their insights with all the stakeholders in healthcare. This effort will ensure that harmful habits are prevented or discovered early so future health problems are less expensive to address.

A more proactive healthcare will:

  • improve the quality and value of primary care
  • generate data that payers can use to incentivize consumers for good health management
  • generate data that dentists can use for confirmation, prevention and timely dental care
  • develop health measures that could allow policymakers to build standards to reinforce an environment of better health at lower cost

A proactive healthcare would also encourage a shared liability with consumers where timely feedback to and from consumers would improve the quality of care and curb rising costs.