Why Is Health Care In America So Fucked Up?

doghouse

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According to my American colleagues, Obamacare was pretty wank, ill-conceived, more costly to them and it was driven by Obama's ego in creating a legacy.
Accurate. And now somehow the GOP leadership in the House has managed to find something worse! Impressive really, when you think about it.
 

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OP-ED COLUMNIST
The Republican Health Care Crackup

The Republican health care bill could represent the moment when the old order of American politics completely cracks up, the end of a certain era in American politics.

That era began around 1974, when Ted Kennedy introduced a bill to supplement America’s employer-based insurance system with a government program. The Democratic dream of universal coverage continued through Hillary Clinton’s time as first lady and reached a partial culmination with the passage of Obamacare.

Combating government health care was a central Republican preoccupation through all that time, and the passage of Obamacare provoked the Tea Party reaction and final arrival of Goldwaterite populist conservatism.

By 2010, however, both the Obama administration and the Tea Party opposition were out of step with the times. They both still thought the big political issues in American life were universal health care and the size of government.

In fact, another set of problems had magnified and come to overshadow the old set. This new set included:

First, the crisis of opportunity. People with fewer skills were seeing their wages stagnate, the labor markets evaporate. Second, the crisis of solidarity. The social fabric, especially for those without a college degree, was disintegrating — marriage rates plummeting, opiate abuse rates rising. Third, the crisis of authority. Distrust in major institutions crossed some sort of threshold. People had so lost trust in government, the media, the leadership class in general, that they were willing to abandon truth and decorum and embrace authoritarian thuggery to blow it all up.

If President Obama had made these crises the center of his administration, instead of the A.C.A., Democrats wouldn’t have lost Congress and the White House. If the Tea Party had understood the first two of these crises, there would have been no opening for Donald Trump.

Trump came along and exploited these crises. But if his administration’s health care approach teaches us anything, it is that he has no positive agenda for addressing them. He can tap into working class anxiety negatively, by harnessing hostility toward immigrants, foreigners and the poor. But he can’t come up with a positive agenda to make working class life more secure.

So we have a group of Freedom Caucus Republicans who still think the major problems in the country today can be cured with tax and spending cuts. We have a Trump administration that has populist impulses but no actual populist safety net policies. And we’ve got a Republican leadership in Congress mired in Reagan-era thinking and trying to pay lip service to every obsolete prejudice in the various wings of the party.

You end up with this hodgepodge legislation that pleases nobody and takes the big crises afflicting our country and makes them all worse.

The Republican health plan would make America’s economic chasm worse. It would cut health subsidies that go to the poor while eliminating the net investment income tax, which benefits only the top 1 percent.

The Republican plan would further destabilize the social fabric for those at the bottom. Throwing perhaps 10 million people off the insurance rolls will increase fear, isolation, social tension, chronic illness, suicide and bankruptcy.

The Republican plan will fuel cynicism. It’s being pushed through in an elitist, anti-democratic, middle of the night rush. It seems purposely designed to fail. The penalties for those who don’t purchase insurance are so low they seem sure to guarantee Republican-caused death spirals in the weaker markets.

This thing probably won’t pass, but even if it passes it will probably lead to immense pain and disruption. That will discredit market-based social reform, cost the Republicans their congressional majorities and end what’s left of the Reagan-era party.

It will also point the way to a new era.

The central debate in the old era was big government versus small government, the market versus the state. But now you’ve got millions of people growing up in social and cultural chaos and not getting the skills they need to thrive in a technological society. This is not a problem you can solve with tax cuts.

And if you don’t solve this problem, voters around the world have demonstrated that they’re quite willing to destroy market mechanisms to get the security they crave. They will trash free trade, cut legal skilled immigration, attack modern finance and choose state-run corporatism over dynamic free market capitalism.

The core of the new era is this: If you want to preserve the market, you have to have a strong state that enables people to thrive in it. If you are pro-market, you have to be pro-state. You can come up with innovative ways to deliver state services, like affordable health care, but you can’t just leave people on their own. The social fabric, the safety net and the human capital sources just aren’t strong enough.

New social crises transform party philosophies. We’re in the middle of a transformation. But to get there we’ve got to live through this final health care debacle first.

https://mobile.nytimes.com/2017/03/10/opinion/the-republican-health-care-crackup.html
 

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https://www.wsj.com/articles/gop-health-plan-would-hit-rural-areas-hard-1489364405

GOP Health Plan Would Hit Rural Areas Hard

Poor, older Americans would see largest increase in insurance-coverage costs, analysis shows

A consulting firm has projected what consumers could actually have to pay to get health plans under the House’s blueprint. Photo: Ryan Hermens/Associated Press
By
Anna Wilde Mathews and
Dante Chinni
Updated March 13, 2017 12:01 a.m. ET
542 COMMENTS
The House Republican effort to overhaul the Affordable Care Act could hit many rural areas particularly hard, according to a new analysis, sharply increasing the cost for some residents buying their own insurance.

In extreme cases, the amount a consumer might owe for a plan could exceed that person’s annual income. In Nebraska’s Chase County, a 62-year-old currently earning about $18,000 a year could pay nearly $20,000 annually to get health-insurance coverage under the House GOP plan—compared with about $760 a year that person would owe toward premiums under the ACA, an analysis by Oliver Wyman showed.

The consulting firm, a unit of Marsh & McLennan Cos. is the first to project what consumers could actually have to pay to get health plans under the House’s blueprint. The analysis looked at the cost of a benchmark insurance plan at the “silver” level under both setups.

Read More on Capital Journal
Capital Journal is WSJ.com’s home for politics, policy and national security news.

Among people who currently have ACA benchmark plans, Oliver Wyman found those who are older and have lower incomes would generally see their costs for similar coverage increase the most under the House bill. Some with higher wages, and certain younger consumers, would likely do better financially under the new regime. Both urban and rural 35-year-olds making about $54,000 a year, for instance, could on average save roughly $3,000 annually, the analysis showed.

In 2020, the House legislation would completely revamp the federal subsidies that currently help lower-income people afford insurance on the exchanges—replacing them with flat-sum tax credits instead. While the ACA subsidies are pegged to a person’s income and the costs of health plans in the geographic area where the recipient lives, the tax credits are based on age, with income limits.

The Oliver Wyman analysis highlights how rural areas, where individual insurance premiums are often higher, could see a major effect from the shift to flat-sum tax credits. Compounding that, rural populations are often older and poorer, so the proportion of those doing worse under the new subsidy setup may be higher.

Of the 100 counties where a 62-year-old making three times the federal poverty level—generally around $36,000—would see the biggest jump in annual costs for a plan under the Republican blueprint, 97 were rural. “It is disproportionately affecting the rural,” said Dianna Welch, an actuary at Oliver Wyman.

The dynamic may present a political challenge for Republicans, because many rural regions strongly supported President Donald Trump.

A Wall Street Journal analysis of Oliver Wyman’s data shows that 62-year-olds currently earning about $18,000 a year would see a bump in annual premiums of more than $10,000 in 41% of counties won by Mr. Trump last November, and in 28% of counties won by Hillary Clinton.


Kevin Brady, the Texas Republican who chairs the House Ways and Means Committee, said the analysis didn’t reflect all aspects of the House bill. “Our legislation eliminates the red tape, taxes, and mandates that have led to sky high premiums and a collapsing health care marketplace,” he said in a statement.

Stephen Vasey, a retired teacher living in Heber, Ariz., and his wife currently pay about $3,200 a year for their exchange plan, and get a federal subsidy worth more than $30,000 that pays the rest of their premiums. Under the Republican proposal, a couple like them would get a flat $8,000 a year in tax credits, according to Oliver Wyman. Mr. Vasey will be eligible for Medicare before 2020, but his wife is younger.

“It would be a stretch,” says Mr. Vasey. He might have to return to work or opt to begin receiving his Social Security benefits if the Republican approach becomes law, he said, and the couple would also consider a skimpier plan for Ms. Vasey, with bigger out-of-pocket costs.

The Oliver Wyman analysis, which used data from states and the federal Department of Health and Human Services, projected the cost of a benchmark plan at the “silver” level in 2020 in each county in the U.S. It compared the amounts that consumers at different income levels and ages would pay for those plans, after any federal subsidy they would receive under the current ACA regime or the tax credit envisioned in the Republican bill. It didn’t include the impact of some other provisions in the bill, including ending enforcement of the ACA’s coverage mandate and a new penalty for people who have a gap in coverage.

Countrywide, a rural 45-year-old making around $18,000 a year would pay about $2,291 a year more on average from his own wallet under the Republican bill than under the ACA, according to the analysis—compared with a $1,588 increase for a 45-year-old urban resident. For 62-year-olds earning about $18,000, the average increases in cost under the Republican bill’s setup were far greater: $9,075 for rural and $6,954 for urban consumers.

People with higher incomes could see their costs go down under the Republican proposal. For instance, a rural 62-year-old making about $54,000 would spend about $2,588 less per year for a plan on average under the Republican bill’s subsidy structure, which gives tax credits to people at higher income levels than the ACA does. The urban 62-year-old at that income level would spend $2,856 less.

Rural regions’ higher premiums are driven partly by a population that tends to be sicker and require costlier care, with higher rates of chronic conditions such as diabetes and heart disease, said April Todd, an executive at consulting firm Avalere Health, a unit of Inovalon Inc. Also, insurers often struggle to win price concessions from health-care providers who have few competitors, she said. “Given that they’re the only hospital, you don’t have a lot of negotiating leverage.”

At Lexington Regional Health Center in Lexington, Neb., the Republican proposal could lead to a larger volume of unpaid bills, as patients lose coverage or aren’t able to pay what they owe out-of-pocket for care, said Leslie Marsh, the rural hospital’s CEO. The Republican proposal doesn’t include the ACA’s extra subsidies that help low-income consumers with deductibles and other such charges. The hospital is already operating at a loss, she said. “The takeaway for us is, it’s going to be negative” Ms. Marsh said.
 

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http://www.washingtonsblog.com/2017...care-healthcare-system-completely-broken.html

Forget ObamaCare, RyanCare, and any Future ReformCare–the Healthcare System Is Completely Broken
Posted on March 27, 2017 by Charles Hugh Smith
As with many other complex, opaque systems in the U.S., only those toiling in the murky depths of the healthcare system know just how broken the entire system is. Only those dealing daily with the perverse incentives, the Kafkaesque procedures, the endlessly negative unintended consequences, the soul-deadening paper-shuffling, the myriad forms of fraud, the recalcitrant patients who don’t follow recommendations but demand to be magically returned to health anyway, and of course the hopelessness of the financial future of a system with runaway costs, a rapidly aging populace and profiteering cartels focused on maintaining their rackets regardless of the cost to the nation or the health of its people.

Ask any doctor or nurse, and you will hear first-hand how broken the system is, and how minor policy tweaks and reforms cannot possibly save the system from imploding. Based on my own first-hand experience and first-hand reports by physicians, here are a few of the hundreds of reasons why the system cannot be reformed or saved.

Say 6-year old Carlos gets a tummy-ache at school. To avoid liability, the school doesn’t allow teachers to provide any care whatsoever. The school nurse (assuming the school has one) doesn’t have the diagnostic tools on hand to absolutely rule out the possibility that Carlos has some serious condition, so the parents are called and told to take Carlos to their own doctor.

Their pediatrician is already booked, so Carlos ends up waiting in the ER (emergency room). Neither the school nurse nor the parents see the symptoms as worrisome or dangerous, but here they are in ER, where standards of care require a CT scan and bloodwork.

Hours later, Carlos is released and some entity somewhere gets an $8,000 bill–for a tummy-ache that went away on its own without any treatment at all.

Since the Kafkaesque billing system rewards quick turn-arounds, observation is frowned upon unless it can be billed. So if observation is deemed necessary (to avoid any liability, of course), Carlos might be wheeled into an “observation room” filled with other people, where a nurse pops in every once in a while. This adds $3,000 to the bill.

(Never mind the stress on Carlos being in such unfamiliar surroundings; he might have felt better if he hadn’t been subjected to the anxieties that come with being enmeshed in the healthcare system’s straight-jacket of standards of care.)

If Carlos doesn’t feel better after all this, then the bill is set to balloon bigtime because an overnight stay in the hospital is the next step–and if there isn’t a 100% certainty that there is no chance of his stomach-ache becoming something serious, then the system will insist on overnight observation as the only legally defensible option.

There are other ways to increase the fees without actually providing additional care; was Carlos receiving “critical care”? Of course he was, because, well, it pays better, and by definition any ER visit is critical care.

This example is just the tip of the iceberg, but you get the point: all institutional care decisions ultimately revolve around thwarting future liability claims and maximizing the billing value of each interaction or procedure.

You’ve probably seen some of the racketeering that passes for “business as usual” in the pharmaceutical arm of the “healthcare” industry. A pharma company that spent $500,000 trying to keep pot illegal just got DEA approval for synthetic marijuana (via Chad D.)

Pinworm prescription jumps from $3 to up to $600 a pill (via John F.)

Off-patent medications double or triple in cost, and then double or triple again with a few years, without any justification. To extend expiring patents, Big Pharma corporations petition the FDA to change the target audience for the med, and this trivial administrative change awards the corporation years more of lucrative patent protection.

The scams are endless, the skims are endless, the fraud is endless, the waste is endless, the fortunes expended to limit “winner take all” liability claims are endless, the paperwork churn is endless and the perverse incentives and negative unintended consequences are endless.

Everyone knows the system is unsustainable, perverse and insane, but they are powerless to change it within the system as it is. The usual sort of political horsetrading that passes for “reform” yielded ObamaCare, which did essentially zero to limit costs or cartel rackets.

A system based on parasitic predation by all the cartel players cannot be reformed or saved from its own perverse incentives and skyrocketing costs. The foundations of U.S. healthcare are rotten to the core. “Reform” is an appealing delusion, but the rot is so deep and so pervasive it is embedded in the society and the culture, beyond the reach of legislative overhauls, no matter how well-meaning.

This chart-fest reflects the trends that cannot be reversed by policy tweaks and tucks: The U.S. spends more than twice as much per person than our advanced competitors such as Japan and France.


The U.S. spends 2.5 times more per person than the OECD (i.e. the industrialized nations) average:


Wages have risen 16%, GDP rose 168%, and healthcare soared 818%. Do you reckon wage earners might have a hard time paying for healthcare nowadays?


If healthcare had risen only as much as official inflation, each household would be saving $10,000 per year–$100,000 each decade. $100K here and $100K there, and pretty soon you’re talking real money in a conventional wage-earner household budget.


Projections of skyrocketing Medicare and Medicaid program costs guarantee national bankruptcy. The projection of 90 million Medicare enrollees is predictable, but there is no reason to believe costs will be limited to $20,000 per enrollee annually.


U.S. healthcare costs more in every category than other healthcare systems.Tweaking policy in one slice does nothing to limit the staggering increases being logged in all the other tranches of the system.


America’s healthcare system is the perfection of the fraud triangle: the pressure to increase billings, fees and profits is immense, the rationalizations are unlimited (it’s within the legal guidelines, etc.) and the opportunities for fraud are equally unlimited.

Individual caregivers and administrators want a different, better role and a better outcome, but each is trapped in the system as it is–and reform is impossible given the systemic foundations, incentives and legal framework.


It’s time to start planning for what we’ll do when the current system implodes.We might start by considering The “Impossible” Healthcare Solution: Go Back to Cash(2009).
 

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Protectionism Makes Dental Care Expensive

The Washington Post had a very useful front page piece on the poor quality of dental care received by large segments of the population. It noted the high price of dental care, but never examines why it costs so much in the United States.

A big part of the story is that dentists earn on average $200,000 a year, roughly twice the average of their counterparts in Western Europe and Canada. This is in large part because our dentists benefit from protectionism. We prohibit qualified foreign dentists from practicing in the United States unless they graduate from a U.S. dental school (or in recent years, a Canadian school).

The price of dental equipment is also inflated due to the fact that it enjoys government granted patent monopolies. In most cases, this equipment would be relatively cheap if it we sold in a free market. (Yes, we need to pay for the research that supports technological innovation, but there are alternative mechanisms. This issue and protection for dentists is discussed in Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer [it's free].)

Anyhow, this is yet another example of how the religiously pro-free trade Washington Post happily turns a blind eye to protectionism when it is the wealthy who benefit.
 

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Protectionism Makes Dental Care Expensive

The Washington Post had a very useful front page piece on the poor quality of dental care received by large segments of the population. It noted the high price of dental care, but never examines why it costs so much in the United States.

A big part of the story is that dentists earn on average $200,000 a year, roughly twice the average of their counterparts in Western Europe and Canada. This is in large part because our dentists benefit from protectionism. We prohibit qualified foreign dentists from practicing in the United States unless they graduate from a U.S. dental school (or in recent years, a Canadian school).

The price of dental equipment is also inflated due to the fact that it enjoys government granted patent monopolies. In most cases, this equipment would be relatively cheap if it we sold in a free market. (Yes, we need to pay for the research that supports technological innovation, but there are alternative mechanisms. This issue and protection for dentists is discussed in Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer [it's free].)

Anyhow, this is yet another example of how the religiously pro-free trade Washington Post happily turns a blind eye to protectionism when it is the wealthy who benefit.
Wrong. US dentists don't make 2x the Canadian earnings. Actually, Canadian dentists outearn Americans. Poor quality data on dentist earnings.

As an example, here, first year grad will make $125K. Three to five years later $300K to $500K. Varies by location.

Europe, yes, there is a big difference in earnings compared to North America.

Protectionism? Does the writer actually think that all countries are equal in training?

Dentists from the subcontinent, China, Korea, Japan and a host of other countries don't actually do much clinical treatment while school if at all. Scary shit.

There are all kinds of 2-year qualifying programs that foreign-trained dentists can do to qualify.

Costs are high because overhead is pushing 70%.

Tuition is crazy high too. Average tuition is pushing $40K per year for in-state students at public schools, $60K for non-residents; private schools are in the $80K to $100K+. As an example, University of the Pacific is $106K per year.

The poors can't afford it. Although if they brushed their teeth and stopped eating shit, they wouldn't have such high decay rates. Personal responsibility, blah, blah, blah.

Poors don't want to go to a regular dentist; don't feel comfortable there. Dentists don't want them in their waiting room either.

Look at the stats on how the poors don't show up for appointments. Lost appointments = lost earning. Critical in a fee for service model.

Poors are unreliable.

Medicaid paperwork is so ridiculous and the reimbursement is pennies on the dollar. Most practitioners just do an amount of pro bono work instead.

America can't figure out how to provide medical care to its people. Why should dental care be any different?
 

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Wrong. US dentists don't make 2x the Canadian earnings. Actually, Canadian dentists outearn Americans. Poor quality data on dentist earnings.

As an example, here, first year grad will make $125K. Three to five years later $300K to $500K. Varies by location.

Europe, yes, there is a big difference in earnings compared to North America.

Protectionism? Does the writer actually think that all countries are equal in training?

Dentists from the subcontinent, China, Korea, Japan and a host of other countries don't actually do much clinical treatment while school if at all. Scary shit.

There are all kinds of 2-year qualifying programs that foreign-trained dentists can do to qualify.

Costs are high because overhead is pushing 70%.

Tuition is crazy high too. Average tuition is pushing $40K per year for in-state students at public schools, $60K for non-residents; private schools are in the $80K to $100K+. As an example, University of the Pacific is $106K per year.

The poors can't afford it. Although if they brushed their teeth and stopped eating shit, they wouldn't have such high decay rates. Personal responsibility, blah, blah, blah.

Poors don't want to go to a regular dentist; don't feel comfortable there. Dentists don't want them in their waiting room either.

Look at the stats on how the poors don't show up for appointments. Lost appointments = lost earning. Critical in a fee for service model.

Poors are unreliable.

Medicaid paperwork is so ridiculous and the reimbursement is pennies on the dollar. Most practitioners just do an amount of pro bono work instead.

America can't figure out how to provide medical care to its people. Why should dental care be any different?
Dr. Thruth Thruth has spoken.

I'm actually surprised the Japanese are that far off. If you said the UK however I'd believe you...
 

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Wrong. US dentists don't make 2x the Canadian earnings. Actually, Canadian dentists outearn Americans. Poor quality data on dentist earnings.

As an example, here, first year grad will make $125K. Three to five years later $300K to $500K. Varies by location.

Europe, yes, there is a big difference in earnings compared to North America.

Protectionism? Does the writer actually think that all countries are equal in training?

Dentists from the subcontinent, China, Korea, Japan and a host of other countries don't actually do much clinical treatment while school if at all. Scary shit.

There are all kinds of 2-year qualifying programs that foreign-trained dentists can do to qualify.

Costs are high because overhead is pushing 70%.

Tuition is crazy high too. Average tuition is pushing $40K per year for in-state students at public schools, $60K for non-residents; private schools are in the $80K to $100K+. As an example, University of the Pacific is $106K per year.

The poors can't afford it. Although if they brushed their teeth and stopped eating shit, they wouldn't have such high decay rates. Personal responsibility, blah, blah, blah.

Poors don't want to go to a regular dentist; don't feel comfortable there. Dentists don't want them in their waiting room either.

Look at the stats on how the poors don't show up for appointments. Lost appointments = lost earning. Critical in a fee for service model.

Poors are unreliable.

Medicaid paperwork is so ridiculous and the reimbursement is pennies on the dollar. Most practitioners just do an amount of pro bono work instead.

America can't figure out how to provide medical care to its people. Why should dental care be any different?
Would a promise of free tuition in exchange for serving the poor pro bono for X amount of years be, at least, a solution for the poors and debt problems?
 

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Would a promise of free tuition in exchange for serving the poor pro bono for X amount of years be, at least, a solution for the poors and debt problems?
They have such plans. Some are free tuition but most are post-graduation with loan forgiveness for every year worked. No programs forgive 100% AFAIK.

There is also the US Public Health Service/Indian Health Service where you become a commissioned officer.

Almost every state has some form of return of service program. Most state-run in association with HRSA-determined underserviced areas.

The problem is that there are limited amounts of programs for the poors which limits the number of practitioners to service them.

There are dental clinics in all Federal Qualified Health Centers.
 

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Dr. Thruth Thruth has spoken.

I'm actually surprised the Japanese are that far off. If you said the UK however I'd believe you...
Japanese dentistry sucks. Most Asian countries have shit dentistry (schooling and treatment).

India by far is the worst. Western Europe, Australia, New Zealand is good.

You don't see graduates from these countries clammering to come to North America like Indians and Arabs

The UK redid their NHS dental program and eliminated capitation, which led to undertreatment.

Now there is a monitored first year of practice and mentorship. Pretty decent system.
 

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Taiwan is OK (and cheap dentistry ~$5aud a visit) - as most Dentists are USA trained. Many countries have their medical and dental training almost entirely as book learning and they don't touch a patient until after graduation. In recruitment there's a black list (that doesn't exist) of countries where anyone in the know will not even interview a candidate.

Another - universal problem - is that there is no real budget for basic preventative work.

Added to this basic work is overly expensive for several reasons - not the least of which is the fact that dentist surgeries are just that - set up with the near highest degree of infection control etc when a bloody lot of good dental care can be carried out on a chair in the kitchen with some basic hygiene protocols - and it can be preformed by a technician - no need for a 5 year degree or more.

There's more...later

On another subject - slightly -
Thruth Thruth we are doing some interesting work pioneering/trailing/pilots/teaching of the Hall Technique crowns for paediatrics oral health.
 

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Taiwan is OK (and cheap dentistry ~$5aud a visit) - as most Dentists are USA trained. Many countries have their medical and dental training almost entirely as book learning and they don't touch a patient until after graduation. In recruitment there's a black list (that doesn't exist) of countries where anyone in the know will not even interview a candidate.

Another - universal problem - is that there is no real budget for basic preventative work.

Added to this basic work is overly expensive for several reasons - not the least of which is the fact that dentist surgeries are just that - set up with the near highest degree of infection control etc when a bloody lot of good dental care can be carried out on a chair in the kitchen with some basic hygiene protocols - and it can be preformed by a technician - no need for a 5 year degree or more.

There's more...later

On another subject - slightly -
Thruth Thruth we are doing some interesting work pioneering/trailing/pilots/teaching of the Hall Technique crowns for paediatrics oral health.
America has introduced dental therapy in Alaska and Minnesota. Other schools are being developed. Both programs are based on the NZ, Australian & our Narional School of Dental Therapy (whose funding was killed in 2010). I consulted with these programs when they were being established.

Alaska is for their own communities. Minnesota grads will eventually all end up working for HMO's and managed care instead of helping the poors.

Prevention is difficult even if funding exists because of competing priorities, food security being the biggest one.

Of course prevention and public funding is always just a fraction of the total billions spent on oral health.

I introduced the Hall Technique to therapists here 3 or 4 years ago. It has value but limited applications. Biggest problem is that here, the damage is done by age 2 and kids are treated via GA because you cannot do much in the chair at that age besides ART.

School-based prevention programs are too late. Need to have other health care providers doing fluoride varnish and targeting parents in conjunction with immunization and medical appointments where infants are a captive audience.

The poors can parrot back preventive messages but do not practice what they know because of their SES barriers.
 

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Gee damage done by 2 years old? You have flouride in water? I suppose I could look it up.
In major centres. Fluoride does not completely overcome decay risk.

Decay is a major problem in northern/remote/inner city populations where high risk people live. Inappropriate use of baby bottle (too long and with apple juice or pop) is the big culprit
 

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The non-flouride brigade crack me up.
IT IS POISON. I CAUSES DOWN'S SYNDROME. IT CAUSES CANCER. IT CAUSES DECREASED INTELLIGENCE. ALIEN ABDUCTIONS. CATTLE MUTILATIONS. FLUORIDE CREATED MTV. IT IS A COMMUNIST PLOT.

Mandrake, have you ever seen a Commie drink a glass of water?

Well, I can’t say that I have.

Vodka, that’s what they drink . . . on no account will a Commie ever drink water, and not without good reason . . . Have you never wondered why I drink only distilled water, or rainwater, and only pure-grain alcohol? Have you ever heard of a thing called fluoridation of water? Do you realize that fluoridation is the most monstrously conceived and dangerous Communist plot we have ever had to face?

General Jack D. Ripper
 

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A tinfoil hat-wearing posse publicly berated Associate Minister of Health Peter Dunne about his disdain for anti-fluoride activists.

The fluoride campaigners – including Hamilton City Councillor Siggi Henry - wore the hats at a public meeting in Hamilton to protest Dunne's descriptions in Parliament of such activists.

He called them "tinfoil-hat wearing ... UFO-abducted pseudo-scientists".

http://www.stuff.co.nz/national/health/92529695/Fluoride-campaigners-protest-at-Peter-Dunne-speech
 
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