December 27, 2007

Two Odd Editorial Juxtapositions

by PG

Last Friday, the Times editorial board railed against the EPA's decision that California and other states could not set their own standards for "greenhouse gases," those that are thought to contribute to global warming. Though I am sympathetic to California's argument, I found this statement in the editorial odd:

One of [EPA Administrator] Mr. Johnsonís arguments was that a "national solution" to carbon dioxide emissions was preferable to a "confusing patchwork of state rules." A national solution is precisely what the administration has refused to offer. And the California rule -- once in force there and in 17 other states -- would in fact constitute a uniform standard covering nearly half the car market. That is why the automakers lobbied so fiercely against it.
Apparently a patchwork isn't a patchwork if one material makes up almost half the quilt, and Bush's executive order doesn't constitute a national solution. (Admittedly, not a good national solution, but it is something.) It was all the more strange to realize that someone on the editorial board had to have vetted an article that ran the next day, with this statement:
But even though the energy bill has not changed the direction of lighting research, most manufacturers are relieved to have a federal standard in place.
"If each state passed its own rules for light bulb efficiency, we'd have to make 50 different types," Mr. Jerabek said. "Now we can all standardize our production techniques."

Fifty laboratories that may have higher standards than the federal floor are well and good when it comes to state constitutions' protection of nude dancing/ live sex acts, but they are more complicated when it comes to environmental regulations. The higher state standards absolutely should be respected when they existed before there was a federal one, such as California's standards on emissions that were grandfathered after the Clean Air Act. And there are sound arguments to make on the states' behalf in their standoff with the EPA, but an editorial that doesn't address the opposing argument, especially one being raised in an article that probably was being researched while the editorial was written, is a poor one.

Then on Monday, the Times editorial board complained that doctors recognized their high professional standards but refused to abide by them: "A new, worrisome survey raises doubts about physiciansí willingness to meet their medical and societal responsibilities." Toward the end, the editorial acknowledged, "To their credit, fewer than 1 percent of the doctors said they had lied to a patient in the last three years, and three-quarters reported delivering free care to patients who couldn't pay."

Yet in a Monday article about the truly wretched level of dental health in Kentucky, there was no mention of the perhaps relevant fact that the dental profession does not hold itself to any ethical obligation to provide free services to the needy. The article quotes extensively one dental practitioner who does volunteer, but he seems likely to be exceptional not only for having given his own money to outfit a mobile clinic, but for providing free dental services at all. The American Dental Association, unlike the AMA and ABA, has absolutely no suggestion in its code of ethics that dentists have any professional obligation to provide pro bono services to the needy.

I'm not saying that the editorial side should be interfering with the news side. Quite the opposite: I wish the editors gave an appearance of being as educated by their own paper's news as I am. Reading the article gave rise to the following conversation between a law student (me) and a medical student:

AIM Conversation: A Profession Without Pro Bono

PG: Did you know that 1 in 10 people in Kentucky are missing all their teeth? "'Under Medicaid,' Dr. Smith said, 'the only choice a person with a severe infection has is to have the tooth pulled, even if she's 25 years old and the tooth is right in the middle of her face.' He added that the program does not pay for root canals or dentures, though it does help pay for a liquid diet for those without teeth.'

Med: Yeah, that's why dentists are rich, because there's no 'social conscience' to make them see patients who can't afford them. Good luck getting a dentist at Ben Taub. The UT dental students don't rotate at any public hospitals.

PG: Really? That's messed up, considering that they are a profession. They're protected in most states from other people's practice of dentistry. Kentucky doesn't let non-dentists make and fit dentures, for example. I think that if there is a profession, there is a professional obligation to provide free assistance, because by definition there isn't a free market in the service so some people will be priced out. That's why I like the law firms that provide just normal 'storefront' legal advice for their pro bono, and pretty much every fundraiser in law schools and among lawyers is for Legal Aid and other pro bono groups. It's almost socially required among lawyers to feel guilty if you don't either donate to a pro bono organization or engage in pro bono, even if you do other kinds of charity stuff, because you're making your money partly off the fact that it's a profession.

Med: Yeah it's pretty messed up. It's part of the professional culture of dentistry. That's why half the doctors i knew before starting med school told me i should apply to dentistry instead, because there'd be no impetus to take Medicare and such. You don't have to deal with insurance. Most people don't have dental insurance, so you can run a mostly cash business. That's why it's important to have it be part of the profession's code of ethics. Dentistry seems to be more focused on how to make sure you make it in the "real world," probably because most dentists are still in private individual or group practice. They have 4th year seminars where they have to create a business plan and run a fake practice. It's good because they have a lot more business savvy than most med students do. I think most med students just assume the money will come up somewhere. I guess you can blame part of it on a general feeling that "oral health" isn't that important. It's rarely ever "life threatening." That's the people who end up going into dentistry -- a lot of med school rejects and people who wanted to do something health-oriented but didn't want to spend years at the low end of the income totem pole and fighting with insurance companies.

PG: That explains why there isn't health insurance coverage for it, but that doesn't explain the attitude in the profession. It looks like instead of a normal pro bono, the ADA has Give Kids a Smile Day.

A one-day event like Give Kids A Smile isnít a cure-all; itís a wake-up call. People shouldnít have to depend on charity for basic dental care. Itís time for politicians, parents and others who care to work together toward a solution. Give Kids A Smile is meant to accomplish two things, help children get the dental care they so desperately need AND raise awareness that our children deserve a better health care system that addresses their dental health needs.
We need to educate policymakers and parents that good oral health is integral to overall health. We need commonsense, market-based solutions and other reforms that will encourage more dentists to participate in public health insurance programs.
Please update your program's statistics. We will share our national grand total with legislators and other policymakers.
Lawyers aren't militating for the government to be required to provide everyone with an attorney for non-criminal matters (well, very few lawyers are; the ABA isn't pushing that). But there's still at least a hypocrisy in the profession. We at least mouth the words that everyone should have access to legal services. Maybe dentists are just less hypocritical than lawyers.

Med: Perhaps. That's sad to hear about the dental health in Kentucky. I have heard numerous stories from all over about people just having teeth pulled out whenever they have dental issues.

PG: There definitely is a problem in how Medicaid is set up if it will pay for a liquid diet but not a root canal. That's moronic. Talk about penny wise and pound foolish.

December 27, 2007 07:14 PM | TrackBack
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