Paul's Internet Landfill/ 2013/ Dentistry Supply

Dentistry Supply

It is no surprise that my workplace (aka the cult) takes on a large number of projects. Some of these projects are successful and some flop. Some have little apparent relationship to employment counselling. Some of the projects I like, others I tolerate, and some I don't like much at all.

There are rumours (still not publicly announced, but which I believe are pretty solid) that the cult is opening a dental clinic. Dental hygienists and dentists will offer their services to low-income patients (hopefully at affordable rates). From my professional perspective this project could be a real headache; such projects come with technological challenges, and anything involving healthcare adds additional layers of rules and bureaucracy. But from my personal perspective this project really appeals to me.

Dental problems are a huge factor in people's ill-health. The food at St John's Kitchen has to be uniformly soft, because too many people who eat at the Kitchen cannot chew hard food. For some reason tooth health is different from other medical health, so dentistry is not covered under OHIP. Dental cleanings and dental work are expensive so people go without, which means their teeth deteriorate. Then they live in constant pain that makes it hard to focus on anything else. As someone who deals with mild but chronic dental pain, I can assert that bad teeth make a big difference in one's ability to get things done.

Teeth also have social implications. People with bad teeth are much more likely to face discrimination, because we associate bad teeth with hicks and rednecks. Those who advocate poor people just "get a job" or "pull themselves up by their bootstraps" often fail to take this form of systemic discrimination into account, and fail to see that the large capital costs it takes to fix one's teeth keep people in poverty.

In this sense, a dental clinic would be super-exciting. I do not expect that such a clinic would carry out every expensive procedure for free, but even addressing basic operations that reduce tooth pain would help a lot.

However, I also feel many frustrations around this. First of all, I have little sense of how this initiative will be funded. Maybe the participating dentists and dental hygienists will help keep the place running. There is a chance that some bureaucracy will understand just how acute this problem is, but I do not have high hopes for this; dental care tends to fall through funding cracks.

But the aspect that really breaks my brain is the issue of supply and demand. I have begun to think that having poor people suffer dental pain is the price we pay to have widely available dental care for people with money, and that drives me nuts. If true, it would show our vaunted socialized health care is a sham.

Here is the observation: health care is funded inconsistently. Many things -- doctors, surgery -- are funded by OHIP, so in principle they are accessible to all Ontarians. In practice, there is a scarcity of doctors, so many poor people (such as people who go to St John's Kitchen) do not get good health care access (which is why other projects such as the cult's Psychiatric Outreach Project and the non-cult Kitchener Downtown Community Health Centre are so valuable). Meanwhile, the rest of us with money also face scarcity and delays, although many of us end up with adequate health care.

Contrast this to those medical disciplines which are not well-covered by OHIP: dentistry, most optometry, and a few others. Maybe it is no surprise that we are awash in optometrists in this area: the University of Waterloo does have a School of Optometry. But (to my knowledge) there is no dental school nearby, and yet there is no shortage of dentists. Finding a dentist who will care for you is no problem, if you have money. But dental care is largely inaccessible to those without money, other than through band-aid programs like the Ontario Works emergency dental funding, the Healthy Smiles Ontario program, and this proposed dental clinic.

There is an argument (which as a bleeding-heart brainless left-winger I am not permitted to believe) that people with money are significantly better off with unfunded dental care, because they can access dental services easily. Meanwhile, poor people are not that much worse off, because some significant fraction of the poor already has problems accessing conventional medical care, and therefore would not be much better off if dental care was socialized. I think that this argument does not hold water even for those who are not bleeding-heart brainless left-wingers, because the quality of life for the poor is better off with some health care rather than no health care. But if you are willing to throw the poor under the bus (which will be increasingly the case as health care costs spiral out of control) then this argument gets more attractive. As long as you personally have sufficient funds to pay for medical treatment and dental care, then why would you care that others do not?

The other aspect of this dental clinic that bugs me is that -- just like food banks and soup kitchens -- it will become institutionalized, and we will see it as an inevitable intervention in taking care of the poor. There are two things that bug me about this. Firstly, it is becoming trendy to think that we should do away with all of these expensive social services and just give poor people money directly. Secondly, if we accept this as an inevitable institutionalized intervention, then why should it be funded through voluntary (and undependable) charitable contributions? Many programs for the poor (Out of the Cold, St John's Kitchen, and others) are funded this way. I sincerely cannot decide whether this unstable funding is a feature or a bug, but it means that when economic times get tough then life for these programs gets even more precarious, which is bad news for those who have become dependent on them.

Are these services essential or not? If they are essential, should we fund them through taxes? Or is it better for this patchwork of supports to take the burden? I don't know.