Take Maine state Rep. Richard Malaby (R-District 136), who sponsored a bill in 2014 to let mid-level dental professionals--known as dental therapists--provide additional care for the state's poor, rural areas. Though the bill eventually passed, the legislative battle was surprisingly brutal. A group of local dentists stopped using Malaby's 19th century inn for their annual Christmas parties. So many American Dental Association lobbyists descended on the Capitol that lawmakers started hanging signs declaring their offices "dental free zones." Legislators told the Post that they got an earful when they visited dentists for regular check-ups.
These battles will be brutal. The good news is that Malaby won.
Now the bad news:
But the dentists' lobby sees dental therapy as a threat to its control of the dental care market. So the Michigan Dental Association is fighting a dental therapy bill, despite the fact that more than 200 communities in Michigan lack access to basic dental care. In Texas, a trade group of dentists helped defeat a similar bill in 2015. The American Dental Association has spent millions of dollars trying to block those bills and others in Ohio, Massachusetts, and Kansas; it has also filed multiple lawsuits trying to stop an Alaska program.
One of the most disappointing aspects of the health care debate since I've been following it--which was in September 1982 when I became Marty Feldstein's health economist with the Council of Economics Advisers--is that well over 80% of the discussion has been about the demand side: insurance, tax policy for insurance, Medicare and Medicaid spending, etc. Little has been said about the supply side.
Yet there are huge gains to be had by deregulating the supply side. The legal changes to allow dental professionals to practice are one little step. Another step would be to let other health care professionals do surgeries, prescribe drugs, etc. When a contractor builds a house, he typically gets a plumber to do the plumbing. He doesn't require that the plumber have learned all about electrical work. But to be an M.D. and specialize in one kind of surgery, you have to train in a wide range of medical fields. It would be like requiring that everyone the contractor hires for specific tasks be trained in all those tasks. Virtually everyone can see the problem with that. The problem is not less bad in medical care simply because we're used to it.