Deadly Denial of Dental Care

It is hard to make the travesty of 12-year-old Deamonte Driver’s death more plain than reporter Mary Otto did in Wednesday’s story about him [1] in The Washington Post:

Twelve-year-old Deamonte Driver died of a toothache Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

If his family had not lost its Medicaid.

If Medicaid dentists weren't so hard to find.

Deamonte Driver had a toothache that led to an infection that spread to his brain. A long, $200,000 hospital stay couldn't save his life.

Deamonte's family lives in Prince George’s County, Maryland, within about a half-hour’s drive from the U.S. Capitol. In the Capitol, the conversation about universal health care coverage is dominated by why it can’t happen — it’s wrong to get the government too involved; we can’t buck the powerful insurance and pharmaceutical companies; we can’t raise taxes to cover the costs, even if those taxes would mean more efficiency and, most importantly, better health.

Those of you who believe that universal health care is either a political pipe dream or some crazed socialist idea that is best used as a talking point to bludgeon a Democratic candidate during an election campaign, please step up and explain why Alyce Driver should lose her son because of the lack of it.

Of course, it is not just the Driver family who finds that a trip through the trapdoor-riddled health care maze constructed for low-income people can be fatal. The Institute of Medicine said, based on a 2002 study [2], that roughly 18,000 people in the United States die each year because of a lack of health insurance. When that report was released, Mary Sue Coleman, co-chair of the committee that wrote the report, was quoted in a statement as saying, “Because we don't see many people dying in the streets in this country, we assume that the uninsured manage to get the care they need, but the evidence refutes that assumption."

Alyce Driver is a working mother, but her low-wage jobs did not provide health insurance. Her children were eligible for Medicaid, but dental care under Medicaid, as the Post story documents, is particularly problematic. Fewer than one in three children enrolled in Medicaid receive preventative dental care in Maryland, and only 900 of the state’s 5,500 dentists accept Medicaid because of the low reimbursement rates. But Maryland children are better off than those in Virginia, where only one in four Medicaid children receive preventative dental care.

Compounding the problem was that Driver lost her Medicaid coverage during a period when she had to stay in a homeless shelter. She apparently missed some paperwork that had been sent to her. Deborah Weinstein, executive director of the Coalition on Human Needs, said that people losing their coverage as they slip in or out of homelessness is not uncommon.

“Dental coverage is required of children who are in Medicaid. But you read in that article the many ways that does not happen,” Weinstein said.

"Unfortunately, this story is poignant illustration of the inadequacy of our current child health insurance system," said Casey Aden-Wansbury of the Children's Defense Fund. "That Deamonte and his brother went untreated for dental problems for such a long period of time because they could not find a provider willing to serve them is morally intolerable in this country—the richest in the world."

The Children's Defense Fund has a legislative proposal [3] for a health insurance system that ensures that all eligible children will not only be automatically enrolled but also retain coverage by eliminating pervasive existing bureaucratic barriers that too often deny health coverage to children when they need it most, as happened to Deamonte. The organization is also seeking an increase in reimbursement rates for dentists and other child health providers to ensure all children timely access to all medically necessary care, including early dental prevention, screening, diagnostic and treatment services.  

Getting Congress to focus on the dental care problem faced by the Driver family is difficult, Weinstein said, because “the trouble is, there are multiple problems and they all need fixing.”

“Of course, we need a much more comprehensive solution,” she said.

That would be a solution that doesn’t deny working mothers like Alyce Driver a chance to give her son $80 worth of dental care that would have saved his life.