“Health care providers have become agents for financing.” Back in 2010, Andrew Cuomo, then New York State Attorney General, announced that his office was opening an investigation into health care credit cards. By the time Cuomo appears in a news clip, about halfway through the new Frontline episode, Dollars and Dentists, his point is past obvious. What’s to be done about the problem is less clear. Correspondent Mile O’Brien here focuses on dental care. More than 100 million Americans don’t receive regular—or even intermittent—care because they can’t afford it, having no dental care insurance, a number that includes some 19 million children. When patients become desperate and do seek care, they’re usually relying on Medicaid, a payment source too frequently not accepted by dentists because it is reimbursed at something like 20% of costs. Increasingly, the widening void between no care and urgent care is filled by corporate dental chains, financed by private equity. And increasingly, O’Brien reports, chains like Kool Smiles or Aspen Dental, find ways to profit.
It’s a nightmarish situation, combining the chaos of uninsured health care and the horrors—fictional or not—of visiting the dentist. Sometimes, the process involves over-treating,” fitting children with stainless steel crowns rather than fillings (which can cost some 50% less). Other times, it has to do with how the company is paid. The system works something like the for-profit higher education industry investigated in Frontline: College, Inc., which is to say, the company sells not only the product—the crowns, the dentures or the degree—but also the financing, through credit cards charging frightening interest rates, rates that begin accruing as soon as you sign for the card, that is, before the work is even scheduled. O’Brien speaks with former office managers who reveal that dentists and other personnel are paid bonuses. When he asks Polly Buckley, the spokesperson for Kool Smiles, and Bob Fontana, Aspen’s CEO, both insist their businesses are focused on patients’ welfare, providing services otherwise unavailable. This just before or after the Frontline camera follows a patient into a manager’s office, where he or she is urged to sign up for a formidable financing “package.” At tis point, though, as O’Brien hears from an uninsured truck driver who hasn’t seen a dentist for 10 years, his pain is such that he’ll do “just about anything” to have his teeth removed.