00:00Thank you very much for your testimony and for your work.
00:03I think every one of the panelists
00:05has indicated that we have a serious dental crisis
00:08in America.
00:09You've all made the connection between dental health
00:11and physical health.
00:13So let me start off with a simple question.
00:17In the richest country in the history of the world,
00:21why are we experiencing the kind of dental crisis
00:25that we have, where tens and tens of millions of people
00:28can't afford to go to a dentist, can't find a dentist?
00:32Or if they do find a dentist, there
00:34are waiting lists for six months or a year.
00:39That's the crisis.
00:40How do we solve it?
00:40Dr. Simon?
00:42Dentistry has been separate from medicine
00:44since the first dental school was founded
00:46in Maryland in the 1840s.
00:48And since then, the separation of medicine and dentistry
00:51has spun off and continued to cause problems
00:53by the way it's upheld within our insurance structures,
00:56our education system, and the ways health care is delivered.
00:59When things are separate, it makes it harder
01:01to get through a second door.
01:02Americans already struggle to get health care
01:04in the first place.
01:05If we make it that they have to walk through one door
01:07and get to a smaller locked one, they
01:09are going to have a hard time moving in.
01:10So bottom line is dental care is health care
01:13should be available to all as a right.
01:15Dental care is health care, and health care is a human right.
01:17Dr. Mendenjordan, what's your thoughts?
01:20I think there's been a lack of recognition of the cost
01:23savings that we could have if we were
01:26able to integrate oral health and medical.
01:28And I certainly agree with Dr. Simon.
01:30We know, again, that periodontal treatment
01:32for people with diabetes has been shown
01:34to reduce overall health costs.
01:35And Medicare, we know that there's a potential
01:37to save up to $14 billion annually
01:40by providing appropriate oral health
01:42care with people with diabetes.
01:43With heart disease, we could save almost $30 million.
01:45Let me jump in.
01:46We've heard this story 1,000 times.
01:48That's correct.
01:49What did you say, Senator Cassidy?
01:51An ounce of prevention?
01:54All right.
01:55We hear this over and over again.
01:56We're pretty good at spending zillions of dollars
01:58treating people on death's door, but we
02:01don't prevent the cavities that little kids have.
02:05That's right.
02:05Dr. Swan?
02:07Well, I agree with the prevention issue.
02:12We also start looking at the fact
02:13that we have to train across disciplines.
02:16Everybody should know what the risk factors are.
02:18There should be no entity that's not advocating
02:21for healthy societies.
02:23So we need to put our money where our mouth is.
02:26Dr. Isbell?
02:28Senator, all I can tell you is what we do in our world.
02:32We have free clinics in our practice
02:34and have for many years.
02:35And now we have a free clinic in our town.
02:37We work with RAM.
02:38And I applaud Dr. Swan for his RAM program.
02:41We were there to take care of people.
02:42I'll tell you about a student that
02:46was going to nursing school.
02:47All of her front teeth were rotted out.
02:49She came and was concerned and whatever.
02:51So we rebuilt her mouth.
02:52We did it.
02:53She went to nursing school and is a successful practitioner
02:55today.
02:56We did it for her for nothing.
02:59And dentists do that all over the country.
03:01And you're not telling that story, Senator,
03:03because there are dentists that are out there
03:05that are helping people.
03:06And is there more?
03:08There's always more.
03:10I'm saying that there certainly are.
03:12And I thank you very much for what you do.
03:15And many dentists do it.
03:17We have a crisis.
03:19Millions of people cannot find a dentist,
03:21cannot afford dental care.
03:22I don't think that that is under debate.
03:26I think that's the reality.
03:28Let me ask all of you another question.
03:30And I was kind of shocked to learn this a few years ago.
03:34I talked to dentists who have graduated dental school,
03:38$300,000, $400,000 in debt.
03:41So we talk about not getting dentists out
03:43into rural areas, lower income areas,
03:45taught to make money in lower income areas.
03:48What does the cost of dental school and dental school debt
03:52impact where dentists go?
03:54Dr. Simon?
03:56The average dental school graduate
03:57graduates with almost $100,000 more debt
04:00than the average medical school graduate.
04:02Around $300,000, as you say.
04:04I think it absolutely influences where they practice.
04:08Okay.
04:09Yeah, Dr.
04:11I mean, I would agree with Dr. Simon.
04:13There is a crisis as to how we can afford education
04:16and the impact of the cost of education
04:18on the choices that professionals make
04:20when they go to provide care.
04:22It certainly impacts dentists
04:23and their ability to accept patients with Medicaid
04:26because of the low reimbursement rates,
04:27as well as the multifactorial costs
04:30that are inherent in having a dental practice.
04:32So part of what we have to address
04:34is the use of ancillary providers as well
04:36as a means of expanding access to care.
04:39Dr. Swan?
04:40I agree with the statements that have been made.
04:43NYU's tuition right now for four years is $700,000,
04:48whereas medical school tuition is zero
04:50because of some donation.
04:52So we see these students getting out.
04:54I have talked with a young doctor
04:55who's been practicing seven years.
04:56He's got $600,000 in debt.
04:59He's frustrated, doesn't know what to do.
05:01He can barely make it.
05:03So I think that's one issue.
05:05Another issue is putting more emphasis
05:06on reimbursement rates, especially around prevention.
05:10Good, Dr. Isbell?
05:11Yes, I agree with that statement, too.
05:14It's scary.
05:15The average right now, they say, is 262,000,
05:18but I know many students with much higher than that.
05:20So it's a challenging situation.
05:23Then where do they go?
05:24The big deal is to give them an opportunity
05:26into residencies, and if we could have some form,
05:30and there's legislation in front of you
05:31to possibly there could be just a halt on it.
05:34They're not asking for forgiveness.
05:37They're asking for just to be able to go to residency
05:40and train where they can have access
05:42to care and treat patients.
05:43And really, if we could develop programs
05:46to get our dentists into rural areas,
05:48I know in our state, that's something we've worked hard at,
05:51and we're having some success,
05:52but getting students from the beginning
05:54that are planning to go back into the rural areas
05:56to take, because our citizens deserve that, Senator.
05:59Well, let me just, my time has expired,
06:02but just, I would also think,
06:04not only if I graduated dental school
06:06with hundreds of thousands of dollars in debt,
06:08that's one thing, but if I'm a young person,
06:11a working class kid, thinking about going
06:13into dental school, do I really wanna go into a profession,
06:16we're gonna end up with three, four,
06:17$500,000 in debt?
06:18I suspect that's a deterrent
06:21for a lot of young people going to dental school.
06:23Is that right?
06:24But I'm seeing your heads being nodded here.
06:26Okay, my time has expired.
06:28Senator Cassidy.
06:29Thank you.
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