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Letters to the Editor
Communications to ñLetters to the Editorî are the opinions solely of the writers and do not necessarily reflect the views of Northwest Dentistry, the Minnesota Dental Association, the Publications Committee, or Northwest Dentistry editorial staff. Letters will be accepted by e-mail at info@mndental.org
July, 2003
To the Editors,
As I paged through the recent May-June issue of Northwest Dentistry, I received a small burn on my index finger as it touched page four, Dr. Kim HarmsÍ letter to the editor. She obviously feels very strongly about matters with third-party payers, the Attorney GeneralÍs office and dentists.
I felt a rising indignation for third-party payers as she described the ñinterferingî and ñintimidatingî tactics by the third parties. I also felt some anxiety that I may be the next to be singled out. As I read further, Dr. Harms explained that the controversy in question was that ñIn most cases, the dentistsÍ interpretations involved some disputes regarding contract languageî with the third party. At that point, I was at a loss to understand the nature of the dispute in question, as I had not seen the contract between the dentists and the third party. My blood pressure returned to normal as I realized this matter did not affect me.
As I finished her letter, I was struck by her last statement that ñIf we [as an organization] donÍt stand up to injustice when we see it happening, we are just as guilty as the perpetrators.î I certainly concur with that statement.
Two issues of injustice occurred to me immediately. The first injustice is the provider tax. Dr. Harms offered a solution to the provider tax dilemma by placing the onus on the insurance companies to pay the tax. All this does is shift the injustice. If the insurance company pays the tax, that becomes a cost to them which is passed on to the consumer. Taxing sick people who seek health care is the real injustice. We must work to right this wrong. The second injustice is the practice by dentists who give a discount to patients based solely upon which insurance company covers them with an absence of any socially redeeming value. (A socially redeeming value could be: giving a discount to Medical Assistance patients because they cannot afford the full fee.) I believe this practice is unfair to our patients and unethical. In the first injustice, if we are not standing up to eliminate the tax, we are as guilty as the state of Minnesota. In the second injustice, we are the perpetrators.
My last comment has to do with third party ñinterference.î As someone who is ñon the outside looking in,î it seems that the use of the word ñinterferenceî is inaccurate. According to the MDA legal counsel, a major third-party payer has a contract where the dentist must follow the rules and regulations of that third-party payer. Further, many of those rules and regulations may be changed at any time with short notice or sometimes no notice. So, when there is a dispute about the interpretation of CDT codes, the third-party payer has the right to change that rule or regulation.
How can we as members of the MDA expect our officers and legal counsel to negotiate with a third-party payer when individual dentists have signed a contract with that third-party payer? Unless there is a clear case of a law being broken, we, as a group, cannot keep the third-party payer from ñinterferingî with the practice of a dentist who has signed a contract with that third-party payer.
Dr. Harms asks rhetorically, ñWhat could I as an individual dentist do to stop such practices when the odds seem stacked up against us?î The odds ARE stacked up against US. With the existence of anti-trust laws and signed contracts between individual dentists and third-party payers, we have little to no leverage to make any substantive changes to the present situation. We can offer each other a sympathetic ear, intellectual support and even monetary support. The only real power we have is as individuals. Although trite, the 10 tiny words of power are engraved on the sword of truth: ñIf it is to be, it is up to me.î
Sincerely,
Frederick W. Nolting, D.D.S.
111 Frontage Road NE
Byron, MN 55920
June 18, 2003
To the Editors,
Many years ago when I served on the Executive Council of the Saint Paul District Dental Society, I coined a monthly commentary for the DistrictÍs newsletter. It was called ñDoctor, Heal Thyself.î The commentary sought to make us look at ourselves much as the public might view us.
This astute critique was eventually deep-sixed, most likely, I suspect, because some of us did not like to be criticized. DHT has basically remained dormant for more than two decades. Well, my friends, the time for ñDoctor, Heal Thyselfî to bare its harsh breath has come again. This time I would to talk about the so-called ñsick taxî.
The words ñsick taxî really offend me. This particular description does not conjure up emotions of being unfair or even the anguish of making those who are already burdened having to pay out more. The words fall short of suggesting the frustration of having a few assume responsibility for an alleged health care entitlement. The words ñsick taxî actually make me want to avoid looking at the problem altogether. They make me feel like I want ñitî to go away, like a bad cold that is constantly annoying me.
I think we should address this particular tax for what it is and stop worrying about it. Legislators and their constituents created the tax, not health care providers. State law mandates that third parties pay the tax when itemized, and if anything, thatÍs what the MDA should focus on. Do retailers worry about the amount of sales tax they must collect and send to the state? No! Why then should dentists waste time worrying about a tax on health care?
For many years the MDA spent a lot of money fighting with the city of Brainerd over fluoridating their city water supply. When the MDA finally made a decision to stop arguing, the city of Brainerd then began fluoridating their water, simply because they knew it was best to do so.
I think we should call a spade a spade. We should call the ñsick taxî what it really is, a health care tax, and let it go at that. Sooner or later the Minnesota tax payers, and their representatives, will figure out the health care tax is their problem and act accordingly.
Sincerely,
Lloyd A. Wallin, D.D.S.
50 McAndrews Road East
Burnsville, MN 55337-8331
Copyright 2003. Minnesota Dental Association
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