Ceci n’est pas un blog

The idea of expanding Medicare to cover everyone is apparently so scary that the Senate Finance Committee is afraid to even let it be DISCUSSED at round tables on health care reform.

Alerted by an email from the good folks at Physicians for a National Health Plan, I just called Senator Schumer to urge him to invite a single payer advocate to participate in the upcoming May 5 and May 14 Senate Finance Committee roundtable discussions on healthcare reform scheduled to take place in Washington, D.C.

Dear Senator Schumer,

A majority of Americans know that a Medicare-like program available to all and a vastly reduced role for insurance companies is the only way to control costs and provide decent care to all Americans. Allowing the insurance and pharmaceutical lobbies to control the debate* is simply shameful. Please commit to including proponents of single-payer universal health care fully in the May 5 and 14 roundtables and in ALL deliberations about health care reform.

Please act with courage and honesty on behalf of your constituents, not corporate interests.Thank you.

*Insurance companies contributed $46 million in political contributions in 2008; pharmaceuticals a mere $28 million. PNHP’s income (as reported on 2007 990)? $153,000. Not my definition of a fair fight.

Health Care Crisis
When Walgreens becomes your doctor’s office.

Uploaded on September 24, 2008
by quinn.anya

Had the implant removal done on July 3, just before leaving on vacation. Another medieval procedure, removing something that was meant never to be removed. The implant is screwed into bone, which grows around it, so taking it out meant lots of novocaine followed by well over an hour of drilling around and around it then occasionally torquing it with various wrenches and all of my dentist’s body weight. My dentist was frustrated, his technician desperately wanted to go home, I was aching from keeping my mouth open. Did I mention that my 4:30 appointment didn’t start till after 6 because he had an emergency case? When he finally dropped the bloody quarter-inch chunk of metal into a pan close to 8 pm, we were all exhausted.

A lovely bruise surfaced on my chin a day or two later and my jaw was sore for days, but now it’s 3 weeks later, my stitches are out and apparently things are healing nicely. So in a mere 6 months, the bone grafting should have done its thing and he can put a new and better screw back in my jaw. Oh joy.

Gummy Teeth by rachel is coconut&lime via Flickr.

Taking advantage of the best dental insurance I’ll ever have, I’ve agreed to let my Boston periodontist remove and re-do the implant that was under the crown. He didn’t approve of the work of EITHER of my NYC dentists. The implant is too low, not straight, too small. This means 9 more months of a hole in my mouth. Sure hope this one comes with a lifetime guarantee.

I understand the issues of interoperability in the world of technology a little (as with so many technological issues, my colleagues at Berkman have written extensively about it), but I now know they exist in the rest of the world too. For example, dentistry. Because of a lack of dental interoperability, I spent nearly 90 minutes of my sunny Saturday morning with a frustrated dentist drilling more or less continuously (with bit after different bit) at a single tooth implant that I had paid two highly qualified dentists obscene amounts of money to install in my mouth a couple short years ago.

The crown, which in this case means not a cap on a tooth but an entire artificial molar, replacing a tooth that had been pulled, was badly fitted you see, leaving a teensy-tiny little gap between it and the gum that food could get caught in, very frequently annoying and occasionally causing my gum to get all infected and puffed up and tender. This was done by a dentist in the West Village of Manhattan I loved and had been going to for almost a decade. Referred by a friend whom I know to be appropriately elitist and fussy about medical care. A dentist who I still believe to be very good at what he does, honest, etc. And of course expensive. So why did he do me so wrong?

Here’s how it all happened. I had a tooth crisis, an old root canal gave up the ghost, tooth definitely had to go, called my downtown dentist. He’s out because he only works 3 days a week, has a pager number. I scribble it down, dial it, it doesn’t anwer (or it does but he never returns the call, I don’t remember). Panicked, I call another friend who has (by marriage in this case, but no matter) equally discerning taste in medical professionals (hers are all Upper East Side, which is now more convenient than the Village, as well as even snootier). She sends me to her periodontist, on Fifth Avenue. Floor to ceiling diplomas, photos from her exotic vacations, supersmart, funny, specializes in single tooth implants. Great. She has me to a surgeon to get the tooth out and then, after the bone recovers, does the surgical procedure of the implant, essentially installing a tiny esoteric bolt in my jawbone. So far, so good. She tells me she can refer me to “one of her guys” to do the crown part, that is, actually putting something I can chew with into this gaping hole. I say I’m going to ask my downtown dentist to do it. She says she doesn’t know him. I shrug. I know him. That’s enough for me.

So I go back downtown. My dentist says he would have sent me to his periodontist (turns out I mistranscribed his pager number by one digit). He takes a look at what uptown dentist has installed. Doesn’t recognize it. Complicated negotiation where I get her office to send his office the part number (in hindsight, this should have been the tipoff! Run away!) He’s never worked with this manufacturer. But no matter, he’s confident, apologetic about the time it’s added (I have to come back after he’s gotten the info and ordered the parts), forges ahead, takes an impression, makes me a new tooth, and glues it into my mouth as if forever.

Some time later, I go back to uptown dentist to discuss another implant I need (the same molar on the other side, root canal from the same time 20 years ago has also died, she’s pulled it), she looks at downtown dentist’s crown and is horrified. It’s a disaster. It’s not seated properly, it’s got a gap, it’s a terrible texture, she can’t believe it doesn’t bother me, etc. I should insist he redoes it. Of course, she’s not going to call and tell him all this. Some professional etiquette. But I should.

Next time I see downtown man for cleaning, I gently suggest that food does get trapped under the crown. He looks at it, says oh no it’s fine. I don’t push it.

I move to Boston, get a new job with even better dental insurance, decide to get this nonsense sorted. Get a recommendation for a super-duper periodontist, right downtown (this time I don’t even care how expensive, I never see the bills, thank you Harvard thank you so much). He xrays, pokes, says wow that’s a disaster. The crown (downtown guy) doesn’t fit and the implant itself (uptown gal) is really strangely done, he doesn’t approve at all. They’re BOTH wrong; where did I find these people? Recommends at least replacing crown, possibly re-doing implant. His colleage the prosthetics guy can remove the crown. He looks at it, doesn’t recognize the type of implant, I have to have the uptown dentist’s office send the parts info (I’m old enough to like private, but I find it nuts that I can’t authorize one doc to ask another for my records, I have to do it myself).

Anyway, eventually (last Saturday) I’m in with the “mechanics” guy, and he pulls and drills and wiggles and drills and swears and drills and drills and drills and twists and drills and twists some more and finally cuts the damn multi-thousand dollar profanation out of my mouth, leaving a deep well in my jaw with a tiny metal bolt sticking out of it. I insist on keeping the burnt and mangled tooth as a souvenir.

Next week the periodontist will look at the hole and decide if the implant is ok enough to re-use, whether he needs to add some bone grafting to make it better, or whether it needs to be re-done too.

I actually believe all four of these folks (downtown NYC dentist, uptown NYC periodontist, Boston periodontist and Boston prosthedontist if that’s the right word) are tops in their field. I am sure that if I went to my downtown dentist’s periodontist, he would have put a perfect crown on top of that familiar implant. OR that if I had gone to my uptown periodontist’s crown guy, he would have done a fine job with her implant. But working with unfamiliar parts, it just didn’t happen. And it turns out neither one of them was right according to my Boston guy.

Anyway, I’m inside one shop now, really hoping I can get back to a full set of teeth while I have this insurance.

Sent today to Boston Globe letters editor, all the democratic candidates, and the DNC:

Boston Globe Columnist Derrick Jackson got it exactly right (”Kucinich is right on healthcare“): the other candidates are lying when they say they will provide affordable health care for all. As Mass-Care director Benjamin Day’s op-ed the next day eloquently describes,   the touted Massachusetts reform is not working; like the proposals by every candidate but Kucinich, it never can. Reorganizing the cost and availability of a variety of health insurance plans is a shell game, a game the private insurance and pharmaceutical companies will always win. Only a single-payer non-profit system can get affordable health care to everyone who needs it, regardless of their income, employment, age, or past or current illnesses. 

Everyone who wants fairer and more efficient health care should demand that ALL the democratic Presidential candidates together with party leadership get with the program. They should jointly and publicly pledge: the Democratic presidential nominee, whoever she or he is, will making passing HR   676, the single payer health insurance bill, the administration’s first priority. They will lose the financial backing of the insurance and pharmaceutical lobbies of course, but they’ll gain the gratitude of the majority of the people they say they want to serve.