The New York Times ran an eye-opening feature on dental care in Kentucky, the state with the worst incidence of toothlessness in the nation. Smoking, chewing tobacco, and even methamphetamine use are high in Kentucky, and these lead to loss of teeth. This causes a downward spiral of quality of life: “Try finding work when you’re in your 30s or 40s and you’re missing front teeth”. Also, if you can't chew, your diet is limited and you can end up suffering malnutrition.

This being the New York Times, of course, the reporter points an accusatory finger at Medicare, which does not pay for dental care. Well, Medicare's not going to address the dental care of working-age people, because it's for seniors. What about Medicaid, which is supposed to be the safety net for low-income citizens? Forget about it!

Even after the state raised fees for children's dental care by about 30 percent, fewer than one quarter of the state's dentists take Medicaid patients, so low are the rates. Furthermore, under Medicaid, the only choice a person with a severe infection has is to have the tooth pulled, even if she’s 25 years old and the tooth is right in the middle of her face. It does not pay for root canals or dentures, though it does help pay for a liquid diet for those without teeth.

On the other hand, a dedicated dentist, Dr. Edwin E. Smith, has invested $150,000 of his own money in a mobile dental clinic that he takes to Kentucky's poorest areas, giving free dental care to those who would never otherwise see a dentist or dental hygienist.

A colleague and I recently wrote about how the massive growth of the American welfare state had reduced our ability to support our distressed citizens voluntarily. Those who think that relentlessly throwing more money at government programs like Medicaid or SCHIP will improve the lives of our most disadvantaged citizens ignore and disrespect the civic commitment of health professionals like Dr. Smith.

Merry Christmas!