The Health Care Reckoning Roaring Toward Us
Photo: Denis Vermenko/Getty Images

The Health Care Reckoning Roaring Toward Us

Sometimes, a toothache is more than a toothache — it’s a…

It was a pain like nothing I’d ever felt. The type of pain you don’t wish on your worst enemy — so severe it caused me to hunch over, eyes watering, as it shot from my tooth through my left cheek and into my head.

At the beginning of the week, I had noticed a slight discomfort on the left side of my mouth, but dismissed it. By Wednesday, the discomfort became more noticeable, but I shrugged it off — I had had my annual cleaning in August, and walked out with a sparkling smile and no cavities — then popped a couple of Advil and continued about my day.

After a night spent tossing and turning, I woke up with the intention of calling my dentist for an appointment, only for an overpacked schedule to interfere. But a little after 8 p.m. that night, while watching the dueling town halls of Biden and Trump, I let out a sudden scream — not out of frustration with the lies of President Trump, but at the excruciating pain. In a flash, the discomfort I had been feeling went from manageable to I might not make it.

I couldn’t even think about my tooth — partially because of the extra dose of anesthesia I’d gotten, but mostly because I thought about the many Americans that don’t enjoy the privilege of insurance, health care, and finances to address something as simple as a toothache.

I called my dentist immediately. She asked me a series of questions, then had me shine a flashlight in my mouth over Whatsapp video — telemedicine at its finest. She thought I might have a fracture in my tooth, and located an emergency dental surgeon in New York City; by the time we were off the phone, I had an appointment at 8:30 the next morning.

When I arrived at the surgeon’s office, the first test wasn’t an examination of my tooth, but rather if I could provide my insurance information. One numbing agent later, the doctor determined the cause and course of action, then said someone would be right with me to discuss the treatment plan. Given that I’d already given them my insurance information, I thought that was odd — but a few moments later, an administrator in business attire sat down next to me and proceeded to inform me both of the (astronomical) cost of the procedure and the fact that the surgeon is cash only.


There was no choice. The pain was too unbearable to shop around for a surgeon who accepts insurance; I needed the procedure to happen immediately. The administrator came back with a wireless card reader, inserted my card for payment, asked if I wanted the receipt printed or emailed, and gave me the “have a nice day” smile. The surgeon and dental assistant were back within a minute, ready to get to work. It felt cold, transactional, indecent. It felt un-American.

As I was returning home, my heart felt heavy. I couldn’t even think about my tooth — partially because of the extra dose of anesthesia I’d gotten, but mostly because I thought about the many Americans that don’t enjoy the privilege of insurance, health care, and finances to address something as simple as a toothache. Over the past 24 hours, I had bought multiple tubes of tooth gel, mouthwash, a large bottle of Advil; I had secured access to my dentist at night; she had made a telemedicine assessment and vetted a qualified dental surgeon; I had walked into their office fully insured; and I had paid for the procedure in full, knowing it would not affect my ability to put food on the table or keep a roof over my head.

This is not the case for every American. And it should be. No American should have to deal with that type of pain while negotiating the cost of treatment. Privilege shouldn’t enter into this at all. Health care should be a right.

According to the American Dental Association (ADA), dental problems accounted for 2.1 million emergency room visits in 2010. The majority of these cases could have been prevented easily with routine dental care and dental hygiene. This is the case for most dental decay. Roughly 74 million Americans have no dental coverage — that’s 23% of the population, nearly double the number of those who lack health insurance. Even if you have employer-provided plans, dental care can still be unaffordable. When left unaddressed, dental problems can become incredibly serious, and even lead to cardiovascular disease, some types of cancer, pneumonia, dementia and Alzheimer’s, and birth complications.

Those who suffer from extreme dental pain can go to the emergency room, but they likely won’t be able to receive dental care there beyond being given pain relievers. According to the ADA, ER visits on average are three times more expensive than dental visits — and their failure to address the underlying cause leads to many return visits. Making matters worse, dentists are not required by law to provide service to the uninsured the way an emergency room is.

The result can be tragic. In 2007, 12-year-old Deamonte Driver died after complications from a tooth abscess. His mother, Alyce, had searched for a dentist to treat Deamonte’s toothache who would accept Medicaid, but she was unsuccessful. Ultimately, Alyce took Deamonte to a hospital emergency room, where he was given medicine for a headache, sinusitis, and a dental abscess before being sent home. But his condition soon took a turn for the worse, and a second ER visit led to the discovery that bacteria from his abscessed tooth had spread to his brain. Two operations and eight weeks of additional care and therapy followed, but it was all too late. Despite $250,000 worth of intervention, Deamonte died — when his life could have been saved by a routine dental visit and an $80 tooth extraction.

In 2010, the Affordable Care Act (ACA) required that all insurance plans offered through new health insurance exchanges starting in 2014 include oral care for children, and prohibited these insurers from charging out-of-pocket expenses for preventive pediatric oral health services. These new requirements alone will give millions of children financial access to dental health services — many for the first time. Yet, dental care for adults is still not an essential health benefit under the ACA. In Medicaid, depending on the state, it can be optional or piecemeal. Medicare does not cover routine dental care.

In June 2020, the Trump administration asked the Supreme Court to overturn the ACA. If successful, this lawsuit would permanently end the ACA. Republican officials in 18 states, including Texas, are working with the Trump administration in this lawsuit. The case will be heard on November 10 — one week after the general election. If the ACA is abolished, 23 million people in the U.S. will lose their health care entirely. 130 million Americans with preexisting conditions will lose their ACA protections. And so will their children.

So consider the choice you’re making on November 3. Do you want $80 to be the difference between life and death?