Eugenics on the QT

How else do you explain the practical effects of a health-care system that lets poor children die for want of a dentist who will deign to fix the teeth of . . . poor people.

And we thought Marie Antoinette was bad when she said "Let them eat cake" after being told the poor had no bread to eat.

Of course, letting the poor die ends up costing hundreds of times more than just getting on with it and fixing their damned teeth. That is, child's bad tooth abscesses, infection spreads to brain, child ultimately dies . . . but only after two emergency brain surgeries and a quarter-million-buck hospital bill that his momma sure as hell can't pay.

The Washington Post reports:

WASHINGTON - Twelve-year-old Deamonte Driver died of a toothache Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

If his family had not lost its Medicaid.

If Medicaid dentists weren't so hard to find.

If his mother hadn't been focused on getting a dentist for his brother, who had six rotted teeth.

By the time Deamonte's own aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, the Prince George's County boy died.

Deamonte's death and the ultimate cost of his care, which could total more than $250,000, underscore an often-overlooked concern in the debate over universal health coverage: dental care.

Some poor children have no dental coverage at all. Others travel three hours to find a dentist willing to take Medicaid patients and accept the incumbent paperwork. And some, including Deamonte's brother, get in for a tooth cleaning but have trouble securing an oral surgeon to fix deeper problems.

In spite of efforts to change the system, fewer than one in three children in Maryland's Medicaid program received any dental service at all in 2005, the latest year for which figures are available from the federal Centers for Medicare and Medicaid Services.

The figures were worse elsewhere in the region. In the District, 29.3 percent got treatment, and in Virginia, 24.3 percent were treated, although all three jurisdictions say they have done a better job reaching children in recent years.

"I certainly hope the state agencies responsible for making sure these children have dental care take note so that Deamonte didn't die in vain," said Laurie Norris, a lawyer for the Baltimore-based Public Justice Center who tried to help the Driver family. "They know there is a problem, and they have not devoted adequate resources to solving it."

Maryland officials emphasize that the delivery of basic care has improved greatly since 1997, when the state instituted a managed care program, and in 1998, when legislation that provided more money and set standards for access to dental care for poor children was enacted.

About 900 of the state's 5,500 dentists accept Medicaid patients, said Arthur Fridley, last year's president of the Maryland State Dental Association. Referring patients to specialists can be particularly difficult.

Fewer than 16 percent of Maryland's Medicaid children received restorative services -- such as filling cavities -- in 2005, the most recent year for which figures are available.

For families such as the Drivers, the systemic problems are compounded by personal obstacles: lack of transportation, bouts of homelessness, erratic telephone and mail service.

The Driver children have never received routine dental attention, said their mother, Alyce Driver. The bakery, construction and home health-care jobs she has held have not provided insurance. The children's Medicaid coverage had temporarily lapsed at the time Deamonte was hospitalized. And even with Medicaid's promise of dental care, the problem, she said, was finding it.

When Deamonte got sick, his mother had not realized that his tooth had been bothering him. Instead, she was focusing on his younger brother, 10-year-old DaShawn, who "complains about his teeth all the time," she said.

DaShawn saw a dentist a couple of years ago, but the dentist discontinued the treatments, she said, after the boy squirmed too much in the chair. Then the family went through a crisis and spent some time in an Adelphi homeless shelter. From there, three of Driver's sons went to stay with their grandparents in a two-bedroom mobile home in Clinton.

By September, several of DaShawn's teeth had become abscessed. Driver began making calls about the boy's coverage but grew frustrated. She turned to Norris, who was working with homeless families in Prince George's.

Norris and her staff also ran into barriers: They said they made more than two dozen calls before reaching an official at the Driver family's Medicaid provider and a state supervising nurse who helped them find a dentist.

On Oct. 5, DaShawn saw Arthur Fridley, who cleaned the boy's teeth, took an X-ray and referred him to an oral surgeon. But the surgeon could not see him until Nov. 21, and that would be only for a consultation. Driver said she learned that DaShawn would need six teeth extracted and made an appointment for the earliest date available: Jan. 16.

But she had to cancel after learning Jan. 8 that the children had lost their Medicaid coverage a month earlier. She suspects that the paperwork to confirm their eligibility was mailed to the shelter in Adelphi, where they no longer live.

It was on Jan. 11 that Deamonte came home from school complaining of a headache. At Southern Maryland Hospital Center, his mother said, he got medicine for a headache, sinusitis and a dental abscess. But the next day, he was much sicker.

Eventually, he was rushed to Children's Hospital, where he underwent emergency brain surgery. He began to have seizures and had a second operation. The problem tooth was extracted.

After more than two weeks of care at Children's Hospital, the Clinton seventh-grader began undergoing six weeks of additional medical treatment as well as physical and occupational therapy at another hospital. He seemed to be mending slowly, doing math problems and enjoying visits with his brothers and teachers from his school, the Foundation School in Largo.

On Saturday, their last day together, Deamonte refused to eat but otherwise appeared happy, his mother said. They played cards and watched a show on television, lying together in his hospital bed. But after she left him that evening, he called her.

"Make sure you pray before you go to sleep," he told her.

The next morning at about 6, she got another call, this time from the boy's grandmother. Deamonte was unresponsive. She rushed back to the hospital.

"When I got there, my baby was gone," recounted the mother.

AND, ANYMORE, it's not just the poor who are being whipsawed by a health-care and insurance framework that's wildly out of control.

I mentioned, about two months ago, that I'd had a heart-attack scare that ultimately turned out to be (probably) a 24-hour bug that did a wonderful job of mimicking the chest pain of a coronary. Nevertheless, I ended up in the hospital emergency room for eight hours after the doctor on call at my primary-care provider told me to get myself there pronto.

I mean, if you think that maybe, possibly something could be a heart attack, you get to the hospital.
But what about when it turns out to be nothing big, but you've run up an almost $6,000 tab and your insurance carrier -- which for years has been going way up on premiums but way down on actual coverage -- pays what it's going to pay, and you're still stuck with a thousand-dollar hospital (and cardiologist) bill?

Do you think I'll think twice about being "better safe than sorry" next time I have chest pains? Damn straight I will. It's not like we have $1,000 to blow on what just might be a false alarm.

And we're a middle-class family. And we're insured. And I'm worried about the calculus of bankrupting family vs. "Could this radiating chest pain be the Big One."

So imagine the calculus if you're poor, you have no insurance because you barely even have a place to sleep, and it's hell on earth to find a doctor who'll treat po' folks.

I'm serious as a . . . uh . . . heart attack when I say the practical effects of how America administers health care to Americans is tantamount to eugenics -- let the poor and non-optimal die.

Just in the, ultimately, most convoluted and expensive manner imaginable.