A Subprime Mortgage For Your Mouth: Private Equity’s “Market-Based” Dental Care Solution

Terrance Heath

The hubby and I were channel surfing last night and ended up watching Frontline. The feature story was “Dollars and Dentists”.

The more I watched, the more stomach churning it got. If the Supreme Court does a number on health care reform, this model could be waiting in the wings.

No wonder conservatives don’t have a plan to “replace” health care reform. They don’t need one. Private equity firms are already test driving a “market-based” solution.

dentist The story focused on “Dental Deserts” — areas where people have little no access to preventative dental care. The reasons why are manifold. About 49 million people — up from 33.3 million in 2011 — live in these areas. Many of them don’t have dental care because their jobs don’t offer dental insurance. Some probably also don’t have the extra time or money, and delay care. They end up getting care in conservatism’s favorite form of “universal” health care: the emergency room.

The thing is, there’s no shortage of dentists. Most of them graduate with huge debts, and tend to flock to more populated areas, where they can attract more patients who can pay for their services, or have dental insurance that can pay.

Medicaid covers children and some procedures for adults, but we all know how that can work out sometimes. If you don’t, just ask Deamonte Driver. Oh, wait. You can’t. He died for want of a dentist. Deamonte’s story figures prominently in “Dollars and Dentists.”

That was five years ago, and it hasn’t gotten any better. Medicaid is administered by the states, and the rate of coverage varies wildly from state to state; from $150 in Maine to $29 in Idaho and nothing at all in Arkansas. Thirteen states have cut dental benefits in 2011 or plan to this year. (If you think Paul Ryan’s plan to block grant Medicaid is going to remedy this, take off your tinfoil hat. It’s interfering with the radio-wave reception in your fillings.)

Not to worry. Private equity is coming to the rescue. If that doesn’t scare you, it should.

Yesterday, I went to the dentist… Aspen Dental is a chain of nearly 350 offices in 22 states managed by a company owned by a private-equity firm. It is part of a fast-growing industry of corporate dental practices, many of which specialize in serving people who cannot afford to go to the dentist, a group many dentists ignore.

By marketing to people who haven’t seen a dentist in years, Aspen Dental often gives new patients treatment plans costing thousands of dollars. The Center for Public Integrity (CPI) and FRONTLINE spent months examining Aspen Dental and found that the same business model that makes Aspen Dental accessible to people short on cash can also lock people into debt and has led to complaints of patients being overcharged or given unnecessary treatments.

Former employees say Aspen Dental trained them in high-pressure sales. Corporate management scrutinizes the production of dentists and staff daily. And internal documents show that dentists get paid bonuses as key production targets are met.

“You’ve got people who are not dentists, that are in management… they are breathing down the doctor’s back,” said Jenny Hayes, who worked as an office manager for Aspen Dental in the Chicago-area last year. “There are goals and if you are not hitting your goals, then you lose your job.”

The private equity recipe is to set up corporate dental clinics in areas where people can’t afford to go to the dentist, staffed by people who are not formally trained dentists, who recommend more work than a patient really needs — like a complete exam for a patient who needs two teeth pulled, or extracting all the teeth of a patient who just had a toothache in one — for more than the patient can possibly pay. Then, the patients are handed off to managers who set them up with special “health-care credit cards.”

That’s when the real trouble starts. Via their “health care credit cards,” patients are charged for procedures they not only didn’t need in the first place, but that haven’t even been done yet. And the interest starts racking up immediately. If you can’t afford to go to a dentist in the first place, you probably can’t afford this either. You can imagine what happens. What was a relatively minor dental problem becomes a massive total-mouth makeover, with a price tag in the thousands, and that gets even bigger as interest racks up.

This is the “market-based solution” for people like Theresa Ferritto.

Newspaper advertisement for Dr. J. S. Frost, 1912 Surviving on a meager $1,300 a month, 87-year-old Theresa Ferritto fretted about the cost when her dentist told her she needed two teeth pulled.

She figured an oral surgeon would be too expensive. So she decided to try out a dental chain that promoted steep discounts in its advertisements. She went to an Aspen Dental office just outside Cleveland.

Ferritto said Aspen Dental wouldn’t just pull the teeth but insisted on a complete exam. She was bewildered when they finally handed her a treatment plan four pages long. Total price: $7,835.

Ferritto could not afford it, but Aspen Dental signed her up for a special credit card, with monthly payments of $186 for five years. She blames herself for signing the papers.

“I made a big mistake going there,” she says. “I should have known better.”

After a day of cleanings and two fillings, Ferritto asked her son for help. He called Aspen Dental to complain but said he got nowhere. So they turned to the state attorney general.

Aspen Dental took all charges off her credit card for treatments she hadn’t yet received. But the company said the $2,540 she was charged for two fillings and cleanings was appropriate.

Aspen Dental charged Ferritto $350 for an antibiotic put next to the teeth the dentist was going to pull, a charge other dentists say makes no sense. There were four separate charges for an antibacterial rinse, similar to Listerine, for $129. There was even a $149 charge for an electric toothbrush that Ferritto didn’t even know she had, until she recently retrieved an Aspen Dental bag from her garage and found it inside.

Imagine how many groceries that would buy, she sighed.

The Center for Public Integrity has also posted Ferritto’s bill on their website.

America, this is your “market-based” health care solution. It’s pretty simple.

  1. Set up shop in an area where people don’t have access to and/or can’t afford dental care
  2. Recommend expensive procedures they don’t even need. (Charge extra for things like toothbrushes and mouthwash.)
  3. Sign them up for credit cards they also can’t afford. (Reassure them that these are “no-interest” credit cards, but don’t tell them about the penalties — nearly 30% interest on the entire amount — if they miss payments.)
  4. Profit.

Think of it as combining dentistry with payday loans and you get the picture. Better yet, think of it as a subprime mortgage for your mouth.

Oh, and it’s entirely unregulated.

That’s the problem with applying a “market-based solution” to a problem like health care. I can’t explain it any better than Republican Senator Chuck Grassley.

But Sen. Charles Grassley, a Republican from Iowa, questions whether dentists at corporate dental chains are free from corporate pressures to maximize profits. Grassley, the ranking member of the Senate Finance Committee, wouldn’t speak about Aspen Dental specifically, but he’s had committee investigators looking into the company and other private-equity-owned chains for months.

“Because when private equity firms get involved,” Grassley explained, “you got to understand that their motivation is to make money. And they are not dentists. And dentists ought to make the determination ’ of what is good for the teeth.’ Not some private equity manager in Wall Street.”

The problem is that there are populations that need services, but there’s no profit to be made in serving them. There are services that we as a country, at least until recently, have agreed that people should receive whether there’s a profit to be made or not. Health care is one of them. “Market-based” solutions require profit, and the only way to make a profit serving these populations is to overcharge, under-serve, or both.

If you want to know what kind of solutions Republicans have in mind, if the Supreme Court eviscerates the ACA, take a look at this Frontline piece.

It’s sure to leave a bad taste in your mouth.

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