editorial
Proposed Medicare Dental Benefits for all Seniors Epitomizes Peter Principle ADA counterproposal exposes government program incompetence and inefficiency.
T
he Peter Principle theorizes that workers rise to their level of incompetence.1 It reflects the tendency to promote employees based upon the employees’ survival or apparent success in their current job, rather than on the skills required for the promoted position. The principle similarly applies to the federal government’s role in the legislative proposal in Congress this year that, although recently modified, sought to expand Medicare to include dental benefits for all seniors. Like minimally competent employees promoted beyond their skill level, the government, as an entity, lacked the requisite knowledge and management capacity to successfully administer the proposed function. What the Proposed Legislation Would Do Medicare does not provide dental benefits, except under limited circumstances. As of 2019, 47% of Medicare beneficiaries lacked dental coverage. However, approximately half of seniors between the ages 65-80 either have dental insurance or can afford to self-pay.2 The insurances primarily consist of privately offered Medicare Advantage plans with low premiums. At the opposite end of the spectrum, seniors with incomes at or below 133% of the federal poverty level (FPL), and without dental insurance, experienced the greatest increase in cost barriers to care over the past decade.3 The proposed legislation planned to add dental benefits to Medicare, along with vision and hearing coverage, for all seniors, regardless of need. While
2 NOVEMBER 2021
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The New York State Dental Journal
the future of the dental and vision coverages remains uncertain at the time of this writing, dental beneficiaries included individuals aged 65 and over who already had insurance and those financially able to pay. In addition, it called for the government to administer the plan under existing Medicare Part B, which imposes the relative value unit system (RVU), a physician-oriented reimbursement system, and other administrative mandates traditionally applied to medical offices upon participating dentists. ADA Counterproposal The ADA countered with its own Medicare benefit proposal consistent with the ADA Elder Care Policy, to provide access to oral healthcare for low-income seniors without existing coverage who cannot afford to seek care. These populations typically suffer from a high incidence of oral disease, seek care in hospital emergency facilities and require costly medical care for related issues. The ADA structured its proposal upon intimate grassroots understanding of the delivery of dental care, with an eye toward the dwindling Medicare trust fund. The Congressional Budget Office has projected current Medicare program costs will exhaust the medical hospital insurance trust fund by 2024.4 Limiting benefits to the poorest seniors would help maintain the program’s future financial viability. The ADA proposal exposes government administrative inefficiency and ignorance of the workings of a dental practice. First, the ADA plan limited Medicare dental benefits to seniors with incomes of up to 300% of the
