Even compared to the rest our shambolic health care system, American dentistry is a mess. As of 2012, about 130 million individuals lacked dental insurance—and while Obamacare may have improved that figure a bit by extending coverage to more children, even families with plans still find themselves unable to afford procedures because of high out-of-pocket costs, or because providers won't accept Medicaid.
In other words, far too many people in this country can't afford to take decent care of their teeth, a point made very clear in the Federal Reserve's recent Report on the Well-Being of U.S. Households. A quarter of the survey's participants reported that they had skipped dental treatment because of the expense, which is 10 percentage points greater than the fraction who said they had missed a doctor's visit.
Of course, treating basic dental care as a luxury has consequences, since tooth problems are miserably painful and have a way of keeping people—especially kids—from doing simple things like going to work or school, or eating. As a Senate report by Bernie Sanders put it a few years back:
Untreated dental problems result in missed work and school, poor nutrition, and a decline in overall well-being. The U.S. Surgeon General’s report, Oral Health in America, published in 2000, noted that students miss more than 51 million hours of school and employed adults lose more than 164 million hours of work each year due to dental disease or dental visits. A more recent study published in 2009 found that 504,000 children age 5 to 17 missed at least one day of school due to a toothache or other oral health problem in California alone
Meanwhile, when oral disease becomes too much to bear, many low-income Americans end up resorting to the emergency room, leaving the public and hospitals to pick up much of the tab.
But hey, if everybody could afford to take care of their mouths, nice teeth wouldn't be such a useful class signifier, now would they?