My lack of understanding about the realities of the private sector was not a short-coming, just a reality due to the fact that I had little experience working outside of government. But now that I am in the private sector, one thing I am learning first-hand is that many folks working in public service have no idea what it means to run a business; in some cases, they can be openly hostile, or just plain suspicious, of the private sector and profit-making.
This brings to mind the current debate over Dental Service Organizations. DSOs are for-profit companies support dentists that often go into low-income areas and provide care to children who lack dental insurance, or whose parents cannot provide proper dental care for any number of reasons.
According to a recent report, tooth decay is the most common disease impacting children in the United States. Known as the "dental divide," tooth decay rates among children in impoverished communities have been consistently higher than in children from more affluent communities.
Some DSOs have been criticized by some government officials who have asserted that because they are profit-driven companies, they are incentivized to provide their patients -- underprivileged children -- with more dental work than they need – such as filling cavities in baby teeth that are about to fall out anyway. And ultimately, because these children are typically covered by government programs like Medicaid, the taxpayers are left to pick-up the tab.
In my opinion, it is completely nonsensical to assume that DSOs are fundamentally flawed because they exist to make money. First and foremost, without DSOs, these children would have no access to dental care. So while eliminating DSOs might prevent instances of fraud, it will also prevent millions of children from getting proper dental treatment.
Second, I am not convinced that fraud is any more widespread among dentists working in DSOs compared to individual providers, who have the same incentives. No doubt, there have been some bad actors performing procedures that can be considered wasteful. While those providers belong in jail for fraud, my guess is that most dentists are ethical and are primarily concerned with the well being of their patients.
Kool Smiles, South Texas Dental and other industry leaders are growing businesses that create jobs and provide opportunities for dentists. DSOs allow dentists to be dentists, earn a good salary and not worry about the bureaucratic red tape, capital investment or expertise needed to manage a practice. Dentists taking jobs at DSOs are looking to make a living plying their trade – not take advantage of poor children. After all, most dentists choose the profession because they sincerely believe in taking care of others.
The reason I am also convinced that DSOs need to be accepted is because without them, the children they are currently treating would be left without any viable alternatives for dental care. After all, it is not like dental practices in suburban or wealthy communities are suddenly going to up and move to serve children in poor parts of their cities. DSOs were created to take advantage of a gap in care and there is no reason to believe that gap would be filled if DSOs were all put out of business by well-meaning, but misguided, public employees.
Just like there are bad teachers, bad farmers and bad lawyers -- there are bad DSOs. But it is off-base for government regulators, politicians and the media to assert that because DSOs are profit driven they are incapable of providing quality dentistry. The right approach is to use existing regulations to remove the bad actors and allow the good DSOs to continue treating these children. The wrong approach is assuming that just because someone makes money, that they are doing something wrong.
Shows is a fomer U.S. Representative from Mississippi.