Are PPOs Constitutional?

Michael Schuster, DDS

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the Pursuit of Happiness.” The Declaration of Independence

We are a country that fights wars all over the world in the name of freedom. Yet slowly, both patients and their dentists are losing their freedoms.

The words here are the truth. What you choose to do with the truth is your personal choice.

• Patients have the freedom to choose their doctors.
• Patients have the freedom to choose their treatment plans.
• Dentists have the freedom to charge fair and reasonable fees.

There is an old adage — “He who has the gold makes the rules.”

Since 1995, when we had the first Private Care Conference in Scottsdale, Ariz., together with executives from the ADA, dentists have been losing their freedoms. The very reason we went into practice in the first place was to have an opportunity to practice our profession in an environment free of third-party interference. Most of us dentists are “free and independent thinkers.” We want to run our practices and we want to establish relationships with our patients. We want to do the right thing, and we want the freedom to pursue happiness.

We bought into the American Dream when we sacrificed, borrowed money, and paid the price to get our dental degrees. Slowly over time we have watched as insurance companies continue to use their power and control to interfere with the doctor/patient relationship, so much so that many dentists and their patients now have a codependency relationship with the insurance companies.

At the time when the cost of everything continues to increase — from salaries, to supplies, to equipment, to taxes — the reimbursement for services for those caught in the insurance game is decreasing. The future looks dim for those who take the PPO route. There is less freedom, less choice, less fulfillment, less comprehensive care, and less profit.

Anyone in a codependent relationship with anyone or anything has not only lost control, they also have lost their freedom. When I speak with physicians, they tell me that there is no way they would recommend that their children become physicians. It isn’t simply about the ever-decreasing financial reimbursement as insurance companies shift to PPOs; it is the fact that the physician, and in our case, the dentist, no longer has the privilege to develop each patient’s ethical and proper treatment plan without third-party interference.

Insurance companies manage massive group risks, whereas dentists manage “individual risk” of disease. As insurance companies continue to use their power over dentists to make them and their patients more dependent, people lose more of their freedom to choose.

Are PPOs constitutional? Are they helping you care for your patients with ethical, comprehensive dentistry? Or are they manipulating you and your patients into episodic, single-tooth dentistry? Are PPOs providing either you or your patients with more freedom?

Medicine has all but lost its primary care providers. MDs have migrated more into specialty branches to avoid the ever lower paying reimbursement from insurance companies and the government. This leads to doctors moving faster, seeing more patients, and doing less adequate exams, diagnosis, and treatment planning, which in fact leads to more disease and more cost.

The medical system is broken. The medical system broke when insurance companies and the government intervened. There will be a small group of independent dentists who will stand outside the broken system and continue to fight and live for the freedom promised by our Constitution.

These observations are the result of interviewing and talking with dentists every day throughout the U.S. You and I have to help our patients understand what they are giving up. Do you think your patients understand when their employer signs them up for a PPO (in order to reduce their insurance costs) that they are losing their freedom to choose?

A practicing dentist, Michael Schuster, DDS, founded the Schuster Center in 1978. Guiding thousands of graduates to achieve wealth and freedom, the Schuster Center is the first business school created exclusively for dentists. Dr. Schuster is a cadre and former director at the Pankey Institute, and adjunct faculty at the Dawson Center, OBI, and LSU Cosmetic Continuum. He can be reached at (800) 288-9393, www.SchusterCenter.com, or [email protected].