The Michigan state government is a $40 billion behemoth containing more than 1,000 budget line items representing expenditures on everything from art subsidies to road work. There are two line items in the state budget that could be eliminated — or privatized — involving dental care. This story isn’t limited to ending government programs, however; it is also an example of how private, voluntary civil institutions provide valuable services.
The Michigan Department of Community Health budget contains "Dental programs" and "Dental program for persons with developmental disabilities" line items. The first has two distinct parts and works to help people who are uninsured but do not qualify for dental services through Medicaid.
The first part of the dental programs line item is known as a "donated dental services program," and the second as the "local health department dental care program." The Dental program for persons with developmental disabilities is similar though it is dedicated solely to people with disabilities.
According to the House Fiscal Agency, appropriations for each line item in fiscal 2006 totaled $485,400 and $151,000 respectively. Neither was generated through the General Fund/General Purpose portion of the state budget. This was not always the case. In fiscal 2004 the dental programs line item received $225,000 from GF/GP. The state’s GF/GP is the portion of the budget over which legislators have the most discretion.
The idea of eliminating state dentistry subsidies is not unheard of. Gov. Jennifer Granholm recommended eliminating the dental programs subsidy for 2006 and the state House concurred, but the Senate restored the funding.
In fiscal 2004 the dental program line item involving donated services helped 410 patients receive over 5,600 dental procedures. Approximately $4.9 million in dental treatment has been provided gratis to patients over the past nine years.
The funding for this program is used solely to administer a matching service done under contract with a non profit that brings together dentists who volunteer their expertise with patients who need it. Taxpayer funded government middlemen, however, are not the only way to assist people with dental needs. Dentists and others are very generous with their time, and may make up for this subsidized matching service with efforts of their own.
Rather than allowing political society — one characterized by government coercion including taxes and mandates — to address the needs of the state’s current patients in dental programs, we should allow civil society to shoulder the burden in its entirety. Civil society is simply that network of "from-the-heart" private institutions that provide charity and similar services in helping the less fortunate. Dentists and other medical professionals are very generous in supporting private, charitable institutions with time and resources.
Almost 7 out of 10 of dentists provide charitable dental care to members of their communities, according to a survey by the American Dental Association. They also provided an average of $8,323 in free or reduced cost dental care in 1999 when the ADA last completed its survey "2000 Survey of Current Issues in Dentistry: Charitable Dental Care."
Charitable dental work currently abounds in Michigan, and the state’s program duplicates services that are already being provided. Many dentists, as the ADA documents in its survey, provide charitable dental care either for free or at a reduced rate, according to an individual patient’s ability to pay, and they usually do so without fanfare. The ADA found in its survey that a typical dentist provided services free of charge to an average of 88 patients per year, while providing reduced rate services to approximately 113 people per year.
These dentists serve communities of handicapped individuals, low income individuals, the homebound and elderly, institutionalized patients, HIV/AIDS patients, and migrant workers, in addition to others — such as disaster victims, the homeless, foster children, and missionary workers. They would likely do even more if government would stop taxing them to provide the very services to people to whom so many already volunteer to assist.
There are also clinics such as Hope Medical Clinic, Inc. in Ypsilanti that provide volunteer dental work several days a week throughout the year. In addition there are many referral services — including local clinics like Hope, and organizations like the National Foundation of Dentistry for the Handicapped, the United Way, and the Red Cross — that maintain lists of dentists who are willing to donate their services to those in need.
The NFDH maintains a list of 808 dentists in Michigan who are willing to provide dental services pro bono or at a reduced cost. This is up almost 26 percent from 2003 alone. The list of dentists includes both general practioners, and specialists such as oral surgeons.
Elimination of a state service now being delivered might be deemed unfair and will be inconvenient to current recipients. In addition, many charitable institutions currently feel overwhelmed by demand. But it is also unfair and inefficient for the government to ascertain which Michigan citizens deserve special accommodations through government programs and which do not.
It is unfair because people who struggle to meet their own dental demands are taxed to pay for those who do not. It is inefficient because a) government programs usually require costly overhead and paperwork, and b) bureaucrats, however smart and caring, do not have the information available to them to make the type of highly nuanced health care decisions that a diffused population of dentists, nonprofits, and patients can make without central planning.
There is no doubt the dental programs run by government are well intentioned, but they ultimately work to crowd out the generous institutions of civil society — family, friends, churches, organized charities, and other individuals — from doing all they can do voluntarily to assist the needy in a very personalized fashion.
Laura J. Davis is an adjunct scholar with the Mackinac Center for Public Policy and a University of Michigan law student. Michael D. LaFaive is director of fiscal policy for the Morey Fiscal Policy Initiative at the Mackinac Center for Public Policy.