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Resisting NHI
LETTERS TO THE EDITOR THE JOURNAL devotes this section to comment by readers on topics of current interest to dentistry. The editor reserves the right to edit all communications to fit available space and requires that all let ters be signed. Printed communications do not necessarily reflect the opinion or official policy of the Association. Your participation in this section is invited.
Resisting NHI □ Dr. W aldm an’s “ Perspective” on the B ritish National Health Service (The Jo u rn a l, Septem ber) was a w hitew ash__ I practiced in England for four years as an A ir Force dental officer. About once a week I had an opportunity to see patients who had been treated in the NHS. I can’t com ment on the exam ination or diag nosis aspects, b u t the restorative techniques were far below our stan dards. Decay was not completely re moved; amalgam fillin g s were poorly contoured; and overhangs were the rule. . . . I too have talked to English den tists, and I found that most of them ran very busy offices, spending little tim e w ith in d iv id u a l patients. Dr. W aldm an said that this rem inded him “ o f the assembly lin e approach to d e n t is t r y th a t I ’ve seen in M edicaid m ills in the U nited States. ” What he failed to make clear is that most practices in England are NHS m ills, w h ile very few practices in the U nited States are M edicaid m ills. He says, “ Surely it is o nly a matter of tim e before the Democratic and R epublican parties in the U n ite d States w ill adopt a sim ilar posture” (w ith respect to National Health In surance). Do we w ant a “ R eview Body on Doctors’ and Dentists’ Re m uneration” and a “ D ental Rates Study Group” setting our fees? I w ill resist NHI, and I urge others to do the same. National Health Insurance is socialistic and too expensive. It is a disease in its own right. A. WHARTON RAMSEY, DDS ROANOKE, VA
□ Dr. Waldman asks us to overcome our traditional prejudices and fears of governmental programs. This is d iffic u lt for me to do when I con template the lack of services of the US Postal Service, the insecurity of the Social Security System, and the disaster called Amtrak. It is d iffic u lt for me to do when I contemplate the p le th ora o f HEW g ive a w a y p ro grams replete w ith graft, bribery, fraud, nepotism, and featherbedding. I agree w ith the author that it is o n ly a m atter o f tim e before the p o liticia n s o f the Dem ocratic and Republican parties add another piein-the-sky giveaway in the form of N ational H ealth Insurance. I o nly hope that a reasoning electorate has h a d e n o u g h o f g o v e r n m e n ta l boondoggling and realizes that the only means of attaining the Great So ciety we a ll seek is through free en terprise. RUDOLPH STRAMBI, DDS MORRISTOWN, NJ
□ There is one aspect of the subject that Dr. Waldman d id not m ention ... the qualifications, or the types of people who are applying to profes sional schools in England. I specif ic a lly wondered i f the financial lim i tations imposed by the B ritish Na tional Health Service have discour aged any o f the b rig h te r yo un g people from entering the professions and encouraged them to seek oppor tunities elsewhere. NORMAN R. ARNOLD, DDS CLEVELAND
A u th o r’s re p ly : I s p e c ific a lly ad dressed sim ilar questions to numbers
of dental school admissions officers. A ll responded sim ilarly, saying that there has been a c o n tin u e d im provement in the q uality of a p p li cants d u rin g the past n um ber of years, based on academ ic p e rfo r mance on advanced level courses (their counterpart to our college level courses). In the U nited States most schools participate in the Am erican Associa tion of Dental School central a p p li cant service for the processing of ap plicants, but students are perm itted to apply to any number of schools. In Great B ritain, students are perm itted to apply o nly to a lim ite d number of schools and must rank th e ir prefer ence. In the U nited States, schools must . . . w a it for students to an nounce th e ir preference after receiv ing acceptance from one or more in stitutions. The ratio of applicants to available seats in entering classes is approxim ately 3:1 in Great B ritain co m p ared to a bo ut 2.5:1 in the U nited States. One m ust rem em ber that more than 30 years have passed since the developm ent of the NHS. Today’s applicants to schools o f d e n tistry were raised w ith in the NHS structure and surely m ust consider the system the natural order of things. They do not remember “ how it once was.” The applicants seem as bright, alert, o p tim is tic , and concerned about th eir future and the future of th eir profession in these changing times as do their counterparts in the U nited States. H. BARRY WALDMAN, DDS, PhD STONY BROOK, NY
J A D A , V o l. 9 9 , N o v e m b e r 1 9 7 9 ■ 7 9 3
Resisting NHI □ Dr. W aldm an’s “ Perspective” on the B ritish National Health Service (The Jo u rn a l, Septem ber) was a w hitew ash__ I practiced in England for four years as an A ir Force dental officer. About once a week I had an opportunity to see patients who had been treated in the NHS. I can’t com ment on the exam ination or diag nosis aspects, b u t the restorative techniques were far below our stan dards. Decay was not completely re moved; amalgam fillin g s were poorly contoured; and overhangs were the rule. . . . I too have talked to English den tists, and I found that most of them ran very busy offices, spending little tim e w ith in d iv id u a l patients. Dr. W aldm an said that this rem inded him “ o f the assembly lin e approach to d e n t is t r y th a t I ’ve seen in M edicaid m ills in the U nited States. ” What he failed to make clear is that most practices in England are NHS m ills, w h ile very few practices in the U nited States are M edicaid m ills. He says, “ Surely it is o nly a matter of tim e before the Democratic and R epublican parties in the U n ite d States w ill adopt a sim ilar posture” (w ith respect to National Health In surance). Do we w ant a “ R eview Body on Doctors’ and Dentists’ Re m uneration” and a “ D ental Rates Study Group” setting our fees? I w ill resist NHI, and I urge others to do the same. National Health Insurance is socialistic and too expensive. It is a disease in its own right. A. WHARTON RAMSEY, DDS ROANOKE, VA
□ Dr. Waldman asks us to overcome our traditional prejudices and fears of governmental programs. This is d iffic u lt for me to do when I con template the lack of services of the US Postal Service, the insecurity of the Social Security System, and the disaster called Amtrak. It is d iffic u lt for me to do when I contemplate the p le th ora o f HEW g ive a w a y p ro grams replete w ith graft, bribery, fraud, nepotism, and featherbedding. I agree w ith the author that it is o n ly a m atter o f tim e before the p o liticia n s o f the Dem ocratic and Republican parties add another piein-the-sky giveaway in the form of N ational H ealth Insurance. I o nly hope that a reasoning electorate has h a d e n o u g h o f g o v e r n m e n ta l boondoggling and realizes that the only means of attaining the Great So ciety we a ll seek is through free en terprise. RUDOLPH STRAMBI, DDS MORRISTOWN, NJ
□ There is one aspect of the subject that Dr. Waldman d id not m ention ... the qualifications, or the types of people who are applying to profes sional schools in England. I specif ic a lly wondered i f the financial lim i tations imposed by the B ritish Na tional Health Service have discour aged any o f the b rig h te r yo un g people from entering the professions and encouraged them to seek oppor tunities elsewhere. NORMAN R. ARNOLD, DDS CLEVELAND
A u th o r’s re p ly : I s p e c ific a lly ad dressed sim ilar questions to numbers
of dental school admissions officers. A ll responded sim ilarly, saying that there has been a c o n tin u e d im provement in the q uality of a p p li cants d u rin g the past n um ber of years, based on academ ic p e rfo r mance on advanced level courses (their counterpart to our college level courses). In the U nited States most schools participate in the Am erican Associa tion of Dental School central a p p li cant service for the processing of ap plicants, but students are perm itted to apply to any number of schools. In Great B ritain, students are perm itted to apply o nly to a lim ite d number of schools and must rank th e ir prefer ence. In the U nited States, schools must . . . w a it for students to an nounce th e ir preference after receiv ing acceptance from one or more in stitutions. The ratio of applicants to available seats in entering classes is approxim ately 3:1 in Great B ritain co m p ared to a bo ut 2.5:1 in the U nited States. One m ust rem em ber that more than 30 years have passed since the developm ent of the NHS. Today’s applicants to schools o f d e n tistry were raised w ith in the NHS structure and surely m ust consider the system the natural order of things. They do not remember “ how it once was.” The applicants seem as bright, alert, o p tim is tic , and concerned about th eir future and the future of th eir profession in these changing times as do their counterparts in the U nited States. H. BARRY WALDMAN, DDS, PhD STONY BROOK, NY
J A D A , V o l. 9 9 , N o v e m b e r 1 9 7 9 ■ 7 9 3