While I empathize with our state’s financial dilemma and comprehend the logic that this “solution” will certainly bring in short-term cash flow, please consider that it might have future long-term ramifications far worse than the predicament it’s trying to resolve. Also, it’s probable that this inadequately researched and ill-conceived assessment will also result in many unintended consequences.
Currently, Vermont has an adequate dental workforce and the Vermont State Dental Society is making great strides to ensure we continue this favorable ratio. As the majority of my colleagues in the state approach retirement age, recruitment of our replacements will become extremely important. Consider that the cost of a dental diploma is very expensive and that we’re competing with other states for dental personnel, especially in northern New England.
Might a recent graduate searching for a place to establish a practice even consider living in a state with a provider tax targeting only him or her? Most of us are here for the lifestyle, and we moved here when everything was more affordable. From the day my brother began practicing dentistry in New Jersey, his gross receipts have doubled mine.
For a new graduate with monumental debt, a young family, and no savings, whether or not to settle here in Vermont will be simply a matter of mathematics. Please do not undermine our successful recruitment efforts. Without dentists to replace us, there will become a serious shortage of providers. With fewer dentists, access to care will worsen, production will decrease, and after causing the damage, Vermont’s 3 percent of gross receipts will nosedive anyway.
Good nutrition is the first step toward good health; and a healthy dentition is the essential means to that end. As you may have read or heard in the media, chronic inflammatory disease is directly related to serious health problems such as heart and kidney disease, diabetes, stroke, Alzheimer’s, arthritis, birth issues and pancreatic cancer. No doubt, there will be many others added to this list. Dental pathology is the most prevalent chronic inflammation.
Increasing the cost of dental services might discourage preventative care thereby increasing the incidence of debilitating and fatal systemic illnesses. Greater medical health care costs will result. Doing anything to discourage the pursuit of good oral health could have devastating life-threatening consequences. Already, compliance with OSHA, HIPPA, ANR, EPA, and other federal and state mandates has increased the cost of providing dental care. This will be yet another mandatory expense that will cost, but not contribute, to providing actual hands-on clinical services.
The recent report of Vermont’s Blue Ribbon Tax Commission clearly recommended against establishing any health care services tax, citing such a tax as an impediment to care during a tough economic time. www.vermonttaxreform.org/wp-content/uploads/2011/01/WEB-REPORT-2.pdf
It’s my understanding that dentists are the only health care practitioners targeted by this tactic. Why? If health care must be taxed (and I firmly believe it should not be), it must be across the board. Dental care is not a discretionary expense, like buying a toaster. Everyone needs health care, yet this proposal “penalizes” only those attempting to maintain their dental health and those who provide that care. It’s another destructive act by third-party intervention that has nothing to do with the problem.
· Established dentists have savings that enable them to ride out our current economic slump. Young dentists won’t have that ability. They will either have to pass this tax on to their patients, or do whatever they can to reduce overhead costs. Possible options will include dismissing employees, using older equipment, cutting back on materials and supplies, and/or making other sacrifices. To provide the standard of care for our patients, none of these is an acceptable choice.
· Unfortunately, because overhead costs are so very high, dental care is not inexpensive. We take pride in providing state-of-the-art dentistry. Without sacrificing our quality of care, we have always done whatever possible to minimize costs for our patients, friends and neighbors. Another tax will surely compromise that shared benefit.
· Once a tax is enacted, history indicates:
1. “It is unlikely that it will ever be removed.
2. The amount (%) of the tax used for other purposes increases. Its original benefit is lost.
3. **The percentage of the amount collected and matched with federal dollars that is returned to the provider class diminishes over time. Eventually, only the negative effects of this decision will persist.”
It’s so easy to criticize from the sidelines without contributing constructive suggestions, so, I’ve some here: As is already the case, an extremely high percentage of our health care dollars go toward administration and not direct patient care. Do you really want to worsen this health care situation? Instead of taxing good-health choices, consider taxing bad-health choices. This could be a win-win-win strategy by:
1. Discouraging unhealthy purchases,
2. Encouraging healthy purchases, and
3. Generating substantial revenue for the state!
Consider increasing taxes on the following unhealthy choices:
1. …All tobacco products. Up the ante on cigars, pipe tobacco, chewing tobacco, snuff, and related paraphernalia.
2. …Foods with high sugar, fat, and salt content. Those with two or all three would move to the top of the hit list. To avoid arbitrary designation, “Nutrition Charts” and MDR’s can determine each item’s health risks and its position on the list.
3. …“Unhealthy” beverages -- soda, beer and spiked soft drinks. Red wine has been proven to be heart healthy. Perhaps it should be at the bottom of the list?
It’s my understanding that the junk food lobby is very persuasive, but this is matter of public health…and must be a priority over lobbying interests. Everyone likes “feel good” junk food, so all of us would contribute to this fund. Now, that’s an equitable tax!
I would appreciate an opportunity to meet with you in person to discuss this matter?
Thank you and be well.
Stephen Zonies, DMD, lives in Fayston.
