© Jack Cashill
Published in ingramsonline.com - November 2012

A liberal application of free enterprise demonstrates the difference between U.S. health care and socialized models.

I

n his 2010 State of the Union address, President Barack Obama described the bank bailout as being as “popular as a root canal.” Not surprisingly, this struck a nerve with the nation’s endodontists. The reason is simple: They understand better than the president that today, thanks to the glory of free enterprise, a root canal is less an ordeal than watching the average presidential debate.

I speak from experience. Last month, my dentist referred me to the Valencia Endodontic Associates for my first root canal, a procedure I knew only through reputation. Walking into Valencia, however, reshaped my thinking.

The bright, airy office looked like the set for a futuristic movie on dental care, not, of course, that anyone is likely to make a sci-fi movie about dentistry. It has a commanding view of the Country Club Plaza, 10 plush dental chairs, all with a view, and a hustling staff of 10, plus the two endodontists, Ron Wollard and his son, Chad Wollard.

As I stood there, I began to wonder what getting a root canal must be like if in a socialized system like, say, Britain’s National Health Service. As best as I could piece that experience together, I am very glad America still inspires practices like Valencia.

Before going further, consider this exchange in Parliament on the subject of root canals. “Root canal treatments are included as items of treatment in the statement of dental remuneration for which dentists can claim an NHS fee,” the minister of health explains to the gathered MPs, who will be improbably helping him determine the price of a root canal.

The MP from Gosport, an instant expert on endodontics, lays into the health minister. Does he not realize that the fees payable to dentists for root canal work, “which takes about two hours,” are completely inadequate? Given the low fees, the MP continues, does the minister not know that “dentists are undertaking such operations speedily and unprofessionally, which is resulting in low standards with further operations sometimes being necessary thereafter?”

I would ask, does the MP not understand that the health system his nation has created inevitably results in inefficiencies and absurdities?

Ron Wollard did not spend two hours with me. He spent about 15 minutes. The root canal itself was no more deserving of a metaphor than a tooth cleaning. When I returned a month later to complete the process, he spent another 15 minutes. That was that. It cost more than the NHS charges, but it was worth it.

Wollard has been doing root canals for nearly 40 years. He studied under one of the real pioneers of endodontic science, Samuel Seltzer, and developed his speed and diagnostic skills as the sole endodontist for 25,000 Vietnam-bound troops at Fort Carson in the early 1970s.

By the early 1960s, endodontics was a recognized specialty in American medicine. In the 1990s, the British were still debating whether there was “an identified public need [for endodontics] extending beyond the provisions of the general dental services.”

According to a recent estimate, there are now 1,765 private endodontists in the U.K. I sorted through the practice descriptions for scores of them and could not find one that specialized exclusively in endodontics. “All as-pects of dentistry are addressed at this dental group,” reads the typical practice description.

There are 16 endodontists in the Kansas City area, all of them, according to Wollard, “very good.” As far as I can tell, each uses the word “endodontist” in the practice’s name. In the U.K., the practices have names like “The Smile Clinic” and “The Dental Studio.” Endodontics is just something else they do.

Specialization matters. The day I spoke with Ron Wollard, he was scheduled to perform 28 root canals, a pace that his son cannot yet match. He uses the highest tech equipment, the latest techniques, and works with impressive speed and skill. In that he depends fully on referrals from general-practice dentists, he cannot afford to screw up.

In the U.K., it’s another story. “You can have root canal treatment on the National Health Service,” the NHS cautions its enrollees. “However, due to the time it takes and the skill needed, many dentists prefer to carry out this treatment privately. Your dentist will be pleased to give you an estimate.” In other words, unless you are absolutely desperate, find a real dentist and pay the extra cost out of pocket.

NHS patients have to pay for root canals, currently about $300 American. They do not have to pay, however, for an apicectomy, a more complex endodontic surgery performed in the hospital that costs more than three times as much. NHS covers the entire cost of that procedure. Patients have figured this game out.

A British dental journal dryly observes that the free apicectomy “represents a significant barrier to the patient seeking specialist endodontic treatment and a considerable expense to the National Health Service.” Stop the presses!

As to NHS dentists, they prefer to pull teeth. Although it will cost the patient and the system more down the road, yanking the tooth is quicker for the non-specialist and less fraught with failure than trying to saving it.

Although dentists in the U.K. seem to have more economic freedom than do British doctors, they work in a system that discourages innovation and enterprise. In the United States, dentistry remains much more free of government intervention, and the results are obvious to all but the ideologue.

Ron Wollard gets up at 4:45 every morning, does four miles on his treadmill, showers, eats a light breakfast, and comes to work at his bright, cheery office, feeling like “one of the luckiest guys in the world.” He tells me that he gets his greatest reward working with children and is the only endodontist in the area who will accept a Medicaid fee for kids.

In the U.K., there are dentists who like to work with kids too. What they lack is the financial incentive to work as long, as hard, and as smartly as Wollard does. Wollard does not talk about the money. Doctors rarely do. It is hard-wired into the American DNA.

When we start tinkering, let’s not forget that.

Who is Jack Cashill?