KDA Today

KDA Today

For Immediate Release

Date: Apr 18th, 2011
Contact: Dr. John Thompson
Phone: 800-292-1855
Email: info@kyda.org

Blindsided

The intransigence that is so characteristic of Kentucky politics was completely circumvented by the Kentucky Optometric Association during the just completed short session of the Kentucky Legislature.  The irony is that Ophthalmologic Medicine never saw it coming.  Senate Bill 110, which would expand the number of procedures optometrists can perform, including certain laser surgeries passed the House on February 18^th in an 81 to 14 vote.  This legislation previously passed the Senate on February 11^th in a 33 to 3 vote.  This bill was first introduced on February 7^th and obviously moved through both houses at lightning speed.   It became the first bill to reach the governors desk during this 2011 session.

I am not going to denigrate this legislation by calling it a turf war.  This legislation was passed through both houses and their respective committees with either limited or no adequate time to discuss the real merit or unintended consequences of this bill.  Optometry presented its case and Ophthalmology could only react to what amounted to a blitzkrieg of well prepared position statements.  During the eleven days that was the entire process, I had no more time to form a personal opinion than anyone else in the general public.  I have great respect for optometry and it is my preference that my corrective lenses are prescribed by an optometrist by virtue of their very specific training.  I also have developed signs of dry macular degeneration, first observed by an optometrist.  I have tremendous respect for my ophthalmologist who I would have to trust for any surgical or medical intervention in preserving sight itself, again by virtue of their very specific training. These newly allowed procedures seem to lie in a gray zone.  I am professionally uncomfortable with continuing education for perioptical surgery that might be a two-day course presented at a hotel.  I am as uncomfortable as I would be with a colleague in dentistry placing implants after the same continuing education.  I am certain that my patients can get along better with the loss of one tooth than they can with the loss of one eye.

 The political reality is that optometry was aggressively focused and well prepared and most notably well funded.  No one in medicine had their eye on the ball, the association was fractious and ophthalmology stood alone. The fact that they could garner only seventeen votes in the entire legislative process speaks volumes.  We as a profession must learn something from what we have seen in this eleven-day process. T he most obvious lesson is that PAC MONEY TALKS. 

The perception that votes were bought is inescapable, but the political reality is that PAC money buys access and the face time that is required to educate or persuade decision makers.  Legislators are going to listen to and wherever possible vote in support of their friends.  This is not about Dale Carnegie and How to Win Friends and Influence People, nor about becoming a Face Book friend, this is about cold cash that funds elections.  The legislative process has become less about logic and more of a battle of mentality.  If German General Heinz Guderian studied Union General William T. Sherman and General Norman Schwarzkopf studied both, then we need to take a lesson from history.  Our Kentucky Dental Association should look at both the perils and parallels that might serve us well in dealing with our near future.  If you read my last commentary, you should see the reasoning.   

We have to be aware that Health Care Reform is a process that redraws boundaries as to who provides health care services heavily influenced by cost of care.  The true cost of care may be real or perceived depending on who is the better salesman.  Look no further than the current federal budget debate. A new term was coined for a balanced budget by excluding interest on debt in the equation.  If we are going to have a say in what our profession looks like going into the future we must have access to legislators who have to make these decisions.

Our governor has been compelled to move funding from next year to avoid a MEDICAID collapse.  This delays an inevitable crisis in the MEDICAID programs which will include a reimbursement reduction from little to almost nothing.  Drastic measures may be required to maintain health care providers, including dentists.  Did one state solve its participation problem by making MEDICAID participation a requirement for license renewal? You may want to look this one up.  The question is: Would we be able to mobilize a rebuttal or alternative, and would we have access to more than seventeen legislators if this took place during next years full Kentucky General Assembly?

If you look at how we as a profession support our KDPAC the answer will be obvious. We are screwed!  There is no question that there are dentists that know legislators and some are in fact, personal friends.  If Kentucky legislators were generally independently wealthy (they are not) then those friendships might mean a real difference. The harsh reality is that most legislators are looking for funding to support campaigns that will keep them in office and the friends that they listen to are putting their money where their mouth is.  Our KDPAC could simply be overwhelmed by an organization that has determined that dentistry is NOT healthcare that works and had garnered support from a well-meaning foundation such as Pew or Kellogg.

There is only one conclusion that dentists can make based on eleven days in February, we have to begin a reasonable and consistent support of our PAC.  Support may include direct contributions to candidates or legislators that are coordinated through the PAC, but the fact that money comes from a supporting dentist has to be made clear to be effective.  Dentistry has to give money from our PAC on both a consistent and timely basis to our friends.   We are a republic and as such we have representatives that cast votes on behalf of constituents. We must continually be an educational resource to those representatives who will cast the votes in our favor, not just because we gave them money, but that we also had their ear and a message they can understand that says we care about the oral health care of the public we serve and they are charged to represent.

Let us never be in the position of trying to fund our PAC and trying to write checks in a crisis.  That is too much like throwing up a prayer for rain when your house is burning down around you.  This might make a few people uncomfortable and some mad, but this is just the way it is and we had better get over it and do something now.  Now that I have this off my chest I am having a good day and I hope you will also.

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