With all the high emotion having faded perhaps its time to look back over the furor concerning the stance taken by many dentists over the plan to allow non-dentists to perform procedures previously reserved for dentists. The argument seemed to be centered over the perceptions of many Natives that they could not obtain adequate dental care in the Bush without this option. Dentists were horrified that the plan would allow persons not professionally prepared to perform the procedure to become what amounted to seat of the pants dentists, arguably creating a second-class dental system for Natives. Natives then claimed that it was the dentists being racist.

What can finally be distilled from this once the facts have been distilled is that the underlying problem is that Bush Natives won’t pay what the market demands to have real dentists come to them and so they are willing to pay less for non-dentists. One cold simply chalk this up to a consumer decision (perhaps an unwise one, but a consumer decision nonetheless) until one remembers that the federal government owes a duty to these same consumers because they are dependent peoples.

Alaska Natives have been demanding and assuming leadership roles in shaping health care policy in Alaska and one can only note with disappointment that while assuming responsibility is probably a good idea, negotiating for inadequate health care is probably a giant step backwards.

More and more Bush residents are now being “treated” by “paraprofessionals”. This is a very real effort to avoid the cost of professional services and we have seen similar moves against lawyers and teachers. Some argue that its only the difference between “models”, like the difference between buying a Porsche or an Escort. The difference is more akin to hiring a home builder who only knows how to use a hammer and is not quite sure what the function of a screwdriver is; that was supposed to be covered in the portion of the training he skipped.

Nor is this like going to see an Advanced Nurse Practitioner or Physician’s Assistant, both positions still being professional and both having clearly defined professional rights and duties as well as mandatory supervision.

What’s frightening (beyond my quite liberal fear that this situation means substandard health care for Natives) is that this model, as it gains momentum, means a lower standard of care for everyone as the number of doctors decreases in response to the lack of financial reward (except of course for the fabulously wealthy.)

For years the federal government encouraged practitioners to support medically challenged areas by paying off school loans. However, with the decision to make school loans a profit center for commercial interests these efforts, just like investments in physical infrastructure like roads and bridges, have been neglected as we go into national debt in order to create profits for the like of Haliburton.

If we want quality health care through out the U.S. (or to put it another way, if we want health care in the U.S. to at least meet Third World standards) then we had better alter national policy and starting investing in this country.