By Bailey Kennedy
Though Pres. Biden’s expansive infrastructure and social spending bills remain mired in Congress, it still seems likely that his administration will preside over one of the most dramatic revisions in America’s public safety net since the Great Society.
One of the most discussed provisions in the omnibus bill would expand Medicare benefits to include hearing, vision, and dental care. Currently, millions of Americans are forced to go without the types of care that the proposed Medicare expansion would address. And seniors, in particular, are likely to deal with vision and hearing-related health care issues, which pose a high financial burden.
While the proposed expansion has met pushback, including these aspects of health care in standard insurance plans is significantly overdue.
It’s not necessarily obvious why a standard health insurance plan might be expected to pay for the issues that an individual experiences with his nose, but not with his ears, or why a broken bone will generally be covered, but a broken tooth generally wouldn’t.
One reason that vision, dental, and hearing aren’t covered is historical. Optometrists, who most Americans see for routine eye exams, do not go to medical school. Optometry is its own field, rather than a field within the medical profession. The history of dental care is similar. Divides created by the professions themselves were reinforced by the insurance industry, which, in its earliest stages in the United States, tended to pay for care provided by physicians, but not for other forms of care.
Still, there is no reason that history has to be destiny. In recent decades, the government has taken on a much larger role in providing health insurance to Americans, and in regulating the health care industry. This could extend to dental, vision, and hearing care. Indeed, the Affordable Care Act did take steps towards making these types of care more accessible to certain segments of the population. But the fact remains that people who want to secure access to these types of care if the need arises are often forced to buy additional insurance plans on top of a standard health insurance plan.
The most obvious reason why these benefits are not covered is economic. If you are a person who needs glasses and who maintains a steady level of vision, you will probably be able to predict with some accuracy how much you need to spend on your eyes every year. You’ll pay a hundred dollars for an eye exam, another few hundred for contact lenses, and if necessary another couple hundred for new glasses. You will not want to pay more than that amount for a yearly insurance plan, and insurance companies offering these benefits will not want to charge less than this amount for the benefits. Dental care and hearing loss present similar problems.
However, this accounting problem is similar to that posed by many chronic, lifelong conditions which are covered by health insurance plans. Once an insurance plan goes beyond purely covering catastrophic care, it becomes difficult to draw lines as to which types of care should be covered and which should not. Adding coverage of chronic conditions like vision loss is, in a sense, redistributive: it’s likely to make it more costly for insurance companies to offer plans, but the burden will be shared across a wider pool. It’s hard to see why society would morally object to burden sharing in vision or dental care, while finding it acceptable to share burdens in treating people with arthritis or chronic migraines.
Ultimately, the expansion of Medicare to cover these types of benefits might serve as a pilot program for society at large. A woman in her forties might notice that her mother is now accessing vision benefits through health insurance, and wonder why her health insurance policy is not offering similar benefits. Perhaps within a few decades, we’ll look back at the early 21st century and marvel at the fact that we used to live without easy access to dental care. In the meantime, those who need to get their teeth cleaned will have to open their wallets.