In 1958, the American Medical Association, the American Dental Association, and several other health professional organizations created the Joint Council to Improve the Health Care of the Aged, which was dedicated to opposing the creation of the program that would eventually become Medicare. In the years since the council’s defeat, Medicare has proved transformative, with enrollment in the program at 65 years of age resulting in improved access to care and reductions in health-related racial inequities.1 Yet organized medicine and dentistry’s historical opposition to Medicare has at least one present-day legacy: with the exception of some Medicare Advantage plans, Medicare still lacks dental coverage.
In 1965, nearly every older adult could expect to eventually lose all their teeth. Today, edentulism is no longer a consequence of age but is one of structural injustice. Dentistry continues to operate under a fee-for-service payment model, with higher proportions of costs that are out of pocket and higher financial barriers to access than other forms of health care. Moreover, most practice models focus on reconstructive care rather than on preventive measures to maintain dental health.2 These factors contribute to inequities in pain, edentulism, and unmet need affecting lower-income people, people of color, and older adults. Black and Latinx Americans are two to three times as likely to have untreated dental decay as White Americans, and low-income older adults are more than three times as likely to have lost all their natural teeth as older adults with incomes at or above 200% of the federal poverty level (FPL).3 The primary sources of dental coverage in the United States and their limitations are shown in the table.