License, Not Freedom

It is quite difficult to get people who are used to modern city or suburban life to move into the villages and small towns of bush alaska.  While these places have acquired many of the technological features of the rest of the united states, such as television, phones, indoor heating, and so on, they remain difficult to get into or out of, especially in the winter, and lack many modern conveniences.  It has been especially difficult to attract dentists.

In response to the lack of dentists, and the sorry state of dental health of many rural alaska residents, the Alaska Native Tribal Health Consortium (ANTHC) several years ago established a program for the training of dental therapists to provide primary dental care to “native” people in bush communities.  These therapists, initially trained in new zealand but now educated here in Anchorage, are able to do preventative dental care, as well as simple fillings and extractions.

Although training and utilization of such therapists is established practice in a number of other countries, including canada, south africa and the united kingdom, it is new here, and the Alaska Dental Society, the American Dental Association, and the Alaska State Board of Dentistry have been quick to try and prevent dental therapists from practicing in this state.  Their legal efforts have so far been unsuccessful in stopping this program, but because of opposition from dentists, therapists are at present allowed to practice only in alaska, and only on “native” (ie, eskimo, indian, and/or aleut) people.

The claim from the dentists is, naturally, that no one else can provide good dental care but they.  This is patent nonsense, and, presumably, will eventually go the way of similar arguments by medical doctors that nurses and physician assistants are not capable of giving good medical care.  But it will be a long, difficult fight, since the legal monopoly of dentists is firmly established all over the united states.

Like physician, nurses, and other health providers, dentists have been able to gain an exclusive right to practice their profession by convincing governments to set up regulatory laws and boards that restrict entry into their field by granting licenses.  Although the licensure rules change from time to time as educational practices evolve, they never fail to serve their core purpose: to restrict the numbers of practitioners and stifle competition in order to protect the jobs, income, and status of those who hold licenses.  These laws prevent people from choosing alternative providers by criminalizing the practice of dentistry (or medicine or nursing) without a license.

The professionals claim that government oversight is needed to protect “the public,” but licensure has always been asked for and driven by providers, not consumers.  It may incidentally offer recipients of health care some recourse when they have been badly treated, but that was never the main justification for regulation of the health professions.

Unfortunately, none of the advocates of the dental therapist program, however, are interested in getting rid of the system of regulation that encourages and justifies the attacks they have endured from dentists.  In south africa and the united kingdom, for example, dental therapist are already registered and regulated by the state, and it is likely that such a system will eventually be established in alaska.

While this innovative program has angered dentists, who see it as a threat to their state-mandated privileges, it was clearly not created by a free market or libertarian mindset.  It exists only because dentist-based programs were unable to provide adequate personnel, and would never have come into existence to challenge institutional dentistry if the dentists themselves had stepped up to the plate.

The program already shares features with licensed professions, in that people are required to attend a specific training program and numbers of trainees are limited.  Furthermore, there is no discussion of broadening the program to include non-“native” people.  This is no surprise when one considers the program is sponsored by ANTHC, which is a creature of government that runs a segregated health care system funded largely by federal dollars.  One would not expect such a group to advocate free choice in providing and consuming health care.  They monopolize the provision of health care to eskimo, aleut, and american indian people and jealously guard their own turf.  Questioning state oversight of health care is not on their agenda.

Welcome as it is to rural alaskans, the dental therapist program came about as a last resort in a crisis.  It would be a mistake to see it as an indication of a move towards deregulation of dental and medical care.  But it has provoked the dental associations and their enforcers on the state dental board to show their true colors: monopolists whose primary interest is maintaining their government-protected market share, even if that means denying dental care to those who need it most.

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