Officer, The: Dental readiness: a Reserve priority

The Reserve Officers Association was founded on 2 October 1922, when World War I combat veterans gathered with GEN John J. "Blackjack" Pershing out of concern for decreasing national defense preparedness. The original mission was to promote military policy that would provide adequate national security.

Reserve force readiness is a key aspect of national defense. When the president calls for Reservists and National Guard they must be ready to answer this call! Although there is no question we have the best-trained, best-equipped Reserve force on the planet, if the individual Reservist cannot pass a physical examination, he or she cannot meet the call. At this time too many Reservists cannot pass a dental physical.

According to a study published in Military Medicine, June 2002, 35.8 percent of members of a National Guard Unit who were processed for mobilization were Dental Class 3, meaning they had significant oral conditions present that were expected to cause an emergency within 12 months. The Reserve dental departments do not have the legal authority to treat these patients, and even if they had the authority they would not have the manpower. The nation relies on civilian dentists to provide this care and expects Reservists to seek out and pay for this care. However, when possibly one-third of the active Reserve is not dentally fit, the current system is broken and needs to be fixed.

This problem must be attacked on two fronts. First, dental readiness must be raised to a higher level of awareness by military leadership, from senior enlisted to the secretary of Defense.

Second, we must improve the resources available to Reservists to improve access to dental care. One option is to vastly increase the size and scope of the Reserve dental departments. This would require a Title law change to allow the dental Reserve departments to provide dental treatment to drilling Reservists.

In terms of health-care cost, dentistry is a great bargain. During the Vietnam War, one-third of all those who were medical casualties who left the field and were later returned to duty were returned by a dentist. This high return was achieved with only 5 percent of the medical budget.

One solution would be to give the responsibility for care to a much larger Reserve dental force. The other option is to provide a better system for funding privately delivered care. The current dental insurance is a failure but there is a much better system available.

DIRECT REIMBURSEMENT

The most cost-effective, "bang for the buck" dental plan is direct reimbursement. Under this system the Reservist goes to any dentist, gets the care he or she needs, and then files a claim to the pay office. No waiting, no preauthorization, no complex reimbursement formulas or varying levels of reimbursement.

The suggested initial plan would call for a $2,000 annual benefit. Seventy-five percent of the dental treatment expense would be reimbursed by DoD; the other 25 present would be paid by the Reservist. There would be no deductible. The Reservist would pay premiums to cover $500 of the benefit, DoD would pay up to $1,000 a year per Reservist enrolled. So the plan pays $3 and the Reservist pays $1 for up to $2,000 of treatment per year.

The Reserve components have a built-in system of adequate controls and safeguards of the quality of care provided because each Reservist would still be required to have an annual dental examination by a Reserve dental department. Military people are accustomed to paying a bill and then turning in a receipt for reimbursement. The administrative cost would be minimal, as there would be no insurance company taking a cut of the premiums. The premiums would be withheld from Reserve pay and placed in trust. The remaining funds would be budgeted and placed in the trust by the services each fiscal year and paid out as utilized. If the Reservist is activated, premiums would stop until the service member is discharged.

This nation is at war and the Reserve force can no longer tolerate significant numbers of dentally unfit members. Every member is critical to the overall mission. There are only two ways to provide enough dental care to have a fully mission-capable force: Vastly increase the size and scope of the active Reserve dental departments or find a better way to provide the necessary care privately. It is clear that the only practical option now is the second option. A direct reimbursement system is the most cost-effective way to fund this mission requirement.

ROA is in the business of promoting the nation's security and dental readiness should be high on the list of issues we support.

Captain Austin is the ROA national dental surgeon.