Friday, April 26, 2024

Presidential Immunity by Joyce Vance

 


[Yesterday,] we focused on Trump’s appeal to the Supreme Court after Judge Chutkan denied his motion to dismiss the Special Counsel’s election interference case, claiming he has absolute immunity from criminal prosecution as a former president.

It was a sobering experience, even with a Court that has shown a propensity to abandon first principles, precedent, history, common sense, and the good of the American people when their political allegiances demand it. The outcome of the case is far from certain. The argument was disheartening.

I had the interesting experience of commenting on the argument on location, in the “Senate Swamp,” which is across the street from the Court. The location came complete with a protestor who loudly yelled “fake news” at us for several hours, a sign of the times.

This is a court that’s concerned with future presidents and the rules that guide their conduct as much as they are with Trump. In fact, the argument was oddly devoid of mention of the former president by name. Usually, an oral argument focuses on a defendant and his conduct.

Not so here. This was all about future presidents and how they would execute their constitutional duties. The six conservative Justices left Donald Trump on the periphery for the most part, with the possible exception of Justice Amy Coney Barrett.

But make no mistake about it. The case is all about Donald Trump and whether he can be prosecuted for the most serious of his crimes against the American people, trying to hold onto power after losing the 2020 election. It’s also about the legacy of the Roberts Court and whether history will view the already unpopular Justices as the Court that gave away democracy.

A big question is why Clarence Thomas, whose wife was involved in January 6, decided it was appropriate for him to participate in this case and why no one intervened. His presence on the bench today was a blot on the Court and the rule of law. We are forced to set that one aside for the moment. There is a possibility he could be part of a 5-4 majority that gives the former president a reprieve from prosecution.

After the dust cleared, it seemed that the three progressive Justices, Sotomayor, Kagan, and Jackson, and to a lesser extent perhaps, Justice Amy Coney Barrett, were interested in finding a path forward that would clear the way for prosecution.

Despite some early questions that suggested they weren’t buying absolute immunity, as the argument developed, it became increasingly clear that Justices Alito, Gorsuch, and Kavanaugh were all willing to throw Trump a lifeline in some shape or form.

Kavanaugh dug in on a pro-Trump argument that says a former president can’t be prosecuted under any statute that doesn’t explicitly say the president can be prosecuted, an argument that has the effect of de facto immunity since few statutes do. Justice Gorsuch joined in to make the point that an obscure statute, 18 U.S.C. 1607, expressly provides for prosecuting the president.

It reads, in pertinent part, “It shall be unlawful for an individual who is an officer or employee of the Federal Government, including the President, Vice President, and Members of Congress, to solicit or receive a donation of money or other thing of value in connection with a Federal, State, or local election, while in any room or building.”

The overwhelming majority of statutes don’t, for the obvious reason that once a president leaves office he’s a private citizen and there is no need for the inclusion.

But it became clear this was a significant issue for several of the conservative justices who engaged in pearl-clutching over how broad the statute Jack Smith used to charge Trump with conspiracy to defraud the government, 18 U.S.C. 371, is.

The Special Counsel’s office argued in its brief that Trump was not entitled to absolute immunity and that even if there was some small scope of immunity for a president’s official acts, it clearly did not apply to Trump’s conduct. Jack Smith’s office reasoned that meant that applying first principles, the Court should not decide issues that were unnecessary to resolve the case in front of it and should remand the case to Judge Chutkan for pre-trial proceedings to recommence.

That doesn’t seem to be how this will go, although it can be notoriously difficult to read the tea leaves in oral argument, where the Justices sometimes appear to be arguing the case as much to each other as with the litigants.

One concession came from the Trump side early in the argument, with Trump lawyer John Sauer agreeing that there was no immunity for private acts committed by a former president while in office. The absolute immunity they claim is for official acts, not private ones.

In this case, the distinction amounts to that between official acts taken by President Trump and private ones taken by candidate Trump. That is an approach that is appealing in some ways.

The Special Counsel had argued in his brief, as a fallback position, that the indictment alleged sufficient private conduct to prosecute Trump on even if they lost all of the official conduct.

They maintained they were entitled to use certain acts that the Court might view as official—like the effort to subvert DOJ by appointing a new Attorney General or the pressure campaign on Mike Pence—as evidence of Trump’s knowledge and/or intent.

They agreed today that if this happened, the jury should get a limiting instruction, telling them they could not consider that evidence as part of the charges but only as evidence of Trump’s state of mind.

After the briefs were in, that seemed like the Special Counsel’s rock bottom worst-outcome in the case. Not ideal, but certainly a position that would let them proceed to trial with the scope of the charges narrowed but still capturing significant criminal conduct.

But, after today’s argument, it’s clear that isn’t the worst outcome that is on the table. Early in the argument, Justice Sotomayor proposed the notion that a former president might get some limited immunity for official acts that were undertaken to protect the country, like Obama’s anti-terrorism strikes, as opposed to Trump’s actions, whose only beneficiary was himself.

She pointed out that immunity means no prosecution for conduct committed for purely personal gain. That logical notion got no traction during argument.

Even Justice Alito, at one point early on, suggested an objective test rather than absolute immunity. He questioned Sauer about his claim immunity was essential to the functioning of the presidency, asking whether “full immunity” was really necessary or whether he’d agree to a rule that allowed prosecution for official acts unless no plausible justification could be imagined.

Sauer agreed that might be better than the distinction between official and private conduct, despite having conceded already that there was no immunity for private conduct. Of course, Alito’s objective standard is in the eye of the beholder, and as slick as some of the Justices have become, perhaps they could “imagine” a “plausible justification” for everything Trump has done, again bestowing de facto immunity.

The one place where it appeared Trump was likely to lose was on his argument that a former president must be impeached and convicted before he can be prosecuted for an official act. Although five votes might be there, we didn’t hear that today. But it wasn’t smooth sailing for the government beyond that.

All paths seemed to lead to the bad place. At what looked like a four-four split the vote of the Chief Justice seemed to be the one that is in play. And he was difficult to read. On the one hand, would he truly want to sign off as the last majority vote on an opinion that would be so damaging to the rule of law he has always claimed to stand for?

But on the other, he didn’t take the strong stand for the rule of law and the executive branch’s power of prosecution you might expect if he was aligned there. For instance, while Justice Jackson opined that any conduct committed by candidate Trump could clearly be prosecuted and it was essential to have a check on a criminal president or in the future, the Oval Office could be reduced to a hub for crime, Justice Gorsuch seemed more concerned with the possibility prosecutors might abuse their power.

Michael Dreeben, arguing for the Special Counsel and the Justice Department, pointed to the layers of checks on prosecutorial power, from the need to persuade a grand jury to indict, to the role of the trial judge in calling balls and strikes, to the decision of a jury, and on to the multi-tiered appellate process.

But Gorsuch didn’t seem interested. In fact, every time Dreeben tried to respond to questions they asked him and began to score points, they seemingly lost interest, never permitting him to get in a full answer.

He also argued presidents have access to extraordinarily good legal counsel from their attorney general, who could help them decide whether a course of action was legal before embarking on it and are otherwise protected from abuse by judicial construction of statutes and the availability of defense, like one called public authority, again being cut off before he could make his full argument. The Chief Justice was nowhere to be seen in any of this.

[The] argument got way down into these legal weeds. One theme emerged: the likelihood that whatever the ultimate majority in the case looks like, it’s very likely that it will involve crafting rules about the scope of immunity.

That could mean sending the case back on remand, Sauer suggested to the trial court, for a decision about whether or not, on the facts in this case and given whatever rule the Supreme Court lands on, Trump is entitled to immunity.

And that, of course, would take more time. Delay is a win for Trump, putting the case out of even theoretical reach for prosecution before voting starts, since Judge Chutkan has already told Trump he has at least 81 days left on the clock for trial preparation after jurisdiction is restored to her.

We don’t know for certain where Chief Justice Roberts is and how he will vote. But if this comes to a decision that some conduct does get immunity and the trial judge must make those rulings, there is one possible silver lining. Judge Chutkan could hold an evidentiary hearing on remand to facilitate her decision.

That would mean briefs and even live testimony where the government would get to lay out all of its evidence against Trump.

It’s not a full trial followed by a jury verdict. But if this case isn’t going to trial, it would be one way of getting more information about Donald Trump’s conduct out for public consumption.

The House January 6 committee hearings gripped the nation. The Special Counsel, with access to the powers of an investigative grand jury and the possibility of more cooperating witnesses, especially from other charged cases, would have an even larger story to tell.

When it comes to delay, there was an interesting filing in Mar-a-Lago today. Trump’s lawyer, Chris Kise, notified the court he would be out for surgery from April 29 to May 14.

His absence will likely delay the CIPA Section 5 proceedings over classified information and its use at trial. More delay. Sometimes delay is legitimate and unavoidable. Set your expectations accordingly.

Near the end of today’s argument, Justice Jackson put all the cards on the table, suggesting the Court should just answer the question they took the case on: Is a former president entitled to immunity for criminal acts committed while president, and if so, what is the scope of that immunity?

It would be the right way to resolve the important question the nation faces. Sadly, it doesn’t seem like where we’re headed.

Enormous thanks to those of you who, through your monthly and yearly subscriptions, are providing financial support for the work I do. You let me devote the time and resources necessary to write Civil Discourse. If you’re not already a paid subscriber and you’re enjoying the newsletter, I hope you’ll consider it. We live in challenging times, and I understand that not everyone can or wants to buy a paid subscription. I’m happy to have you here either way!

We’re in this together,

Joyce Vance

 


Wednesday, April 24, 2024

Palestinians as “The Others” by Ralph Nader

 

Image by Sohaib Al Kharsa

Throughout history, military empires have reduced their victims, their subjugated, and their abducted to a state of “The Others.” The political and mass media institutions usually follow suit by supporting their empire’s predatory policies with slanted coverage.

 

Such is the case with the U.S. global and the Israeli regional empires. The U.S. federal government and the mainstream media often move in lockstep.

 

For example, take the word “terrorism.” The New York Times regularly refers the Hamas regime as “terrorists,” while describing the far more extensive Israeli acts of state terrorism as “military operations.” Since October 7th, the Israeli military superpower has killed over 500 times more children than Hamas killed in their raid through a still uninvestigated collapse of Israel’s vaunted multi-tiered border security.

 

Apart from a massively greater overall civilian toll inflicted on Palestinians in Gaza – the vast undercount stands at 34,000 Palestinian deaths compared to the deaths of 1,139 Israeli civilians, soldiers, and foreign workers.

 

This staggering ratio – over 14,000 Palestinian children (with many thousands under the rubble) compared to 30 Israeli children – escapes proper reporting. “The Others” don’t get accurate coverage as was also the case with huge Iraqi losses during the Bush/Cheney criminal war. (See, the March 5, 2024, column: Stop the Worsening UNDERCOUNT of Palestinian Casualties in Gaza).

 

Take the use of the term “hostage.” Hamas seized over 240 Israelis hostages on October 7th. Since then, the Israeli army has seized about 9000 Palestinians, including women and children, and taken them without charges, along with many more thousands languishing in these prison camps also without charges for years (it’s called Israel’s “administrative detention”). Many of the imprisoned Palestinians are being tortured. Who has gotten the far greater attention? Aren’t these Palestinian hostages also? Again “The Others.”

 

How about the application of the right to self-defense? Every state has the right to self-defense. Count the many times you have heard, “Israel has a right to defend itself” compared to “Palestine has a right to defend itself.” Members of Congress who bellow the former declaration daily cannot get themselves to say the latter.

 

It is a forbidden phrase. Yet, who is the violently occupying, colonizing, land, and water-stealing party? Israel. For over fifty years, more than 400 times more innocent Palestinians have been killed and injured compared to innocent Israeli civilians. Where is the detailed coverage of the loss of life from enforced destitution and denial of life-saving medicines, equipment, and emergency transport to health facilities? Again, it is “The Others.”

 

“The Others” are always described with less charitable words. In a meticulous content analysis by The Intercept of the Los Angeles Times, the New York Times, and the Washington Post between October 7 and November 24, the use of the words “slaughtered,” “horrific” and “massacre” in relation to Israeli and Palestinians killed was 218 to 9!

 

The Intercept said Israel’s war on Gaza is “perhaps the deadliest war for children – almost entirely Palestinian – in modern history.” There is scant mention of the word “children” and related terms in the headlines of articles in that span of time.

 

(Note, reporters from these papers are like the rest of the mainstream Western media reports, including Israeli journalists, who have been long banned by the Israeli government from freely reporting from inside Gaza, but have managed to write some exceptionally graphic stories from a distance.)

 

Palestinian Arabs are denied the description of armed-force anti-semitism by the Israeli war machine. Arabs are Semites and have long been the victims of violent racist, hate-filled anti-semitism by brutal Israeli leaders. (See the “Anti-Semitism Against Arab and Jewish Americans” speech by Jim Zogby and DebatingTaboos.org).

 

The Intercept reported that the three newspapers mentioned anti-semitism against Jews in the U.S. 549 times compared to 79 mentions of Islamophobia, notwithstanding, far more frequent, and violent assaults on Muslims and Arabs.

 

Western medical doctors spending a few weeks in bombed Gaza hospitals are personal witnesses of scenes beyond any level of deliberate slaughter they have ever experienced in their courageous service in troubled areas around the world.

 

Ambulances, hospitals, and thousands of families – adults, children, women, and babies alike – huddling in areas outside these facilities are routinely bombed, and shelled by Israeli planes and tanks, and targeted by Israeli snipers. Courageous Israeli human rights groups and refuseniks will detail more of the mayhem over time.

 

Biden’s chosen humanitarian aid emissary David Satterfield did not mince words in his remarks during a virtual event hosted by the American Jewish Committee, “there is an imminent risk of famine for the majority, if not all, the 2.2. million population of Gaza.” According to Satterfield, “This is not a point in debate. It is an established fact, which the United States, its experts, the international community, its experts assess and believe is real…”

 

Still, the duplicitous Netanyahu twirling the hapless Joe Biden around his bloody fingers continues to obstruct the entry of hundreds of trucks with critical food, water, and medicine, sometimes paid for by U.S. taxpayers that are lined up daily at the borders of Gaza. Netanyahu continues to enforce, whenever he can, the genocidal orders by his barbaric ministers on October 8 – “No electricity, no food, no fuel, no water. …We are fighting animals and will act accordingly.”

 

To the White House and the Netanyahu-dominated U.S. Congress, violating numerous federal laws, (See the April 19, 2024, Letter to President Joe Biden), the response is to make the American taxpayers continue to pay billions of dollars to unconditionally weaponize further the Israeli death machine in Gaza, right down to 2000-pound bombs that destroy entire civilian neighborhoods. After all, Gazans are “The Others.”

 

The streets of America have come alive with valiant Jewish, Muslim, and Christian protestors joining together and showing up wherever Biden and other callous politicians speak such as Senator Tom Cotton (R-AR) who said, “As far as I’m concerned, Israel can bounce the rubble in Gaza.”

 

After 76 years of Congress blocking testimony by leading Israeli and Palestinian peace advocates, more lawmakers are starting to listen. But many more in Congress –– are still mired in their clenched-jaw obeisance to the AIPAC lobby. It is time to stop the rubble ‘bouncing’ over decomposing bodies in the besieged tiny Gaza Strip.

 

Ralph Nader is a consumer advocate, lawyer and author of Only the Super-Rich Can Save Us! 

-CounterPoint

 


Tuesday, April 23, 2024

The Senate is expected to pass legislation Tuesday granting Ukraine a new lifeline

 



Half a year of political squabbling and deadlock ended this weekend after a bipartisan vote in the House allowed for the passage of a bill greenlighting some $61 billion in military aid. House Speaker Mike Johnson (R-La.) opted to antagonize the Trumpist wing of his caucus by pushing through the funding requests, which are expected to be signed off by President Biden.

That was no easy feat for Johnson, a relatively inexperienced figure catapulted to prominence amid the dysfunction and internecine battles of his own party. After months of stalling on Ukraine’s desperate aid requests, he appeared compelled by high-level intelligence briefings about the state of Kyiv’s plight and the entreaties of a handful of more establishment-leaning, senior Republican lawmakers as well as some leading Democrats.

“Look, history judges us for what we do,” Johnson said at a news conference last week in response to a question from my colleagues about his decision to invite the ire of the Republican far right. “This is a critical time right now, critical time on the world stage. I could make a selfish decision and do something that’s different, but I’m doing here what I believe to be the right thing.”

Far-right Republican lawmakers have openly mulled launching a bid to oust Johnson from his role as speaker. In Europe, though, the movement on Ukraine was cheered by Kyiv’s boosters. “Better late than too late,” Polish Prime Minister Donald Tusk posted on social media. “And I hope it is not too late for Ukraine.”


Ukraine’s struggles after more than two years resisting Russia’s invasion have been well-documented. The country’s weary armed forces are short on personnel and even shorter on ammunition, and officials in Washington and Kyiv warn that Ukrainian troops may soon be outgunned by the Russian invaders by roughly 10-to-1 in artillery rounds.

Russian long-range missiles and drones land indiscriminately on Ukrainian cities, many of which lack the sufficient defenses to ward against such attacks. And far from retaking lost territory, Ukrainian forces are locked in a desperate battle to hold their ground, with Russia concentrating its latest offensive on the eastern town of Chasiv Yar in the partially occupied Donetsk region.

In an interview with NBC, Ukrainian President Volodymyr Zelensky indicated that his country had lost precious time while waiting for Congress to come to their rescue. “We’ve had the process stalled for half a year and we had losses in several directions, in the east. It was very difficult and we did lose the initiative there,” Zelensky said. “Now we have all the chance to stabilize the situation and to take the initiative, and that’s why we need to actually have the weapon systems.” 

-Washington Post


A few simple precautions can make all the difference

 


To help safeguard your information, if you get an unrequested phone call:

  • Do not provide or "confirm" any of your personally identifying information.
  • Never read back a one-time security passcode (unless you have initiated the service call to a company's official phone number).

Here are more steps to protect against scams and identity theft.

Stay vigilant against phishing!

Phishing is a technique criminals may use to try to trick you into giving them your personal information—information that they may then use to try to steal your identity. They often do this by impersonating a company or institution, and then asking you to click on a link, open an attachment, or to "confirm" your date of birth, Social Security number, or account credentials.

Even if you feel confident in your ability to spot a scam, it's important to stay vigilant in your daily life. Most phishing attempts are carried out by email, text message, or phone. Here are several warning signs that should raise suspicion:

Warning signs of phishing attempts

  • Someone contacting you to say that you have won an award or freebie.
  • Someone contacting you with a deal that sounds too good to be true.
  • Phone calls, emails, or texts that claim to be from the IRS.
  • Unusual communication from someone asking for help.
  • Unusual communication (that may sound legitimate) claiming to be from a company you work with.
  • Communication from an unfamiliar email address or phone number.

Remember that phishers may use urgent-sounding language to try to get you to click on a link or attachment right away—before you have time to think it through. To create this sense of urgency, they might claim that something very good has happened (like you've won some money), or that something very bad has happened (like you're in debt with the IRS). Be suspicious anytime you receive an out-of-the-ordinary text, call, or email that makes such claims.

Here's how you can protect yourself, particularly if you've received a suspicious or unexpected communication:

Protecting yourself against phishing attempts

  • Stop communication with the phisher immediately.
  • Hang up the phone or ignore the suspicious email or text.
  • Do not click on any links or download any attachments.
  • Do not provide or "confirm" any of your personally identifying information.
  • If you think the communication could be a legitimate request from a company you do business with, hang up and then call the company directly.
  • Never grant remote access to your computer or read back a one-time security passcode (unless you have initiated the service call to a company's official phone number).

Protect your phone service.

Think of how protective you are with something like your Social Security number. You know that if a criminal were to obtain it, they might be able to take out a credit card in your name, obtain your tax refund, or even worse.

Increasingly, your cell phone account is becoming something you need to protect just as diligently. If criminals can gain access to your phone calls and text messages, they can potentially steal one-time passcodes and break into your accounts.

For example, one way they may do so is with "SIM swapping." (A SIM card is a small plastic card that stores identifying information on your cell phone, and that allows you to make and receive calls.) With this scam, a fraudster may call your cell phone provider pretending to be you, saying that you have a new SIM card to activate. If the scammer already has some of your personal information (like the last 4 digits of your Social Security number, your date of birth, or your password for your mobile provider account), they might be able to convince the cell phone carrier that they are you and get your phone number reassigned to their SIM card.

Here are several warning signs not to ignore:

Warning signs that your phone has been compromised

  • You stop receiving phone calls and text messages.
  • Your phone says "no service" or "emergency calls only."
  • Restarting your phone does not restore service.
  • You receive emails from your cell phone provider about changes to your account.

 

-Fidelity Viewpoints


Monday, April 22, 2024

Caring for older Americans’ teeth and gums is essential, but Medicare generally doesn’t cover the costs

 


C. Everett Koop, the avuncular doctor with a fluffy white beard who served as the U.S. surgeon general during the Reagan administration, was famous for his work as an innovative pediatric surgeon and the attention he paid to the HIV-AIDS crisis.

As dentistry scholars, we believe Koop also deserves credit for something else. To help make the medical profession pay more attention to the importance of healthy teeth and gums, he’d often say: “You are not healthy without good oral health.”

Yet, more than three decades after Koop’s surgeon general stint ended in 1989, millions of Americans don’t get even the most basic dental services, such as checkups, tooth cleanings and fillings.

Americans who rely on the traditional Medicare program for their health insurance get no help from that program with paying their dental bills aside from some narrow exceptions. This group includes some 24 million people over 65 – about half of all the people who rely on Medicare for their health insurance.

“Medically necessary” exceptions

When the Medicare program was established in 1965, almost all dental services were excluded due to the expense and vigorous opposition from associations that represent dentists out of fear that reimbursement rates would be markedly low compared to traditional insurance plans or out-of-pocket payment.

However, interest in including dental benefits in Medicare is on the rise at the Centers for Medicare and Medicaid Services, the federal agency responsible for the Medicare program, as well as many organizations that seek to provide dental benefits to all members of society.

The Biden administration initially considered the addition of comprehensive Medicare dental coverage as part of its proposed Build Back Better legislation, a broad US$1.8 trillion legislative package designed to fix problems ranging from child care costs to climate change, but failed to get enough support in Congress.

Dental coverage was eliminated from the version of the bill the House passed in 2021, in part due to cost concerns and resistance from organized dentistry due to the low reimbursement rates for medical care for patients with Medicare benefits.

In 2022, after the broader package was blocked in the Senate, the federal government added coverage for dental treatment that was designated as “medically necessary” for people with Medicare.

The list of circumstances that would lead patients to be eligible is short. Some examples include patients scheduled for organ transplants or who have cancer treatment requiring radiation of their jaws. But we believe that dental care is necessary for everyone, especially for older people.

Chew, speak, breathe

While many working Americans get limited dental coverage through their employers, those benefits are usually limited to as little as $1,000 per year. And once they retire, Americans almost always lose even that basic coverage.

Given the importance of oral health for your overall health and quality of life, and increasing scientific understanding of the role of poor oral health in a wide array of chronic diseases, we believe that Medicare should include basic dental services.

A healthy mouth is essential for chewing, speaking and breathing. Being able to flash a good smile boosts self-esteem and helps maintain a sense of well-being.

Left untreated, dental diseases often result in infections that can cause severe pain. Poor oral health can lead to hospitalization and even death. Yet, routine oral care is frequently unavailable to many Americans.

Rich Americans with Medicare coverage are almost three times more likely to receive dental care compared to those with low incomes. And almost 3 in 4 low-income people over 65 don’t see a dentist in a typical year.

Connected to many serious conditions

Numerous epidemiological studies have associated atherosclerosis, a serious condition colloquially known as clogged arteries, cardiovascular disease and stroke, with periodontal disease – chronic inflammation of the bone and gum tissues that support the teeth.

Having diabetes makes you three times as likely to develop gum disease because diabetes compromises the body’s response to inflammation and infection. At the same time, treating diabetes patients for gum disease can help control their blood sugar levels. Researchers have found that when people with diabetes get preventive dental and periodontal care, their diabetes is better controlled and health care costs decline.

Poor oral health can also increase the risk of contracting pneumonia, especially for patients in hospitals and nursing homes. When patients see a dentist before entering the hospital, they’re less likely to get pneumonia during their stay.

There is also evidence that untreated dental problems may contribute to rheumatoid arthritis as well as Alzheimer’s disease and other cognitive impairments.

Chemo can damage your teeth

Many cancer treatments can damage teeth, especially for older adults. As a result, Medicare has started to reimburse for dental bills tied to tooth decay or other oral conditions after they get chemotherapy or radiation treatment.

The American Dental Association warns of the oral health problems that arise following chemotherapy and radiation treatment and offers tips on protecting your teeth during treatment.

More than nice to have

The history of U.S. health care helps explain why Medicare generally won’t cover the cost of dental and gum treatment. Doctors and dentists are educated separately, and doctors learn very little about dental conditions and treatments when they’re in medical school. Most dental electronic health records aren’t linked to medical systems, hindering comprehensive care and delivery of dental care to those in need.

At the same time, medical insurance and dental insurance have evolved to serve very different functions. Medical insurance was designed specifically to cover large, unpredictable expenses, while dental insurance was intended to mainly fund predictable and lower-cost preventive care.

While protection from catastrophic medical costs has always been perceived as a necessity, coverage of dental services was conceived as a benefit that’s mostly nice to have. But that’s an outdated idea disconnected from a large body of scientific evidence.

Medicare Advantage plans

Until Medicare expands coverage to include preventive dental services for everyone, alternative plans such as Medicare Advantage, through which the federal government contracts with private insurers to provide Medicare benefits, serve as a stopgap.

In 2016, only 21% of beneficiaries in traditional Medicare had purchased a stand-alone dental plan, whereas roughly two-thirds of Medicare Advantage enrollees had at least some dental benefits through their coverage. However, these plans vary greatly in the procedures that they cover.

The costs of this hole in Medicare coverage are high: 1 in 5 Americans with Medicare – including many with little disposable income – are spending at least $1,000 a year on dental care.

It seems that Dr. Koop was onto something – you can’t be healthy without good oral health. Adding basic dental benefits to Medicare would likely help many older Americans to live happier and healthier lives, and at the same time potentially reduce overall health care costs.


-Frank Scannapieco, Professor and Chair of Oral Biology, University at Buffalo


-Ira Lamster, Clinical Professor of Periodontics and Endodontics, Stony Brook University (The State University of New York)

The Conversation