An argument that dental hygiene would benefit from a mixture of political philosophies.
by Howard M. Notgarnie, RDH, MA
I moved to Colorado because I wanted to practice with fewer of the restrictions that pervade dental hygiene practice in most jurisdictions that recognize our profession. When I mention this to colleagues I often hear something like, “Yeah, they’re more liberal here.” However, I will argue that “liberal” is not a true description of fewer regulations. In fact, a conservative view includes minimal regulation on people conducting their business as they see fit. Consumer behavior in a free market is a much better motivation to improvement in business. Stifling business regulations have the effect of making choices on behalf of consumers and inhibiting entrepreneurs from innovations or even starting a business.
Dinesh D’Souza1, a conservative scholar who worked in the Reagan administration, describes conservatism as the desire to conserve the ideals that this country was founded upon. He defines liberal in two ways: liberal, as originally defined, is the recognition that all people should be free in their economic, political, religious, and expressive endeavors. However, liberal, as a political philosophy, suggests liberty often requires not only passively offering freedom to citizens, but actively ensuring that they have necessities of life, enabling them to exercise their freedom. This idea began in the administration of President Franklin Delano Roosevelt.
Does conservatism favor health care?
D’Souza explains that the conservative view of government is to protect its citizens from domestic crime and foreign invaders. In return, citizens give up certain liberties they would have and accept responsibilities they would not have if they lived without a society.
This social contract does not call for programs that redistribute wealth. In fact, the redistribution of wealth is a violation of the social contract that otherwise makes government legitimate. The welfare system, Social Security, and other social programs are carried on by force. You do not have a legal right to decline the social safety net. If you refuse to pay your share, that share will be taken away forcefully. Government agencies expand for the purpose of gaining power in the same way that business expands by gaining wealth - an agency’s success is measured by how much control it has over its citizens, not in what it accomplishes. Businesses in the private sector could accomplish goals better and with less corruption because they would be selling their products and services. For example, private educational institutions would teach what the market for education wants rather than what special interest groups want. Government should step in only to help those who cannot afford the cost of educational expenses.
D’Souza also defends conservatism in showing how capitalism improves the lives of those in a society where business is not hindered by excessive regulation. Capitalism in technology has increased the standard of living for the rich and poor. Wealthy people still have it better, but even poor people in the United States live longer now than wealthy people lived 100 years ago, and their life expectancy is closer now to that of wealthy people than it was then.
The chart contrasts the views of conservatives and liberals described by D’Souza on the broad characteristics of issues a society faces.
This conservative view strikes me as supporting fewer restrictions of health professionals. The market rather than special interest groups should decide what dental hygienists do. For that matter, the individual consumer and the practitioner offering care are in the best position to make that decision jointly. Healthy competition in the marketplace promotes economic growth and innovation.
In terms of market behavior of heatlh-care practitioners, each practitioner has a duty to take responsibility for his or her actions. A private mediator can provide judicial services if a dental hygienist is accused of malpractice and the government need intervene only when a real crime is committed or the practitioner and client cannot agree on a mediator.
Does liberalism favor health care?
Robert Reich2, former Secretary of Labor in the Clinton administration, agrees with the material definition of liberal and conservative political points of view but is about as strongly attracted to the liberal view as D’Souza is to the conservative. Reich argues that the corruption supported by conservative values not only fails to improve the economy as a whole, but also is far more damaging to society than are the private indiscretions by politicians that are typically forgiven by their liberal constituents. Board members of large corporations provide questionable benefit to their companies, yet they take huge salary and benefit packages while their employees and stockholders receive a small “trickle” promised by supply-side economics. This has resulted in a widening gap between rich and poor with a dwindling middle class. The average (mean) wealth in the United States has increased, but only because there is a small number of super-wealthy people who have used political power to get even more wealth. The redistribution of wealth that conservatives claim to detest is occurring, but in the wrong direction. As impressive as our gross domestic product is, a large portion of that GDP does not represent economic strength but instead represents correction of problems for which money did not have to be spent in the first place.
Our society spends a huge amount of money on drugs to control chronic illnesses, many of which could have been prevented at a very small fraction of the cost. Children born to poor families still have a theoretical right to the American dream, but do not have access to the resources they would need to pursue that right. Only the wealthy members of our society have financial access to the high level of education and health care that are needed for the exercise of freedom.
Like the conservative view, this liberal view could equally argue against overregulation of dental hygiene and other health professions. Laws should exist only to protect people and their environment from harm, and not to regulate what may be negotiated between a professional and a client. In particular, laws should not be protecting those who already have an advantage in their industry. Better access to care reduces cost. More people will have the health care they need, and because they are healthier, they will be more productive at work.
What view benefits dental hygiene?
Both liberal and conservative political views may actually be needed to come to the conclusion that dental hygiene, among other preventive professions, ought to be free from the constraints imposed upon them by legislation. Our work benefits consumers by reducing their risk of disease. This could provide competition in the marketplace for health-care services leading to easier, less expensive treatment; yet regulations hinder just that sort of competition.
A liberal view says that the social contract should be viewed widely. The government, especially in a democracy, is an extension of the citizens. The protection provided includes not only protection from invaders, dictators, and criminals, but also protection from disease (the opportunity to have a healthy and prosperous life).
A person who does not have access to health care is not truly free because that person does not have the ability to exercise rights guaranteed by the government in the social contract. Society has the obligation to offer basic health care to its citizens. A person who is unhealthy and spends all of his money - perhaps even going into debt - to treat disease is at the mercy of others who may have a different political agenda. He is not free or protected in the social contract because he has lost his say in the democracy.
This is the logic behind the social safety net that includes financial support for health and living expenses to the elderly, children, displaced, and unemployed members of our society. The conservative point of view is that each member of society has a reciprocal obligation of reducing the risk that taxpayers will have to provide funding for the social safety net. The government should help people who tried but failed anyway. However, it should not have to pay for the result of laziness or irresponsibility. Too many people see the government funding of their health and retirement needs as a substitute for their own savings, insurance, and prevention.
This sense of entitlement without responsibility causes everyone to pay higher taxes, including those who are taking personal responsibility seriously. Since they feel they are being cheated by the system, some of those initially responsible want to get as much back from the system as they can, so they go to the irresponsible side themselves, compounding the problem.
Part of the solution to both liberal and conservative concerns, then, is affordable health care-preventive techniques so that prevalence of disease is minimized - with a requirement that preventive health care is sought regularly by any person who wants treatment of disease to be eligible for funding by the social safety net. This combines the liberal view of protection with the conservative view of personal responsibility. But how is this achieved when laws that restrict preventive health practitioners also restrict responsible consumers from gaining access to those practitioners?
In our quest to make our profession more autonomous, dental hygienists can appeal to the sensibilities of both conservatives and liberals. We need continuing interaction with other prevention-oriented health professionals who are successfully educating legislators and the public on the personal, social, and economic value of autonomy in health care. Autonomy provides professionals an opportunity to develop their businesses and consumers an opportunity to acquire those professional services. Eliminating the restrictions on our profession supports the conservative value of capitalism and the liberal view of compassion by making our work more widely available to consumers.
1 D’Souza, D. (2002). Letters to a Young Conservative. New York: Basic Books.
2 Reich, R. B. (2004). Reason: Why Liberals Will Win the Battle for America. New York: Knopf
Howard M. Notgarnie, RDH, MA, practices dental hygiene in Colorado, and has eight years’ experience in official positions in dental hygiene associations at the state and local levels.