What union support of Obamacare may mean for dentistry

Editor's note: This article first appeared on the website Dental Intelligence on October 24, 2012. Reprinted with permission of William T. Brown, DDS.

As the 2012 presidential campaign nears its climax, my interest was piqued by a recent article in Forbes Magazine.

The September 10, 2012, "Mallory Factor" discusses one of the great mysteries of modern politics: Why was there high level of union support for the Affordable Care Act (ACA; also known as "Obamacare")? According to Mallory, government unions spent tens of millions of dollars and used enormous political capital to pass the ACA. This was done despite the fact that universal healthcare shouldn't be a core issue for unions because most of the union members have more than adequate coverage. So what was the reason for the overwhelming support?

Mallory contends the real reason unions fell behind Obamacare is that the law throws the door wide open for unionizing most of a 21-million-member healthcare workforce. Presently only about 1.5 million of America's healthcare workers are unionized -- less than 10% of the total -- primarily because many are self-employed or work in small offices and can't be unionized under current law, according to Mallory. The unions want to overcome this hurdle with plans to ultimately unionize every healthcare worker in America.

The unions' agenda

First they would move private medical practices into large hospitals. Once healthcare workers are employed by hospitals, they can be unionized as private hospital workers as government employees if they work for government hospitals. This plan is already moving forward; for example, by next year only 33% of medical doctors will be in private practice, down from 57% in 2000.

Next on the unions' agenda is to use a new organizing model to unionize self-employed people, including the remaining healthcare workers in private practice. Mallory writes:

Service Employees International Union (SEIU), American Federation of State, County & Municipal Employees (AFSCME) and other government employee unions have tested out this organizing model on health care providers and in-home child care providers over the last decade. These providers are partially or fully paid from government programs that subsidize the cost of their client's care. The unions' allies in state government use the fact that these individuals receive payments under government programs to treat them as 'government employees' who can be unionized.

According to Mallory, Obamacare legislation dramatically increases the number of healthcare workers receiving payment for their services under a government program. He continues with a scenario in which the government employee unions can enlist pro-union state governments to treat these healthcare workers as "government employees" and unionize them just as they unionized the care providers.

He believes that as we move closer to a single-payor system, many more healthcare workers will be compensated through government programs. He thinks that eventually virtually all healthcare workers ("except Park Avenue plastic surgeons") will receive at least part of their compensation from a government payor, which transmutes into the status of a "government employee."

99% of U.S. dental practices have 50 or fewer employees.

What's in this plan for the unions is huge. For every million additional healthcare workers unionized in the 27 non-right-to-work states, the unions stand to earn a billion dollars in dues.

Writing on the wall?

Does this glimpse into the future reveal the writing on the wall for the dental profession? I don't have a crystal ball, but if history is a guide, there will be a significant increase in payments to dentists from government entities. That translates into many dental staffs becoming "government employees" by default. This change could replace private insurance company bureaucrats with Washington bureaucrats. It is difficult to view that as an improvement.

What are the implications to oral healthcare delivery? Will dentists still have autonomy to build relationship-based practices based on collaboration, education, and trust? Or will they and their staffs be reduced to following operations manuals with rules promulgated by government clerks and monitored by union work rules? Some may view these changes as an improvement in oral healthcare delivery. But others may see it as a radical change in the traditionally independent dental practice.

Obamacare and unionization of healthcare workers may not be relevant to dental practices today, but recall the famous quote regarding the ACA by Speaker of the House Nancy Pelosi: "We have to pass the bill so that you can find out what is in it."

It may be a stretch, but fundamental changes are a significant conundrum for consideration. Will unintended consequences of the ACA result in a new dental practice model, with 2% cosmetic practices and 98% working for government unions?

William T. Brown, DDS, practices in Des Moines, IA. He started his blog, Dental Intelligence, in 2010 to share information and experiences that have fundamentally changed the way dentistry is practiced.

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