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Tuesday, March 30, 2004 - Page updated at 10:11 A.M.
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Crowning blow: Economy bites deep into dental care

By Shirleen Holt
Seattle Times business reporter

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Call it unemployment's drill-down effect. First went the manicures and massages. Then the evenings out. Then the cable TV. Then, after months without a permanent job, went the dentist.

"I haven't been to a dentist in about three years," says Jerry Wood, a contract programmer from Bothell who lost his dental insurance when he lost his last permanent job in early 2002. "In today's economy, bills take priority over anything else."

Plenty of others are in the same circumstance. Of the 8.2 million Americans out of work, more than half are postponing medical or dental treatment, according to a survey by the National Employment Law Project.

"We've had lots of patients who lost their jobs and really can't afford it," says Mark Walker, a Kent dentist whose clientele includes current and former Boeing workers. "Or they're so unsure about the future that they've elected to put off preventive things."

Walker's practice was growing about 10 percent a year until the economic downturn. Last year, business stayed flat.

Although he continues to see patients for emergencies such as an abscess or a broken tooth, many aren't returning until another problem erupts.

"The response is, 'I got laid off, and once I get a job and get insurance we'll get going on that' " preventive care, Walker says. "They wait and the problem gets worse, and we end up having to take the tooth out rather than do another procedure."

James Mercure, a 37-year-old unemployed Web designer from Seattle, tried to suffer through a painful toothache last year because he couldn't afford a trip to the dentist. When the throbbing got too intense, he called a low-cost clinic. The appointment was at 5:30 a.m. Cost: $200.

Dental clinics serving the poor have seen a dramatic increase in the number of uninsured patients. Puget Sound Neighborhood Health Centers, a string of five dental clinics serving low-income patients, counted 19,365 uninsured patients in 2002, a 23 percent increase from the previous year. That number dropped to about 18,000 in 2003, but it's still higher than in the past.

"Many of our patients come to us with severe problems," says Linda Orgel, dental-program manager for the nonprofit.

After reading a Seattle Times story in December about Mercure and long-term jobless people, Bellevue dentist Steven Cook offered to clean their teeth for free.
He had plenty of holes in his schedule at the time. Patients "were either out of work, or money was just too tight for them to come in," he says. Cook has also accepted barter for his services: One unemployed patient paid him with photography.

The average length of unemployment is five months, according to the U.S. Bureau of Labor Statistics. Nearly a quarter of America's jobless have been out of work longer than six months.

When the unemployed return to work, they may be surprised. Rising health-insurance costs have prompted many companies to either cut back on benefits or shift a bigger share of the costs to employees in the form of higher premiums or deductibles.

Although dental-plan premiums are rising more slowly than those for medical insurance, in 2003 they increased 5 percent to 8 percent, depending on the plan, according to Aon Consulting.

Workers also are paying a higher percentage of their dental premiums than in the past — 62 percent in 2002 compared with 59 percent in 2000. It's expected that they'll pay even more this year, and often for less coverage.

"Companies are buying plans that don't provide as much benefit," says Walker, the Kent dentist who is also president of the Washington State Dental Association. "And there are a lot of plans that the maximum (coverage) is at the same level as it was 20 years ago."

Meanwhile, the cost of a crown has risen from $300 in 1981 to $900 today.

Faced with having to pay more out of pocket and worried about job security, even insured patients are delaying treatment, Walker says.

"All of this is related to economic uncertainty. When people feel like they're going to have their job tomorrow, they're willing to spend money for their health."

Shirleen Holt: 206-464-8316 or

Copyright © 2004 The Seattle Times Company

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