Imagine your knee is causing debilitating pain and, like 1.3 million Americans a year, you need to have it replaced.

Worse, your knee is infected, abscessed and damaged so badly you can barely walk. The surgeon walks you through the process, answers your questions and you hobble to the front desk to schedule your appointment. It is then you are notified that the procedure is going to cost more than $30,000 per knee.

“Not to worry,” the patient coordinator says cheerfully, “your insurance will cover $2,000 and we offer financing, or you can always remortgage your home.”

Stunned, you ask what other options you have. “Well, we can remove the knee entirely and fit you with these acrylic legs. You won’t be able to run, or feel anything and they take months to get used to but it is better than being in pain.”

Imagine the outrage of politicians if this scenario ever played out in a medical office. Realize it happens multiple times a day in dental offices across the country and we hear not a whimper.

Dental care is not a luxury but a cornerstone of overall health and well-being. Yet for far too many residents of Maine, quality dental care remains out of reach due to its high cost, lack of providers and meager insurance coverage. This crisis has serious implications not only for individuals but also for our broader healthcare system and economy. It’s time for policymakers, insurers and the dental industry to address the lack of coverage for dental treatment and ensure equal access for everyone.

The greatest hurdle to affordable dental care is the poor reimbursement structure of insurance plans. The annual maximum of $2,000 has remained unchanged for decades while costs to provide care have done nothing but skyrocket. While there is legislation being discussed that would require insurance companies to return some profit to patients, what we truly need is a complete system reform. According to recent studies, nearly one-third of Americans forgo routine dental visits due to cost.

Here in Maine, where median incomes often fall below the national average, the impact is even more pronounced. Low-income families, seniors on fixed incomes and even middle-class residents are finding themselves forced to choose between essential dental procedures and other basic needs like housing or groceries. Insurance companies must be required to provide 100% coverage for medically necessary procedures. This is the only way we can avoid the inevitable choice between paying rent and sacrificing a limb.

In my last op-ed in these pages, published July 2023 (“Bring a dental school to Maine”), I spoke about support for dental therapists. At that time, I offered my Auburn dental office as a home base for the therapists while they were training. I offered my associates, myself and my staff to fast-track a dental therapy school in Maine. Yet I was met with unequivocal indifference from those tasked with forming this new discipline.

I met with college deans, instructors and dentists who had helped create dental therapy schools in other states. We discussed copying the CODA-approved curriculum for use in Maine and using my facilities as testing grounds for a feasibility study. Yet all this effort was met with a complete lack of interest from those who held the power to actually create the school. After months of unanswered emails and pleas falling on deaf ears, I threw up my hands in exasperation, feeling powerless to effect any change whatsoever.

There are solutions to this crisis, but they require bold action. Expanding Medicaid coverage to include full mouth replacement is a critical first step. Maine’s recent decision to offer dental benefits to adult Medicaid recipients is a positive development, but it is just a drop of water in the ocean. Dental needs must be treated equally with medical needs and Maine has an opportunity to lead the way in addressing this crisis. Sen. Susan Collins has vowed to support Mainers in her new role as Chair of the Senate Appropriations Committee and I have no doubt she would enact immediate change if she were made aware of the incredible needs our fellow Mainers are facing.

By prioritizing dental therapy and increasing insurance reimbursements, we can improve the lives of countless residents while strengthening the health of our communities. The time to act is now.