David Heath is a Senior Reporter at the Center for Public Integrity. For nearly 9 months, Heath reported on a collaborative story between FRONTLINE and CPI called “Dollars and Dentists.” The story examines why so many people face tooth pain every day and are unable to seek treatment. Heath spoke with JCCF’s Lyndsey Wallen about his role in the investigation.
What made Frontline and the Center for Public Integrity decide to pursue this story? Did you get any tips or personal requests for an investigation?
The producer, Jill Rosenbaum, she’s a producer for Frontline and she works out of our office, was looking for stories and I think she actually saw an article about how the New York Attorney General had at one point looked at big banks providing credit cards for health care and doing kick backs and things like that. And that was actually the angle that she started looking at and I think she talked to the executive producer at Frontline, David Fanning, and he wanted to sort of pull back and take a whole look at dentistry.
She came to me. She had worked on it for a few months and she asked me if I would help her out.
How long did you work on this project?
It was about a year. And I think I worked on it for maybe 8 or 9 months.
How many people worked together on this project?
There were two of us reporting (David and Jill.) This whole project was directed by Frontline. The whole crew was involved from about the time that I got involved.
Were you working on other projects at the same time or exclusively this one?
It was pretty exclusive, especially the last 6 months. I do that a lot. I do project reporting as an investigative reporter… so it wasn’t anything terribly unusual for me. The thing that was different was I had never collaborated so closely on an investigative story with broadcast, especially like an hour long documentary format, so that was a learning experience for me.
What kind of computer assisted reporting did you do for this story? Did you use any databases, summary reports, etc?
I was focusing largely on the corporate dental chain story, and we needed some way to quantify some of our findings because some of what we were getting was anecdotal, so we wanted to get some data to see, especially in the case of Kool Smiles, we wanted to see if they were using more stainless steel crowns than other providors. And for people who maybe haven’t read the story, the idea is that they can charge a lot more for a crown vs. a filling. We were looking into whether or not they were basically putting crowns on kids unnecessarily. And so we tried to get data from a lot of different states, and some were not cooperative, but we managed to get data from Virginia and Texas. We did a very simple calculation in comparing number of crowns to all forms of restoration, which is essentially crowns and fillings. And what we found basically was that Kool Smiles was doing a lot more crowns than the average Medicaid provider.
Since the story came out, the Supreme Court ruled to uphold most of the Affordable Care Act. What kind of impact will this have on dental care?
I’m not an expert at that, but it’s interesting that the health health care reform law, one of their goals was to expand the Medicaid program in states. And what I’m seeing now with the decision is that many states are not going to do that, and have decided not to expand their programs. I don’t really yet understand or know what the impact will be on dental care. We might see a paring back even of the benefits. Texas, in fact, just the other day, Governor Perry said that he wasn’t going to expand the Medicaid program and I know that they’ve had some issues in Texas with essentially a lot of fraud. And they’ve dramatically increased their rates for dental care as a result of a law suit in 2007. And they saw like an explosion of dental providors putting braces on kids on Medicaid and the corporate chains coming in. And so there’s been quite an interesting dynamic going on in Texas and I wonder if you might possibly see them cutting their rates again. And so it’s this balance between providing access and dealing with people who might be as Senator Grassley [R-Iowa] said “gaming the system.”
What was the most surprising thing you learned or came across while working on this story?
One of the things that we realized sort of late is that half the kids in this country are on Medicaid or CHIP, which is a program similar to Medicaid. That was pretty stunning. Just the numbers of people who don’t have access to dental care. I hadn’t really thought so much about how dental care is really not treated with the same level of… it’s not given the same level of priority as other forms of health care. And yet it can have devastating consequences, so there’s a lot of people out there who basically have these dental issues and they’re being forced, when they’re in excruciating pain, to go to the emergency room. I think one of the top things that emergency rooms are treating to day are issues that should be treated by dentsits. So that was pretty shocking to me.
What was your biggest challenge in this story?
Any time you’re doing reporting in areas where there’s been very little reporting you’re sort of breaking new ground. You’re having to go out and find evidence of what it is that you’re looking at. So I think the challenge was just looking at the issue and getting all the documents and the data and the evidence to show that there was some bigger problem here.
Was the goal of the story to try to spur policy changes and investigations, or was trying to start conversations about this issue a main goal?
I think it was probably both. I think we were interested in just looking at what was going on and documenting what was happening. And then I think there was also an interest in seeing what could or should be done about improving people’s access to dental care. So Frontline spent quite a bit of time looking at alternate programs and alternate models for that[of dental care.
Any tips for journalists who may be reporting on these issues in their own communities?
Well I spent 9 months on the story. So I guess it would kind of depend on what aspect of the story they were going to be looking at. I don’t think too many are going to be spending 9 months on a story. I think there’s still a big story out there in terms of some states like Florida and others where kids just can’t find a dentist. I think there are a lot of stories to be done about that. There was a tragic case in Maryland a few years ago of a kid named Deamante Driver, who had a toothache and his mother wasn’t able to find a dentist. He ended up in the hospital and I think they spend tens of thousands if not hundreds of thousands of dollars to treat him and he ended up dying. And that case got a lot of attention, but that happens and kids these days with soda and other things kids are exposed to these days there’s a lot more cavities and health issues related to the teeth. And so I think that there’s a real problem that gets very little attention. People just don’t think about writing stories about dentists.
Then I also think that the private equity angle, the clash between the interest of private equity investor and health care providers is very interesting, and I think there’s a lot more to be written about that. I know that Business Week and Bloomberg have been writing about that lately too.