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Perspective US Health Care Reform
John E. McDonough
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The 2000 Surgeon General’s report identified the state of oral health in America as an issue of major concern, highlighting significant disparities among vulnerable populations and associations with overall health and social determinants. Subsequently in “A Call to Action” issued by the Surgeon General in 2003, one of the five suggested actions was to promote collaborations among dental, medical, and public health communities to effect policy change.1 In the intervening years, many stakeholder groups devoted significant resources to enhance the nation’s oral health. Many of these efforts focused on policy reforms and demonstration projects that would enable better integration of oral health with the health system. In 2018, the Roundtable on Health Literacy of the National Academies of Science and Medicine (NASEM) convened a workshop on integrating oral and general health.2
A decade after the 2000 Surgeon General’s report, the Patient Protection and Affordable Care Act (ACA) was signed into law by the Obama administration. While the law was wide in scope, it maintained the division between medicine and dentistry and did little to reform oral health policies. Health policy experts have long called for expanding oral health services, bridging the divide between medicine and dentistry, and improving the current dental workforce model.3 The Surgeon General’s new report, to be released in 2020/2021, is also expected to focus on the integration of oral health and to stress the importance of changes in the oral health delivery system.
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