Why Is California's Most Influential Health Policy Think Tank Silent on Drill-for-Dollars Dentists and Predatory Healthcare 'Loan' Companies?

(AP Photo/Julio Cortez)

It used to be that Republicans were considered the party of the rich and were beholden to corporate interests and that the Democrats were considered the party of the working class. But over the last… well, for a very long time, really, neither party in actuality represented the working class. Then along came Donald Trump, who gave voice to working-class voters who felt unheard, and some Republicans found a renewed focus on issues important to the working class. Along with Sens. Marco Rubio and Ted Cruz, Missouri Sen. Josh Hawley’s sending a big message:

“The days of conservatives being taken for granted by the business community are over,” he wrote in an essay for USA Today. In tone, it mirrored his pronouncement on Election Day last year: “We are a working class party now. That’s the future.”

Indeed, Rubio publicly endorsed a unionization effort by Amazon employees, and a majority of Republican legislators favor data privacy and consumer protection legislation important to working-class voters.

But in California, the state in which “consumer protection” laws have gone so far overboard that it’s billed unfriendly to business, predatory practices have been allowed to run rampant in one industry – dentistry. Despite the efforts of powerful Democrat members of the state legislature, industry lobbyists have been able to significantly water down any legislation passed that would protect consumers from dentists pushing unnecessary procedures to drive up revenue, or from companies like Care Credit, which offer deceptive “zero interest” lines of credit ostensibly to cover dental procedures not covered by insurance and are promoted by the dentists themselves, in their offices, lending an air of credibility to them.

Do we really need more government interference in business or in private dental practice? I’d submit that we don’t need more government interference in business, but when a company is in the business of having dental providers push deceptively-marketed loans to patients they’ve just told need thousands or tens of thousands of dollars in dental work, and when those dentists are able to bill the full amount of a series of procedures before the first bit of work is done and see the patient’s credit limit as the amount they can charge them, when permanent and serious physical harm can be done by unnecessary procedures, and when those patients are possibly under the influence of a sedative while making a major financial commitment, yes, some safeguards need to be in place.

You’d think that California’s notoriously liberal health policy think tanks, including UC Berkeley’s influential Petris Center (which advocates for single-payer healthcare, among other things) would be sounding the alarm and that unions would be organizing their members to fight these practices. But even years after several investigative series chronicling the serious issues consumers are facing were published, The Petris Center hasn’t weighed in on the issue. Why?

Before getting to the possible answer to that question, let’s look at some examples of the fraud and abuse that’s occurring.

One California dentist, Dr. John Lund, performed so many unnecessary procedures on his patients – 90 percent of his patients with crowns ended up with root canals – that he was arrested for insurance fraud, and at least two of his patients sued him for fraud, deceit, elder abuse, and malpractice. One shocking example is a patient in her 50s who’d never had cavities:

Over the course of a decade, Lund gave [Joyce] Cordi 10 root canals and 10 crowns. He also chiseled out her bridge, replacing it with two new ones that left a conspicuous gap in her front teeth. Altogether, the work cost her about $70,000.

Joyce Cordi’s new dentist says her X-rays resemble those of someone who had reconstructive facial surgery following a car crash.

Some dentists don’t even bill insurance for procedures that would be at least partially covered, instead allowing the full amount to be billed to the credit card. Eric Schattl of Neighborhood Legal Services of Los Angeles County told CalMatters in late 2019:

“We definitely see dentists refusing to run the (Medi-Cal authorization) request a lot. So then they’re guiding people toward the card early on in the process, even if they know they are Medi-Cal recipients. Even if the paperwork may say, ‘this is a covered benefit.'”

And, while patients are supposed to sign both the credit card application form (in addition to the standard consent forms), one California woman said she walked into a chain dental office with shooting pain in one tooth and left with a bridge and more than $9,000 in credit card debt she doesn’t recall signing up for – and wondered how she was approved since she was unemployed.  She told the Fresno Bee that the signatures on the consent forms do not match her own and that the dental group failed to bill her insurance, which ended up paying $1,045 toward the bill.

Even worse, some patients are left with thousands of dollars in debt for failed dental work; one woman interviewed by the Fresno Bee said she has no teeth left.

These aren’t just a couple of isolated incidents. According to the CalMatters/Fresno Bee investigation, as of 2019, thousands of consumers had filed complaints against Synchrony Bank, the bank issuing CareCredit cards. Of these, 43 were complaints by Californians mentioning the terms “dentist” or “dentistry.”  And, the Health Consumer Alliance said in 2019 it had aided California consumers with 28 dental credit card cases, and 55 in 2018, and Central California Legal Services estimated it’s handled 24 cases since 2013.

In 2013 both New York State and the Consumer Financial Protection Bureau cracked down on Care Credit for deceptive enrollment practices, saying that “clients were not receiving clear communication about deferred interest or copies of their card agreements,” and that “poorly-trained staff at some providers’ offices were confused about the product they offered.”

But where’s California?

One group, the Western Center on Law and Poverty, sponsored a bill back in 2009 that required dentists to disclose that patients were signing up for credit with a third party and not with the dentist’s office themselves (which later was expanded to all healthcare providers), and in 2019 sponsored a bill through Sen. Holly Mitchell (D-Los Angeles) that would have prevented healthcare providers from offering deferred interest loan products in their offices and from accepting them as payment. The California Dental Association (CDA) mobilized and “negotiated” with Mitchell. From their website (emphasis added):

The proposed legislation was drafted to provide consumer protections on financial products purchased by patients and used to finance various types of health care-related procedures and products, including dental procedures.

To ensure financing products remain available for patients and providers, CDA has taken an “oppose unless amended” position to request amendments that will continue to allow these products to be marketed in dental offices without interrupting the practice of dentistry or the dentist-patient relationship.

Along with these proposed amendments, CDA has committed to support the financial services industry’s proposed amendments that would protect the range of financing options, including deferred interest financing.

While CDA is advocating to secure the ongoing availability of in-office financing products, we also are working to protect members and their patients from exposure to any potential liability shifted from the financing company.

It’s understandable that the financial services industry would lobby against this bill, but the CDA’s stance is antithetical to their mission.

As noted above, the academics and political movers-and-shakers at The Petris Center, an influential health/consumer policy think tank housed at UC Berkeley, haven’t weighed in on this issue at all, which is curious for an organization “focusing on consumer protection, affordability, regulation, and access to health care,” which has published research on California’s dental industry, and which has at least one dentist on its board.

Could the group’s ties to the CDA, Gavin Newsom, and other prominent Democrats have caused the silence?

The Petris Center’s director, Dr. Richard Scheffler, was named to Gov. Gavin Newsom’s “Healthy California for All” committee, a group focused on implementing single-payer healthcare in the state, and also penned an opinion piece touting then-Attorney General Xavier Becerra’s health policy bona fides when Becerra’s nomination to be Joe Biden’s HHS Secretary was under fire.

The CDA is also cozy with Newsom and was one of his anti-recall campaign’s top donors, contributing $532,000. Perhaps coincidentally, Newsom ended up signing 14 CDA-supported bills in 2021.

Since 2005 The Petris Center has received a total of $644,000 from the CDA Foundation for commissioned research on the dental industry, but none of the seven resulting studies had anything to do with protecting consumers. Instead, the published studies advocated for more dental coverage (read, more access to dollars), more dentists, and more hygienists.

And it’s not that Petris doesn’t delve into potentially hot-button political issues in its research. A press conference held by then-Attorney General Xavier Becerra and Scheffler touted the think tank’s research on healthcare market consolidation in the state, which led to Becerra pursuing an antitrust suit against Sutter Health (eventually shaking them down for $575 million) and which was vigorously opposed by the American Hospital Association.

It’s clear that Petris isn’t afraid of making waves. And it’s equally clear that Petris won’t take any position that isn’t supported by the California Dental Association or the state’s most powerful Democrats – even if their silence hurts the state’s working-class citizens.