A 72-YEAR-OLD woman went in for surgery to remove a brain tumor in 2019. The last thing she remembers before her surgery was a doctor putting her to sleep. When she awoke, she was missing her dentures, her glasses, and had no memory of how she got home.

Shortly after, the COVID-19 pandemic hit, and for a year thereafter she had no teeth or glasses.

Most seniors are surprised to learn that when they retire and begin to rely on Medicare for their health coverage, they are left without oral health care. In fact, of the 60 million Medicare beneficiaries, more than two-thirds don’t have any dental coverage at all. Medicare doesn’t cover vision or hearing health services either. Nearly half of all Medicare patients haven’t visited a dentist within the past year. Those numbers are closer to 70 percent for Black, Hispanic and lower-income Medicare beneficiaries. One in five rural seniors haven’t seen a dentist in the past five years.

Poor health coverage has unsurprisingly led to poor health outcomes. Poor oral health is directly linked to conditions such as diabetes, heart disease, respiratory illness, and even Alzheimer’s – all diseases that particularly impact our older citizens and put them at even greater risk of COVID-19.

This is just one example of how gaps in coverage and access to care that have existed for generations were exacerbated during the pandemic, leaving some of the most marginalized populations to bear the brunt of our health crisis.

As we work to emerge from this pandemic, we cannot ignore these gaps in coverage any longer. As we continue to negotiate a budget reconciliation proposal for working families, we’ll be fighting to make sure our seniors get the dental, hearing, and vision coverage they deserve as part of a strengthened Medicare program.

Closing gaps in this coverage will not only improve access to quality care, it will help save money in the long run. Currently, more than 2 million people visit emergency rooms each year due to oral health complications, many of whom could have been treated in a preventive, less-expensive primary care setting. One study identified $65 billion in medical savings over 10 years simply by providing dental and periodontal treatment through Medicare.

There is momentum to change the unacceptable status quo for our seniors. Earlier this month, the Senate pushed through a $3.5 billion budget resolution that included Medicare dental, vision, and hearing coverage. Sen. Ben Cardin of Maryland introduced legislation to guarantee Medicare coverage for dental health under Medicare Part B, which I’m proud to support. In the House of Representatives, Congressman Lloyd Doggett of Texas introduced legislation to include these benefits supported by an additional 75 members of Congress. President Biden has also proposed including these benefits during his campaign for president.

These policies are overwhelmingly supported by Americans from all demographics, regions, and political parties. According to a nationwide survey by CareQuest Institute, 93 percent of Americans supported the inclusion of dental coverage under Medicare. In a recent Morning Consult/Politico poll, 84 percent of voters – 89 percent of Democrats and 79 percent of Republicans – favored adding dental, vision and hearing coverage. Similar numbers supported allowing the federal government to negotiate drug prices.  The need and support for these benefits to be covered under the Medicare program is crystal clear.

Strengthening Medicare to include dental, vision, and hearing is a no-brainer from a care, access, equity, and cost perspective. And it’s supported by, well, everyone.

By closing this giant gap in our Medicare system, we’ll finally be building a path to a healthier future for our seniors and all those who have been left behind by a broken health system. This pandemic has presented us with enormous public health challenges, but it has also given us the opportunity to rewrite the book and recover stronger, healthier, and more equitable than ever before.

Edward Markey is a senator from Massachusetts and Dr. Myechia Minter-Jordan is the president and CEO of the CareQuest Institute for Oral Health. 

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AS A COUNTRY, we are waking up daily to the unacceptable and completely avoidable loss of black life. We know some of their names, like George Floyd and Breonna Taylor. But many more we sadly only know as numbers and statistics, reported as part of the daily coronavirus public health updates.

What they have in common is their cause of death: systemic racism.

The COVID-19 crisis has laid bare the inequities in health care that existed well before the pandemic. We know this not only from the powerful experiences of black and brown people, we know it because we can see it in the data.

Just last week, Massachusetts Gov. Charlie Baker released new COVID-19 data showing that blacks account for 7 percent of the state’s population, but 14 percent of COVID-19 cases. Hispanics account for 12 percent of the population, but 29 percent of the cases.

The Massachusetts COVID-19 Health Equity Advisory Group blamed the disparate impact of COVID-19 on “racism, xenophobia, and lack of economic opportunity.”

No wonder cities are now declaring racism a public health crisis, as Boston Mayor Marty Walsh did recently. They are absolutely right.

Lack of economic opportunity, lack of affordable housing and healthy food options, lack of access to health insurance, lack of quality affordable care, lack of representation in the medical field, implicit bias and stereotyping, all contribute to a system that does not adequately value black lives.

These inequities have created a disparity so great that the life expectancy of a black man in Roxbury is 30 years less than that of a white man just a few miles away.

I saw this firsthand as a physician and CEO of the Dimock Center in Roxbury, where the relief on black patients’ faces when they saw a doctor walk in the room who looked like them – who would truly understand them – was palpable.

And I see it in my current role, leading the DentaQuest Partnership for Oral Health Advancement, a nonprofit organization working to reform the broken health care system.

Poor oral health has a direct link to higher risks of chronic illnesses, including cardiovascular disease, diabetes, hypertension, asthma, and more. It leads to greater instances of depression and other mental health diseases.

Yet oral health is often overlooked by policy makers as a way to improve overall health. The fact is if we want to address disparities in health care, we must also focus on oral health.

We have a long way to go.

Recent research from DentaQuest showed that over 74 million Americans lack access to dental coverage — four times the number of people who are medically uninsured. More than 45 million Americans live in areas without an adequate number of dentists. It shouldn’t surprise anyone that this gap in access disproportionately harms poor, black, and brown Americans.

• Americans in poverty are 2.5 times more likely to have an unmet dental need due to lack of insurance.
• Black adults are 68 percent more likely to have an unmet dental need than white adults.
• Latino adults are 52 percent more likely than white adults to report having difficulty doing their job due to poor oral health.
• Nearly 4 in 10 black and Latino adults reside in the 14 states where Medicaid’s adult dental benefits cover no services or emergency-only care.

This has significant economic impacts as well. Due to a lack of access to preventive care and a reliance on emergency care, low income adults spend 10 times more of their annual family income on dental services than high income families.

Fortunately, there are tangible things we can do. Increasing access by keeping or adding an adult dental benefit for Medicaid patients should be a no-brainer. This will not only help our most vulnerable patients but also decrease the burdens on emergency rooms by reducing the number of people relying on them for dental care. We need a revolution in patient care – integrating medical, dental, and behavioral health. And we must better leverage technology, like telemedicine, as not just a crisis tool but a long-term solution to increase access and reduce costs.

We also must empower patients, continuing to educate people about the direct link between good oral health and good physical health.

Dr. Martin Luther King Jr. once said, “Of all the forms of inequity, injustice in health care is the most inhumane.”

He was right. We must be outraged and motivated to end the racial disparities in our health care system. As we emerge from this pandemic, we have an opportunity – and a moral imperative – to do just that.

Black lives depend on it.

 Dr. Myechia Minter-Jordan is  president and CEO of the DentaQuest Partnership for Oral Health Advancement, a Boston-based nonprofit organization focused on reforming the broken health system and enabling better oral health for all. She is the former CEO of the Dimock Center.

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EACH WEEKDAY in Greater Boston, more than 400,000 workers, students, shoppers, seniors, and visitors board an MBTA bus. Buses serve three times as many riders as the commuter rail. But despite their importance, buses remain an underappreciated and often neglected component of our region’s transportation system. The T’s own performance dashboard sets a meager on-time performance expectation for bus service of just 75 percent. And even that bar has been met on only nine days so far in 2019. On not a single day so far in 2019 have buses achieved even an 80 percent on-time standard.

If the commuter rail were performing that poorly, it would be the leading news story each and every day, and our elected officials would be calling it a crisis. The historical race and class context for this reality cannot be ignored. Urban bus riders deserve the same urgency and attention as suburban commuter rail riders. While rail is an important part of our transportation system, it is the bus that has been, and will be, our region’s public transit workhorse.

Fortunately, fixing the bus system is one of the cheapest and most efficient ways we can improve the MBTA. It doesn’t require billions of dollars and decades-long construction. In fact, some bus system changes, like modernizing routes, will actually produce cost savings to the MBTA that can be plowed back into improved service.

The MBTA took a major first step last month, when the Baker administration and the Massachusetts Department of Transportation proposed a slate of changes to 63 bus routes that will make bus service faster, more efficient, and more responsive to rider needs. We strongly support this process, and call on riders, communities, and elected officials to embrace experimentation and changes to routes that haven’t been updated in decades, if ever. This effort will hopefully lay the groundwork for a more robust overhaul of the system, including adding new routes system-wide and expanding the MBTA’s fleet of buses.

But improving routes and adding news buses to the fleet will only get us so far. To truly revolutionize our bus system we need to look at how we allocate precious road space. This work has started, with bus-lane pilots in communities such as Everett, Cambridge, and Roslindale. But the process needs to be accelerated, particularly in neighborhoods that depend on bus service as their main transit option.

The four bus lines that serve the Dimock Community Health Center carry more than 16,000 riders per weekday. Three quarters of those riders are people of color, and the majority of riders live in a household that does not own a vehicle. For the most part, cities and towns can control how well buses run — or don’t — on their streets, by creating bus lanes and other transit priority amenities. These simple fixes have already proven effective in the region. In Boston, a bus lane pilot on Washington Street in Roslindale produced a travel time reduction that averaged 25 percent for nearly 20,000 daily bus riders. All that with just some orange cones and red paint.

MassDOT could build on this success by improving bus service on roads it controls. This will require a combination of creating bus lanes on more state-owned highways, and using smarter tolling to get key bus corridors like the Tobin Bridge, the Ted Williams Tunnel, and the Massachusetts Turnpike moving faster (both for bus riders and drivers). In Seattle, these two tools have helped increased ridership to the point that almost one in five workers commutes by bus. Seattle’s downtown has gained about 60,000 jobs since 2010, but there are approximately 4,500 fewer single-occupancy vehicle commuters.

Gov. Charlie Baker’s Commission on the Future of Transportation made prioritizing public transit its first recommendation for creating a robust, reliable, clean, and efficient transportation system. Let’s elevate the bus – low cost, efficient, flexible – as the once, current, and future workhorse of that system.

Dr. Myechia Minter-Jordan is the president and CEO of the Dimock Center and Chris Dempsey is the director of Transportation for Massachusetts

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