THE TEETH, EYES & EARS ARE NOT OPTIONAL ACCESSORIES.

VAULT · UNIVERSAL SUFFRAGE 2028

Published by Langhorne P. Breedlove

MONDAY, NOVEMBER 9, 2026 · 1:45 AM ET

Reading time: 8 minutes

Tags: Universal Healthcare · Dental Care · Vision · Hearing · Medicare · Medicaid

Dear fellow American proletariat: a person can arrive at a physician's office with a mouth full of infected teeth, damaged eyesight, or hearing loss and discover that American health insurance has subdivided the human head into separate accounting departments. Apparently the rest of the body was purchased under a different subscription plan.

The question is not whether teeth, eyes, and ears are medically important. The question is why insurance law and benefit design treat so much routine dental, optical, and hearing care differently from ordinary medical services—and what it would take to make comprehensive coverage real rather than simply give the brochure a more ambitious title.

ROOTS · THE EXCLUSIONS WERE WRITTEN INTO LAW.

Medicare's original statutory design included a broad exclusion for treatment, filling, removal, or replacement of teeth and structures supporting them. That exclusion remains in section 1862(a)(12) of the Social Security Act, with specific exceptions (Source 01). Its continued operation is a legal choice, not evidence that an infected molar is separate from the human body.

Original Medicare generally does not pay for routine dental services, eye examinations for prescription glasses, hearing aids, or examinations solely for fitting hearing aids. Certain dental care inextricably linked to covered medical procedures can qualify, and some medical eye or ear services remain covered. Medicare Advantage plans may provide supplemental benefits, but their availability and limits depend on the plan (Source 02). Saying 'Medicare covers no eyes or ears' would therefore be wrong.

Congress made another distinction in the Affordable Care Act's essential-health-benefits framework: pediatric oral and vision services are specified categories, while routine adult dental and vision services are not generally required essential benefits in Marketplace coverage (Source 03). The legal framework divides by age and benefit type rather than by the body's actual anatomy.

A CHILD'S BENEFIT CAN DISAPPEAR AT ADULTHOOD.

Medicaid's Early and Periodic Screening, Diagnostic and Treatment program requires coverage of medically necessary child health services through age twenty, including dental, vision, and hearing screening, diagnosis, and treatment (Source 04). That does not mean every provider accepts Medicaid or that every eligible child receives timely appointments. Statutory coverage and practical access are different measurements.

For adults, federal Medicaid law does not establish a minimum dental benefit. States decide what dental services to cover, so adult benefits can vary substantially (Source 05). Some states offer broader care; others impose restrictive service limits. Utah, for example, reports adult Medicaid dental coverage including checkups, cleanings, fillings, and treatment of pain and infections (Source 06). The existence of one state benefit must not be mistaken for a uniform national guarantee.

The resulting distinction is difficult to explain to a patient: a tooth requiring treatment at age nineteen may fall under a broad child entitlement, while a tooth needing similar attention at twenty-five may be subject to an entirely different coverage package. The tooth has not enrolled in a new political party. The eligibility law has changed.

TODAY · WE SPEND THE MONEY SOMEWHERE.

The Centers for Medicare & Medicaid Services estimated total U.S. dental-services expenditures at $189.2 billion in 2024, a 6.6% increase from 2023. Out-of-pocket spending and private insurance together accounted for approximately 80% of dental spending in that category (Source 07). These figures concern dental services, not the complete combined cost of dental, vision, and hearing care.

Those expenditures are an essential starting point for fiscal analysis, but cannot be used as the price of expanding universal dental benefits. Some payments would shift from families and private plans to public financing; some care would be newly used by people previously unable to afford it; provider capacity, negotiated rates, administrative costs, and preventive care patterns would also change. A larger public budget does not automatically mean an equally large increase in national resource use.

THE EYES HAVE IT—EXCEPT ON THE BENEFITS FORM.

Routine refraction examinations and corrective eyewear have commonly been handled outside Original Medicare's ordinary benefit package, though coverage can exist for specified medical conditions and services (Source 02). The distinction between treating eye disease and obtaining the glasses needed to function can leave people navigating separate networks and bills.

A comprehensive benefit would need to define routine examinations, medically necessary diagnostics, corrective lenses, replacement intervals, low-vision rehabilitation, and specialized devices. It would also need protections against unnecessary upselling and clear clinical standards for high-cost products. Not every expensive frame is an essential medical device, but basic visual function should not be mistaken for a luxury upgrade.

THE HEARING AID THAT HEALTH INSURANCE FORGOT.

The Food and Drug Administration permits adults age eighteen and older with perceived mild-to-moderate hearing loss to purchase eligible over-the-counter hearing aids without a prescription or mandatory audiologist visit. These products are not designed to substitute for specialist assessment or devices appropriate for severe loss, children, or certain medical concerns (Source 08). Expanding retail access is a genuine regulatory change, but making a device easier to buy is not the same as making it affordable.

A broad hearing benefit would need audiologic assessments, appropriate hearing aids, fittings when necessary, follow-up support, repairs, replacements, and communication accommodations. It should consider over-the-counter options where appropriate while retaining professional care for complex cases. An inexpensive device nobody can properly use is an expensive paperweight.

WHY THE SEPARATE INSURANCE MARKETS PERSIST

Different professions, delivery networks, insurers, benefit definitions, and financing arrangements developed around distinct services. Separate coverage can allow specialized pricing or administration, and employers or consumers may value a choice of supplemental plans. But separate premiums, networks, coverage caps, waiting periods, and claims processes can make the total care package difficult to compare or use.

Supporters of comprehensive public benefits emphasize continuity of care, financial protection, and fewer administrative boundaries. Critics raise questions about financing, overuse, workforce shortages, product limits, and whether a universal guarantee should prioritize the highest-value care. Both sides are asking questions that require evidence, not an argument with a fictional dentist.

WHAT WOULD COMPREHENSIVE COVERAGE ACTUALLY REQUIRE?

American Proletariat's proposed Universal Comprehensive Healthcare policy includes dental, vision, and hearing services. That is a mandate to design, legislate, and finance—not existing federal law. Congress would need to define covered services, eligibility, provider payments, clinical standards, coordination with Medicaid and Medicare, and transition rules for people already holding separate coverage.

A practical sequence might prioritize infection treatment, preventive dental care, functional vision correction, and clinically appropriate hearing assistance, then expand according to evidence and capacity. The policy would need transparent decisions on dentures, implants, orthodontics, advanced lenses, hearing technologies, frequency of replacements, appeals, and protections for people with disabilities.

Payment reform must also avoid promising unlimited appointments in a system without enough participating dentists, optometrists, ophthalmologists, audiologists, technicians, or laboratories. Training, accessible clinics, rural delivery, mobile services, and fair reimbursement are part of the cost. A benefit printed on a card is not an appointment.

THE TEN-YEAR QUESTION

A responsible ten-year ledger would begin with the current public and private expenditures, then model incremental utilization, changes in payment rates, administration, provider capacity, workforce training, equipment, transportation, and enforcement against fraud or inappropriate billing. Year one must appear separately. Existing public expenditures should be counted once, not again as newly invented savings.

Some preventive care may reduce later treatment costs, but the magnitude and timing vary by service and population. Claims of automatic self-financing are not justified without causal evidence. No national ten-year fiscal estimate can be responsibly assigned to AP's specific benefit design until the package, population, payment rules, and transition assumptions are specified.

WHAT THE EVIDENCE DOES & DOES NOT SHOW

The federal coverage documents establish that exclusions and benefit differences are real (Sources 01, 02, 03, 04, 05). The dental spending figures show the size and financing mix of one category of care (Source 07). They do not, by themselves, demonstrate what a particular universal program would cost, how quickly providers could expand, or how every health outcome would change.

The strongest practical test would compare actual access, untreated disease, functioning vision and hearing, out-of-pocket costs, patient experience, clinical quality, and provider participation before and after any reform. Reports should distinguish children from adults and separate benefit eligibility from services actually received.

WHY IT MATTERS

A person does not stop needing teeth after turning twenty-one. Vision does not cease to matter when a job requires reading a screen. Hearing does not become optional at retirement. The consequences of fragmented care reach employment, learning, social participation, and everyday independence.

The larger lesson is that 'universal healthcare' describes a goal until someone writes the benefits, builds the clinics, funds the providers, and protects access. If the government offers coverage for the body but sends the teeth, eyes, and ears to three separate cash registers, the definition of comprehensive remains unfinished.

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SOURCES & FURTHER READING

01 · Social Security Administration — Social Security Act §1862(a)(12), Medicare exclusions for dental services. https://www.ssa.gov/OP_Home/ssact/title18/1862.htm

02 · Medicare.gov — What's Not Covered by Original Medicare; dental, vision and hearing exclusions and exceptions. https://www.medicare.gov/providers-services/original-medicare/not-covered

03 · HealthCare.gov — Marketplace Health Benefits and Coverage; pediatric oral and vision essential benefits. https://www.healthcare.gov/coverage/

04 · Centers for Medicare & Medicaid Services — Early and Periodic Screening, Diagnostic, and Treatment; child dental, hearing and vision. https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment

05 · Centers for Medicare & Medicaid Services — Dental Care; adult Medicaid dental coverage at state option. https://www.medicaid.gov/medicaid/benefits/dental-care

06 · Utah Department of Health and Human Services — Medicaid Dental Coverage and Plans, adult and child benefits. https://medicaid.utah.gov/dental-coverage-and-plans/

07 · Centers for Medicare & Medicaid Services — National Health Expenditures, 2024 Highlights; dental spending. https://www.cms.gov/files/document/highlights.pdf

08 · U.S. Food and Drug Administration — Over-the-Counter Hearing Aids: What You Should Know. https://www.fda.gov/medical-devices/hearing-aids/otc-hearing-aids-what-you-should-know

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WE ARE ONE.  ·  E PLURIBUS UNUM.