Smarter Government For Social Impact: A New Mindset For Better Outcomes

In 2007, a treatable toothache took the life of 12-year-old Deamonte Driver in Prince George’s County, Maryland.

A routine $80 tooth extraction could have saved the boy’s life, but Deamonte and his family faced obstacles to timely treatment. Adding to the challenges already confronting the family living in poverty, administrative barriers in Maryland’s public benefits system complicated their access to service. While Deamonte’s family was eligible for Medicaid, their coverage had lapsed when they moved out of a shelter and paperwork was sent to an old address. Even with coverage, finding a dentist willing to treat high-need, low-income youth would have been difficult: Medicaid reimbursements in Maryland were set so low that few dentists were willing to treat these patients. As a result, fewer than one in three Medicaid children in the state received dental care in 2005.

By the time Deamonte was admitted to the hospital, it was too late. The underlying bacterial infection causing his toothache had spread from his tooth to his brain, costing $250,000 in emergency medical care and ultimately his life.

Shockingly, the barriers Deamonte faced in receiving timely and effective treatment are encountered throughout the healthcare system. Rather than paying to provide all Medicaid patients with needed dental treatments that improve overall health, government often pays only when these patients end up in the ER, at a price averaging three times that of a routine dental visit.

The total cost to U.S. taxpayers is around $2.1 billion: $1.7 billion more than if government fully covered the provision of routine dental care for all Medicaid recipients. Rather than paying for better care, such as regular dental checkups and preventive treatments, that lead to better outcomes for citizens and society, too often government pays only for high-cost, emergency services that do not solve root problems and leave patients and taxpayers worse off.

Tragedies like Deamonte’s may have been unavoidable in the past, but every day new data and emergent technologies are presenting opportunities for government to learn from policy failures and successes and act on new knowledge about what works to improve the lives of citizens. As we move into the future, we need a twenty-first century government system that can respond to rapid change and adapt its behavior to produce better outcomes for citizens.

We need a government that applies smart incentives and leverages modern tools to enable policymakers to make better informed decisions, to identify and address systemic barriers to effective and efficient service delivery, and to seek out and promote innovative solutions to our greatest social challenges.

America needs a smarter government.