Issue No. 1A parody in nine chaptersFree, you already paid for it
Dental Managed Cartels, Incorporated: The Plan
Many years ago, a few lawmakers tried to hand every low-income smile in California to one company. The plan never quite worked. The company never stopped trying.
This is its story, told the only way it deserves: as a comic book. With a game at the front, where you get to be the villain.
Parody. The company is invented. So are its bosses, its vault and its plan. The real record is in the boxes marked Meanwhile.
Insert coin. It's taxpayer money.
Dental Managed Cartels, LLC
You are the new Architect of the Denial Machine. Swipe a card or tap a choice. Keep the vault full, the regulators asleep and the members quiet. See how long your reign lasts.
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Chapter 1
The Back Room
Sacramento, many years ago. A room with no windows, one swinging lamp, and a table piled with money that didn't belong to anybody yet.
Dental Managed Cartels, Incorporated had a pitch for a few lawmakers. Some of them were crooked. Some of them were just tired. All of them loved the words cost savings.
The pitch was simple. Give us every low-income Californian. Pay us a flat fee for each one, every month. We'll handle the teeth.
Sacramento. Many years ago.
The Cartel: Every county. Every smile. One easy monthly payment.
A lawmaker: Save money and fix teeth? Where do I sign?
The Cartel: Right here. Don't read the part about the teeth.
The Plan
Top secret. Do not show the teeth.
- Put every low-income Californian in our network.
- Get paid per head, per month, no matter what.
- Make care hard to reach. Hard is cheap.
- Keep the regulators comfortable.
- Repeat until the end of the world.
Chapter 2
The Plan Falls Short
The Plan was supposed to cover the whole state. It didn't. County after county wriggled out of the net.
But the Cartel got its hooks into one county and never let go.
Every few years there's a new pitch, a new back room, a new reason to leave the net right where it is. Once, the State itself tried to cut it loose. Somehow, the net is still there.
Chapter 3
The Grip
Half a million people, in one county, held in one tight fist.
In the Cartel's dream, nobody gets out. No other dentist. No other door. Nobody else to call. Just the network, the hold music and the monthly check.
The law does leave one gap in the fist, written just for this county. The Cartel's favorite part? Almost nobody fits through it.
When a member asks for the way out, the Cartel promises to call her back. It dials once, at 3 a.m., from a blocked number. Then it tells the State she didn't answer.
Chapter 4
The Capitation Extraction Model
Now for the money. The Cartel gets a flat fee for every member, every month. Fix their teeth or don't, the check still comes.
So every skipped cleaning is profit. Every lost referral is profit. Every gum left bleeding is profit. The Cartel has a name for this. It calls it the Capitation Extraction Model.
Try it yourself. The machine is very easy to use. That's the problem.
Kept in the vault$0
Paid for care$0
Gums left alone0
Each press is one member, one month. The State's money drops in either way.
Chapter 5
The Vanishing Referral
A dentist looks in your mouth. Bleeding gums. Deep pockets. Bone slipping away. She writes a referral to a periodontist, the gum specialist.
In the Cartel's world, that piece of paper has a strange habit of disappearing. No referral on file means no specialist to pay, and nothing to count.
And the specialists? Hard to find. Some live only in the directory. Some were never there at all.
Chapter 6
The Inquiry Laundromat
When a member calls to complain, the Cartel has a trick.
A grievance has to be answered, counted and reported to the government. An inquiry is just a question. So in the Cartel's call center, grievances go in the wash and come out as inquiries. Small, gray and easy to forget.
The call notes that mention a referral get deleted. The recordings get overwritten. If it isn't written down, the Cartel says, it never happened.
03:12 Returned member's call about her exception. No answer. Closed.
09:02 Member asked about cleaning. Booked.
10:14 Member asked where her periodontist referral went. Said she wants to file a grievance.
11:30 Member asked for office hours.
Chapter 7
The Mills
The Cartel doesn't work alone. It has partners: high-volume clinics that people in the business call Medicaid mills. Some are chains with a corporate office. Some wear the badge of a community clinic.
They know the game. Fill every chair. Keep every visit short. Bill what pays, skip what doesn't, and never, ever refer out.
Not every clinic plays. Plenty of dentists in these networks fight for their patients every day. This chapter is about the ones who don't.
Chapter 8
The Sleeping Regulators
Every quarter the Cartel sends a report to the people who are supposed to watch it. The Cartel writes the report. The Cartel picks the numbers.
The watchers read it, nod, and go back to sleep. In the Cartel's world, the Department of Eventually has been napping since the first back room.
Only one thing wakes a regulator for good: a complaint with dates, names and copies attached.
Chapter 9
Until the World Ends
The last step of the Plan was always the same. Repeat until the end of the world.
The sun gets bigger. The oceans boil. The vault keeps filling. Somewhere, a member is still on hold.
Unless.
Unless the members keep copies. Unless the dentists put it in writing. Unless somebody, somewhere, wakes up the people who are paid to be awake.
Four billion years later.
The Cartel: Did this month's check clear?
Or, maybe, sooner.
Everyone: We kept copies.
The small print, in large print
This is parody
Dental Managed Cartels, Incorporated, Dental Managed Cartels, LLC, the Board, Senator Ruby Stamp, the Department of Eventually, MegaMolar Mills and every other company and character in this comic and its game are invented. So are the back room, the vault, the Plan and the Cartel's methods.
Nothing here is directed at any real person on planet Earth specifically. It is directed at any and all people who operate like this, in any way.
Nothing in the story or the game is a finding that any real plan, company, clinic, lawmaker or regulator did any of it. The facts on this page are only in the boxes marked Meanwhile, in the real record, and each one links to the page of this site that shows its sources. Not sponsored by the State of California, DHCS, Medi-Cal Dental or any managed care plan. Not legal, medical or dental advice.
If you think we have crossed a line, our corrections policy applies to the Cartel too.
Seen the Cartel at work?
A referral that vanished, a grievance that turned into a question, a call nobody logged. If something like that happened to you, tell us what happened and when. No names needed.