Give Medicare teeth

Dental care was left out of Medicare from the start, when dentists lobbied against its inclusion and the government worried about the cost. Leaving the mouth out of Medicare was its original sin, and we’re living with the consequences.

There’s a reason you probably paid a lot the last time you visited the dentist. Without Medicare funding, fees make up 60% of total funding for dental care. The share of funding coming straight out of patients’ pockets is five times higher than it is for PBS drugs, and nine times higher than it is for GP visits.

That’s why more than two million Australians say they delay or skip dental care because of the cost. Not surprisingly, disadvantaged Australians are hit the hardest. A Senate inquiry last year heard harrowing stories from people who can’t afford dental care. Some go through extreme pain, emergency hospital care, being embarrassed by their rotten teeth at job interviews, and even being afraid to smile.

Missing out on dental care can have devastating results for individuals, and it wastes scarce healthcare resources. There are about 80,000 hospital visits a year for preventable dental conditions, and poor dental health is linked to a wide range of chronic diseases.

The situation is likely to get even worse, with dental health deteriorating, and patient fees rising much faster than government investment.

It’s time to fill this growing cavity in Medicare. For decades, a string of national inquiries and reports have recommended universal coverage for dental care. The Greens have proposed it, Labor backbenchers want it, and it should be part of every party’s platform for the next election.

But setting up a new universal dental scheme isn’t just an opportunity to expand the benefits of Medicare, it’s also a one-off opportunity to fix two of its worst flaws.

The first is that too many communities miss out on Medicare. Many outer suburbs, and even more towns, have too few GPs. The problem is even worse for allied health and medical specialists. Decades of experience shows that subsidising businesses through Medicare won’t get enough clinicians to set up shop where they’re needed most.

Part of adding dental care to Medicare should be funding public clinics where subsidies don’t attract enough dental workers. That funding should be carefully targeted. It should be based on the supply and demand of care in local areas, not where public clinics are now, or how remote an area is, which is not always a good guide to where more care is needed.

A second lesson from Medicare is that value for money should be built in from the start. By the time a universal dental scheme is phased in, it will cost about $7 billion a year. That can be a great investment, but only if it gets good value for taxpayers.

Public funding should not pay for cosmetic treatments. It should be based on efficient staffing, with dental assistants and therapists using all their skills. And data should be collected on patient satisfaction and health outcomes, to make sure that care is getting the best results.

Getting good value for healthcare spending isn’t just nice to have. Government healthcare spending is growing so fast that taxes and budgets aren’t keeping up. Australia’s productivity growth is worryingly slow, putting our prosperity at risk, and healthcare productivity growth is even slower.

Universal dental care could start to turn this around. A healthier population will help nudge employment and health spending in the right direction. And it is a chance to build a well-managed system that provides care in the right places, keeps costs down, and focuses on impact.

The calls to fill this gap in Medicare are getting louder, and hopefully action is finally on the horizon. How it happens will have a lasting legacy. Once the plan is made and the rules are set, it will be very hard to change course.

The decision to exclude dental care from Medicare was a terrible one. But it does come with a silver lining. We’ve had a long time to learn the lessons of Medicare, and now we know how to do it better.