It’s time to give Medicare teeth

Dental care was left out when Medicare was established half a century ago because of the cost and opposition from dentists.

Today, we can afford a universal scheme where no one misses out on care, if we’re smart about how we design and plan it.

More than 2 million Australians skip dental care because of the cost – far more than those who skimp on GPs, medicines, or hospitals.

That’s triple trouble. For the people missing out on care, it can mean unnecessary and sometimes extreme pain, and high costs when their dental problems get worse. For the health system, it means more than 80,000 hospital visits a year, most of which could have been avoided if people went to the dentist for regular check-ups. And for the economy, it means reduced productivity because of illness and days off work.

It also makes Australia less fair. It’s been said that you can look into a child’s mouth and tell their parents’ income bracket. More than one-in-four poorer Australians who need dental care skip it because of cost. Among wealthier people, it’s one-in-10.

We would never accept the mounting costs of illness and lost productivity if our legs or livers were left out of Medicare. It’s time to end this dental double standard and build a universal dental scheme.

The Greens propose spending more than $20 billion a year, ramping up over five years. That’s an eye-watering investment, and there’s no way to scale up the workforce that quickly.

But it doesn’t have to be that expensive. The cost can be slashed by designing a system that’s better than Medicare 1.0, building in efficiency and fairness from the start.

By capping funding for each patient, excluding cosmetic and orthodontic treatments, and using efficient workforce models, the cost would come down to about $8 billion a year.

Planning public clinics in areas with too few dentists would make sure every community has enough care.

And phasing in the scheme over a decade would allow the federal budget, and dental workforce training, to keep up.

The Grattan Institute has identified a menu of spending cuts that could pay for this generational reform several times over.

In health, for example, there is waste in public funding of pathology tests and some medicines, and there are excessive costs and potentially harmful low-value care in public hospitals.

Outside health, dumping Western Australia’s special GST funding deal would save the federal government something like $5 billion a year. And reducing income tax breaks and tax minimisation opportunities – for example by reining in superannuation tax concessions, curbing negative gearing, halving the capital gains tax discount, and imposing a minimum tax on trust distributions – could raise about $20 billion a year.

Filling those budget cavities would be more than enough to give Medicare teeth.