Is it finally time Medicare covered dental work?

I haven’t been to the dentist in over a year. The reason is not just the pain of the drill but the pain of the bill.

I’m not the only one skipping the dentist; The Grattan Institute says 2 million people are not getting the care they need because of the cost. The effect is highest on people who are already disadvantaged. 

But now a major report is proposing we change all that. The Grattan Institute is arguing for bringing in a Medicare-style universal insurance scheme for primary dental care which could make visiting the dentist possible for more Australians.

Australians, the Grattan Institute says, visit the dentist relatively rarely for such a wealthy country.

A shortfall of dental care leads to greater health problems. We now have greater understanding of how oral health and body health interact. Diabetes in particular has a “two-way” relationship with oral health. Inflammation of the gums — known as periodontitis — can make the symptoms of diabetes worse, and having periodontitis is a risk factor for getting diabetes. Poor oral health is also linked to poor heart health.

Making dentist visits government-supported would remove one of the major impediments and be an investment in the overall health of all Australians.

Why separate dentists from doctors?

It may have been this somewhat barbaric history of dentistry that impeded its ability to merge with medicine. Modern dentists and barbers have their origins in a common profession — the “barber surgeon” — a sort of jack of all trades when it came to the human body. In pre-modern times much of the work of a barber surgeon was haircuts, bloodletting, amputations and teeth-pulling.

The history of barber surgeons is long. In 1540, Henry VIII merged the surgeons and barbers guilds into one and they remained as one profession for centuries. Some barbers continued to pull teeth into the 20th century.

In 1840 two dentists approached the medical school at the University of Maryland to ask about adding a dentistry course to the syllabus there and the doctors sent them packing. Dentists refer to this event as “the historic rebuff”, and the two professions have stayed as separate since.

A big cost to swallow

The cost of making government-funded dental care universal is an estimated $5.6 billion a year when the scheme is fully running. It would be a fraction of our federal health budget of around $100 billion. But that’s not to say the government will come up with the money easily.

A sum of $5.6 billion a year is almost as much as the government makes from taxes on alcoholic beverages, less than half of what it makes from taxes on tobacco, or about 10% of GST receipts.

So raising $5.6 billion may not be impossible but it would certainly be enough to tip a budget surplus to deficit. (Next year’s surplus is forecast at $2.2 billion.) The cost is just enough to make funding dental visits a hard choice.

What’s more, the cost of a dental scheme would be ongoing, in bad times and good. Politicians might prefer one-off spends like infrastructure that create less long-term fiscal commitment, and citizens might prefer other spending too — full funding of the NDIS or more money for schools. Just because spending is logical — and funding dental is nothing if not logical — doesn’t make it a priority.

But funds will always be limited and we must still always make tough choices.