When the forerunner of Medicare was established in the 1970s, dental care was conspicuously left out. Now, half a century later, Australians are still suffering the consequences. In an era where medical care is largely covered by the universal healthcare system, the cost of dental care remains a burden for many, disproportionately affecting the most vulnerable populations. While a growing number of policymakers and advocates are pushing for reform, the question remains: is it finally time to put the mouth into Medicare?
High Cost of Dental Care in Australia
Dental care in Australia is expensive. In fact, patients pay a much higher proportion of the cost of dental care than they do for other health services. This disparity has had a direct impact on the oral health of Australians, with many delaying or skipping dental visits altogether due to financial barriers. According to data, more Australians delay or avoid dental care because of cost than their counterparts in most other wealthy countries.
The consequences of this are severe. Oral health plays a vital role in overall health and well-being. Poor dental health can lead to significant medical complications, including infections, cardiovascular problems, and even diabetes. Yet, as dental health deteriorates for those unable to afford care, dental fees continue to rise. It’s a vicious cycle that is leaving millions of Australians behind.
A Decades-Old Problem
Calls for reform are not new. For decades, a litany of reports, inquiries, and commissions have urged the government to consider universal dental coverage to address the deep-seated inequalities in dental health care access. Yet despite these repeated recommendations, progress has been painfully slow.
In recent years, however, momentum has begun to build. The Greens party has proposed expanding Medicare to include dental care, and the idea is gaining support among Labor backbenchers. With growing public pressure and increasing political will, could it finally be time for dental care to be brought under the umbrella of Medicare?
Case for Universal Dental Coverage
The case for adding dental care to Medicare is clear. Dental health issues are not limited to just the most vulnerable or elderly Australians. More than two million Australians avoid seeing a dentist due to cost, and more than four in ten adults wait over a year before getting dental treatment. These delays can result in minor issues escalating into severe problems, requiring more intensive and expensive interventions.
Moreover, access to dental care is not just about individual well-being—it’s also about reducing broader costs to the healthcare system. Every year, there are around 80,000 hospital visits due to preventable dental problems. Many of these visits could be avoided if Australians had better access to preventive dental care.
Bringing dental care into Medicare would require a significant expansion of the workforce, with thousands of new dental professionals needed. But experts argue that with a phased approach over ten years, such a system could be implemented effectively.
Real Reason Dental Care Was Excluded
The exclusion of dental care from Medicare has always been a matter of cost. Expanding the system to include dental services would require billions of dollars—money the federal government claims it doesn’t have. Australia is facing a structural budget problem, with government spending outpacing revenue. This is partly due to the high cost of healthcare, with hospitals and medical benefits among the fastest-growing areas of expenditure.
Without significant policy changes, this gap is expected to grow. As a relatively low-tax country with high service expectations, Australia faces tough choices about where and how to allocate resources.
Can We Afford Universal Dental Care?
Despite the federal government’s financial constraints, experts argue that Australia can afford to expand Medicare to include dental care—but it will require smarter choices and difficult decisions. The key to making this work lies in being selective about which dental services to cover and finding ways to raise additional revenue while cutting inefficiencies in other areas of government spending.
One potential solution is to avoid replicating the flaws of the current Medicare system. Medicare payments to private businesses have failed to attract health services to many of the communities that need them most, especially rural and disadvantaged areas. These regions are often left without sufficient access to bulk-billing GPs or Medicare-funded mental health services. The same mistakes must not be made with dental care.
To ensure the money is spent where it’s needed, a significant share of new investment in dental care should be directed toward public dental services, with a focus on areas that are currently underserved. If the program is well-targeted, it could prevent many of the 80,000 annual hospital visits for dental issues.
A Smarter Funding Model
Another issue with Medicare is the lack of alignment between payments and the actual cost or impact of care. Expanding Medicare to include dental services must avoid this pitfall. To manage costs effectively, certain cosmetic treatments and orthodontics could be excluded from coverage, with the focus instead on essential, preventive, and restorative care.
Additionally, new workforce models should be introduced, where dental assistants and therapists are able to provide care within their scope of practice, reducing the need for patients to always see a dentist. This would help alleviate the workforce shortages that are expected to accompany an expanded dental care program.
Payments should be structured to reward ongoing care, not just one-off treatments, and there should be a cap on spending per patient to manage costs. By implementing these measures, the estimated cost of the Greens’ plan could be reduced from over $20 billion a year to around $7 billion—a much more feasible figure.
How to Pay for It
While $7 billion a year is a significant investment, there are numerous ways the government could generate the necessary revenue. Several health-related reforms could help reduce overall government health budgets without negatively impacting patient care. For example, cutting waste in government funding for pathology tests and less cost-effective medications could save billions.
Investments in prevention could also yield long-term savings. A tax on sugary drinks, for example, would not only improve public health by reducing rates of obesity and dental decay but also raise hundreds of millions of dollars annually. Such a tax would help offset the cost of expanding dental care while simultaneously improving health outcomes.
But even with these savings, the broader challenge of balancing the budget while meeting rising healthcare demands will remain. As the population ages and more expensive treatments become available, the need for a sustainable healthcare funding model becomes even more pressing.
Bringing dental care into Medicare is just one piece of the puzzle. To balance the federal budget and ensure adequate funding for all healthcare needs, a broader strategy is required. There are several options available for reducing government spending and raising revenue without damaging economic growth.
One area of potential savings is Australia’s infrastructure and defense megaprojects. More careful selection of these projects could save billions of dollars each year. Additionally, addressing the special GST funding deal for Western Australia—widely regarded as one of the worst public policy decisions of the 21st century—could free up another $5 billion annually.
Tax reforms could also generate significant revenue. By reducing tax breaks and opportunities for tax minimization—such as curbing superannuation tax concessions, reducing the capital gains tax discount, and limiting negative gearing—the government could raise over $20 billion per year. These funds could be used to expand public services, including dental care, while delivering economic benefits through a more efficient tax system.
The Inevitable Choice
The reality is that no one likes spending cuts or tax hikes, but they are inevitable. As demand for healthcare continues to rise, the government will be forced to make tough decisions about where to allocate its resources. If managed wisely, dental coverage could be the incentive the public needs to accept these changes.
Universal dental care has the potential to improve the health and well-being of millions of Australians while preventing more costly medical interventions down the line. The question is no longer whether we can afford it—but whether we can afford not to act.
By making smart, targeted investments in dental care and reforming government spending and revenue-raising mechanisms, Australia can build a healthcare system that truly serves all its citizens. After fifty years of waiting, it’s time to put the mouth into Medicare.
