The cost of a healthy smile

Medicare doesn't cover most dental work. Should it?

Medicare is often cited as a prime example of a public health care system, but it is far from universal. Of all the services Medicare fails to cover, dental is the most surprising. Basic dental is essential to maintain oral health.

Without subsidisation, a simple check-up and clean can set back an adult over $300. Fillings range  from $150-250, a crown $1500-3000, and an extraction upwards of $4000. The most minor procedures can put patients in serious debt.

These costs can have a severe impact on tertiary students. Whereas children are entitled to yearly dental check-ups under Medicare, most university students receive no concession. When combined with an inability to work full time while studying, the high cost of preventative dental care can leave thousands of Australian students suffering.

“It had struck me as odd that Medicare should subsidise health treatment for all parts of the body except the mouth.”

Of all recent health ministers, Tony Abbott made perhaps one the best critique of Medicare’s lack of dental coverage. Putting aside his generally chequered record, Abbott raises a good point. Dental work is often viewed as an aesthetic choice or self-inflicted blight, and therefore less deserving of taxpayer funded subsidisation.

In 2011, when national attention once again turned to the lack of
Medicare subsidised dental, Senior research fellow at the Centre for Independent Studies Jeremy Sammut told the Sydney Morning Herald:

“Personal responsibility and lifestyle choices play a crucial role in determining health outcomes … If you want better teeth, you should drink less cola. If you want to be able to see the dentist, you should spend less on cola and other things.”

Yet an overwhelming amount of scholarship links genetics to oral health, you’d be hard pressed finding a dentist who wouldn’t concede that some patients simply have a predisposition towards cavities, plaque build-up, and general decay. Sammut’s attitude also overlooks the impact that greater health problems — diabetes, cancer, and malnutrition — can have on patients’ teeth.

Poor dental health carries significant social stigma — for example, people with bad teeth are likely to be ridiculed and miss job opportunities. Some cavities and fissures can lead to permanent nerve damage and blood poisoning.

Luckily for some students, they may qualify for limited free dental work. To qualify for bulk billed cleaning, fillings, and some major procedures, students need to approach a community dental clinic with a low income health care card. These cards are only given to some students on Austudy and Abstudy; a student’s income needs to be less than $4296 over an 8 week period to qualify.

There are a number of community dental clinics in Sydney; the two closest to the University of Sydney being the Pitt Street Dental Hospital and the Marrickville Community Dental Health Centre.

Even with this concession, wait times are long. A staff member from Dental Health Services told Honi that although extremely urgent cases can be taken care of in a few days, the waiting times for non-urgent treatment are “quite a few months”. Wait times were are on a case by case basis, but for issues that don’t require emergency attention the wait time was likely to be significant due to severe understaffing.

When it comes to Medicare-covered dental, many argue that if all the people who can’t afford dental work suddenly appear the amount the federal government spends on Medicare would balloon out of control, which is concerning when we have an ageing population. This is doubly worrying when many elderly citizens grew up in a pre-fluoride era and are particularly fond of expensive dentures.

Others agree with Sammut and believe that it’s not the public’s responsibility to pay for dental care — why should taxpayers foot the dental bill of people who can’t take care of their own teeth?

Much like other long-term investment portfolios such as environment and education, health is the victim of short election cycles because voters care about what is happening right now rather than the future.

Australians living with untreated oral health problems don’t have the luxury of debating based on principle or voter behaviour.

Instead they’re left with a choice between filling a cavity or paying their rent.