Communist Party of Australia

The Rudd government is considering a proposal to establish a national dental care plan, as part of its overhaul of the national health care system. The adoption of a comprehensive national dental system, which would include special provisions for dental services for indigenous Australians, would mark a historic and very welcome shift in federal government policy.

However, the plan itself, known as Denticare, is coming under increasing fire because it would not be part of the national Medicare plan, and because of the continuing influence of private dental and insurance interests in its operation.

The long wait to see the dentist

When Medicare was introduced by the former Hawke government in 1983 it did not include provision of dental services, even though dental work is a very specialised part of medical practice, and dental problems can affect the body’s health beyond the mouth and cause suffering, just as other ailments do. Private dental practitioners and business firms involved in the supply of dental equipment lobbied hard against the inclusion of dental services in Medicare, and the Hawke government deferred a decision to include it indefinitely.

The Howard government declared that public dental services were a state responsibility, and abolished a preliminary public dental plan which had been established by the Keating government, and which provided very basic dental services.

However, shortly before the November 2007 federal election, in a blatantly cynical election manoeuvre, Howard’s government set up the Medical Dental Scheme, under which chronically ill patients who could not afford to pay for dental work could receive a grant of up to $4,250 from Medicare for extractions, fillings or dentures.

The Rudd government has already attempted to abolish the Medical Dental Scheme, but has met with determined opposition in federal parliament. The government has stated that it will not introduce a national dental care system until the Medical Dental Scheme has been replaced. But the Greens and others have made it clear that they will block any such initiative in the Senate, because it would leave Australia with only the promise of a full national dental plan at some time in the future and with no publicly-funded dental care at all in the meantime.

The Denticare cavities

The proposal to establish Denticare is part of the initial recommendations of a report by the National Health and Hospitals Reform Commission (NHHRC), set up by the Rudd government to make recommendations for changes to the current health care system. Under the NHHRC proposals, Denticare would cost an extra $3.9 billion this financial year, and would be funded by adding 0.75 percent in income tax by way of the Medicare levy.

The Commission claims that Denticare would provide universal access to preventative and restorative dental care and dentures. However, as the NHHRC report has noted, people would have to opt “…to become a member of a dental health plan (with a private health insurer) or to use public dental services.”

The report also notes that “Denticare Australia would pay the premium for that plan from the funding pool. The premium payment would be set at a level so that individuals and families were covered for about 85 percent of the current costs of private dental services covered under the package.”

And there’s the rub – or one of them. Whereas a visit to GPs are either bulk-billed to or subsidised by Medicare, a visit to your private dentist under Denticare would result in a full bill for the fee for service provided. Your insurance premiums would be covered by Denticare, but you would still have to lodge a claim with your insurer for a maximum reimbursement of 85 percent of the fee for service, leaving you short of the remaining 15 percent.

The Commission’s report recommends that public dental services (which are run by the states and are chronically unable to meet demands for their services) should be expanded through the Denticare program. However, it acknowledges, with remarkable understatement, that “… waiting times to access such care might be prolonged.”

Which way to go?

The conservative Australian Dental Association (ADA) takes the view that any national dental plan should benefit “only those that currently find difficulty through financial hardship accessing such care.”

Nevertheless, the ADA’s warning that Denticare would provide “two tiers of dental care” and would result in “poor dentistry for the poor” was echoed by others. Professor Hans Zoeliner, representing the Association for the Promotion of Oral Health, described Denticare as a two-tier system “…where federal money is filtered through private health insurers to pay for private dental services, and if you can’t provide private health insurance, Denticare as currently proposed would simply give the money to the private system so you can join the waiting list.”

The Greens and other progressive independent MPs are backing Professor Zoeliner’s conclusion that “The most simple solution is to put dentistry into Medicare. Medicare is a system that .. (has) been shown to work for …people with chronic diseases over this past year and it will work for the whole community.”

But will the Rudd government follow this most obvious course of action? Watch this space, and contact your MP.

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