Grin and bare it

13 April 2012

Written by: Jake D'Amato

There’s a time bomb in my mouth. Lain long ago, the timer’s nearly expired, resulting in pain and destruction. Nearly everyone past their mid-twenties has a story to tell about their wisdom teeth: removals so vigorous they felt like their jaw would break, mind numbing pain and days spent in hospital, clumps of food rotting in the empty wounds left behind. Our ancestors’ diet of rough, raw foods necessitated a third set of molars which no longer fit in our comparatively small jaws. But evolution moves slowly and most people still grow them, leading to a painful right of passage. While horror stories about having wisdom teeth removed are worrying, what’s really terrifying is how much that kind of dental work costs in Australia.

The cost of getting all four wisdom teeth out starts at about $1000 and increases significantly if hospitalisation is required, or if teeth are impacted into the jaw. While Australians are blessed with Medicare to cover most of our medical needs, it doesn’t help out at the dentist, and the high costs exclude many from receiving even basic dental care. A recent survey by the University of Adelaide shows one in three Australians avoid or delay dental treatment because of the cost.  With sad predictability, those on low incomes fare the worst; a Federal report released in February shows 39 per cent of adults from households earning below $20,000 a year live with untreated teeth decay—twice the number of those in households earning over $80,000 a year.

Australia is considered to have among the worst oral health in the developed world, seemingly incongruous with our proud claim of having one the world’s best public health systems. The lack of universally subsidised dental care is conspicuously absent. The shortcoming is even more flagrant when compared to what is provided by otherwise comparable health schemes. That $1000-plus wisdom teeth extraction? A publicly-funded dentist in the United Kingdom would charge £47GBP (about $70AUD) for the same procedure. So accessible too is the British public dental system that over half of all Brits have been to a public dentist in the past two years. While there are some community clinics in Australia, they’re only available to welfare recipients and the waiting lists are crippling.

So we pay for our own dental work. ‘So what?’, you may say. ‘I’d rather pay for just my own than have my taxes pay for yours too’. Well, this isn’t just a case of an inadequate health care system, it’s one of injustice too: the Federal Government puts your taxes towards some Australians’ dental care, but not necessarily those who need the assistance.

The subsidy comes in the form of the Private Health Insurance Rebate, which covers 30 per cent of the cost of insurance for things like dental work. For example, if someone takes out a mid-range ‘Extras’ cover for one year at $500, the Government will cover $150 of that bill. That insurance should cover at about half a $1000 dental bill. So as a rough break down, they could get away paying a dentist $500 to take out their wisdom teeth, and the rest would be covered by their insurance (for which the patient paid $350 and tax payers paid $150).

Someone without private insurance wouldn’t receive any government assistance at all and would pay the full cost of treatment themselves. The rebate subsidises the dental care of those who can afford insurance, while no assistance is offered to those least able to pay for their own health care.

The argument in support of the rebate on private health insurance is that it encourages the use of the private health system, easing the burden on the public system. This may apply for hospital treatment, but there isn’t a public dental system to ease the burden of, making the rebate on dental insurance an imprudent and inequitable drain on public health expenditure.

This year’s federal budget included a modest $53 million for ‘dental internships’, to encourage student dentists to spend their final year of study working in community clinics. The Gillard government is also implementing a means-test of the rebate on hospital insurance, so high income earners won’t receive the subsidy, but there is no plan to change the rebate on dental or ‘extras’ insurance.

These are small steps in the right direction, but universally available dental care looks a long way off. In the meantime, Australians will continue to have among the worst oral health in the developed world.

Patrick Hatch is a Melbourne based writer and multimedia producer. Check him out at Radio Bombast.