Dental care: still not in Medicare after 40 years of promises

The gap in the middle of Medicare

When Medicare was introduced in 1984, the original vision included dental care. It didn't happen. Forty years later, Australians are still paying through the nose - literally - for basic dental treatment that citizens in comparable countries receive as a normal part of public healthcare.

The average Australian now spends around $670 per year on dental costs, and total out-of-pocket dental expenditure across the country exceeds $10 billion annually. For the roughly one in three Australians who avoid the dentist due to cost, that number is zero - because they simply go without.

This isn't a minor policy gap. It's a gaping hole in our health system that causes real, measurable harm.

What the current system looks like

Right now, dental care in Australia is a patchwork:

• Medicare covers almost no dental. The Child Dental Benefits Schedule (CDBS) provides up to $1,095 over two years for eligible children aged 2–17 - but that cap hasn't kept pace with costs and covers only basic services.
• Public dental clinics exist in every state, but waiting lists are brutal. In Victoria and Queensland, adults wait an average of 12–24 months for a simple public dental appointment. Emergency extractions - the last resort of someone in serious pain - are often the only timely option.
• Private health insurance covers some dental, but average premiums for 'extras' cover run around $800–1,200 per year for a single adult, and the benefits rarely cover the full cost of treatment.
• Concession card holders get some subsidised care, but state-by-state funding is inconsistent and chronically underfunded.

The result is a two-tiered system: if you have money or private insurance, you get care. If you don't, you wait, you suffer, or you go without.

Who is actually affected?

The people most harmed by the absence of universal dental care are predictable:

• Low-income earners and welfare recipients who can't afford private insurance or out-of-pocket fees
• Regional and rural Australians, where dentist availability is already limited
• Older Australians on fixed incomes, particularly those in aged care
• People with chronic health conditions - poor oral health is linked to heart disease, diabetes complications, and premature birth
• First Nations Australians, who experience significantly higher rates of tooth decay and gum disease

A 2022 Australian Institute of Health and Welfare report found that 1 in 5 adults had avoided the dentist in the previous 12 months due to cost. For those in the lowest income bracket, that figure rose to nearly 1 in 3.

Forty years of broken promises

This isn't a new issue. Here's a brief history of how we got here:

The pattern is consistent: dental care becomes a Labor election promise, doesn't survive contact with government, and the Coalition never prioritises it at all.

So why doesn't it change?

The honest answer involves two words: professional lobbying.

The Australian Dental Association (ADA) has historically opposed universal public dental care, fearing it would reduce fees and professional autonomy - the same argument the AMA used against Medicare itself in the 1980s. Private health insurers, who profit from extras cover, also have a strong financial interest in keeping dental out of Medicare.

These groups donate to political parties, fund campaigns, and have direct access to ministers. Ordinary people with toothache don't have lobbyists.

The cost of universal dental care is also routinely cited as prohibitive. Estimates for full dental inclusion in Medicare range from $5 billion to $8 billion per year. That sounds like a lot - until you consider that Australia spends over $250 billion annually on health, and that untreated dental disease creates significant downstream costs in emergency departments and hospital admissions. A 2020 Grattan Institute report found that targeted public dental investment would deliver strong cost savings over time.

The money exists. The political will does not.

What would voters actually choose?

Polling consistently shows that Australians strongly support universal dental care. A 2023 Essential Research survey found over 70% of respondents supported including dental in Medicare, with support high across all income levels and voting intentions.

Yet decade after decade, the policy doesn't happen. Why? Because in our current system, what voters want and what government delivers are two different things. Elected representatives respond to party donors, factional interests, and lobbyists - not to the 70% of Australians who want dental covered.

This is exactly the problem that direct democracy is designed to solve.

If Australian voters had a direct say on whether dental care should be included in Medicare, the outcome would almost certainly be different. Instead, we have a system where both major parties can acknowledge the problem, promise action, and then quietly walk away after the election - with no meaningful accountability.

What should happen

The evidence points clearly toward a phased inclusion of dental in Medicare, starting with:

• Immediate expansion of public dental funding to eliminate waiting lists
• Full inclusion of preventive dental care (check-ups, cleans, x-rays) within Medicare
• Targeted programs for high-need groups: children, pensioners, First Nations communities, and people with chronic health conditions
• A clear ten-year pathway to full universal dental coverage

This isn't radical. The UK, Germany, France, and New Zealand all provide public dental benefits. Australia is an outlier among wealthy nations.

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Dental care is one of the clearest examples of a policy that the public wants, the evidence supports, and the political system keeps blocking. At Direct Democracy, we believe Australians deserve a direct voice on exactly these kinds of decisions.

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