Whilst Aus healthcare is great, why aren't some very essential care needs covered?

It's been proven yet again that Aussie healthcare system is one of the best in the world despite all the limitations it has. Most of the 'essential' care needs are covered for free in Medicare, with or without any queue/ delay (I am not focusing much on those issues here) or, at worst, at a comparatively reasonable cost through a private insurance (I know about a high insurance cost and all related issues.. but still).

However, I was wondering as to why some of the 'very' essential and common care needs/ services were not covered in Medicare fundamentally? e.g. Dental or Ambulance. When it comes to dental or ambulance, they are too heavy on the pocket even with an insurance cover. Ambulance insurance cover offers only 2-3 trips a year, which is still ok for the most of the people but dental insurance hardly covers anything considering the total cost of any major treatment. Most of the dental covers have an annual cap per person which isn't very high. If someone needs more frequent dental visits and major treatments, then they pay a very hefty amount out of pocket as a percentage of an average Australian household income annually. These are such basic needs that the common sense of a layman suggests they should be covered in the public healthcare or there should be insurance products that 'fully' cover it - not too sure if any country has the dental (and ambulance) fully covered though.

Well, pardon my naivety; I am not arguing whether a system that has been well-established for decades is right or wrong, but I am just trying to understand why would they have kept these options out of the public healthcare cover in the first place (and why wouldn't they have created a policy that would make the private dental insurance covers more effective at least). I am sure it's not as simple, but happy to hear your thoughts.

Comments

  • +5 votes

    $$$

  •  

    I don't wanna seem mean in asking, but what is an example of a necessary dental treatment that Medicare won't cover?

    I've been to the dentist once in 10 years maybe and they said my teeth are fine.

    My dad had a problem with one of his wisdom teeth (he's 55 now) but it wasn't that bad. Medicare might've covered some of the costs for him to get it fixed and it definitely wasn't expensive.

    • +1 vote

      From https://www.medicare.gov/coverage/dental-services

      Medicare doesn't cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices.
      You pay 100% for non-covered services, including most dental care.

      • -3 votes

        That's what I meant though - most of that is unnecessary. Most of it is cosmetic.

        I think if it's deemed life threatening and referred by a doctor it would be covered?

        • +4 votes

          Medicare doesn't cover anything dental as Rolts mentioned - cleaning, root canal, filling, caps, etc. They are all essential for people who don't have great teeth.

        • +5 votes

          You've obviously never broken a tooth, or needed a root canal filing or an extraction. I can assure you from experience, these are not done for cosmetic reasons. I had an abscess around a tooth nerve, it was as painful as when I've broken bones. None of these procedures are covered by Medicare. Pain in the mouth and in the hip pocket.

          •  

            @Rolts: Yeah among my siblings I hit the lottery in regards to teeth. Only one in family that didn't need braces thank god.

            Good luck in regards to your dental affairs

            • +2 votes

              @epkh: Born pre-fluoride, in the era of amalgam filings which degrade over time and need extensive/expensive replacement.

            • +2 votes

              @epkh: Can you see this from someone else’s perspective?

              A lot of dentistry is preventative. Eg. Cleaning, fillings.

              Without these preventative measures serious illness can lead to hospitalisation or death.

              • -1 vote

                @Eeples: Yes I can see it now.

                It was just a bit hard since I'm not that old and people my age don't really get problems with their teeth.

      • +1 vote

        That's the USA Medicare website. Here's the Australian one:

        https://www.healthdirect.gov.au/cost-of-dental-care

  • +1 vote

    I think that it all comes down to China!

  •  

    The reason dental isn’t covered is because people would tale less care of their teeth, If they could get it fixed for free time after time. That’s what ph is for.

    And where’d you stop, what about People with bad who eyes don’t get free glasses or lasik surgery, it’s just life

    • +7 votes

      Yet gym memberships have soared in the decades since Medicare began treating heart disease for free.
      Do you have any evidence at all that people disregard their health because they can get low cost or free treatment?
      The evidence would seem to indicate the cost of preventative dentistry like cleaning and check ups is likely to discourage visits, ultimately leading to poorer outcomes.
      In the USA there is lots of evidence the cost of healthcare leads to needed care being neglected.
      https://www.cnbc.com/2020/03/11/nearly-1-in-4-americans-are-...

      •  

        You may be right I never put put much thought into it as it was 5:30 am.

        Gyms are a plentiful, so are private dentists
        Public health system couldn’t cope with free dentistry , it would be backlogged like hell just look and just be tax payer money anyway.

        If people have to pay for it a lot of people will not goto a dentist, or after one visit be more likely to start and be more prudent, otherwise it would be abused like all hell and the health system would be backlogged like anything. After my first root canal I started brushing more and flossing,

        People goto a gym because it makes them look good, not because heart disease is on their mind, heart disease surely would be caused by shithouse diet more than exercise.

        I like how in the uk you get unlimited sick days, in Australia you get 10, Australian shave more sick days over the years from memory of an article I read.

        • +2 votes

          At least the dental insurance covers should be governed by such a policy that they legitimately cover either all or a major portion of your expenses. Currently dental covers are a joke. I am surprised that this gap is not coming to the surface.

        •  

          Unlimited sick days in the UK? Source? You might get unlimited sick leave but it will require medical certification to keep your job.

          •  

            @crashloaded: What’s the difference? Source, I lived there for 9 years, from what I remember there is no limit.
            I was a contractor so I went to work with broken legs if need be

  • +4 votes

    free in Medicare

    Medicare being free is an illusion. The healthy working people of Australia is paying for it.

  •  

    Are you willing to pay more tax to cover the difference? If so how much? And when does it stop being the responsibilty of the person and become the responsibility of the nanny state you propose?

    • -3 votes

      I'm not. I have great teeth. No fillings.

      • +3 votes

        Ah, the f*** you, got mine approach.

        • -1 vote

          Uh.

          Oh. I'm so lucky I brushed my teeth.

          Ah. The "my problems is a shared problem" approach.

          • +2 votes

            @tshow: The inference here is that all dental problems can be prevented by brushing your teeth, which is outright nonsense.

            • -3 votes

              @pais: And the inference that it may not be so means we should all shoulder the cost is outright nonsense.

          •  

            @tshow: Not sure where you got this understanding from that brushing teeth is a magic medicine for preventing any teeth related issues. It sounds like washing hair everyday with a healthy shampoo is a solution to avoid any hair related issues in life. I wish..

            Health of eyes, hair, teeth, bones, skin etc is not always related to how much care you took. There are a lot of reasons for having issues with these, and the most beyond anyone's control, just like any other organs.

  • +4 votes

    The argument that we (as in governments and by default taxpayers) shouldn't have to pay for dental costs of others via medicare because it's an individual's responsibility to not neglect their teeth, reeks of privilege and self righteousness.

    Firstly there are people that simply do not know how to look after their teeth, or do not have the resources to. Secondly, dental care is linked to health care, as in it is linked to our health and wellbeing. As others have alluded to, there are people who are living with chronic dental issues that they cannot afford to have fixed.

    My other big issue with this argument is that it fails to acknowledge the contradictions in our health care system if the arguments is that we can disregard health care issues that stem from 'neglect'. This ranges from issues like lung cancer from smoking, to broken bones from an accident. Are we to turn a blind eye to these issues too, as they stem from one's choices resulting in medical issues? Where are we to draw the line?

    If we become a society that decides we judge people for their choices and our judgement is ultimately that people can live in pain, or die simply because of 'bad' choices and lack of education or resources then we would be a society that I think is quite merciless, unforgiving and also kind of inhumane.

    I complain about how much taxes I pay as much as anyone else, but I am so thankful that should something happen to me or my loved ones we have a safety net to fall onto that I, and many other Australians have been paying for but also reaping the benefits of.

  • +3 votes

    Politics. It cost too much for the government at the time to include it. Quick googling says:
    In 1974, the Whitlam Government decided to exclude dental care from Medicare for two reasons.  The first was cost. The second was political in that Gough Whitlam felt that combatting the doctors would be hard enough without having to combat dentists as well.

    Just like most things the pollies decided what was best for themselves, not the people. They wanted a policy that was not going to make the general voting public scream too much about cost yet get elected.

    Why don't we include it now? Because no political party has put it forward as a policy and been elected to implement it. Clearly all of them have figured out it would cost too much to too many voters to win any votes.

    • +1 vote

      I think its actively a Greens policy and Labor would be inching towards it if they didn't have to fight the small but slow erosions of Medicare as it is. It's hard to add things when others are trying to take things, kind of an uphill battle.

  • +1 vote

    Aus healthcare isn't great. It's good for some, terrible for others.
    Living in a regional town, I get taxed the same amount for medicare as people in cities but I have to wait 3 weeks just to see a GP. No point in it being "free" if I'm stuck at home sick for nearly a month before I can even see a doctor.

  • +3 votes

    Whilst Medicare sometimes covers limited dental services if they relate to other chronic health conditions, these circumstances are quite narrow and patients need to be on an Enhanced Primary Care Plan and a Team Care Plan (so complex conditions that need liaison between a GP and one or more specialists), there must be a recognition that the dental problems are or will likely impact on the patient's health, the services required (can be anything from preventative up to restorative such as bridges, crowns, implants or dentures) are not offered or funded through any other commonwealth or state dental service and the rebates are up to $4250 over two calendar years. If the amount doesn't get fully used, whatever is left is gone at the end of the two years.

    Same with the child dental scheme, which pays up to $2000 per child for eligible children up to when they turn 18 (every two calendar years it renews so whatever isn't used is gone and the $2K starts again and is valid for the next two years). That's for use at any private dentist so it's also worth shopping around for the best price to get the most out of the amount available if your children are eligible.

    There are public dental clinics in every state and territory but as Ssquid said above, the value of any publicly funded service depends entirely on accessible it is and the quality of the service provided. Because there is no universal dental coverage under Medicare, and the cost of private dental insurance is incredibly high and so too are the out of pocket costs, public dental clinics typically have incredibly high waiting times for dental services and due to that, plenty of people end up with acute or emergency issues because there is virtually no preventative care available. There are too many people with serious dental problems and no means to deal with them before they get to the point of abscesses, terrible pain or tooth loss. Or, like myself, there are plenty of people who have had negative experiences with dental clinics as children and that phobia is so great that dental services are delayed or avoided until it's far too late (that's not an excuse, simply an observation based on my own experience). Obviously acute patients are dealt with far more quickly (usually by lining up first thing in the morning and waiting for hours with others who also have a dental emergency and need to be seen urgently - and that's only if you are able to get time off work or arrange care for family or children, or you are able to physically get to the nearest clinic depending on your transport options, more barriers to getting timely dental treatment if you are relying on the public clinics)and again, because public dental clinics have limited funding and the focus is on the cheapest solution (they're not really taking into account the long term consequences), a tooth that might be saved with a root canal is often just extracted as it's quicker and cheaper. It fixes the immediate issue of pain or difficulty eating but can lead to others because once a person starts either losing teeth due to injury/decay/gum disease or dental extractions, it has a domino effect as the surrounding teeth can also begin to loosen and become compromised due to loss of structural integrity of the gum and underlying bone.

    Many people who are reliant on public dental clinics spend years with progressively more compromised oral health (particularly more so if you didn't win the genetic lottery when it comes to teeth, I know I sure didn't!), which can compound or even lead to problems with mental health, general health, speech impediments, self-esteem and even problems when looking for work. It can contribute to all of those issues, but whether federal governments have taken the time to estimate the flow on health (physical and mental) and productivity costs as an actual financial number versus the financial number of how much a Medicare funded dental system would end up costing the budget I have no idea.

    At the end of the day, I think Medicare should cover dental expenses as it seems the private health system has adequately failed to do so, even for those who can afford the yearly premiums but may then have to decline or delay proper treatment due to gap fees or low coverage limits. It truly does seem to be one important area of health where it seems neither the private nor the current public health system provides adequate support for.

  •  

    There are options for free/ heavily subsidised dental care through public dental clinics. There are criteria for qualifying and the wait lists are long, but it'll cover all or most of your dental care. There are other avenues for cheap dental including universities (seeing a student or a qualified dentist)

  • +2 votes

    hopefully Labour gets voted in next term

    • +1 vote

      I'm with you there but I'm not sure even they are that interested in incorporating dental into Medicare. I know the Greens have a fully costed proposal for it but it's virtually impossible they will win government so I'm hoping the two will at least be able to work together and the Greens can get it implemented in some kind of form, even if it's done in stages etc.

      • +1 vote

        Last election Labor had a free dental for pensioners scheme as part of their policies. I think they're interested, but it's just not easy to get it implemented.

  • -1 vote

    Come here illegally you get free everything …including dental

  • Top