Got a dental problem? Ask a doctor.

Recent policy announcements to shore up bulk billing for GPs and a story about Medicare dentistry set the scene for the upcoming federal election.

A recent television story highlighted a push from the Australian Greens to expand Medicare to include more dental services, coming on the back of recent pre-election announcements from both the government and opposition to increase funding for GP visits.

The story highlighted a number of issues confronting the dental profession. Firstly the frustration that an extensive story on primetime national television about access to dental care featured interviews with two doctors, but no dental practitioners. It is extremely difficult to get cut through in the media at the best of times, and to put forward positive stories that demonstrate the importance of good oral health and access to dental care. The angle this story took highlighted the link between poor oral health and general health, and the resultant problems of people ending up at their GP to try and resolve a dental issue. So the inclusion of the perspectives of medical practitioners was important. And framing dental health in the context of overall health is helpful in prioritising the need to improve access to dental care. But neglecting a dental perspective is, well, perplexing.

The main thrust of the story was the Australian Green’s policy of expanding Medicare to include dentistry, which is to ensure that every person who holds a Medicare card will be able to access the essential dental services they need – for free! There is support amongst the dental profession to expand Medicare to include more dental services, and the Australian Dental Association is advocating for a Seniors Dental Benefits Schedule for holders of Commonwealth seniors’ health cards, pensioner concession cards and health care cards who are 65 years or older.

But the broader debate about Medicare bulk billing and the plan to have free dental care highlights concerns that dental practitioners have about including dental services under the Medicare umbrella.

Medicare rebates are supposed to be indexed according to the Department of Finance’s Wage Cost Index, a combination of indices relating to wage levels and the Consumer Price Index. An indexation freeze was first introduced by Labor as a temporary measure in 2013, as part of a $664 million budget savings plan, and was continued when the Coalition was elected in 2014 - initially for fours years, but later extended out to 2020. Although the freeze has now been lifted, recent indexation rates have not closed the gap that opened up over more than a decade as the cost of providing services continued to increase.

The recent policy announcements from both the government and opposition provide a unity ticket to put more than $8 billion back into Medicare, targeted at arresting the falling bulk billing rates. Depending on who you believe, it will either ‘fix Labor’s healthcare crisis and ensure all Australians have timely and affordable access to a doctor’ or ‘restore the $8.3 billion the Australian Medical Association says was cut from Medicare through the funding freeze initiated by Peter Dutton a decade ago.’

Dental practitioners are concerned that freezing rebates is an inevitable consequence if dentistry was also included in Medicare. The Child Dental Benefits Schedule (CDBS), administered through separate legislation called the Dental Benefits Act 2008, did not experience a similar freeze. Indeed, both the cap and rebates have increased consistently since the scheme was first implemented, although they have failed to keep pace with inflation. When the scheme was first introduced in 2014, the eligible patient benefit cap was $1000 over two years, and the rebate for an examination was $52.65. By 2025 the cap had increased to $1,132 and the rebate for an examination to $59.60 - a 13.2% increase. Over the same time period, inflation was 31%.

Despite the Greens push for free dental care, there is not (currently) the same expectation that dental care should be bulk-billed free through a Medicare-type scheme. Patients are accustomed to out-of-pocket payments in dentistry, either for the full amount of treatment or the gap between the usual fee and a private health insurance rebate. The CDBS allows for gap payments, although it does have one of the highest bulk-billing rates across of all of the Medicare programs.

It’s also worth highlighting the constitutional impediment to mandating bulk billing. Section 51 of the Australian Constitution authorises the parliament to make laws for the provision of medical and dental services, but expressly prohibits any form of civil conscription. This means that the government cannot compel medical and dental practitioners to bulk bill.

s51(xxiiiA.) The Parliament shall, subject to this Constitution, have power to make laws for the peace, order, and good government of the Commonwealth with respect to the provision of maternity allowances, widows' pensions, child endowment, unemployment, pharmaceutical, sickness and hospital benefits, medical and dental services (but not so as to authorize any form of civil conscription) …

There is no doubt that the election is just around the corner, and health is going to play a pivotal role. As a profession, we need to be prepared to engage robustly in the political debate to ensure equitable outcomes for our patients. Because those patients should be visiting a dental practitioner, not the GP.

Water Fluoridation

I have written previously about the important benefits of water fluoridation, and the concern that many people have over the appointment of renowned anti-fluoridationist Robert F Kennedy Jr as the Secretary of Health in the USA.

Just this week Cook Shire Council in Far North Queensland voted to remove fluoride from their water supply effective 25 March 2025, putting the oral health of around 5000 residents at risk. This is a retrograde step, and will further embolden other local councils in Queensland to follow suit at a time when RFK Jr will be enacting similar measures across the USA.