John Murphy (Lowe, Australian Labor Party, Shadow Parliamentary Secretary to the Leader of the Opposition) Share this | Hansard source

I oppose the Health Insurance Amendment (Medicare Dental Services) Bill 2007. I support the contribution to the debate made by the previous speaker, the member for Hindmarsh. The debate on this bill is timely indeed. It comes during a period when Australia is, undoubtedly, in the middle of a calamitous dental care crisis. Despite living in a First World country, it is absolutely appalling that large chunks of our population are living with Third World mouths. So alarming are the statistics that many members would no doubt have to pinch themselves to see whether what they have just read is true. Currently, there are 650,000 people on public dental waiting lists around Australia. In New South Wales alone there are 178,876 people waiting to be treated, including, appallingly, some 45,000 children. These waiting lists are seemingly carved out of stone, and such is the permanence with which the names are etched into them that Australians have been waiting on these motionless lists for an average of 27 months, many of them waiting years upon years for treatment.

That in itself is unacceptable, but there is far more to Australia’s dental care crisis. The Howard government’s dental care credentials only get worse with each published report and survey. The Australian Institute of Health and Welfare recently found that 30 per cent of Australians reported avoiding dental care due to cost. Indeed, 20.6 per cent said cost prevented them from having recommended treatment and 18.2 per cent said they would have difficulty paying a $100 bill, as mentioned by previous speakers.

Those facts are sobering enough, but the Howard government’s inept response to the dental care catastrophe over 11½ long years has ensured that there is a conveyor belt full of other heartbreaking statistics. Most heartbreaking of all are figures from the New South Wales Chief Health Officer stating that, between 1994 and 2005—more than a decade—the hospitalisation rates for children under five seeking to have their teeth removed or restored has increased by 91 per cent. It is not a record to be proud of. The government should be deeply ashamed that Australian kids, who had the world’s best teeth during the mid-nineties, have seen the state of their teeth spiral downwards over the last decade. The Minister for Health and Ageing should ponder those facts very carefully. He should reflect upon the fact that the Howard government has presided over a 91 per cent increase in hospitalisation rates of our children and the fact that waiting lists have grown out of control and adults cannot afford basic dental treatment.

More importantly, the minister should have some humility and accept some responsibility for the fact that Australia is a First World country with many Third World teeth. The response from the minister has truly been inadequate. We have seen the Howard government engaging in yet another round of the blame game, blaming all and sundry for the nation’s ills, without accepting an ounce of responsibility. In his second reading speech, the minister said the measures in this bill ‘will help to further strengthen dental care in Australia’.

Putting aside for one moment the folly of that statement, there appears to have been a sudden revelation amongst members of the Howard government that dental care is a serious problem in Australia. You can be certain that it is. And it is no coincidence that the enlightenment has only come at a time when the government tries to bolster its electoral fortunes in the lead-up to an imminent federal election. The minister’s previous responses have been most illuminating and have given a more accurate reflection into the insight of the Howard government. Prior to its flagging electoral fortunes, the minister was quoted as saying:

The government believes that it has already taken sufficient action in this area.

The minister was also quoted ad nauseam as having said that dental care is a state responsibility. Indeed, the Prime Minister repeated that nonsensical claim today in the House. It is hard to tell whether they are being facetious or whether they are far removed from the reality of the Australian Constitution, as was made plain during question time today. I know that both the minister and the Prime Minister are avid supporters of our constitutional monarchy yet they have seemingly not bothered to take a cursory glance at section 51 of the Constitution, which I will record again in the House today:

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:—

       …         …         …

(xxiiia.) The provision of maternity allowances, widows’ pensions, child endowment, unemployment, pharmaceutical, sickness and hospital benefits, medical and dental services ...

On our side of the chamber we live in hope that the Howard government will slowly but surely find the will to pursue a just and orderly dental care policy. Given the circumstances, we hoped that the government might develop effective policy solutions to address some of the areas I mentioned earlier. A just and orderly approach to dental care would recognise that 650,000 Australians need to be taken off waiting lists before they develop chronic health problems. A just and orderly approach to dental care policy would attempt to stem the growing tooth decay epidemic by engaging in a broad based public health campaign highlighting preventative oral health care.

Having spent years pontificating and blame shifting, with an election looming the government now wants to be seen to be doing something. At five minutes to midnight the government has brought to the parliament a bill that seeks to expand a failing Medicare dental program for people with chronic conditions and complex care needs. After all of the minister’s hot wind and bluster about dental services being a state responsibility, it was pleasing to see the government at least talking about dental care—I will give them credit for that. However, the minister is talking about dental care in such a way that we will not see real solutions to any of the major dental care problems in Australia. That is the truth. Money is being allocated to half-hearted and flawed policy initiatives that will see very few people get the care they so desperately need. Under the government’s initiatives in this bill patients will still need to go through the rigmarole of showing that (1) they have a condition with complex care needs; (2) they have a dental problem which significantly adds to the seriousness of their medical condition; and (3) they are receiving care from a general practitioner under a written management plan. All of this just to get a tooth fixed.

What the government is effectively telling Australians on waiting lists is that they must wait until they develop chronic problems before the government will provide assistance. Talk about putting the cart before the horse. The government’s chronic disease management program, to which this bill makes minor changes, has been so poorly designed that very few people have used it since its inception in 2004. I have absolutely no confidence that the bill’s cosmetic changes to threshold amounts and increases in claimable Medicare items will make this program any better. There are a range of other problems besetting the program that this bill does not address, particularly the overly restrictive eligibility criteria. This is not only my view. Professor John Spencer, Professor of Social and Preventive Dentistry at the University of Adelaide, stated in his submission dated 24 August 2007 to the Senate Standing Committee on Community Affairs:

I make this submission in response to an invitation to do so. The views expressed are those of an individual dental academic at The University of Adelaide and are not endorsed by any level of the University of Adelaide.

The Health Insurance Amendment (Medicare Dental Services) Bill 2007 increases access under Medicare to dental treatment for people with chronic conditions and complex care needs. The rationale for this Bill is that people with chronic conditions have poor oral health which can adversely affect their condition or general health. This is an important, albeit very constrained step in improving the oral health and access to dental care among the Australian population. Nonetheless, there are several issues that should be discussed with regard to this Bill and its rationale.

First, many Australians who suffer with poor oral health will not obtain dental services through this Bill. This is despite the observation that “You cannot be healthy without oral health” (US Department of Human Services, 2000). This quote from the US Surgeon General challenges the premise of the Bill ‘that poor oral health is only important in so far as it affects a chronic medical condition or its management’. This premise has been previously captured in the phrase ‘medically necessary dental treatment’. However, the quote from the US Surgeon General acknowledges that oral health per se is important, even without an identifiable increase in the severity or complexity of the management of any medical condition.

Second, classifying those medical conditions which are adversely affected by poor oral health is a difficult task. Poor oral health may quite plausibly affect nearly all medical conditions through pathways involving reduced ability to chew, altered food choice and decreased nutritional value of foods consumed. Alternatively oral symptoms may adversely affect quality of life, reducing coping and self-efficacy. However, there is lack of research in these areas. There is difficulty in ruling a line between medical conditions which are affected or not by poor oral health. At present any decision about what conditions are included will seem quite arbitrary.

Third, the criteria for inclusion of dental services in a GP Management Plan are not defined. Uncertainty about specific medical conditions to be included could lead to either few or many eligible patients receiving dental care. Past experience with much lower rebates was that few eligible patients received dental care. If the new arrangements are more attractive to patients, general medical practitioners and dentists, it is possible that most people under a GP Management Plan and Team Care Arrangements, estimated at approximately 400,000, could desire dental care. At the maximum Medicare benefit for dental services and the level of funding set out in the Financial Impact Statement only some 45,000 people will receive dental care in any year of full funding. How then will the one in eight eligible adults under a GP Management Plan be chosen by their general medical practitioner? Will they be limited to people with particular chronic conditions, specific oral disease or dental treatment needs, financial circumstances, or none of these criteria.

Professor Spencer goes on to conclude:

The Financial Impact Statement for this Bill outlines a total cost of $384.6 million over 4 years. This will present the second highest outlay on dental services by the Australian Government (the highest is the 30 percent private (dental) health insurance rebate). Such an outlay needs to be actively monitored and evaluated. It is likely that ‘fine tuning’ will be required to ensure satisfactory processes lie behind the provision of Medicare Dental Services and the best outcome is achieved for the expenditure.

To inform these judgements, evaluation needs to be conducted at two levels: one among persons receiving Medicare Dental Services, and another at the population level. Among persons receiving Medicare Dental Services profiling of these patients and what services they receive would be an expected routine part of any administrative overview. However, a number of more specific questions might reasonably be asked about the persons receiving Medicare Dental Services:

• the reasons for seeking care

• the social, medical and other relevant characteristics of those who received care

• the oral problems they had

• the impact dental care had on their underlying medical condition and its management, and

• the perceptions of the process from general medical practitioners dentists and persons involved

At the population level it is important to understand the coverage achieved by Medicare Dental Services among those persons with chronic disease and complex needs and those who are under a GP Management Plan and Team Care Arrangement. Such questions can only be answered by planned evaluation activities. The implementation of such evaluation activities early in the program is of high importance if the management of the interface between oral and general health is to be improved in Australia.

Those are the words of Professor John Spencer, from the Department of Social and Preventive Dentistry at the University of Adelaide.

In my electorate I have been campaigning and fighting for better dental care. Just to give you some insight into how chronic it is in my electorate, at one of my mobile offices, at Concord, a few Saturdays ago an elderly gentleman who was on the pension came up to me with a plastic bag with five dentures in it. This is serious stuff. He had received those from the dental hospital. They were all ill-fitting and he could not use them. As he was speaking to me one of his dentures fell on the ground. He had nowhere to go and he was pleading with me to do something to help him.

We all know the importance of maintaining good oral health. Not so long ago I had three crowns fitted and it cost me something like $4,200. My dentist was definite that I had to have them done because, if you do not look after and preserve your teeth, with the pressure that you put on your teeth when you chew and the inevitability of the ageing process, you put the other teeth at risk. Anyone who knows anything about oral hygiene will tell you that you have to do everything possible to look after each and every one of your teeth. The last thing that anyone should be forced to do is take the easy option of pulling out a tooth. Very soon after you take one tooth out, the teeth nearby are under greater stress because they have to work harder. Eventually you lose those teeth and, in the final analysis, you end up with no teeth, and no-one wants that.

I hope that the minister takes that on board and has taken note of the announcement made by the Leader of the Opposition and the shadow minister for health today in relation to taking responsibility for another one million dental consultations. The government is awash with money—the budget surplus is in excess of $17 billion—and dental health is fundamental for all of us. I think it behoves all of us in a bipartisan way to do something to assist those people, particularly the most vulnerable in our community who are existing on pensions or are self-funded retirees with very limited resources. They clearly cannot afford root canal therapy, crowns and dentures without more assistance from the government. I hope that the minister and the government take that into account and this becomes an important issue at the federal election.

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