Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

I appreciate the undivided attention that so many members of the government are giving to the debate on the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008! The coalition certainly understands the burden of dental disease in our society. It is thought that the rate of tooth decay in adults in Australia is close to 100 per cent. Worldwide estimates for the prevalence of severe periodontal disease generally range from 10 to 15 per cent. There is a complex interplay between dental disease and general health. Each impacts on the other. Diabetics, for example, get more dental disease, and chronic dental disease can make diabetes worse. Anybody whose illness prevents them engaging in good oral hygiene is at risk of significant dental disease. Those with gout, arthritis in the hands, depression or other mental illnesses, dementia, neuromuscular disorders, and drug and alcohol dependency will be at higher risk of dental disease.

On the flip side, dental disease causes problems in its own right. Fifty thousand Australians are hospitalised each year with preventable dental disease. Dental disease directly contributes to other complex medical conditions, such as cardiovascular disease and some cancers. Oral, gastrointestinal, lung and pancreatic cancer are all linked to tooth disease. Being unable to chew your food can cause malnutrition and advancement of chronic disease. If dental disease is not a direct cause of these disorders then it may be a major contributor. Dental disease can be destabilising in other ways. There are Australians out there suffering severe chronic dental pain every single day. This pain keeps them out of the workforce, affects their relationships with their families and affects their relationships with their colleagues.

It was after recognising the strong link between dental disease and complex health conditions that the coalition government decided to introduce dental care into Medicare. It was also, I might add, a direct result of the failure of the state governments to do what they are tasked with doing, and that is to provide dental care through the public hospital system to those most in need. From November 2007, patients who were assessed by their GPs as having complex medical conditions became eligible to see a private dentist and receive $4,250 worth of treatment over two years. The need for this sort of service has been palpable since the program started. The uptake in the first two months of Medicare dental in November and December 2007 alone was 16,000 services. Then in January 2008, according to Medicare, 20,443 services were administered through the scheme. In February 2008, 40,497 services were administered and, in March 2008, 94,617 services were administered. The total number of dental Medicare services administered from July 2007 to March 2008 was about 172,000. We discovered through the estimates committee of the Senate that in fact the total number of services to date is well over 300,000. Yet the Minister for Health and Ageing said on 2 March that only 13,000 services had been provided in four years. I am not sure which planet she is on, but this planet is earth and even her own people are talking about dental services in excess of 300,000 under the scheme introduced by the Howard government.

Also contrary to the assertions in this House by the Minister for Health and Ageing, these figures show an approximate doubling of dental Medicare services each month. These figures were available to the minister in March when she spoke in parliament about the poor uptake of Medicare dental as justification for axing this vital program. Either the minister for health inadvertently misled the House or she simply does not understand that a program that doubles in intake each month and has a total uptake of up to 300,000 services, or even over that, is not an unnecessary program. It is in fact the scheme which saw countless needy Australians access the dental care they needed. It was a scheme which finally allowed those weighed down by chronic dental pain to get their teeth fixed. It was the only opportunity for pensioners to get their teeth fixed up, if they had substantial dental problems, so that they could eat a balanced meal.

I am talking about real people with real illnesses—people like Chris Planer. Chris is a 28-year-old man who had cancer on the floor of his nose and the roof of his mouth. After therapy for his cancer, Chris was able to access Medicare dental to have restorative dental therapy. This is an interesting fact. The Insight program on SBS has footage of Mr Planer actually claiming his dental rebate from a Medicare office, even though on 12 March the Minister for Health and Ageing insisted quite firmly that Chris was not entitled to make such a claim. It is quite concerning the Minister for Health and Ageing seems to have slashed a program that she did not understand. The minister believed that people like Chris Planer could not benefit from the scheme. The minister believed that Australians did not want to or need to access dental care through Medicare. Over 300,000 services were delivered through the Howard government’s scheme, and that does not suggest it was an unnecessary or unwanted program.

The reason the Medicare dental program was so popular is that the average Australian could get little access to dental clinics run by their state Labor governments. Of course, waiting times to get into dental clinics are state secrets. Despite several attempts to obtain this information from a variety of sources, the states have not been forthcoming with their data. What a surprise. So with thanks to Ms Clara Pirani, an investigative journalist from the Australian, the most accurate guideline we have is from 2005. At that stage, Ms Pirani found that there were 650,000 Australians on waiting lists for dental care across the country. More than 20,000 Australians were joining the queue each year. Waiting lists for treatment were up to four years.

Let me go through some of the numbers. I quote these from the information provided to the Australian newspaper: there were 197,810 people on dental waiting lists in Victoria, 167,367 in Queensland, 68,691 in South Australia and 20,701 in Western Australia. In my own state of New South Wales, which the honourable member at the table, the member for Charlton, is familiar with, there were 181,453 people waiting for dental services. That was in 2005. At that stage, we saw 650,000 Australians on dental waiting lists, but that number was growing at the rate of 20,000 per year. So we can assume today, if the trend has continued, that around 700,000 Australians are waiting four years for treatment for painful, debilitating and even dangerous dental conditions.

Waiting too long for dental treatment can mean the difference between treating the tooth and having to have the tooth pulled out. It is these vulnerable Australians who need an alternative to hanging around for years in a state government waiting queue. They need another way to stop the cycle of pain, being unable to eat and being unable to get on with their lives. They need a way to stop their dental disease making them sicker. Medicare dental was the best way forward for vulnerable patients in need to access a dentist for treatment. This government has sought to axe the program unceremoniously, leaving 650,000 Australians languishing.

Today fewer than 10 per cent of dentists work in public dental clinics. I say it again because it is a very interesting stat: fewer than 10 per cent of all dentists work in the public system. Over 90 per cent are in the private system—this is clearly different, obviously, to doctors and general practice providers, many of whom do work in the public system. Therefore, even if you throw more money at public hospitals and the state government system, which this federal government is doing, unless dentists are prepared to work 24 hours a day, seven days a week in order to address the backlog or there is a movement of dentists from the private sector to the public sector, the waiting lists are going to remain very significant. It is unrealistic to expect that the Labor state and territory governments could manage dental disease across the whole country, even if they put in an enormous injection of capital and even if they could pull a rabbit out of the hat and start managing their hospitals efficiently. Does anyone here truly believe the state governments are going to manage their hospitals more efficiently, let alone attract more dentists to the public hospitals to provide the sort of treatment that patients expect? So I ask the obvious question: where are all the dentists who will be moving into the public system going to come from?

One thing people are not going to do is turn to their private health insurance for the provision of dental cover, because, as we know, the Rudd government has taken a baseball bat to private health insurance as well. There is a concerted attack by the government on private health insurance providers—that is, of course, unless they are buying the private health insurance providers, as we saw in the Financial Review on Friday with Medibank Private’s purchase of AHM for $300 million. Can you believe it? Not only do the government oppose privatisation; they support and fund nationalisation—the buying of a private health insurer by a very committed public private health insurer, Medibank Private.

Private health insurance is obviously not going to be the answer for people with severe and chronic dental pain because of the initiatives that came out of the government in the budget. The Medicare levy surcharge threshold was raised from $50,000 to $100,000 for singles and from $100,000 to $150,000 for families. In this one budget measure, the mask that the Prime Minister wore to the election came off. The Prime Minister made firm assertions prior to the election that he supported private health insurance. What we discover now, from the mouth of Medibank Private alone, is that this initiative by the government in the budget is actually going to cause between eight and 10 per cent of the members of Medibank Private to leave, which will in turn put significant upward pressure on private health insurance premiums.

Just to remind you, Mr Speaker, because you are a very wise man, the Medicare levy surcharge formed part of the coalition’s three key policy pillars to support private health insurance. They included the private health insurance rebate, the Medicare levy surcharge and Lifetime Health Cover. These three pillars saw private health insurance taken up by almost 10 million Australians—in fact, somewhere around 9½ million—or 44.6 per cent of the population by March this year. That is the highest level of private health cover since the introduction of Medicare.

When the coalition came to government in 1996, private health insurance membership was around 35 per cent. Under the Howard government it increased from 35 per cent to nearly 45 per cent. Before the election, the current Prime Minister, the member for Griffith, told the Australian people, ‘Don’t worry—I’m the same as the Howard government on private health insurance.’ Then, out of the blue, came this initiative. Driven by the Prime Minister’s office, we understand, the Medicare levy surcharge will be changed, with the government saying, ‘We will spin it to Australians as tax cuts, but in fact it is a budget savings measure because we are paying out less in the 30 per cent private health insurance rebate and the net impact on the private health insurance industry is of no concern to us.’ That is what the government said. Well, it is going to be a concern to the government, because there are going to be significant premium increases.

My understanding of private health insurance is that the Department of Health and Ageing and the various statutory bodies that advise on these things are actually involved in quite micro details relating to the content of policies that can be offered to customers of private health insurers. Therefore, not only does the government control the impact of various macro policy initiatives on private health insurance uptake; it has significant impact on policies offered to consumers. On the one hand, consumers are going to be looking for private health insurance to fill the gap in the absence of Medicare dental, because this government has now abolished Medicare dental without any subsequent support for those who still need dental work. At the same time, if those people go to their private health insurer to take out a policy that will provide them with coverage for potential dental disease, they are going to have to pay higher premiums as a result of this government’s policies.

So I do not know what the narrative is from the government in relation to better dental care for Australians. It is certainly more rhetoric than it is substantial policy. When it comes to policy initiatives, there is no doubt that those people who want to invest in their own health care through taking out private health insurance are going to get no easy passage from the Rudd government. I think what we can look forward to—and we do not look forward with any great hope or pleasure—is private health insurance premiums under the government increasing dramatically as a result of their budget initiatives. Furthermore, their proposal to put more money into the public hospital system to address public hospital waiting lists is going to have minimal impact. They are going to set up a screening program for teens which in part duplicates some of the programs that already exist in some of the states. Thanks to the Rudd government, parents will receive funding for a voucher to find out that their 13-year-old child has dental problems, but they will receive no funding to get the problem fixed—whereas under the Howard government up to $4,250 was available for those people with chronic dental problems to get them fixed as soon as possible by a private provider given that the public system has a shortage of dentists.

We see a shortage of good health policy narrative from the Rudd government. There is going to be a direct attack on the private system as a result of various government initiatives, with the net impact on the public system of driving people from private health and private dental care, even with the assistance of Medicare, into a public system that is already under enormous strain. The public dental clinics are simply unequipped to deal with another influx of dental patients. When it comes to chronic dental problems, it is vitally important that all age groups have access to emergency care—all age groups: not just teens, even though they are vitally important, but pensioners and self-funded retirees who are unable to afford treatment for their chronic dental disease.

Labor’s election promise was for two initiatives. One was the Teen Dental Plan. Prior to the election Labor promised $510 million over three years, but the budget delivered $490.7 million over five years, a dramatic reduction. For the Teen Dental Plan, the Rudd government is going to provide ‘up to’—these are new words—$150 per eligible teenager for a voucher towards an annual preventive check. So we actually do not know how much each child will realistically receive by way of vouchers. Eligible teenagers include those aged 12 to 17 years in families receiving family tax benefit part A and teenagers in the same group receiving youth allowance or Abstudy.

Labor’s own press release prior to the election of 2007 clearly stated that a comprehensive check-up will cost $290, so that will leave parents out of pocket to the tune of $140. The Labor Party proclaimed that their initiative would provide free teenage dental check-ups. The Labor Party are only providing up to $150 when their earlier policy said that a comprehensive check-up will cost $290. Maybe they are subsidising the check-up of the top teeth and not the bottom teeth, or the front teeth and not the back teeth. How beneficial it would be if a teenager did not have 50 per cent of their teeth because then they would get all of their teeth covered! It is ironic but sad that the government promised the Australian people better dental care but have failed to deliver it in their own budget.

If the dentist finds dental disease, including dental challenges in particular patients, what can the dentist do about it under Labor’s plan? Frankly, the dentist has two choices: he can direct patients’ parents to the nearest queue at the local public hospital dental clinic—there the child can wait up to four years for treatment while the problem gets worse—or he can offer to fix the problems himself for a fee. This is the question that a lot of parents are going to be asking: how will they feel if they cannot afford to have their children’s dental problems fixed once they have been identified? These are the same parents who are already under enormous financial strain at the moment. I think both sides of the House agree that families and households are under enormous strain with rising petrol prices, rising grocery prices and rising interest rates or rising rent—rising interest rates and rising rent are fingers on the same hand. Then along comes this government voucher, which does not cover the full cost of a check-up for the child, and obviously if the child does have a dental problem then there is going to be an enormous obligation on the parent to do something about it. Very few parents would identify that their children have health problems and then refuse to do something about them. Now that the government has abolished Medicare dental—taken dental out of the Medicare system—there is no safety net.

The Teen Dental Plan is an example of a program that is doomed to fail. It does not cover all of the costs. It duplicates the system that is meant to be provided by some states. It does not provide any services; it simply identifies the problem without putting the money in place to fix the problem. Ultimately, all it does is give people vouchers. It does not mean they are going to have better health care. The flip side is that the government say they are going to provide additional money to the state governments to address the hospital queues, to address the demand for dental services in the public hospitals. Yet, as I said, unless you have an enormous movement of dentists from the private sector to the public sector then you are simply not going to have the people there who can address the waiting list.

We should for a moment as individuals think about what a dentist provides. If you go into a dentist surgery, you will see an enormous amount of equipment. Let us compare a dentist with a doctor. The cost of the equipment in a dentist surgery is enormous. They have everything from X-ray machines right through to the highly specialised equipment for all sorts of treatments. I do not know about you, Mr Speaker, but I have certainly heard the fearsome sound of a dentist’s drill. My experiences at the dentist have never been cheap; rather, they have been, like so many others, pretty expensive exercises.

Greg Combet (Charlton, Australian Labor Party, Parliamentary Secretary for Defence Procurement) Share this | Link to this | Hansard source

Mr Combet interjecting

Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

Well, it is a danger. Dentists in the private sector have these huge costs associated with their businesses. Ultimately, dentists, like all other professionals, are businesspeople; they are running a small business and they have to charge for their costs. The Howard government scheme of Medicare dental actually did address some of that challenge. The new government scheme says, ‘No, we’ll do it all out of our public hospitals,’ which can only be described as ‘challenging operations’ under the existing system, let alone when more people pour into the public hospitals in search of dental care.

I say finally on this bill and more generally on health: the Prime Minister said before the election that the buck stops with him. He said that he will do something about hospitals in Australia. The coalition will keep him to his word. The now Prime Minister said, ‘We will fix the hospitals.’ He committed, ‘If the hospitals are not fixed by 2009’—not ‘if in 2009 the government does not have a plan to fix them’—‘then the buck stops with me.’ ‘We will have a referendum,’ the Prime Minister said, ‘to take over the hospitals from the states.’ We are in the process of supporting a number of government initiatives in relation to health, but the government is on notice that, when it comes to that promise, we will hold the Prime Minister accountable for every single word and we will ensure that he honours his commitment to the Australian people to fix the health system.

But on the form that has been shown by the government to date—with the sustained attack on private health insurance, which is going to put more people into the public hospitals; with the demolition of Medicare dental, which is going to put more people into the public hospitals; and with the flimsy commitments of the government to ongoing demands from the states in relation to better accountability in statistical collection and in the day-to-day operations of the hospitals—I can see no way the Prime Minister is going to meet his commitments to provide Australia and the Australian people with better quality hospitals and better health services. I expect that in 2009 and beyond the Prime Minister’s words that ‘the buck stops with me’ will come back to haunt him.

Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008, but before I do I would like to make some comments on the contribution of the member for North Sydney. We too could sit here and not tackle the big problems and not tackle health. We too could sit here, wipe our hands of issues, blame the states and play the blame game, as we saw for 11 long years. During those 11 long years we saw that one of the first acts of the Howard government when they came to power in 1996 was to axe the existing Commonwealth dental scheme. At the time, the Keating government was putting $100 million per year into the states and into the Commonwealth dental scheme. The very first act of the Liberal conservative government of 1996 under the leadership of John Howard was to axe that scheme that ensured that Australians were getting the dental care that they deserved. Even today, we see, from the bowels and the depths of opposition, the opposition continuing to play the same game that they played in government. They continue to wipe their hands and they continue to blame the states at every opportunity instead of looking towards the future of Australia and tackling the problems that we have, like health. For 11 years we have seen this area disregarded.

We know that these bills are the first step in delivering on our election promise—our commitment to improve the important area of dental health. This first step is the establishment of the Teen Dental Plan and the Commonwealth Dental Health Program, which will improve dental health by providing additional funding to the states and territories to reduce public dental waiting lists. We are just not sitting and blaming the states for the increasing list of 650,000 people around our nation who are waiting for some form of dental care. For example, in my electorate there are over 25,000 people aged 65 and over. The majority of them are on a Commonwealth pension. Many of these people need dental care and have been on waiting lists for two, three or four years. In the last four years since I was the elected member for Hindmarsh, I have regularly seen constituents in my office and heard horror stories of their not being able to eat their food because their dentures did not fit and of waiting for years to get their first appointment.

We also have in the electorate of Hindmarsh over 7,000 teens, some of whom will be able to benefit from this teen dental health plan. From 1 July 2008, the government will provide up to $150 per eligible teenager towards an annual preventive check-up. That is $150 more than the opposition’s policy or the former government’s policy for those teenagers. Under their policy, those people received nothing unless they had a chronic illness or disease. That $150 annual preventive check-up is for teenagers aged between 12 and 17 years in families receiving family tax benefit part A and teenagers in the same age group receiving youth allowance or Abstudy. The government’s dental program is specifically tailored to assist families who are struggling with the cost of taking their children for dental check-ups. We understand that these new dental programs have to assist those in the most financial need. Those dental check-ups at those early stages will prevent the costs from ballooning out. For the last 11 years there have been no check-ups for those people who cannot afford it; therefore, gum disease and dental diseases have become more severe and more costly to treat.

These new measures will cost $490.7 million over five years. There is an extra $290 million over three years for the reintroduction of a Commonwealth dental health program—a total of $780 million to ensure that Australia’s dental needs are met and that the waiting list of 650,000 people is reduced. The former Howard government cut over $1 billion in dental care from the state and territory governments. As I said earlier, $100 million was lost to dental health per year—year after year after year—for 11 years. That money was there under the Commonwealth dental scheme and was the real money that was taken out of dental care which caused those lists to balloon out to 700,000, or 750,000 in some cases, over the last 11 years. We all know what the former government’s attitude to dental health was. All of us who are now on this side of the House made speeches when we were on the other side. We continually asked questions about this very important issue. We are all too familiar with the wanton disregard it exhibited towards the Australian population’s capacity to maintain dental health and thereby maintain their ability to eat properly and ensure that their health was in check. We all remember too well the Howard government’s callous and almost spiteful rejection of any suggestion that the former government should make a real contribution to dental health in Australia, as it was obliged to do under section 51 of the Australian Constitution. If you read that section of the Constitution, it is quite clear that dental health is the responsibility of the Commonwealth. The former government was very spiteful and callous in this particular area over those 11 years. As I said, questions were asked in those days only to have the government members at the time wipe their hands and say, ‘Nothing to do with us—it’s a state issue; speak to your state mates.’ They were the answers we were consistently getting until some stage in 2007 when the Howard government finally woke up and realised that there was a problem in this area. It put together a policy which did not even get close to the reality of this area. The policy was that you had to have a chronic illness before you would even be looked at. There were 650,000 Australians waiting on the dental care list, the majority of them pensioners who did not have illnesses; they were just pensioners who wanted dentures or needed some form of dental care.

The Howard government pretended to be the best mates of senior Australians, but we all know that was not the case. They denied them even the recognition that their dental health was an issue that they as a federal government should have been concerned with. Instead, we saw the blame game and again for every question that was asked, every time the issue was raised, the message was clear: ‘Don’t look at us. We have nothing to do with this. This is a state issue.’ This was instead of tackling the issues as a federal government that has been put there by the Australian people should have been doing. Of all the evidence that exists of the former government’s disregard for senior Australians, their belligerent refusal—in this place and in the media—to acknowledge their responsibility in the field of dental health surely must be at the top of the list.

The area of dental health typifies the previous government’s approach to federalism. Their approach was simple and that was to blame the states. Whatever the federal government may have as their priorities, whatever health outcomes they may desire, they were always too ready to simply brush any dust from their hands and walk away without so much as a second glance. This is one area that the previous government got very seriously wrong where their natural inclination to curl up into a little ball and pretend no-one could see them was noticeably harmful to their public perception.

I have to say that the good people of Hindmarsh certainly made this point to me over three years. I have probably said this in this place before but, of all of the surveys and invitations for people to comment that I extended throughout my electorate over the years, there has probably been no one issue that demonstrated an intensity of feeling, a uniformity of opinion, and a very real substantial and immediate need than the issue of dental care, especially among the older residents of Hindmarsh, of which there are many.

I would like to draw your attention to the story of a constituent of mine who was interviewed by a weekly newspaper earlier last year. In the article dated 10 June 2007 titled ‘Forced to be a DIY dentist’, we read of the story of a retired toolmaker, a gentleman who worked all his life, paid all his taxes, supported his family and now, in retirement on a pension, looks to living his life with his wife in peace and dignity. We read of his shrinking gums and his misfitting dentures and how he had to wait over two years to get the dentures professionally adjusted. We read of his ongoing battle day after day to do that which each of us here takes for granted—that is, to eat. As the dentures did not properly fit, they kept on slipping within his mouth, causing ulcers. So, as the story unfolds, we read of this gentleman’s desperation building to the point that he felt he was forced to take matters into his own hands. He took his dentures and set to work on them himself with files and abrasive paper in the hope that he would be able to manipulate the plastic to the point that they actually fit well enough for them to be useful and enable him to chew food. This was a pensioner in my electorate. He was not covered by any policy that the former government had because he did not have a chronic illness but nevertheless his health was subjected to horrors because of this.

Some may say that this story, even as I have been giving an account of it here, is pulling at heartstrings and not a serious matter of public policy. I disagree. Older Australians, especially those who we all represent within our electorates and certainly the ones that I represent in Adelaide’s western suburbs, do not take their own dental care lightly. They do not laugh off their rotting teeth and focus on what people opposite may consider serious issues. They do not take kindly to being taken for granted, dismissed and having their concerns trivialised. They do not react favourably to those who simply will not listen to their concerns, understand their needs and develop appropriate policy in response.

We have been speaking here about the Rudd Labor government’s commitment to dental care made in the lead-up to the 2007 general election and the fulfilment of that commitment. We have been speaking about the $780 million investment over five years into the dental health of a nation, which will include people like the pensioner who I just spoke about. We have been speaking about the 650,000 people who have been on waiting lists around the country for an inordinate length of time. Of these 650,000, by far the majority are our older Australians—those who, in many cases, may have worked all their lives, paid their taxes and fought in the war, and as governments we have an absolute responsibility to ensure that we provide them with adequate health care and part of that is a dental scheme.

With these bills, the Rudd Labor government makes good on its election commitment. It makes good on the commitment and the promises we made before the election to give 1.1 million teenagers dental check-ups each year and improve the dental health of seniors in a more effective and timely manner than Australians have seen for over a decade. This Rudd Labor government is looking after the interests of all Australians.

Just last weekend in the suburb of Flinders Park I was holding a series of street corner meetings where I meet people in my electorate. Of all the things that people commented on, the one topic they were most pleased about was the Rudd Labor government’s actions in relation to having, for example, seniors concessions for public transport and the like recognised by states. Previously, when seniors visited a different state their concession card was not acknowledged. This is just another area where Labor have heard what seniors have been saying and have acted upon it. It is an area where we have looked at federalism and instead of wiping our hands and saying, ‘It’s got nothing to do with us,’ we have actually acted upon it and ensured we have made a better policy for Australia.

For 11 years we heard silence from the other side on this issue. Continuously in this House the then opposition would ask questions about dental care, about what the government were doing and about whether they were tackling the list of 650,000 people who were waiting—suffering with pain through bad dental hygiene. Every time it was raised, again, we had the blame game. That is all we heard. Again and again they reverted to that. Even with them in opposition today we hear that the blame game still exists. There is hardly any policy, but the blame game still exists. It seems to be one of the policies that have survived over time, and I assume we will continue to see it. For example, in a question in writing on 13 June 2006—nearly two years to the day—the then Minister for Health and Ageing, Mr Abbott, was asked:

... will the Government reinstate the Commonwealth Dental Scheme, or introduce a comparable scheme ...

His reply was that, no, the Commonwealth had no responsibility. He blamed the states and then continued by saying that plans to assume extra responsibility in this area were zilch. That was his answer: ‘No, no way’. And we heard that time and time again. They wiped their hands and walked away from it.

Today we see the opposition have the audacity to come in here and try and lecture the government on dental care. We constantly raised the issue of dental care in opposition—constantly. Day in and day out, in my three-year term, I must have made dozens of speeches on it. And constantly we heard the same answer. The answer was always: ‘No. It is not our issue. We wipe our hands. It is not our responsibility.’ Then they would go on and we would again hear more blaming of the states. As I said, even today from the bowels of opposition, we hear the same engagement in the blame game instead of working together with the states and ensuring that we work hand-in-hand and complement one another in all ways wherever we can, especially in areas where the most vulnerable are in need. And this is an area where the most vulnerable are in need. Dental care is a very important area.

The difference between the former government’s policy and our policy is that our policy, the $290 million policy, will give one million people who would not have seen a dentist under their policy the ability to see one. That is the difference. I do not know how you can have a go at that, when you have a million people who otherwise would not be seeing a dentist. There is a change of government. There is a new policy. And now those same million people will be able to see a dentist. I cannot see how that is a bad thing—those one million people would otherwise not have the ability to see their dentist. The former government’s policy was for people with chronic illnesses only. So if your grandmother, who is aged in her 90s, needed new dentures but did not have a chronic illness, she had zilch hope of seeing a dentist. She would not have been able to access the scheme. That was the former government’s policy.

Numbers are easy; we can all count. Again, I go back to the one million people who will be receiving treatment under our policy. Under the former government’s policy there was no treatment. So this policy means that there will be more consultations compared to the previous policy, under which very few people met the criteria and were able to gain access. What we on this side of the House are doing in government is ensuring a modern health system for a modern Australia. We need to ensure that we have reforms in place. The former government continuously, for 11 years, refused any form of reform to health. They were not interested in any sort of reform. And it gives me great pleasure to speak today on the many initiatives that this new government is putting in place to ensure that the most vulnerable Australians have adequate access to health care, such as the Commonwealth Dental Health Program. It is so important to Australians’ wellbeing and to their good health.

This Labor government recognises the need for greater investment in and reforms of Australia’s health system. That is why we are doing what we are with this bill, which is injecting $780 million to ensure that people’s dental needs are met and that the waiting list of 650,000 is reduced. Over the last decade, we saw the amount of Commonwealth investment in health services drop by $1 billion, if you consider the $100 million that was going into the Commonwealth dental scheme every year. I am very pleased that we have reversed the first act of the Howard government, which was to get rid of the Commonwealth dental health scheme. We have reversed that and will be introducing it and ensuring that people get the care that they need.

Stuart Robert (Fadden, Liberal Party) Share this | Link to this | Hansard source

The government has announced funding of $780 million over five years for two new dental programs, $490 million for the Medicare Teen Dental Plan over five years and, of course, $290 million over three years for the Commonwealth Dental Health Program. I note with interest that the Minister for Health and Ageing, in her second reading speech on the Dental Benefits Bill 2008, said:

These significant commitments will help ease Australia’s dental crisis, end the blame game, and start addressing the parlous state of Australia’s dental health—the dire state of which should be laid—

apparently—

at the feet of the Howard government: they closed the Labor government’s previous Commonwealth Dental Health Program and refused point-blank to work with the states on addressing this growing problem for a decade.

I think the minister forgets that, notwithstanding the Constitution, section 51(xxiiiA), it is a widely recognised convention that provision of public hospitals and public dental health is a requirement of the states. To what point does the Commonwealth government continue to bail out failing Labor states?

In 1996, when the Howard government came to power, it inherited $96 billion of debt, over $8 billion in interest payments and a $60 billion unfunded super liability. Contrary to what the then finance minister said—that the budget was in surplus—the budget position at the time when the Howard government took control of the Treasury benches was $10.5 billion in the red and going south. I cannot imagine a more parlous economic and financial position for an incoming government to inherit, as opposed to the Rudd government and what they have inherited with an $18 billion surplus and, indeed, $22 billion in the forthcoming financial year.

A range of programs were scrapped to meet the deficit that was faced. In the last 12 years, the $96 billion debt, interest payments and putting $60 billion into the Future Fund equates to approximately $200 billion that was needed to get the country back to ground zero. Is it any wonder that the Howard government knocked the Keating dental plan on the head—a plan that was providing dental services that were the direct responsibility of the states? Faced with a $200 billion hole that took 11 years to rectify and pay off, the previous government turned Australia’s economy into what is being heralded as the miracle of the OECD. The Keating dental plan was but one of the causes of the ‘parlous state’—to use the words of the health minister—of the economy that this country inherited from the previous Labor government. The minister went further in her second reading speech to state:

Latest estimates still remain at about 650,000 Australians languishing on public dental waiting lists. Thirty per cent of Australians are reported to have avoided dental care due to the cost of services.

It is interesting that a Labor federal minister points out the ‘parlous state’ that Labor state governments have left Australian people in.

To widen the context, in my home state of Queensland as per the first-quarter results of Queensland Health, which end at the end of April this year, the waiting list has 36,030 people waiting for elective surgery. There are 159,000 people in Queensland waiting to get on the waiting list for elective surgery. There appear now to be, in the minister’s own words, ‘650,000 Australians’—and let us say one-sixth or around 100,000 of those are in Queensland—‘languishing on public dental waiting lists’. They languish and they wait because Labor state governments, who are directly responsible for dental care and for elective surgery waiting lists, are not addressing the situation.

The issue of elective surgery is only one point of the spectrum. There are no published figures for people waiting to speak to specialist physicians—none at all. Indeed, my discussion with one of the 20 professional physicians in Toowoomba last week indicated that if someone has a category 1 complaint—the most serious—the earliest this physician would be able to see them would be in three months time. Anyone with a complaint less serious than that, at present, will never be seen. So, if you have less than a category 1 requirement for a physician in Queensland, you will never be seen—and the member for Hindmarsh comes in and lectures our side on the responsibility of taking care of the Australian people!

In the 2007-08 budget of the previous government, $384.6 million was committed over four years so that patients could have access to dental treatment in the private sector. This was meant to complement and take the pressure off existing state dental services, not to supplant them. It is, after all, a state responsibility. There are clear lines of responsibility and delineation. Previously, to be eligible for the Medicare dental benefit, a person needed to be managed by a general practitioner under specific chronic disease management and multidisciplinary care plans. Patients would need to be referred by their general practitioner to a dentist. Thus it dealt with dental issues that were impacting on general health. If dental issues were compounding general health issues, that quite naturally and seamlessly came under Medicare and, therefore, came under the purview of the federal government. It was a federal responsibility. Labor’s plan—$290 million over three years—is simply the Keating subsidy plan re-enacted. The spectre of Keating haunts us still, perhaps not from the treasury bench—and we can all be thankful for that—but nonetheless it haunts us.

Over three years it is $95 million per year—but let us look at what the states actually spent in 2005-06. Considering 650,000 people ‘languish’—in the minister’s own words—on waiting lists, the state spent $515 million. That was it. Considering the ‘parlous state’ of Australians’ dental requirements, there was only $515 million. Individuals spent $3.5 billion in that one year—seven times what the state spent. Likewise, in the five years of the Medicare Teen Dental Plan the government will provide $150 per eligible teenager in families receiving family tax benefit A, Abstudy or youth allowance. Since family tax benefit A continues to be means tested, dental care is not universal. Clearly, many people will miss out. Dental benefits are payable in respect of dental services rendered as part of an episode of hospital treatment and vouchers will be issued. But a question remains. Labor’s own policy wording in previous years indicated that more than $150 is needed for a dental check-up. Furthermore, if all of these eligible teenagers take their vouchers, present them and receive their annual preventive dental check-up, what then? What if the results are, ‘You need urgent work,’ ‘You need a filling,’ or ‘You need a crown,’ or they need any of those other dental things? What then? People turn up to get their check-ups and there is nothing left for them. People with complex medical and dental requirements now simply know what they have always felt: there is a problem. But there is nothing left to assist them.

The previous government’s plan dealt with dental issues within the strategy of Medicare, taking care of those with complex medical requirements and enabling them to receive the dental care they needed. That plan was scrapped on 30 March; up until then, the government would honour those payments through to 30 June. But that means that from 31 March until whenever Labor’s new policy is implemented people will be left in the lurch.

Let me inform the House about the impact of what this government has done, using the example of a constituent, Benjamin Boulton-Wright. Benjamin was born with a very complex congenital heart condition called tetralogy of fallot and is under the care of Cameron Ward, a cardiologist at the Mater Children’s Hospital in Brisbane, and Dr Sue Maloney, Director of the Gold Coast Hospital. Ben has endured more than eight cardiac surgical procedures since his condition was first diagnosed, at birth. His condition was life threatening. His is a complex case, hence the complex care plan that the local doctor has instigated. Ben needs to be monitored for life due to his heart abnormality. His parents also need to be vigilant about his teeth and ensure optimum dentistry as he can develop a condition called infective bacterial endocarditis, where his heart can become enlarged due to bacteria lodging in his heart valve. It can be fatal. He must have a full course of antibiotics before and after any operations on his teeth, bowels or any other part to prevent such a condition from developing.

Hence, when Benjamin had a sore gum and it was found he had an issue with a particular tooth, it was suggested that a complex care plan be initiated for this allied health requirement—dentistry—as a new federal government plan was available that had just come into effect, in November 2007. It meant that Ben’s family, as a ‘heart’ family, could access dentistry for up to the amount of $4,000 through the government scheme for families who have children with chronic health conditions such as Ben’s. Ben had also accessed five free speech pathology lessons under the scheme as he had a range of speech pathology issues. It is interesting that the family also paid for more speech pathology as there is a state government public waiting list of over 12 months. Mr Deputy Speaker: is there anything in the medical and dental areas, in the parlous situation under Labor state governments, that does not have a waiting list attached to it?

Ben was referred to a paediatric dentist who examined him, said that he had a few issues that needed to be addressed and advised that, given his complex heart condition, surgery needed to be done in a hospital. The surgeon in question operates out of a private hospital, Alamanda, on the Gold Coast. Ben was admitted, albeit for a day procedure, because there was no way he could be given intravenous antibiotics in a dentist chair. It turns out that the previous Howard government legislation did not permit the rebate of up to $4,000 to be provided if something occurred in hospital as opposed to day surgery. This was an unintended consequence, I am sure. It perhaps was not envisaged by the previous government that there could be a case of a small boy with a congenital heart defect where it could be fatal if dental procedures were done in a chair and therefore he had to be taken to a hospital for surgery. I suggest that not only was it an unintended consequence but that if I had written to the previous health minister and explained this to him I would have received a sympathetic hearing. So you can imagine my incredible surprise when this issue was brought to the attention of the current health minister, who got an acting assistant secretary to write back, saying:

Thank you for your letter of 24 March ... to the Minister for Health and Ageing ... concerning your son’s—

Ben’s—

dental treatment. The Minister has asked me to apply on her behalf.

I am sorry to hear of your son’s medical conditions and the difficulties you have experienced in receiving clear information about the operation of the Medicare dental scheme.

The Medicare dental scheme for people with chronic conditions and complex care needs was introduced by the previous government ... This scheme was based on an earlier dental program that was difficult to access for patients and not supported by most dentists.

Well, it is good to see government departments taking up Labor’s rhetoric. The letter went on:

The previous government’s scheme did not cover dental treatment provided to an admitted patient, either in a hospital or a day-hospital. Unfortunately, this means that the dental treatment provided to your son in January ... was not covered ...

The rest of the two-page letter goes on with Labor’s rhetoric about how terrible the last government was and how good the new one is—I am sure a worthwhile use of an acting assistant secretary’s time in the department.

So here we have a small boy with a congenital, perhaps fatal, heart condition who needed dental treatment. Under the previous Howard government plan he could receive it—up to $4,000—if it occurred in a dentist chair. If it did not, I remain confident that I would have been able to speak to a coalition minister and get some sense on the issue. Under Labor’s policy, the eight-year-old boy is eligible for nothing, even though he has a complex and potentially fatal heart condition. It is not until he turns 12 that he may get a $150 voucher to have his teeth looked at and be told, ‘You have a problem,’ but nothing to assist after that. With 650,000 people on the waiting list, he would perhaps not be seen for many years given the parlous dental conditions under Labor state governments across the country, particularly in Queensland. The minister in her second reading speech pointed to how parlous and dreadful things were and how the new government was doing something but, when presented with the case of a little boy with a dreadful heart condition who needed to receive dental care in hospital because of the possible impact on his life, got an acting assistant secretary to write back to say, ‘Sorry, we’re not prepared to help you with your $1,200 costs, but let me give you the rhetoric on how the last scheme was terrible and the new one is going to be good.’

If that is what Labor brings to the table then I am appalled. We are now faced with Labor state governments with waiting lists that are astronomical, with waiting lists to see physicians that people will never get to, with waiting lists for dental treatment nationwide, as the minister said, at 650,000 and a Teen Dental Plan that says, ‘Here is a voucher to have a look at your teeth, but nothing more.’ You can have your teeth looked at and, yes, there is a problem and then you are back on the state government waiting list. Whereas the previous Howard government’s position was: if you had a condition that impacted medically upon you, then it came under the Medicare scheme and there was up to $4,000 to assist you to work through that.

Dental care remains a state responsibility. I believe that this concept of ending the blame game came about from a report commissioned by the coalition and I believe that its author may well have been the member for Fairfax, the current Opposition Whip. I believe that the term used, ‘stopping the blame game’, referred to the states and they were to stop blaming the federal government for all of the things that were wrong and were the responsibility of the states. Clearly, that phrase has been hijacked by the Prime Minister and his team of merry men and women. But the bottom line is: dental care is a state responsibility. The Labor state governments must stand up and accept their responsibility and treat the people of Australia with the requirements and with the care that those people expect. The previous Howard government’s dental plan provided for an eight-year-old little boy with complex care; it provided for people who required dental care for complex conditions that were affecting their health. This plan simply picks up the old Keating model and provides vouchers for teenagers to say that there is something wrong, with nothing more.

Mike Symon (Deakin, Australian Labor Party) Share this | Link to this | Hansard source

I rise in strong support of the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008 which will enact the Rudd government’s 2007 election commitment for a Teen Dental Plan. I welcome this bill for a Teen Dental Plan because it represents another way that the Rudd government is beginning the process of reinvesting in our health system for the long term. It begins the process of turning around 11 years of chronic neglect in this key area of health, an area that for some reason was never treated with the seriousness that it deserved. If there is only one thing we know about the previous government’s record in dental health it is this: they never believed it should be treated as a key area in health and attract the long-term investment it deserves.

Like so many other areas in health, the Teen Dental Plan reflects how this government has a completely different attitude in this area. At a cost of $490 million over five years the Teen Dental Plan is another critical plank of this government’s plan to ease the cost of living for the working mums and dads of Australia and my electorate of Deakin. This plan forms a critical first step in the Rudd government’s long-term plan to provide broader dental coverage for Australian families through Medicare. It is a critical first step to restore the federal government’s role in dental health care in this country, and it does so by looking at the situation on the ground in teen dental health. It looks at what working families are going through out there in the real world and what the health experts are telling us about what is happening in this area. The Teen Dental Plan looks at these critical things and identifies that there are both the short- and long-term challenges to be tackled if we want to get this right. In the short term we need to address the immediate need of working mums and dads to get their teenage kids in for a preventive check-up as soon as possible. In the short term we need to give working mums and dads a way of getting around that financial hurdle so they can get their children into the dental chair.

In the long term we need to re-invest in preventive dental health precisely at a time when teenagers start to develop chronic dental problems. A preventive approach in this area is critical. Not only does it avoid far more costly dental treatment, it will also take pressure off our health system further down the line. For example, identifying the early signs of a tooth cavity can be the difference between a simple dental cleaning or a major tooth extraction involving surgery and a range of medicines—not to mention lost time at work or study, especially if a parent has to take time off to take their teenager to the dentist as well. Ask anyone who has persisted with a slowly developing toothache—there is absolutely nothing worse. It affects your ability to eat, to sleep, to concentrate, to live. And yet, somehow the importance of prevention seems to have eluded the Howard government.

This is the best way to move forward in dental health and this is the best role a federal government can play when it actually cares about the dental health of its young people. How refreshing it is to see a new federal government being prepared to play that role, compared to what we have seen in this country over the last 11 years. In fact we now have an entire generation of young Australians who have never experienced government support in dental health. What we saw was a steadily evaporating role from the previous government, a government that thought investing in dental health was just another line item that could be cut without consequence. This attitude was no more obvious than when the Commonwealth Dental Health Scheme was scrapped by those opposite in 1996. In fact this was one of the previous government’s first orders of business and shows just how important they felt investment in dental health was.

What were the consequences? Public dental waiting lists blew out to 650,000 around the country. That is the legacy of the previous government in this area: a nation of people with toothaches. When they scrapped the federal contribution to the scheme, along with that came the view that dental health was somehow an area of health not as important as the rest. And while on the topic of those waiting lists, the Teen Dental Plan will build on Labor’s $290 million plan to provide one million extra dental consultations to help clear that backlog. Together, both commitments total $780 million over five years to restore and improve dental health in Australia, underpinning that this funding is a shift in the climate in dental health. The average working family, like the many thousands in my electorate of Deakin, can start to see that their federal government does have a major role to play in dental health. Up until now they have been left wondering why they could get government support for a medical check-up on their children’s tonsils or a sore throat, but not for getting their teeth done right next door!

From 1 July 2008, the Teen Dental Plan will help those working mums and dads with the cost of living by slashing the cost of a trip to the dentist for their teenage kids. This is a plan set to benefit 1.1 million teenagers nationwide, as well as those parents that shoulder the cost. It will provide $150 per eligible teenager aged 12 to 17 to get that yearly check-up and keep their teeth in good health. The check will include an oral examination and, if clinically required, X-rays, a scale, clean and other preventive services.

While many primary school children receive school dental services, these services are not as widely available to teenagers. And what the statistics are telling us is that most chronic health problems begin in the teenage years. So by targeting teenagers, the Teen Dental Plan builds upon that process of dental health coverage and encourages our young adults to continue to look after their teeth once they become more independent. Under the Teen Dental Plan, families will receive a voucher advising them of their eligibility for a dental rebate of $150 to take their teenager to the dentist. And if they are eligible they will be able to take their children to the dentist, get them a check-up and have $150 per child reimbursed through Medicare.

Once real-time eligibility systems are fully established, the dentist may also bulk bill the patient. And what that means for the average Deakin family with two kids aged 13 and 16 is that if they receive family tax benefit part A they will get back $300 a year for both children through Medicare. And according to the 2006 census of population and housing, there are 7,917 people aged 12 to 17, constituting seven per cent of the population, in Deakin. That is almost 8,000 children in my electorate alone that may already be showing early signs of tooth problems. That also represents thousands of working parents that are juggling the family budget and trying to find that $300—or more—for a dental check-up. And as things have stood until now, there has been nothing in place to help get them that check-up. These families have resigned themselves to the idea that the federal government does not want to know them when it comes to their kids’ teeth.

I know, as I get around my electorate in Melbourne’s outer east, that the cost of living is biting hard. With the cost of groceries, petrol and the mortgage continuing to spiral, that is $300 less that a family has to worry about finding from the budget. I am yet to meet a parent from Deakin who tells me this is not a good idea, that it is not needed or wanted.

As we all know from experience, a trip to the dentist is certainly not a cheap proposition any more. The cost of even a basic check-up these days can reach almost $300. Add on the cost of extra work, like a basic filling for a cavity, and it is climbing towards $400. According to the 2006 census, the median family income in Deakin is $1,266. Without the Teen Dental Plan a Deakin family on that income with two teenagers would eat away almost 50 per cent of their week’s budget on a visit to the dentist for two teenagers. When you take out money for the mortgage repayment, groceries to feed two teenagers and themselves and the cost of running two cars in the outer east, not much is left over.

So it is very easy to understand why so many families with teenage kids that are dealing with day-to-day pressures like bills, the mortgage, groceries, petrol, and school costs often avoid a trip to the dentist. The prospect of a $300 out-of-pocket hit for a single child, when there could be two or three kids of a similar age needing exactly the same treatment, is just too much for the weekly budget to bear. So, when the sums are added around the kitchen table, the trip to a dentist is bumped down the list of priorities. This is a decision made under financial duress. It is a decision made against the better judgement of many families. But, many families simply have no choice because the car always needs petrol, the cupboard always needs filling and the bills always need to be paid. The visit to the dentist goes down that list. And all the while those parents are left wondering if avoiding a check-up will cost them even more in the long run when their children develop cavities because they were not detected early on.

These are the worries parents have because of the trade-off many are forced to make. And their worries are valid. The statistics are telling us that neglecting our teeth during teenage years is now a very serious problem for us as a nation. The statistics show us that there is a big relationship between poor dental health and people not getting a check-up because they simply cannot afford it. According to the Australian Research Centre for Population and Oral Health report, Australia’s dental generations: the national survey of adult oral health 2004-06, as many as one in three Australians avoid the dentist just because of the cost involved. Tooth decay is Australia’s most prevalent health problem. Gum disease ranks fifth, and one-quarter of the Australian adult population are experiencing dental decay because they never had it treated.

One in six Australians aged 15 and above are at a point where they cannot eat certain foods because of problems with their teeth in the last 12 months. Furthermore, a report published by the Australian Health Policy Institute in 2001 reveals that Australia now ranks second worst in the OECD for dental health, and the situation for our teenagers is deteriorating rapidly. There is a fourfold increase in dental decay between the ages of 12 and 21. It also shows that almost half of teenagers now show some sign of gum disease. The pattern is easy to see—and so is the link between helping parents get their teenage children to the dentist and preventing those long-term dental problems.

The question then is what the federal government can do in response, considering the statistics are so telling. The right response, the one that addresses the link between improving teenage dental health and making check-ups more affordable, is here in the provisions of these bills. Aside from tackling the immediate dental health concerns for teenagers by removing the financial barrier for parents, it highlights the benefits of preventive health. It teaches our teenagers how important it is in the long run to address a health problem before it becomes a problem. It encourages our teenagers to keep their teeth in good health at a time when they are most likely to experience dental problems and, of course, at a time when they are becoming more independent and having to work these things out for themselves.

The Teen Dental Plan is a strong reflection of the Rudd government’s plan to invest in preventive health care across the board. It does this through helping working families and restoring the long-term vision in the way that we deliver health services in this country. It is an important part of putting dental health right again in this country. In concert with the Commonwealth Dental Health Program, the Teen Dental Plan will replace the previous government’s failed dental scheme—a scheme that was narrowly targeted and far too complex in its referral and its eligibility requirements; a scheme that did in the Commonwealth Dental Health Scheme and caused a 650,000-person waiting list blow-out; and a scheme that basically dropped the ball in dental health and told the states, ‘It’s your problem now.’ I know in my state of Victoria the state government has been working extremely hard to pick up the slack over the last nine years. In my electorate of Deakin in December 2007, waiting times for public dental services were 14 months for the Whitehorse local government area and 20 months for the Maroondah local government area. I note this because it is the legacy in dental care left to us by the former government. It is a telling sign of the state of things left to us by the previous government that we stand here and talk about these things today when debating this bill.

Finally, we have a federal health minister and a federal government that have a plan to work with the state governments. They will clear the backlog and make sure our teenagers get the check-ups they need to relieve pressure on the health system down the line. This was a major election commitment that was extremely well received in my electorate of Deakin. As I travelled around my electorate during the campaign, I spoke to many families and parents that were staggered about why they had never been offered any Medicare relief for basic dental work. They could not understand why they could go to the doctor and get payment back through Medicare, yet for another health service such as the dentist there was no payment back. To them it made absolute sense to cover basic dental with Medicare relief because the dentist is where the hip pocket gets hit hard. Your teeth are just as important a health issue as anything else you would go to the doctor for and then claim by using a Medicare card. In keeping with their logic, and our election promise, I strongly commend this bill to the House.

Tony Windsor (New England, Independent) Share this | Link to this | Hansard source

I expect that everybody in this place will be supporting the Dental Benefits Bill 2008 and Dental Benefits (Consequential Amendments) Bill 2008, but I do have some specific issues that I would like to raise in relation to dental health. I listened quite intently to the last speaker, particularly towards the end when he was suggesting that people find it difficult to understand why they can go to a doctor and be covered under the Medicare arrangement, yet in most cases they cannot go to a dentist and achieve the same outcome. I think there is an issue of priority that is developing in health care. I understand it has been based, historically, on the state-Commonwealth relationship when Medicare was first drawn up. At that particular time the states wanted to maintain some degree of control over dental care, so dental care was not included with the rest of our bodily health.

I attended a television program a few weeks back where the previous Minister for Health and Ageing was in the audience. He would remember a lady at that event who at one stage made a comment about the funding of dental care. I think the comment was: ‘You can access Medicare for a boil on your bum, but you cannot access it for a boil on your gum.’ That encapsulates an issue that is out there in the community that really needs to be addressed. I do not think the legislation that we are debating today addresses that broader issue. It addresses some coverage for teenagers and allows a teenager to be part-funded to go to a dentist for a check-up but it does not allow for any money to change hands to actually do any work. So there is a little bit of an anomaly there. There is also some money going to support the states in their dental care arrangements, and I am sure that will be very welcome to the states.

Most members would know that there are something like 650,000 Australians who currently need public dental treatment. I think the underlying problem here is one of priority. If you ask most people prior to any election what the important areas are to them as family members, as parents, as members of our society, they would say health and education. Health and education are the two most important areas. But we still have a situation in our very wealthy country where there are 650,000 Australians who cannot access public dental care, and there are a number of reasons for that. One of those reasons is the fact that dental care is not included under the Medicare arrangements. I have not had it explained to me sufficiently by anybody why our teeth are treated as some sort of out-of-body part of our bodies. Our teeth, our mouths and our gums are, in legislation, not part of our body in the way in which Medicare funding is accessed. I was told that 20- or 30-odd years ago when Medicare was struck up the states wanted to retain control of dental care, but that is a historical context. That is not a reason why the Commonwealth should not be involved or why Medicare should not be accessed in these modern times.

I would have thought, given the economic circumstances such as surpluses et cetera in recent budgets, that a reprioritisation of dental care as part of our bodily care should have been a major priority at the last election instead of this. Even though I am supporting the legislation, it is really a revamping of funding that was put in place by the former government in a slightly different way.

The former minister for health is with us today and he would be familiar with the debate that took place over the last few years about getting some inclusion of dental care in Medicare. He introduced a scheme which related to people being able to access Medicare payments if they had a certificate from their doctor suggesting that they were chronically ill because of their dental health and that, because their dental health could impact on the health of the rest of their body, they should be able to be treated under the Medicare arrangements. That was greeted with some acclaim, and quite rightly, because it was a move in the right direction. What was really going on was that if people were chronically ill from a lack of adequate dental care they ended up in hospital where Medicare provided for the treatment. In a sense, the former minister was short-circuiting that problem. He should accept my congratulations for doing that. But it did not address the root cause of this problem. It made many people think, ‘I have to get really sick before I can get treatment. I am in a queue of 650,000 people trying to see a dentist in the public system. I cannot afford to pay for the private system. Even if I could, it is unlikely that, depending on where I live, I would be able to get into some of the practices.’ This legislation has not taken away that issue. All this legislation has done is revamp the former minister’s proposal, put a similar amount of money back into the state system and created this teen dental care procedure where teenagers can get a check-up but no treatment—unless their parents pay for it, of course.

The other issue that I think needs to be addressed is the cost of Medicare provision of dental care. The underlying question is: why have governments in the past—or the present government—not addressed that? One of the real problems that we have here is that if you suddenly allowed 650,000 Australians to access dental care they would not be able to find a dentist. That brings home quite clearly the amount of spending that has gone into training dentists in this country. I think the average age of a dentist in Australia is one year older than the average age of a farmer. There are a few farmers in the gallery today. They do not look average to me! I think the average age of a farmer is about 58 years old. I am told that the average age of a dentist is roughly the same. I am also told that, in dental schools in Australia, such as, for example, at Sydney university, a large proportion of the dentists who are trained either go into research or are foreign students who go back overseas to practice in their country of origin. So the rate of return of people who are trained in dentistry in our universities is much lower than what is required to replace the dentists out there at the moment and will not be able to compensate for an onrush of treatment, even though 650,000 Australians require some degree of treatment.

I think that is another message to the government about something that the former government neglected for most of its term. To its credit, towards the end of its 10 or 12 years the former government introduced a dental school in the country based on what I think was the wise theory that if professional people are trained in the country—whether they be dentists, doctors, vets or whatever—they are more likely to stay and practice in the country and develop formative relationships within that country environment. The former minister for health would well remember his trip to my electorate. He was instrumental in the formation of a medical school at the University of New England, in conjunction with the University of Newcastle. They have a very good relationship based on the University Department of Rural Health concept. I remember him coming and visiting the people in Tamworth behind the University Department of Rural Health. I think that was a great success and in no small way led to the extension of a full-blown medical school in that relationship between the University of Newcastle and the University of New England.

But we need more of those sorts of initiatives in dental training as well as medical training. In the latest budget I do not see any sign of that activity happening. If we do not do that, if we do not invest in those professional training areas and if we do not invest in locating some of those professional training areas in the country, we will have not only a deficit in the number of dentists available to treat people, if in fact they could access treatment financially, but also the ongoing difficulty with age. As I said, the average age of a dentist now is the same as the average age of a farmer. I know farmers have difficulties today. It is a bit like pulling teeth—getting the Rudd government to address their particular issue of the single-desk marketing arrangements that are currently before the Senate. That will obviously lead to some degree of decay of their bargaining power in the global market.

So I would hope that the government would look at not only the farmers’ problem but also the issue of dental training. Dental training, I am told by the various academics involved, is very expensive. Given the decline in the last decade or so in the amount of money that the universities are getting for their courses, I have been told by various academics, ‘It’s more profitable for us to be pumping out lawyers and others, low-cost graduates, rather than investing in high-cost graduates such as dentists and vet scientists.’ In dentistry particularly there is a lot of hands-on training. The capital facilities are obviously very expensive. But there again I think it gets down to the priorities of the nation, and we should include dental care under the universal healthcare arrangements that Medicare provides.

The current Minister for Health and Ageing took issue with me on a particular television program recently on how much it would cost—that it is all very well for Independents to jump up and down and say, ‘Let’s have this; let’s have that.’ But I have taken the time to conduct a survey in my electorate on a number of occasions now to see whether people would be prepared to pay a bit more—a substantial bit more—on the Medicare levy to have basic dental care covered under the Medicare provisions. The government may argue from time to time that here is a difficulty that, if we spend more money on dental care, we are going to have to spend less on something else. Let us remove that as an issue, because I believe, and other surveys have shown, that most Australians would be prepared to pay a little bit more to have dental care covered under the Medicare arrangements. None of us know when we or one of our family or friends or someone we know down the street is going to require some degree of dental treatment.

That could come from a whole range of areas. It does not necessarily come from neglect or genetics. Other health related factors will cause dental health problems. So a quite substantial amount of money would be required, and in a lot of cases people do not have that. Until they get chronically ill and enter the hospital system, where they will be treated under the universal health obligations, they will just suffer in silence and in pain. So I would suggest that in coming budgets the government not only have a close look at the allocation of their own funds to various priority areas but look very seriously at this issue of including our mouths as part of our bodies.

I know there are a number of members of this House, including the Prime Minister, who have had various heart treatments at different times of their lives. If you talk to a dentist, one of the first things that happens if you are having a major operation, particularly a heart operation, is that your mouth, your gums and your teeth will be checked. If there is an infection of any sort, the operation will most probably not take place. So I think, if nothing else, that establishes some link between our mouths and the rest of our bodies. I have heard the former Minister for Health and Ageing on a number of occasions talk about people being responsible for what they eat et cetera and that parents have an obligation in terms of the food that their children eat. I could not agree more, but they eat with their mouths and there are various problems that do occur from time to time. I think we as a parliament neglect some of the issues by not including our mouths with the rest of our bodies.

In conclusion, in the survey that I did within my electorate to see whether people were prepared to pay a bit more on their Medicare levy to cover dental health, 81 per cent of people said they were more than happy to pay a bit more and, in that sense, have universal insurance against the occasion when some quite costly dental treatment would be required for them or their children. I would very much argue against cosmetic dental care being included in any form of state contribution, but basic oral health should be included as part of that. A figure of 81 per cent in any survey would indicate that the great majority of people are in favour of a particular issue. I note with some degree of interest that in the surveys into the changes to wheat marketing, for instance, well over 80 per cent of grain growers are in support of a single-desk system, and that has been completely ignored by the Labor Party and completely ignored by the Liberal Party in this place. Both are issues where members of parliament should actually pay some attention to what their constituents are saying. When you are getting those sorts of percentages and when constituents are calling out in those sorts of numbers, whether it be for a single-desk marketing arrangement or for Medicare to cover oral health, I think it is appropriate that this parliament actually listen to what those people are saying and, more importantly, act upon what they have said.

Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

I speak in support of the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008. This is particularly important to me because in my previous work, before I was a member of this parliament, I was a lawyer. I dealt with child safety and protection issues and conducted many cases over the years where I saw photographs of young children and adolescents who had dreadful teeth. It was often an issue of contention for parents in the family law system as well. In my previous role I was involved in the West Moreton community healthcare council. One of the constant refrains of people, especially in rural and regional areas outside Ipswich, was the need for greater health care, particularly more attention to dental health and access to dentists, especially for children.

This bill has to be read in the context of the Rudd government’s commitment under COAG on 26 March 2008 to give $1 billion to the state governments to relieve the pressure on our public hospitals for 2008-09. Of course, $500 million of that $1 billion will be received by the states and territories in this financial year. That is a demonstration of the commitment of the Rudd government to relieving pressure on the public health system in this country, especially public hospitals, which particularly in rural and regional areas are the front line of dental health care. This is in stark contrast to those opposite in the chamber, who gave us 11 years of neglect in healthcare funding, particularly in dental care. We believe that the national health and hospital system needs radical surgery, and that is so in dental health care as well.

When it comes to dental health in this country, we inherited a legacy of neglect and inaction. Upon election to office, the former Howard government abolished the Commonwealth dental scheme and ripped $100 million a year from the public dental system. This terrible public health policy left 650,000 Australians languishing on waiting lists for public hospital oral care and treatment. The Howard government gave us soaring costs for dental care, so much so that in 2007 the Australian Institute of Health and Welfare found that one in three Australians reportedly passed up the chance to visit a dentist because of cost. Further, 18.2 per cent reported that they would have a lot of difficulty paying even a $100 dental bill.

Regrettably, the Howard government dragged Australia’s standard of dental care to amongst the worst in the OECD, with Australian adults ranking the second worst when it comes to dental health care. It is tremendously disappointing to see that there has been a substantial decline in dental health care among our teenagers. This bill attempts to redress this problem. As a result of the inaction of the Howard government with respect to dental health care, one-quarter of Australians were not getting the dental care they urgently required. As a result of the failure of the previous government in the area of dental health, 17.4 per cent of Australians over 15 years of age reported they were incapable of eating specific foods due to teeth and gum decay.

Perhaps most disappointing of all of the legacy of the Howard government was the real decline in the proportion of Commonwealth government funding of public hospitals, which, as I said, carry so much of the front-line burden of public dental health care. What did the Commonwealth government under Mr Howard do to public hospital funding? According to the Australian Institute of Health and Welfare report released on 5 October 2007, during the Howard years, from 1995-96 to 2005-06 the Commonwealth government’s share of public hospital funding decreased from 45.2 per cent to 41.4 per cent. In contrast the state Labor governments, so criticised by the Howard government, actually increased their proportion of spending from 45.7 per cent to 50.6 per cent during the same period. It is a fact that the Howard government failed to invest properly in dental health care. After much public concern and criticism, the Howard government responded with a scheme they called the chronic disease scheme. And guess what? After three years, from 2005 to 2007, only 7,000 people were assisted, due to complex eligibility and referral criteria.

Having been left under such financial pressure, the stark choice for many Australians was between putting food on the table and appropriate dental treatment. The Howard government’s chronic disease scheme was in fact a dodgy scheme. It might have had great aspirations, but in fact it left millions of Australians in urgent need of dental care.

An example of the extent to which they trumpeted this scheme inaccurately to mislead the Australian public was a statement made by the former Liberal member for Kingston, Kym Richardson. He told an Aldinga Bay Residents Association meeting on, I think, 10 October 2007—just before the election—that the government had announced that:

... any person with acute oral pain, any person with oral pain ... can receive up to $4,100 over a two year period ...

The reality under that scheme was that, if you had a chronic medical condition such as heart disease or diabetes,  you had poor oral health care or a dental condition which exacerbated a chronic or complex disease and you were being treated under a multidisciplinary healthcare plan, then you may have been eligible for assistance with your dental care. This narrow eligibility meant that only 7,000 people received assistance over the three-year period. This is emblematic of the consistent failures of the Howard government and the rhetoric it employed to inflate the impact of that failing program.

In total, the Howard government spent less than $50 million on their failed dental scheme. This compares to the $780 million for new dental programs that will be introduced and run over the next five years under this legislation. That is the coalition government’s gift to Australia’s public system: disinvestment, disdain and disinterest, particularly in the oral health of Australians. So it is left up to us to fix that problem. The Howard government failed. The Rudd government has to pick up the ball.

We have put aside $10 billion in health and hospital funding to support strategic initiatives and investments in health. We have put aside $600 million to work with the states and territories to cut elective surgery waiting lists. We are delivering GP superclinics, 31 in all, across the country. We are investing money significantly to tackle other issues that are important to the health of Australians, including $53.6 million to tackle binge drinking, $21.5 million to assist the Northern Territory to boost health services in that outlying area and $249 million to address a national cancer plan over five years. These things are important and they add on to our dental plans. They are integral to delivering Labor’s election commitments. The $780 million over five years is for two parts of the Rudd Labor government plans: $290 million over three years for a new Commonwealth dental health program, and $490.7 million over five years for a teen dental plan. These bills provide a real legislative framework for payment under a new dental benefits schedule, and it is modelled very much on the Health Insurance Act 1973 concerning Medicare.

The new dental benefits scheme will target specific groups of people based, for example, on age and income testing. There is an opportunity, of course, for the Minister for Health and Ageing to include by legislative instrument other dental benefits in the future. I look forward to those, because I think that the task really needs tackling and there is a lot of work to do. These bills allow for the payment of dental benefits and the introduction of the Rudd government’s Teen Dental Plan. They seek to implement and administer the plan also, and they really herald a new era in the dental health of Australians. Specifically, it is the first part of our scheme to do so. This commitment across so many years is welcomed in my electorate, I know, particularly in the rural and regional areas. It is welcomed in that area because it can take between one and two years for a person to see a dentist in the public health system.

From 1 July 2008, the Rudd government will provide up to $150 per eligible teenager towards an annual preventive check for teenagers aged 12 to 17 years in families receiving family tax benefit part A and for teenagers in the same group receiving youth allowance or Abstudy. I welcome the fact that it is estimated that 1.1 million teenagers will be eligible for the Teen Dental Plan each year in a population of 21 million. The Teen Dental Plan will be administered by Medicare using the eligible data provided by Centrelink. In the first year of the program, Medicare will send out vouchers to all eligible teenagers and their families in July/August, and then on a monthly basis to newly eligible teenagers and their families. In subsequent years, vouchers will be distributed in January and then on a monthly basis thereafter. Teenagers will be able to use their vouchers to receive a preventive dental check from a private dentist. The annual check will include an oral exam and, where required, an X-ray, scale, clean and other preventive services. Patients will be able to claim a dental benefit for the preventive check, similar to the Medicare process that so many Australians are used to. If the dentist charges upfront for the preventive check, the patient will be able to claim a dental benefit of up to $150 through Medicare.

I strongly support this scheme. I think this will result in a dramatic improvement in the dental health of teenagers in this country. I think it will make a big difference to the teenagers in my electorate. I am the father of teenage daughters, and I know there are many of my daughters’ friends who will benefit from this scheme. The state of our dental health system in this country was appalling under the Howard government. We are determined to fix the failure of the Howard government, which saw over 50,000 people languishing in hospitals each year with preventable dental conditions. We are determined to alleviate the burden on our public health system by the increased funding, because delays in dental health can mean the difference between a filling and an extraction. It can mean the difference between pain and acute pain. It can mean the difference between the continuation of pain and the cessation of it. I commend the bill. I think it is a great bill, and I applaud the minister for health for the initiative.

Wilson Tuckey (O'Connor, Liberal Party) Share this | Link to this | Hansard source

Mr Speaker, it is very kind of you to come in to hear me make a two-minute speech! Just in opening remarks about this dental bill funding, let me say it is an issue of philosophy over practicality. The issue of how the Australian government might in some way relieve people with severe dental problems who lack the financial resources to meet the costs involved today has challenged a number of governments. More recently, the Keating government implemented a program whereby, typical of the philosophy of the Labor Party, they would send, I think, $100 million a year over four years to the state governments to help them out. The member for North Sydney in his address this morning reminded us that it does not matter how much money you send to these public institutions. They actually only have 10 per cent of the dental workforce and you can double their pay but not their output. This, of course, is a critical issue when one looks at funding state governments to expand the service they already have. But further to this and, consequently, after a lot of deliberation the Howard government thought, ‘Surprise, surprise, the appropriate mechanism—

Harry Jenkins (Speaker) Share this | Link to this | Hansard source

Order! It being 2 pm, the debate is interrupted in accordance with standing order 97. The debate may be resumed at a later hour and the member for O’Connor will have leave to continue speaking when the debate is resumed.