Luke Simpkins (Cowan, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the federal government’s Dental Benefits Bill 2008 and Dental Benefits (Consequential Amendments) Bill 2008. Before moving into this bill, I need to state what the government says this bill will do. The explanatory memorandum says:

From 1 July 2008, the Government will provide up to $150 per eligible teenager towards an annual preventative check for teenagers aged 12-17 years in families receiving Family Tax Benefit Part A ... and teenagers in the same age group receiving Youth Allowance or Abstudy.

Let us not beat around the bush here: $150 vouchers to tell young people and their parents that they need more work done—that is all it is. I heard earlier today that a classic check-up will be well in excess of $150. At least this initiative will offset that cost. To use one of the Prime Minister’s favourite script lines, I find it amazing that when the government talks about these vouchers it can do so as if this is something new. I draw upon a webpage titled ‘Dental health’ from the WA Department of Health site. There is actually a section about the school dental service which says:

Free basic dental care is provided to all school children from pre-primary to year 11 ...

I find it amazing that the Rudd government is providing $150 vouchers to school students who are already entitled to the state provided basic dental care. When I saw that line on the website, I thought, ‘Okay, parents can then use the voucher to offset the cost of a filling or other work identified through the state government provided basic dental care.’ But no, the explanatory memorandum clearly covers that:

... the Government will provide up to $150 per eligible teenager towards an annual preventative check for teenagers aged 12-17 years in families receiving Family Tax Benefit Part A ...

It does not look like there is much flexibility there. A person just listening to the headlines or the announcements could very easily believe that dental care was being provided by the government to teenagers, and people in the suburbs of Cowan, and across Australia, would say that getting a filling is a basic part of dental care—a filling is an integral element of going to the dentist. That is what Australians tell me. So, when this bill is put up as some kind of comprehensive dental strategy, some grand initiative, I question it, and the people of Australia will question the hype and the spin that will not match the reality. This bill—this illusion—will bitterly disappoint Australian families, who were provided with great expectation only to have their hopes dashed.

In Cowan, although clearly a majority of voters supported me and my side of politics in the election, I remember very clearly a conversation I had with a young man in Ashby during the campaign. This young man told me that he was a student and that he had severe dental problems. I recall he was 21 or 22 years of age and at university. He told me that he was going to vote for Labor because they had promised a national health plan. He said to me that he did not have health insurance and could not afford to get his teeth fixed. He was confident in the future and supported the Labor Party because they were going to bring in ‘free dental care’ for everyone. That was one vote that the Labor Party took from me in Cowan, but I recommend to the government that it not rely on him next time. Expectations were built up so very high, but the harsh reality is that he is too old for his check-up, and even the check-up would not have fixed the severe problems he had.

The harsh reality is that this bill comes at the cost of the demise of the coalition’s dental program, under which chronic and complex dental problems attracted Medicare support over two years up to the value of $4,250. That program, between 1 November 2007 and 30 April this year, provided 311,943 services to Australians suffering from chronic and acute dental problems. The government want that all gone and would prefer to point to the savings derived from the pain and misery of Australians with those sorts of severe problems. Again, this is a terrible illusion of action, where the government attempt to persuade parents that they will achieve something new while marginalising those with acute and chronic problems. Yes, there are more teenagers in Australia than there are sufferers of acute and chronic problems, so I suppose the Rudd government did their sums and identified that more votes would be available by the perception of action with teenagers than actual action for those with major dental problems. I say it again: there is a harsh reality coming for parents of teenagers if they believe the smoke and mirrors show of the government, and there is a harsher reality for the government which, after creating the strong perceptions of action on housing, transport and food costs, have also failed in this bill to bridge the gap between perception and reality.

Perhaps it is best to go back to some basic economic theory to address the great problems with rising dental costs to the consumer in Australia. The reality is that of supply and demand. For instance, in this country, only around 10 per cent of dentists work in the state systems, and this is a key point. Where, then, are the initiatives to increase the supply of dentists and staff in the state systems? I cannot find anything in this bill. All we have is the Rudd government saying that they would negotiate with the states and territories to ensure patients with chronic conditions have access to treatment. It is fine to have an intention but, without any supporting funding in the budget or forward estimates, this statement by the government is nothing more than a glib one-liner, a smokescreen that seeks to deflect close scrutiny of this facade of a bill which is nothing more than a hollow impression of action, which is sadly consistent with the modus operandi of a government addicted to spin.

I mentioned before that the government of Western Australia already has a standing commitment to school dental services. These are provided through school dental clinics and mobile dental vans. A few weeks ago I received an email from the Parents and Citizens Association of a primary school in Woodvale within my electorate of Cowan. I will not name the person who sent it to me as I have learnt that there are some occasions on which principals and sometimes even members of P&Cs get counselled by representatives of the state government after contacting them, but I will read the email. It says:

On behalf of the P&C association—

it did name the school but I have taken that out—

I would like to voice our concern about the possible closure of our ... school dental clinic at Craigie Heights Primary School.

That supports the school in question here. It goes on:

It has come to our attention that the clinics are understaffed and lacking in modern equipment. With the clinics being understaffed there is a waiting list of up to 6 months at Craigie and some other clinics are 41 months.

We feel that if these clinics are forced to close then families will feel the financial burden of attending a private dental clinic with some children not receiving any dental care at all. It will also mean a loss of jobs.

This is a school with primary school students who are not covered under the government’s plan. The state of Western Australia says that they provide these services. Unfortunately, they are failing and the closure of the clinic at Craigie Heights Primary School in the electorate of Moore, which serves schools in Cowan, is evidence of this fact. It is therefore important to question the Rudd federal government’s mantra of ‘ending the blame game’, because in the end who is responsible? The service must be delivered. The states have failed and this bill has not addressed this problem, which is having a great impact on Cowan and Australian families.

For those who might say, ‘Well, the suburb of Woodvale is a pretty well-off area; perhaps they don’t need clinics as much as other places,’ I would say that Woodvale is no beachside suburb of Perth; there are no million dollar houses in Woodvale. Woodvale families have to buy petrol, they have to buy groceries and they have to pay housing costs, as do the majority of Australians. Some may say, ‘Just as well that Craigie being closed is a one-off case,’ or, ‘Just as well the clinic down the road in a lower socioeconomic suburb, such as Girrawheen, isn’t closing.’ I am afraid that it certainly is. The clinic at Girrawheen Primary School is closing on 20 June. Those who know Cowan know that Girrawheen as a suburb—the majority of the people there—strongly supports the Labor Party. I do not really know why. The area is beset by law and order problems, and Labor has closed a school and is going to close another school at the end of the year. Now the state Labor government cannot even maintain the dental clinic that serves not only Girrawheen Primary School but also Blackmore Primary, Rawlinson Primary, Our Lady of Mercy Catholic Primary and the Emmanuel Christian School. Why is the clinic closing? Because there is not enough staff to maintain it. In fact, there is not enough staff to maintain the other clinic at Craigie. That is because of an ongoing pay dispute.

Again, I find it amazing that the Labor Party—the party that professes to be for the people and for the workers—cannot do their job in this respect. It is their responsibility to provide these services to the children of Cowan and they are not fulfilling that responsibility. Girrawheen is a long way from Canberra but the failure of Labor to do their job in Girrawheen has a human result. Yesterday my office was called by Karon Anderson, a resident of Girrawheen. Karon informed my staff that she called the dental clinic at Girrawheen Primary School for appointments for her son Leslie and her daughter Joslyn, who are teenagers. I understand that Leslie had earlier this year been informed that he had fillings that needed attention, and his mother called the clinic for an appointment to get the work done. I also understand that Joslyn had a similar but less urgent need to see a dentist. When Karon Anderson called the clinic, the staff said that they were closing at the end of this week—as they are—so they were only doing emergencies. It is important to make the point here that if young Leslie Anderson needs a new filling, as I understand he does, the bill we currently have before the House will not be helping him. A $150 voucher will not get him a new filling or a repair for a filling, and the explanatory memorandum to this bill says exactly that.

It may serve federal Labor’s interests, when a clear and present failure of a state government is exposed, to regress to the standard call of: ‘End the blame game.’ But when is someone actually going to be responsible? When is the buck going to stop? The rules by which this government operates are that anyone can be blamed by this government provided that a Labor politician somewhere is not at fault or called to be responsible for their policy failures.

Again, it amazes me that backbenchers opposite can stand up and talk about this bill in glowing terms, as they do. The bill provides $150 for a check-up. That is it. The sum of those great expectations of the Australian people is $150, and it cannot be used for a single filling. That has come at a cost to the program that offered, as I said at the start, up to $4,250 to achieve serious work; not just a part payment for a check-up which will tell teenagers that they might have more work to be done but a payment for some serious work for chronic disease and dental illness.

Each time young people like Leslie Anderson or that young man in Ashby whom I mentioned earlier take a breath, they probably feel that air running down into a dental nerve. They looked to the state government and then to the former federal opposition, now the government, to fulfil their promises and they expected to see that done. The free state dental clinics and the federal dental plan that they thought would provide them with free dental care have not helped them and will not help them. The people of Australia heard the message that Labor wanted them to hear at state and federal levels. The message was that dental care would be fixed by Labor. The passing of this bill will not help the school dental clinics servicing Cowan and will not help the people I have mentioned today. There is not a filling in sight; just the smoke of this planned perception and very real deception.

I will now draw upon some independent commentary regarding the states and territories and their responsibilities. The Australian Dental Association said:

For far too long, the States and Territories of Australia have failed to meet their obligations to ensure proper delivery of dental care to poor and disadvantaged Australians.

They went on to say, with regard to the federal government:

Instead it has provided the State/Territory Health Services with additional funding … to prop up schemes that have not delivered to date. It’s a Band-Aid solution at best.

I have made my position clear on this matter. The government left the very clear impression that this policy embodies a comprehensive national dental plan. There are people out there on the streets right now who think that specific remedial dental treatment is part of this policy and this bill. The only comprehensive dental treatment that was on offer was in the coalition’s plan. If you needed a significant amount of work done as a chronic sufferer from dental problems, there was only one option, and that was the policy provided by the former government and not this government. I call upon the current government to preserve the former coalition government’s highly effective initiative, which remains the only effective response to serious chronic dental problems, as opposed to the government’s so-called Commonwealth dental health plan. I will conclude, as a non-expert in dental matters, with a quote again from those who do know about the subject, the Australian Dental Association, which describes the government’s plan in this way:

The CDHP—

that is, the Commonwealth dental health plan—

delivers too little for too few people and will not be effective.

Richard Marles (Corio, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the Dental Benefits Bill 2008 and related bill. I start by thanking the member for Cowan for his contribution in this debate. As he set out the description of the difficulties that have been faced by people in his electorate, he neatly set out the very basis on which these bills are now required. The fact of the matter is that the parlous state of dental health care in this country is absolutely the reason for the need for these bills, because of the years of neglect by the Howard government. As the member for Cowan asked the question, ‘When is the blame game going to end?’ and raised the concern about buck-passing, I could only look at him and think that on that side of the House there is an enormous amount of buck-passing. The reason we are in this situation is a blame game which was pursued for 12 long years.

We on this side of the House do take responsibility, and the buck does stop here. The buck stops with the Rudd government. For that reason, we are actually doing something about the issue of the parlous state of dental health care in this country, and that is very much what these bills are about. These bills provide for a legislative framework which is aimed at delivering $780 million, through two dental health initiatives, to this country. Of course, these measures were announced as part of the budget that has recently been announced. It is just another budget measure which is being put forward to overturn the 12 years of neglect and noninvestment that we have seen in this country as a result of the former Howard government.

Fifty thousand Australians each year are hospitalised for preventable dental conditions, and Australian adults rank second worst in the OECD for their overall dental health. That is a disgraceful and shameful position that we find our country in. The measures proposed in these bills will seek to alleviate Australia’s dental health crisis and assist our overall health system. If we look at the state of dental health in our country at the moment, it makes for very sad reading. Six hundred and fifty thousand Australians are on public dental waiting lists. In 2007 the Australian Institute of Health and Welfare reported that 30 per cent of Australians reported avoiding dental care due to cost, 21 per cent said that costs had prohibited them from having recommended dental treatment and 18 per cent reported that they would have considerable difficulty in paying a dental bill of $100 or more. Further statistics indicate that tooth decay ranks as Australia’s most preventable and prevalent public health issue, with more than a quarter of Australian adults having untreated tooth decay. One in six Australians over 15 have avoided particular foods due to poor dental health. In New South Wales, the hospitalisation rates for children under five for dental conditions rose 91 per cent in the decade between 1994-95 and 2004-05.

Our poor state of dental health is not only a public health issue—although it is a very considerable public health issue—but also a social issue. There is a significant link between dental health care and socioeconomic status in terms of both the cause of dental problems and how people’s dental health contributes to their overall social interaction. The fact of the matter is that if you have broken teeth it leads to poor self-esteem and it makes it difficult to interact within our society. Dr Anne Sanders from the Australian Research Centre for Population Oral Health, based at the University of Adelaide, made a comment about exactly that link when she said:

If we could grade the social conditions of society from excellent to poor we would find that population oral health status followed precisely the same gradient. Where social conditions are excellent, oral health status tends also to be excellent. Where social conditions are poor, oral health likewise is poor. This is so because the oral health of populations is socially determined.

This is also a fact, or a phenomenon, which has been identified in Victoria. In 2002 the Victorian Auditor-General’s report on the state of oral health of Victorians said:

Poor oral health may cause people to avoid social interaction and personal contact, reducing their quality of life.

So poor dental health in this country is not only a public health issue but also a very significant social issue, which is why it is absolutely critical that it be addressed, and the Rudd government means to address it.

In Geelong, where my electorate is, we face all these problems, as does the rest of the country. Currently in Geelong the approximate waiting times for public dental health assistance amount to 30 months for general dental care and 37 months for denture care. Statistics provided by the Barwon Health Community Dental Service in Corio in February this year were that there were 2,249 patients waiting for general dental care and 571 for denture care, a 43 per cent increase on the previous six months.

While dental health may not be on the radar of the Commonwealth opposition, the Victorian Liberal opposition do at least recognise that dental health care is a problem. The Victorian state opposition health spokesperson, Ms Helen Shardey, recently asked this question: ‘When will the Brumby government realise the dental problem is not just a small toothache but an excruciating pain across Victoria?’ In that question Ms Shardey has correctly identified that dental health is an issue but she has completely missed the mark in terms of laying the blame for why this issue has come about and how it needs to be fixed. It is absolutely ironic that she should be pointing to the state Labor government when it is in fact the neglect of the former Howard government, in its refusal to properly fund public dental health, that has given rise to not only small toothaches but also large and excruciating pain.

The Rudd government understands that a proper dental health service cannot be provided by our states if it is not first funded by the Commonwealth government. The Howard government did not do that. In 1996, when the Howard government came to power, one of its initial acts was to scrap the Commonwealth Dental Health Program, which was introduced by the Keating government, and in doing so it ripped $100 million from public dental health services. After eight years of Howard government neglect, in 2004 it started to take some dental health measures through Medicare in relation to those who were suffering chronic illness or who had complex care needs. But the criteria for the program that was put in place at that time was so restrictive and the process for gaining access to that program so complex that the program was, at the end of the day, an utter failure. It assisted 7,000 people at an expense of $1.8 million to the public purse over three years, despite the program originally being forecast to assist 23,000 people at an expense of $15 million. By September last year only 14 preschoolers had had their dental needs addressed through that program.

The reality is that the Howard legacy on dental care is one of failure and neglect. They started by ripping money out of the system and then they designed programs that were so intricate that, at the end of the day, they were guaranteed to fail. As with so many other areas of public policies, 12 years of neglect has resulted in the current parlous state of dental health care in Australia. The Rudd government is absolutely committed to addressing that neglect, to building a system that can meet the public need for dental health care and to ending the blame game over the issue of dental health.

As I mentioned, the Rudd government is providing an initial investment through the budget, of which this bill is a part, of $780 million to address the current state of dental health. This money is going to be provided through two schemes. There will be $290 million over three years provided to the Commonwealth Dental Health Program and $490 million provided over five years for the Teen Dental Plan, which of course is the subject of these bills. That is in stark contrast to the Howard government initiatives, which over four years to April 2008 provided less than $50 million. This government’s programs are deliberately targeted to assist those who are currently most in need of dental services, and they will be done in partnership with the states and territories, precisely so that we end the blame game and start a cooperative approach to the way in which this country is governed.

Could I mention briefly the Commonwealth dental plan. This assists states to reduce waiting times. It will provide for up to one million dental consultations over the next three financial years. The funding is being provided in accordance with strict conditions targeting people with chronic diseases as a priority; for example, cancer, cardiac patients and those suffering from HIV-AIDS. It seeks to meet the challenges left by years of the Howard government’s neglect and ineptitude and it will assist the most vulnerable and the most in need, in particular by prioritising Indigenous people and preschool children.

The Medicare Teen Dental Plan, which is of course the subject of these bills, is a very important initiative. It will provide up to $150 per eligible person towards an annual preventative check-up, which can be used at a private dental clinic. Those who are eligible are persons aged between 12 and 17 in families receiving family tax benefit part A or persons in the same age bracket who are receiving either the youth allowance or Abstudy benefits. It is estimated that ultimately this will cover about 1.1 million teenagers.

The preventative check will cover the examination and, where clinically required, X-rays, scaling and cleaning of teeth and other preventative services. The plan will be administered by Medicare using client eligibility data from Centrelink. It will operate on a calendar-year basis without just being distributed in January of each year. Following the first year of the program, vouchers will be valid for the entirety of the calendar year, even if the family circumstances alter during that year.

As I said at the start, dental health is not only a public health issue but also a social issue. So this program provides for an intervention during the teenage years of a person’s life—a critical point in their life—where they can go forward with good dental health. They will be able to engage in the normal social interactions, so if they are looking for jobs or engaging in study or other social activities their dental health will not be an issue.

This bill, along with the Dental Benefits (Consequential Amendments) Bill 2008 also provides for the dental benefits scheme. These two bills will have the combined effect of legislating for the creation of a new dental benefits scheme which will be established to implement the Teen Dental Plan program. The DBS will also provide the legislative framework that will allow the Minister for Health and Ageing the discretion to make dental benefit rules whereby the minister may seek to make additions to the scope of dental benefits items in the future. Unlike the Medicare Benefits Schedule the DBS allows provisions to be targeted to specific groups—for example, by means testing or by age.

In summary, these bills absolutely cut to the core of what the Rudd government is all about—that is, providing services to those who are most in need—and in doing so rectifies the neglectful practices of the Howard years. This program seeks to cut through the red tape of previous programs to provide much greater access and to provide a much less complex system. It is a program that will be delivered hand in hand with the states, precisely so that we can end the blame game.

The Rudd government understands the pressures on working families when it comes to prioritising household incomes, and the Rudd government believes that these bills will allow families to prioritise preventative dental health care in their family budgets, both for their benefit and also for the benefit of the wider community by alleviating the strain on the public health system. These measures will greatly benefit the people of Corio and the people of Australia, and I commend these bills to the House.

Paul Neville (Hinkler, National Party) Share this | Link to this | Hansard source

It gives me pleasure to rise tonight to speak in this debate on the Dental Benefits Bill 2008 and related bill but no pleasure to listen to some of the claims that have been made by the government, to the breast-beating that has been going on and to the talk of the blame game. It is as if the government have been wound up like toy soldiers when everyone comes in and trots out the same line. The line is about the blame game: ‘Let’s look at the blame game.’ With the exception of a four-year period in the early nineties, dental services have, since Federation, been the sole responsibility of the states. It is plain and simple. It has never been any different. That is my first point.

What happened in the mid-nineties? In its dying days the Keating government plucked a program out of the air—much akin to some of the moves that Mr Rudd, the Prime Minister, has pulled in recent days in association with his Asian tour—following a paper called the National Health Strategy background paper. Out of that the Prime Minister of the day, Mr Keating, designed the Dental Health Program. It was mentioned in the 1993-94 budget and it started in January 1994. It was available to both private and public dental practitioners. It was only available to people over 18 who had various types of cards—health cards, benefit cards, pension cards, DVA cards and the like. Its estimated cost was $278 million, and it delivered 1.5 million services over the four years.

By the admission of the government of the day, it was a catch-up scheme. Again, this is plain and simple. It was never intended to be an ongoing program for dental care. How do we know this? We know it because no mention was made of it in any forward estimates. In the years following the introduction of that scheme in the 1993-94 budget it could have been updated and rolled on into the future but it was not. The Keating government, if re-elected, almost certainly would have dropped it. There was no provision made for it.

And we are told that this dreadful coalition government cut it out! That too is incorrect, because this so-called terrible Howard government actually completed the program. In fact, over that period $245 million was spent. So let us get that first myth out of the way. It was never meant to be an ongoing program; it was a program to help the states, which had got behind, to catch up. There was no intention by the Keating government to take that over on a permanent basis. Indeed—and I will come to this further in my address—if the Rudd government had intended to really enter the field they would have done something more substantial than introduce the program that we are debating tonight.

The coalition introduced, in two stages, a dental program to help people whose health was affected by bad teeth. The whole business of dental care needs to be handled by one or the other levels of government—either all by the state or all by the Commonwealth—or it needs to be very carefully segmented. You cannot have bits and pieces here and there, because inevitably, when you go down that route, some people miss out. Under the coalition government’s program, which had really only just got started, $41.4 million was to be spent in the first year. Over four years it was to be $377 million, and the current government projected forward another year for a five-year program of $491 million—which is amazingly close to the cost of the teen dental component of the government’s overall program.

I do not knock the idea of helping teenagers to have good dental health albeit that this is confined to a certain extent by means testing. What does it deliver when you really get down to the nitty-gritty of it? You receive a voucher, you go to a dentist and you can get up to $150 worth of work done. In one sense this is commendable—everyone in that category, if they want to take it up, will be able to get an assessment done. But that is all they will get. They may get a cleaning and scaling of their teeth but that is all that they will get. It is estimated that some dentists charge up to $190 for a first comprehensive assessment, so $150 is at the lower end of the spectrum. So those children or young people will get their dental assessment, but if the family cannot afford dental care and cannot get into a dental hospital in their state then where do they go from there? What has the net advantage been for anyone? The assessment could say, ‘You’ve got to have four teeth seen to,’ but mum might say, ‘We can’t afford it.’ So you have a $150 assessment and nothing else.

As I said, this plan is commendable in one sense, but if it had included, say, two occasions of service—or even just one occasion of service—then a kid with a broken tooth, an abscessed tooth or whatever it might be could at least be treated for those particular immediate ailments. I have heard the government tonight talking about people being in desperate pain. My understanding of it is that all state dental hospitals are supposed to see people with acute pain immediately, and if that is not happening then they as members of parliament should be doing something about it; because, let me tell you, even though I am a federal member, if I see something unfair happening at the state level then I am not frightened to step in—not frightened for a second.

We are going to spend the equivalent of what would have been cut out of the Howard government’s program for five years on this teen dental health program. I would think that, for that amount or for a similar amount of money, you could get a lot better value if you extended the dental program for primary schools into secondary schools. I know that not all states have that. I understand that South Australia, Queensland and one of the other states have these dental fixtures—sometimes they are permanent fixtures in the school grounds, such as a small brick building, and sometimes they are a caravan that alternates between three, four or even five schools. They are generally run by a supervising dentist and dental therapists. I know that might mean some changes to dental therapy training because when you are dealing essentially with milk teeth—as you do with a lot of primary school children—the level of dental expertise required is probably less. But I would have thought that if the government wanted to put all kids on the road to good dental health then it might have considered spending that amount of money—or perhaps up to $1 billion—on equipping the states with dental clinics for schools. If you could not contain that within that price range then could you not use your CCD sociological profiles of areas and say the schools in the areas with the poorest profiles would get the dental clinics first? In other words, you would essentially get the dental care to those people in most need and have kids leaving school at 18 or thereabouts with reasonable dental treatment—it may not be the ant’s pants, but certainly preventative dental care would have taken place.

At the age of 18 the kids can either go to uni or—as for perhaps 70 or 80 per cent of them—go out into the workforce to apprenticeships, to work in shops and other jobs in the community. They will be earning money of their own. If they come out of school with some pride in their teeth then isn’t it more likely that they might wish to look after them and budget from their own savings to do that? Let me tell the House that when I started my first job I had to do that and I do not feel any the worse for it. It was difficult. It was an impost. I have crooked teeth and I have always had trouble with my teeth. It used to cost me a fair slice of my meagre income at the time for a year or 18 months. I have never regretted that. I do not think that kids, given the opportunity of having their teeth looked after by the state until they are about 18, would do anything else but respond positively—getting the resources while they were 19, 20, 21 or 22 to be able to keep it up. So, whilst I think that symbolically this Teen Dental Plan is very good and will help some people with assessments, I ask the question: what will it do for people in real terms?

The government is going to put another $290 million into the states—which was essentially what the Keating plan did. Actually the figure there was to be $278 million. In fact, it is not as much, on adjusted figures, as the Keating government was to put into actual dental care, albeit with a means test. It worked to varying degrees. I am sure it did do some catching up. It is said that 200,000 families got into the system and that there were 1.5 million occasions of service. I think that is about 7½ services per family treated. So, obviously, it did get to a small segment of the market, and it probably looked after those kids and families well—but it depended on the goodwill of the states. One state minister, who shall remain nameless, said to me: ‘Wasn’t this Commonwealth stuff the greatest joke of all time! As fast as the Commonwealth put it in the top, we took it out the bottom.’ That was the attitude of the states. It was just a top-up. Rather than say, ‘Oh, look, let’s match this and get a lot more done,’ I bet you that the attitude in every state was, ‘Well, we are getting all this Commonwealth money; we will not have to go so hard in the next budget with dental care.’ It would be interesting to do a study on the extent to which the states over that period of the Keating plan—and I do not deride the Keating plan other than to say that it was a catch-up program—increased their dental care and whether they kept it in line with CPI or with the general cost of health. That would be a very interesting exercise. Another aspect of this—and I am not straying from the subject, let me assure you, Mr Deputy Speaker—

Bernie Ripoll (Oxley, Australian Labor Party) Share this | Link to this | Hansard source

Mr Ripoll interjecting

Paul Neville (Hinkler, National Party) Share this | Link to this | Hansard source

I am sure the member for Oxley will be quite relaxed when I tell him what I want to talk about. I want to talk about health insurance and the fact that the government is raising the threshold from an income of $50,000 per annum to one of $100,000 per annum. I am not against the lifting of the threshold. It has not been lifted for some years. I would have been reasonably relaxed about it if the threshold figure had been fixed at $65,000 or $75,000 per annum, having been taken in line with a growth figure per year in the health budget or with CPI. But to take it up to $100,000 is definitely going to cause a lot of people to drop out of private health insurance. It is probably going to affect the younger married sector who are pretty healthy and who say, ‘Oh well, we don’t really need this and we’ll drop out.’ The government estimates that 500,000 families will drop out of private health insurance as a result of lifting that threshold—in other words, they will no longer have to pay the levy. Various other sources—economists, commentators, the AMA and so on—estimate the figure as somewhere between 800,000 and one million. That is nearly twice the figure estimated by the government.

Here is the point I want to make—I am sure the member for Oxley will understand it now: amongst that one million people are people who are taking the extras on their private health insurance, including dentistry. I do not know the percentage figure—I would like to know it; I think I would find it very enlightening—but that means that when they drop out they also drop out of having the capacity to pay for dental care. As a result of this, a proportion of those people will shift to the state system. Not all of them will. Some will still say, ‘We can put a bit aside for dental care because we do not have to pay the health insurance premium,’ but most of them will probably say: ‘We will now go on to the state system. We are not going to have private health insurance. We will go on to Medicare for our normal health services and on to the state system for other dental care.’ That is going to add to the number of those seeking dental care.

I also question whether the government has really thought through—and this also impacts indirectly on this dental matter—the idea of the superclinics. I have not found a community yet—although this may not be the case in the outer metropolitan suburbs with which I am not familiar—where anyone wants one of these superclinics. There are perfectly well-run, bulk-billing clinics in Bundaberg that are seven-, eight- and nine-doctor practices but which have only four or five doctors. What possible good would it be to build a superclinic in Bundaberg where we cannot get doctors in the private sector? We cannot get enough doctors in the public hospital. How in heaven’s name are we going to be able to get the doctors into these superclinics? I am told that the government may consider tendering these things out. That would introduce a third level of compliance. You would probably have private doctors, public doctors and these superclinic doctors. The government is equivocating even about that program. It was going to be $5 million, but now it is up to $5 million. Now it may not be a new superclinic; it might be the renovation of a building—in other words, they might do up the old outpatients’ building somewhere that has been closed for a few years. But why would you invest the quantum that would be required to do that at the expense of what could be going into dental care?

I recognise, all Australians recognise, that dental care has not been as good as it might be. We all recognise that. But we need to have a wider strategy that involves, for one thing, the fluoridation of water in those states that do not have it. I would like to see an examination of the ability of dental health clinics to be used in secondary schools. I would like to encourage people to stay in private health insurance and even encourage people to take up dental benefits within that private health insurance. I think that in that way we can share the burden fairly and give the state clinics a better chance of catching up and doing the job that they were destined to do. They are interesting bills, symbolically good; but in practice, in delivering things on the ground, no, they fall very short.

Bernie Ripoll (Oxley, Australian Labor Party) Share this | Link to this | Hansard source

It is a great privilege to speak in support of this bill, the Dental Benefits Bill 2008, and the cognate Dental Benefits (Consequential Amendments) Bill 2008. I note, before I begin, that it is always interesting to hear from the now opposition because it is always the case that we as the government should be doing more but, when the coalition were themselves in government, they did nothing at all, particularly on this issue. They come in here and complain and bleat on, but for the 12 years they were in government not once did they take up the measures that we are moving here tonight. Not once did they reason that more could be done. It is easy for them to come in here and criticise us for not doing enough and say that this does not go far enough, but the reality is that they did not even begin the process—and that is disappointing. It is disappointing for all those people that missed out on all of the possible dental services that they needed over the past 12 years.

What we are finally seeing here with these bills is Australians getting a decent dental healthcare program, something that the Rudd government have made a top priority, something that was part of our election promises and something that we will be delivering through this legislation. The reintroduction of the Commonwealth Dental Health Program and the new Teen Dental Plan are just the start of a continued commitment to Australian health, including Australian dental health.

Previously, dental health was a major issue in my seat of Oxley in Queensland, where many ordinary people suffered because they could not afford proper dental care, let alone check-ups to get the sort of assessment they needed to then go and get further care. A petition about this in my electorate was signed by 1,400 people, making very plain to me, and to the parliament, their strong support for these types of programs. It was a very serious issue then and it is a very serious issue today. I am very proud to have the Minister for Health and Ageing here in the chamber. I am very proud to support this and that we are actually getting on with the job of helping ordinary people get better access to dental health, something that was neglected at the federal level for many years.

Let me just take a little bit of time—and I am conscious of time tonight, as so much of it was wasted today by the opposition—to indulge the House with the recent history of dental health in this country. For 12 long years we saw the previous government continue to neglect and, in fact, refuse to act on Australia’s escalating dental crisis. It was the previous government, the Howard government, that now sits opposite, that cut Labor’s Commonwealth Dental Health Program in 1996, ripping $100 million from the public dental sector across the country. They then continued to ignore the growing impact of their neglect, which led to a whole range of problems—problems like 650,000 Australians on public dental waiting lists across the country; 50,000 Australians hospitalised each year for preventable dental conditions, putting additional pressures on our already strained hospitals; and dental conditions constituting a quarter of hospitalisations of children. These are significant numbers and significant issues and significant people—people who deserved better but were treated very poorly by the previous government, those now sitting in opposition.

There are more problems. Up to one in 10 visits to GPs is caused by dental problems, again placing more strain on GPs, dental clinics, hospitals and the health system in general in this country. More than one in five Australians go without recommended dental treatment because of the cost; it is just too expensive for some people. I heard the comments of the previous speaker, who said this did not go far enough, that in fact this is just for a check-up. It is actually a lot more than that, but you need to at least make that first, conscious decision to provide that access, to get that cost out of the road so that people can make proper decisions and be advised what they need to do next. I think that is the very first and the most important step. One in six Australians avoids certain foods because of dental problems. The aged, the frail and the young endure a lesser quality of life because of this, and I think it is our responsibility to do everything we can—and we are, through these bills.

These facts are indeed an indictment of the previous government. What is frightening is that, all along, they knew what was happening but they did nothing. Today they can support these bills and help ordinary people or they can just bleat and carry on, although for 12 years they did nothing. These are good bills and should be passed.

The list goes on. Tooth decay ranks as Australia’s most prevalent health problem: 25½ per cent of the Australian adult population have untreated dental decay. During the last 12 months, one in six Australians aged over 15 have avoided certain foods because of problems with their teeth. Between 1996 and 1999, five-year-olds experienced a 21.7 per cent increase in deciduous tooth decay—that is, teeth falling out. Hospitalisation rates for children under five for dental conditions increased by 91 per cent between 1994-95 and 2004-05. There was a 42 per cent increase in children being treated in hospitals for dental cavities between 2000 and 2005. These are terrible figures, terrible statistics and a terrible shame. They are a terrible indictment of the previous government. According to the OECD, the dental health of Australian adults ranks second worst in the OECD, with a rapid deterioration in dental health observed in the teenage years in particular.

The previous minister for health, Tony Abbott, and those opposite repeatedly refused to accept any responsibility for Australia’s dental health crisis and continued to play the blame game, leaving it to the states to pick up the pieces. They took no responsibility, they blamed everyone else and, in the end—even worse—they just did nothing. That is the truth of the matter: they just did nothing. They left it to others.

By contrast, this is yet another election promise that Labor are delivering on. We have a massive agenda of reform and work in front of us to ensure Australians have a better quality of life. The dental blame game is now over and funding of $780 million will be allocated over five years to these two new and very important dental programs. The Rudd government’s Teen Dental Plan will assist one million Australian teenagers between the ages of 12 and 17 with dental costs. This is very good news. There are a whole range of other measures, and, as I am conscious of the time, I will respect the proceedings of this House and try to do everything I can—while there are many more good things that I can say about this program, I think it is self-evident in what we are trying to achieve and what will be achieved by it. I give it my wholehearted support. This bill ensures that there will be an overwhelming recommendation of support for people’s dental health care, and I seek the support of the opposition to guarantee that over one million young people can now have affordable dental care and that others can access this program as well. I commend the bill to the House.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

in reply—I thank the members for contributing to this debate on the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008. I acknowledge that many members on this side of the House, and the occasional one on the other side of the House, are pleased that this measure is going to provide significant benefits to many hundreds, in fact thousands—if not over one million—teenagers and other people who will be assisted through the Commonwealth Dental Health Program across the country. These two bills will allow the government to deliver on a key part of its election commitment to improve dental health for working families and address Australia’s dental crisis. The government has committed a total of $780 million over five years for two new dental programs: the Medicare Teen Dental Plan and the Commonwealth Dental Health Program. Both of these programs are squarely targeted at people who are most in need of help, many of whom could not afford dental care without this assistance. We will work with the states and territories and the dental profession to expand the provision of dental care, with a focus on treatment for those in greatest need and preventative care for eligible teenagers. These significant commitments will help ease Australia’s dental crisis, help end the blame game and start addressing the serious problems in oral health that the Howard government ignored for more than a decade—not least the 650,000 people left to languish on public dental waiting lists across the country.

The passage of these bills will enable the Medicare Teen Dental Plan to commence next month. The government is providing $490 million over five years for the Medicare Teen Dental Plan, which will provide up to $150 per each eligible teenager towards an annual preventative check. This will target those who are aged between 12 and 17 in families receiving family tax benefit A. Teenagers in the same age group receiving Youth Allowance or Abstudy will also be eligible under the program. About 1.1 million teenagers will be eligible under the Medicare Teen Dental Plan each year, and the Medicare Teen Dental Plan will operate as part of the broad Medicare arrangements through a new dental benefits schedule.

Under the Commonwealth Dental Health Program, the Rudd government will be providing an additional $290 million over three years to improve access to public dental services, working in cooperation with the states and territories. This marks a stark change from the last decade of the Howard government: playing the blame game and criticising the states for not doing enough on dental health. Commencing in July this year, the Commonwealth Dental Health Program will assist the states and territories to reduce waiting times by funding up to one million additional dental consultations and treatments over the next three years. This means that pensioners and concession card holders will be able to get more help. It will assist the poorest members of our community and people with the poorest dental health. It will also give priority to Indigenous people and preschool children, groups that the Howard government’s dental program clearly failed. We are negotiating with the states and territories to ensure that those with chronic disease will still be given priority through this program.

In summing up, I again wish to thank the members for their contributions to the debate on these bills. In the debate we heard the member for North Sydney claim that the opposition ‘clearly understands the burden of dental disease in our society’. In fact, we heard many opposition members bemoan the poor dental health of many Australians. But it seems to me that the member for North Sydney and the opposition are crying crocodile tears when it comes to dental health. If they really understood dental disease, why did the former government rip $100 million a year from the Commonwealth Dental Health Program and ignore dental health as an issue for more than a decade?

The member for North Sydney professed concern for the 650,000 Australians on public dental waiting lists, and yet, bizarrely, after 11 years of inaction, argued that it is the Rudd government which is leaving them languishing on these waiting lists. Let me provide the House with some pretty basic historical facts. As I have said, it was the previous government that ripped $100 million a year of funding from public dental programs, leading to an explosion in waiting lists. The member for North Sydney says he cares for those people having to wait too long for dental care, but it is something that, when he sat on this side of the House for 11 years, he did not care sufficiently about to convince his government to do anything to fix the problem. And now he still offers nothing to fix the problem, instead engaging in the tired old blame game, saying it is simply the states’ fault and ignoring the history of the government he was a part of. It is only the Rudd government, now having come to office, that is working to address the public dental waiting lists through our $290 million investment in the Commonwealth Dental Health Program alongside our $490 million investment in our kids’ teeth through the Medicare Teen Dental Program.

We now understand, as of today, that the opposition is also planning to disallow the closure of the former government’s failed chronic disease dental program. As I have said in this House before, we do acknowledge that some people got help from that program if they could navigate the complex referral process and the red tape, but many, many people—often the most needy in the community—did not get help and it was not a targeted program. You could be assisted if you had a particular chronic disease in particular circumstances, but you could not be assisted if you had poor teeth simply because of your poverty, simply because you did not have proper health care, you did not have early enough dental care, you did not have a good diet—any range of these problems that can cause severe oral health difficulties would not qualify you for assistance. For example, over the four years to 30 April 2008, in the whole of the Northern Territory no services at all were provided to children and young adults aged up to 24 years. In South Australia over the same four years, no services at all were provided to children up to the age of 14—zero. This means, as I have noted before, that any children born in the Northern Territory or South Australia during the entire life of the Howard government did not get any assistance for their dental care during the life of that government. And now we have the opposition saying that we are not doing enough or that they want us to continue their program as well as invest our new $780 million. It really is pretty cheeky, I have to say.

In total, over the four years to 30 April 2008, the Howard government’s failed scheme will have spent less than $50 million compared to the $780 million that the Rudd government is investing in dental health. In disallowing the closure of the failed chronic disease program, the opposition will be opposing the savings measures that will help pay for the Rudd government’s better targeted programs. We think this is thoughtless, reactionary opposition. It is opposition for opposition’s sake. We see it on dental care, on hospitals, on alcohol and on unfair tax slugs like the Medicare levy surcharge. The opposition is following a clear pattern: do nothing for 11 years and then attack the new government for pursuing the path of reform. The Liberal Party has until the end of the month to choose between responsible economic management and responsible health policy and short-term, cheap politics. I hope that they will make the right choice.

In conclusion, the Rudd government is delivering on its election commitment and making a $780 million investment in Australia’s dental health, an investment in preventative care for our kids and treatments for the most needy in the community. It demonstrates that the Rudd government can make the tough decisions to close down ill-targeted programs which have demonstrably failed and to replace them with targeted programs that help more Australians and those most in need, such as pensioners and concession card holders.

The programs demonstrate the Rudd government’s determination to address the immediate pressures on Australia’s dental health system and the 650,000 people on public dental waiting lists who are the Howard government’s sad legacy, and they demonstrate the Rudd government’s commitment to building for Australia’s future by encouraging our teenagers to develop good dental habits and to preserve their dental health for the long term. Together, these programs will attack the sorry state of dental health in Australia and they mark the start of a new era in dental care and preventative health.

Question agreed to.

Bill read a second time.

Message from the Governor-General recommending appropriation announced.