Stephen Conroy (Victoria, Australian Labor Party, Deputy Leader of the Government in the Senate) Share this | Link to this | Hansard source

At the request of Senator Ludwig I move:

That, for the purposes of paragraph 48(1)(a) of the Legislative Instruments Act 2003, the Senate rescinds its resolution of 19 June 2008 disallowing the Health Insurance (Dental Services) Amendment and Repeal Determination 2008, made under subsection 3C(1) of the Health Insurance Act 1973.

During the election last year we announced we would be delivering a $290 million Commonwealth Dental Health Program to help reduce public dental waiting lists that had blown out to 650,000 across the country. We also announced that we would be delivering the Medicare Teen Dental Plan, which will involve an investment of $490 million. This means that we would be investing, in total, $780 million over the next four years in dental health—compared to the previous government, which spent less than $4 million on dental health over the four years until the 2007 election. So that is $780 million over four years compared to $4 million over four years.

At the same time we made it absolutely clear that we would abolish the Howard government’s poorly targeted and failing chronic disease dental scheme. We were entirely open about our policies. We made it clear that in order to fund our dental program we would have to redirect funding from the Liberal scheme to the Labor scheme—not unreasonable, given we won the election. We had made a choice, and so did the public. They chose in favour of Labor’s better targeted dental programs. That choice was necessary to maintain our budget surplus, and that is the clear choice now facing the Senate.

Today’s motion will decide whether the government can implement the dental policies which the Australian public voted for or whether the government will have to suspend its investment in public dental services because of the economic vandalism of those in the opposition. The motion will decide whether the government can provide a million more dental consultations and treatments for needy Australians, especially pensioners and concession card holders, or whether these people will continue to languish on public dental waiting lists because of the opposition’s irresponsible approach.

It has been estimated that there are 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. Fifty thousand people each year end up in hospital with preventable dental conditions, putting more pressure on our hospitals. Tooth decay is Australia’s most prevalent health problem, with gum disease ranking as the fifth highest. Over a quarter of the Australian adult population have untreated dental decay—untreated because they are not accessing the dental care they require.

This alarming state of affairs is even worse amongst the poorer, most needy Australians. Concession card holders such as pensioners have lost on average 3.5 more teeth than non-concession card holders. As the member for North Sydney said, under the Liberal government things had got to the point where:

Dentistry remains out of reach to those on low incomes with around 30 percent of Australians unable to see a dentist because of cost.

That quote is from 6 March this year by the member for North Sydney. It is clear from these terrible facts that we need action on dental health, particularly for disadvantaged Australians, such as pensioners.

Rather than addressing these problems, the Howard government spent much of the past decade cynically playing the blame game. They did nothing but say, ‘Dental health is not our responsibility; blame the states.’ But it was the Howard government that helped create some of these problems in the first place. One of their first acts of government was to scrap Labor’s Commonwealth Dental Health Program in 1996. They ripped $100 million a year from Australia’s public dental system and this led to the explosion in public dental waiting lists which we see today. Six hundred and fifty thousand people waited, sometimes for years, for treatment. Then, belatedly, the Howard government introduced a dental scheme which was not targeted at people most in financial need and which had a referral process and eligibility criteria so complex and restrictive that few people could access it.

The previous government’s failed chronic disease dental scheme deserves a little bit more scrutiny. Labor recognises that, for those able to navigate their way through the complicated referral process and the red tape, the former government’s chronic disease dental scheme offered some help. But many people missed out—often the most needy people in our community. For example, in the four years up to 31 July 2008, under the Liberals’ chronic disease dental scheme no-one under the age of 30 received any services in the Northern Territory, despite it having some of Australia’s most needy Indigenous communities. This is a fact. No-one under the age of 15 has received any services in South Australia. This means that no child born in South Australia or the Northern Territory during the term of the Howard government received any help from the scheme. Only three people under the age of 20 received any services in Tasmania, Senator Colbeck, under the previous government’s scheme. Only nine people under the age of 25 received any services in Western Australia—and I am looking at a Western Australian senator as I am speaking—under the previous government’s program. Only 21 people under the age of 10 received any services in my own home state of Victoria. That is, on average, less than one person every two months.

Moreover, the former government’s scheme was not targeted at the most disadvantaged, such as pensioners and concession card holders. Under the Liberal scheme, a multimillionaire could get help but a pensioner with a toothache could not. Under the Liberal scheme, if you were a pensioner and you had a toothache, how much help do you think you could get? The answer is none. If you were a pensioner and needed a tooth extracted, how much help could you get? That is right—none. If you were a pensioner in any part of Australia and needed a simple filling to save a tooth, how much help could you get? That is right again—none.

In addition, take-up of the Liberals’ chronic disease dental scheme has been highly skewed, with many states receiving far less than a fair population share. While one in five concession card holders live in Queensland, about 18.9 per cent, it has received only 4.4 per cent of benefits under the chronic disease dental scheme. While one in 11 concession card holders live in South Australia, about 8.9 per cent, it has received only 2.5 per cent of benefits. Again to my colleague from Western Australia, while one in 12 concession card holders live in Western Australia, about 8.5 per cent, it has received only 0.7 per cent—less than one per cent—of benefits for necessary care. While three per cent of concession card holders live in Tasmania, Senator Colbeck, it has received only 0.3 per cent—less than half of one per cent—of benefits.

These figures show clearly that the Liberals’ chronic disease dental scheme has failed. It has failed pensioners, it has failed the poorest, most disadvantaged people in our community with the worst dental health and it has failed our kids and our teenagers. It has failed to help them maintain their teeth to prevent much worse problems later on in life. That is why the government is seeking to redirect funds from the Liberals’ failed program to support better-targeted dental programs, such as the Commonwealth Dental Health Program and the Medicare Teen Dental Plan.

We have made a decision—as governments need to—that we should be helping the most needy people in our community first in the most effective way possible. But, thanks to the economic vandalism and irresponsibility of the opposition, Labor’s more targeted approach is being put at risk. In particular, if the motion before the Senate fails, the government will have to suspend implementation of the Commonwealth Dental Health Program. A million additional dental consultation and treatment services will not be able to be provided—one million services that would benefit pensioners and concession card holders.

If the opposition gets its way, every state and territory would miss out on the additional services and investment in public dental services they would receive under the CDHP. The Liberals are clearly returning to form. They ripped $100 million a year from public dental services when they were elected in 1996 and they still want to block the Rudd government from any further investment in public dental care. This means that every state and territory is at risk of missing out on more dental services. If the Senate blocks the government’s motion, pensioners and concession card holders will miss out on a range of benefits under the CDHP.

States and territories would receive considerably more under Labor’s CDHP than they received over the last four years to 31 July 2008 under the Liberals’ failed scheme. I will go through those figures because I noted your earlier interjection. Victoria—my home state—would receive 3.7 times more funding; Queensland would receive 11 times more funding; South Australia would receive 10 times more funding and—the Western Australian senators should be very conscious of this fact—Western Australia would receive 35 times more; Tasmania would receive 38 times more funds from our scheme than the existing scheme; and the Northern Territory—and I know there are Northern Territory senators present as well today—would receive 174 times more money from our scheme than from the existing scheme.

About 6.6 million people as concession card holders would be eligible for treatment under the CDHP. About 4.3 million of these people are pensioner concession card holders and their dependants. This compares to the Liberals chronic disease dental scheme, which is not targeted to concession card holders. Only about 1.1 million people meet the complex eligibility requirements of the Liberals’ scheme.

The CDHP has a number of priority areas: people with dental related chronic diseases, Indigenous Australians and preschool children aged zero to four years. The CDHP priorities for people with dental related chronic disease includes people with cancer, transplant patients, cardiac patients and people with HIV-AIDS. So it is simply untrue for Senator Colbeck to claim, as he has done, that the CDHP will not benefit people with chronic disease. It is simply not true, Senator Colbeck. The Liberals’ chronic disease dental scheme has also had little benefit in particular for Indigenous Australians and children, with no young people at all up to the age of 14 receiving services in South Australia or the Northern Territory over four years.

The CDHP includes a number of initiatives to support and expand the dental workforce, including the establishment of new public dental clinics, improved training for dentists and fly-in fly-out services to remote areas. The Liberals’ chronic disease dental program does not include any funding for workforce or rural initiatives. There is no funding for rural initiatives under your scheme. All of these initiatives which will help pensioners, people with chronic diseases, children and Indigenous Australians will not be able to be implemented if the Senate supports the opposition’s politically opportunistic and irresponsible approach.

The opposition is demonstrating its economic irresponsibility in its claim that you can have it both ways and keep both the Liberal’s failed dental scheme and Labor’s better targeted policies. The Rudd government is committed to economic responsibility. That means we will have to maintain a strong budget surplus and make tough choices. The Liberal opposition is blowing a multibillion-dollar hole in the budget. The Charter of Budget Honesty costings which Labor took to the election are consistent with what the government is doing and include savings from closing the Liberals’ failed scheme in order to pay for Labor’s better policies. Compare our commitments to the previous government’s record of ripping $100 million a year from public dental services and leaving 650,000 people to languish on public dental waiting lists.

It is a very clear choice today in this chamber whether or not you want to stick with a policy that is untargeted and failing or go for a targeted expansion in dental health care in this country. I urge senators, particularly those from the smaller states, to listen to those statistics that I described and understand exactly where your ideological binge is getting you to. You are going to be denying, massively, your own state populations if you vote to keep the existing scheme and not implement Labor’s.

Richard Colbeck (Tasmania, Liberal Party, Shadow Parliamentary Secretary for Health) Share this | Link to this | Hansard source

Senator Conroy’s presentation here this afternoon demonstrates what happens when someone comes into the chamber not knowing anything about what they are talking about. In fact, it was one of the most embarrassing performances I have seen here for quite some time, because Senator Conroy does not even understand his government’s own election promises. The figures that he provided to the chamber before—and he might like to get up and clear up his misrepresentation of those election promises to the Senate later on—are not the figures that are in their election policies. In fact, I have spent quite a deal of time interrogating the Labor Party’s election policies through the estimates process, and his numbers are just plain wrong.

The government talked about $290 million for the Commonwealth Dental Health Program over three years, not over four years as Senator Conroy has just told the Senate, and, according to the government’s election promises, the Teen Dental Plan was for $510 million over three years. So the figure that he quotes is what has actually been appropriated by the government since the election, not what they promised the Australian people they would spend before the election.

When the election promises went through the Charter of Budget Honesty—and I notice Senator Conroy has now left the chamber—via the Department of Finance and Deregulation, the teen dental program was costed down from $510 million to $326 million. It was then re-announced at $340 million and has been finally costed in the budget at $360 million over three years, the fourth figure we have had since the initial election promise was made. If you go back to how much the Labor Party promised the Australian people they would spend on dental programs at the election, it was $800 million over three years. Their commitments are actually $150 million short of what they promised they would spend. If you go back and do the numbers, that expenditure is $150 million short of what they promised the Australian people at the election.

For them to come in here now and tell us that we are stopping them from implementing a program because of the funding is an absolute absurdity, because they are the ones who have not kept their promise to the Australian people to spend $800 million. Minister Roxon’s spokesperson said before the election when questioned on the costing of the election promises that the government would spend $800 million. That needs to be clear to start with. The commitment was to spend $800 million and, at this point in time, over the term of the parliament they are $150 million short. That immediately kills off any suggestion that any action of the opposition is irresponsible financially, because Senator Conroy has come in here with a set of speaking notes that do not represent the true facts with respect to the government’s election policies.

His comments about the program over the last four years are also deceptive, misleading and dishonest. The enhanced dental scheme that the government is seeking to disallow as part of the removal of this Medicare item only came into effect in November 2007. For Senator Conroy to come in here and quote figures over four years is completely and utterly dishonest. By going back four years, he renders his quotes completely irrelevant because they bear absolutely no resemblance to what has happened since the program was enhanced post the budget last year and taking effect in November 2007. So Senator Conroy can come in here and quote figures from four years ago all he likes, but they bear absolutely no relevance whatsoever to this debate. The figures should be targeted at what has happened within this scheme over the last eight or nine months—since November last year is the time frame of relevance for this scheme. All of Senator Conroy’s figures, all of his assertions and all of his pointed suggestions to senators from different states around this chamber this evening are completely and utterly irrelevant because they relate to a time frame that is not associated with the enhanced dental program that we are talking about here today.

Since this scheme went through its process of disallowance earlier in the year, the reaction that I have had from all over Australia to the importance of this scheme has been quite extraordinary. I had a phone call from an elderly citizen in the electorate of Robertson who actually got into the dentist’s chair only to be told that the dentist would not treat him because of threats from Minister Roxon about the use of the program. This chamber legitimately disallowed the Medicare item that would remove this initiative. This chamber legitimately went through that process and yet Minister Roxon has actively discouraged doctors and dentists from taking up this program—even though doctors and dentists from all over Australia understand the value and importance of this program. The reaction has been extraordinary.

I received correspondence from a Dr Passmore in Sydney. Senator Conroy talked about this being a scheme for the rich. I am not sure whether or not Senator Conroy is suggesting that Medicare should be means tested—I will leave that for him and the government to respond to. But I thought that the universal access obligation associated with Medicare was one of the things that we were all proud of—that anybody could get access to Medicare. Senator Conroy says that this is a program for the rich. Dr Passmore has two practices in Sydney, one in the more affluent suburbs and one in the western suburbs. He practises 1½ days a week at Granville and has another practice in the Labor electorate of Reid. If this is something that only rich people can access, the real experience of the doctors on the ground is what should be considered. In the time that the scheme has been operating, Dr Passmore has not referred one patient from his practice in Turramurra in the electorate of Bradfield, and yet in the western suburbs he has referred 150 patients—all from those lower socioeconomic areas.

Can I say to you, Mr Acting Deputy President, that we should look at the impact of this scheme. I have pictures here of the sorts of things that are being treated. These pictures are a terrible demonstration of the need for this program. And yet the government, while quite dishonestly going back over four years to quote its statistics, believes that there is no place or need for this particular scheme. What the government would prefer to do is to refer people to the state system, back into those huge queues where there is no capacity. Last time I spoke to the department about this at estimates, and even in some documentation I have seen since, the government was still negotiating this initiative with the states. It had no idea how this was going to work. The department could shed no light on how the scheme was going to work and how it would integrate with the existing schemes that operate within the states. It had no idea. The government talks about the opposition stopping the initiative from being brought forward. I have not seen any legislation. I have not heard of any draft legislation. There is nothing on the Notice Paper for the House of Representatives.

All the government is doing is trying to throw up a smokescreen for a failure that it has had in a thought bubble that it put up before the election. The reaction around the country from doctors and from the oral health association has been quite extraordinary in relation to this particular program. I do not think any of us realised what was going on. The allegation from the government is that all the effort was being put into New South Wales and none into any of the other states. But the government has made absolutely no effort at all to let people know this program is there—in fact, quite the opposite; the minister has written threatening letters to dentists suggesting that they not participate in this process because the program is going to end and so there is no benefit in a referral. Yet when you look at what this program can provide to a patient versus what the government’s program can provide to a patient the comparison is quite stark.

The Commonwealth Dental Health Program is estimated at $14.63 per person for those eligible, whereas the program the government want to remove provides $2,165 of dental support per annum over two years. So you just cannot compare the programs. It is quite clear that this program has real relevance. Even in the previous debate we had as part of the disallowance motion, government senators said there needed to be a broad suite of measures as part of this program to look after dental services in the country. We said at the time that this was part of that broad suite. We do not have any problem with the government bringing in their Commonwealth Dental Health Program. We think that is quite legitimate. We think it was quite dishonest of them to say before the election that they were going to spend $800 million and then after the election underspend that by $150 million—and then come in here and blame us for being ‘financially irresponsible’. They are the ones who cannot meet their election campaign commitments. They do not seem to have any remorse in respect of that. As far as they are concerned, as long as the program is being met they are doing the job. But the clear commitment in their election policies was for $800 million. That was confirmed in a statement from the now minister’s office prior to the election.

So I think the government have got a bit of a nerve coming back in here trying to reverse this process. I really do. They talk about the will of the parliament. They talk about evidence based policy. Well, the evidence is that this program has doubled in numbers of participants almost every month since it started. The government talk about a failed system, a system that is hard to access. But they quite dishonestly talk about four years that are not relevant to the current debate. So not only are all of their arguments basically completely without foundation as far as what we are talking about here this afternoon goes but also it is quite dishonest to come in here and say that this program has failed. It is obviously a successful program. It is obviously greatly needed. If you look at the pictures that have been provided to me of people who need assistance under this program, you see that it is quite clear that this program should remain in place. The government have $150 million up their sleeve to spend to maintain their dental promises over three years—not the $780 million over four or five years that they talk about, which is their budget allocation. They ought to keep their election promises. They ought to work with the parliament to see this scheme stay in place. The opposition retains its position with respect to the enhanced Medicare dental scheme because it believes that it has a real role to play in the dental care of Australians. We will not be supporting the motion.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

The Greens will not be supporting this motion either. We are deeply concerned about the dental health of Australians and deeply concerned about a dental program that is now proving to be effective. The Greens are well aware that it was not as effective before as it became in November, when the threshold went up over two years to nearly $4,500. That meant that many people could access dental treatment for the first time. Many people for the first time ever were finally able to access dental treatment. These are people who are suffering from chronic illness and this dental treatment made and is making a very significant impact on their lives. I will read through a few stories shortly.

The Greens position, as the Minister for Health and Ageing quite correctly pointed out in the media today, has for a very long time been one of support for a Commonwealth dental scheme. There is absolutely no doubt about that. Just as the Greens very strongly support a universal public health scheme, so do we support some sort of universal dental plan. However, we would like to point out that the program that we are now talking about getting rid of, dentistry, is for the first time part of mainstream health and funded under Medicare. Therefore, this actually meets a key part of Greens policy. So, far from the Greens now voting against their policy, we are actually supporting a key part of our policy—to fund dental services through Medicare.

The government said to the Greens that it is one or the other. The Minister representing the Minister for Health and Ageing here today said, ‘If you do not support this motion we are not going to be able to fund our Commonwealth dental health program, so we will have to cut this other funding program.’ It is not the Greens fault that the government have decided to invest $31 billion worth of surplus money into tax cuts. The government made the decision, so do not try to shoot it home to the Greens—thank you very much—that we are the ones that are going to be doing in the Commonwealth dental health plan. You did it in yourselves by deciding that you were going to provide $31 billion in tax cuts and to, unwisely, cut into this country’s surplus. I agree that money should be invested into dental health outcomes for Australians and particularly for those low-income Australians who cannot afford adequate dental health cover and who have never or very rarely been able to access dental health services. Don’t come back and blame the Greens for your bad decisions. It is very disingenuous. The Greens are very well aware of our dental policy and we do not need to be reminded of that by the government, thank you very much.

This program is helping thousands of Australians who have been accessing these health services, in some cases for the first time. The numbers accessing the services have doubled, as Senator Colbeck said. When the minister for health first announced these changes earlier in the year, she said that the program had failed. That word has been used here tonight and it has been used in the media—the scheme was failing and had not been providing proper support. In the past, it had not been. But the numbers that we have been provided show that, since November, there has been a doubling in the uptake of this program and that over 640,000 services have been provided to the chronically ill.

I must point out here that the accusation has also been made that this is for rich people—that it is not means tested. The Greens position is, as I have said, that we have a universal health system, so of course we do not agree that it should be means tested. We have done a lot of consultation on this. I acknowledge that we voted differently last time but since then we have carried out a lot of consultation. We have talked to a lot of patients, dentists and doctors who have very clearly pointed out that it is low-income people who have been accessing these services.

May I just ask members in the chamber how many wealthy people who have chronic illness they see running around with bad teeth? I tell you what: dental pain is one of the worst pains you can deal with. People talk about it being one of the most shameful things that they have to deal with. It affects your whole life. So, if you can afford it, you go and get it fixed. The people that have been accessing these services are overwhelmingly those that cannot afford these services.

Dr Passmore told us that he participates in two practices, one in a wealthy suburb and one in a non-wealthy suburb, and that the people in the non-wealthy suburb are the people who have been accessing his services. It was also pointed out that some states have not been accessing these services as much as New South Wales but  it would be interesting to know how they have been promoted and whether doctors have been particularly focused on this issue in New South Wales. That there is an overburden of people with chronic illness in New South Wales who have dental problems is quite obvious. The reason may be that New South Wales is not investing enough in dental services; however, to make the chronically ill and the people who can least afford it carry that can is not fair either. Yes, state and territory governments need to be fixing that, but do not expect the chronically ill to pay for it literally through their teeth.

There are already 650,000 people on waiting lists. The people who would be able to access these services are now going to be forced back onto those waiting lists. We have been told tonight that the new system is going to fund 995,000 services, yet there are 655,000 people already on the waiting lists. So the people who urgently need this dental work will be forced back onto the waiting lists and will not be able to access the most immediate remedies that they need and which they can actually access now through this program.

There is also a dispute about how many people have already been to their GP, have been referred, who should have been receiving treatment and have not been able to receive treatment because we did not know whether the program was stopping or starting. One of my staffers rang up Medicare for some advice and got two different answers. If a person who is usually pretty good at working their way through the system got two different answers, I suspect that Australian punters out there who have been ringing up to try and work their way through the maze will also have had different answers. I suspect, too, that GPs and dentists have. I do not think it is true to say that people knew what was going on. To say that Aboriginal people have not been accessing it is partly true—I have seen the figures; I know they are not accessing it as much—but I have also taken the trouble to speak to a dentist who is working in a remote community and was told that, as we all know, dental services are stretched in remote communities for various reasons, including unfamiliarity with some of the Medicare administration requirements. Dentists up there have only just started making use of this provision and it was around the same time, unfortunately, that the minister announced it was being withdrawn.

That dentist spoke of people’s shame—Aboriginal people suffer the same shame that non-Aboriginal people do when they have bad teeth. When they are having their front teeth in particular extracted, they will not smile. He said that this program had just started to be taken up and had just started to make a difference. He was dismayed at the ending of the scheme because he thought that it was a good way of delivering a service to Aboriginal people in remote communities.

If one of the reasons that the figures are skewed is that the information on service provision has not been good or people have not been able to access the information, you do not then cut the service. Surely, you improve the information available to dentists, to doctors and to the community about the service, which is, as I have said, highly valued by the community. My office has been overwhelmed by the number of people who have contacted us to tell us their stories and how much this program has meant to them. They have told us what a difference it has made to their lives, to their wellbeing, to their self-respect and in some instances to them being able to get a job because they have felt so bad about their dental problems that they have not felt confident enough to participate in the workforce. The service has multiple impacts on people.

I think every member of the Senate has received the photos that show absolutely what this program means to people. My office received a phone call today from a lady in very tragic circumstances. She is suffering from cancer, and I am not going to go through the whole story. She was dismayed when she found out that she probably was not going to be able to access the service. Now she is not going to be able to get the funding she needs to do some very important dental work that would mean a difference between a good quality of life and an extremely poor quality of life for her.

We heard of another example of people who were suffering from chronic hepatitis C, who were unable to eat the more nutritious food that they needed because of their poor dental health. Instead of eating soft food, which is more likely to be high in sugar and fat and which only adds to their chronic illness, if they were able to access this sort of program, it would greatly assist them in terms of their quality of life and their health outcomes.

If this program disappears, these people will go back onto waiting lists and their conditions will worsen. For example, a person suffering from a severe iron deficiency was told to increase his consumption of red meat. He was unable to do so because he could not chew due to his rotten teeth. By the time he finally got to see a dentist under the scheme, all his remaining teeth had to be removed and he was provided with false teeth. That is what happens when you are stuck on waiting lists. The problem gets worse and worse.

The Commonwealth dental health plan, which is what the government said they want to replace this service with, was supposed to begin on 1 July. It did not. It is dependent on funding agreements with the states, and these are to be signed in the very near future, but that has not happened yet. If the scheme is withdrawn now, people who are currently receiving treatment will have nowhere to go. Even if they have somewhere to go at the moment, they will go onto waiting lists, and the funding that is available for those services is not going to provide the sort of care that they need and which they can receive under the current program to deal with the extent of their problems.

I am not here by any stretch of the imagination defending the coalition, because I do not agree with a lot of their health policy plans, so I do not want anyone running away with that wild idea. However, this program was a good program. It is genuinely helping people who are suffering, who have chronic illnesses and who have poor dental health. They need support. I am not about to support a motion that cuts off that little support. It is quite obvious that it is fulfilling a desperate need out there. The doubling of the use of the service in that short space of time says there is a big need out there.

Yes, the Greens support a Commonwealth dental health scheme, but not at the expense of those people who are currently receiving much needed support. Funding has been cut to public dental services and the states have not been performing properly, but I say again that you do not then inflict that pain on low-income workers—on the people who have the least capacity to pay. It is the wealthy people who have the capacity to pay; low-income people do not have the capacity to pay. If we support this motion to rescind the disallowance of the dental services determination, the minister would whip in another instrument to get rid of this program. It would not immediately be replaced with a Commonwealth dental scheme as they say. The time frame is quite loose on that and there is absolutely no guarantee that the people who are currently being treated under this scheme or who would be eligible to be treated under this scheme will be able to be treated in a timely manner that deals with their problems and symptoms immediately under the new scheme.

The government need to come back with a better funding proposal for their dental scheme. They need to show the Greens how they are going to properly look after the people who currently are able to access treatment under this scheme, which is proving extremely valuable and worth while and delivering results to thousands of Australians. They need to show us how these people can be treated and also how they are going to get their Commonwealth dental plan up.

Don’t dare blame the Greens if the government decide they are not going to fund their Commonwealth dental plan. When they announced those tax cuts, they made a decision about how they were going to spend that money. Australia can afford both—don’t you try to tell me that we cannot. We can. We are a caring society and we can afford both. Don’t try and blame the Greens when this goes down.

Nick Xenophon (SA, Independent) Share this | Link to this | Hansard source

Can I say firstly I think the questions put by Senator Siewert towards the end of her contribution are very relevant ones and they deserve a comprehensive and considered answer from the government. I rise to speak briefly on this motion. The previous government’s dental scheme relied on the referral of patients by GPs so that dental services could be accessed through Medicare according to demand. This plan cost $490 million and due to its reliance on Medicare requires a disallowance by this house. The Rudd government wishes to replace this scheme with two new schemes, the Commonwealth Dental Health Program and the Medicare Teen Dental Plan, at a cost of $780 million. The funding for this was factored into the last federal budget on the assumption that the funding for the previous scheme would be stopped—and I note the question by Senator Siewert: why can’t we fund both? That is a reasonable question. It is a question I have posed to the government.

However, I note that the previous scheme was poorly accessed in most states, with my home state of South Australia receiving only 2.8 per cent of the funding. I have had an email from a ministerial adviser to the Minister for Health in South Australia. The minister’s office asserts in that email that, on the basis of the available figures, South Australian patients comprised 1,256 out of the 44,774 patients who accessed the chronic disease dental scheme from 1 November 2007 to 31 July 2008. That is about a 2.8 per cent share of the national total, compared to the 8.7 per cent which South Australia will receive under the Commonwealth Dental Health Program. The minister’s office also says that total benefits provided to SA patients under the old scheme amounted to $2.5 million from 1 November 2007 to 31 July 2008. This is a 2.4 per cent share of the total expenditure, compared with $24.7 million which SA will receive under the Commonwealth government’s proposed scheme. The office goes on to state that, in comparison with the former scheme, the new scheme will provide for 85,600 visits over three years, which will see dental waiting times reduce from around 19 months now to about 12 months. That is the position of the South Australian government. Anyone who knows about my relationship with the South Australian government could never accuse me of being a spruiker for that government, but I think it is a fair point that has been made by the minister’s office. I have taken that into consideration insofar as it impacts on the citizens of South Australia.

It seems to me the dilemma is that the government is not prepared to fund the chronic dental scheme and so what do you do with the available resources? That is my concern, although I think Senator Siewert’s question as to why we cannot fund both is one that must be answered by the government. I see benefit in the proposed new dental scheme that the government wants to implement, and that will be a good thing for South Australians. But I also note the concern that those with a chronic dental problem will no longer be able to access this scheme on the basis of the government’s position.

By the government’s own admission, thousands of people with chronic dental needs who are currently receiving assistance under the old scheme will miss out under the new scheme because they do not qualify for concession cards. That is obviously a real concern. Anyone who has had to wait longer than a day for an appointment with a dentist to treat something as minor as a toothache or a minor chip will appreciate how distressing dental pain can be. If we then consider those suffering chronic dental pain, and how chronic pain dominates all aspects of one’s life, it is not acceptable that these people be deserted to suffer. It is not acceptable for those currently receiving support or those on the cusp of the concession card threshold to be suddenly facing huge dental bills. It is a case where we should not be robbing Peter to pay for Paul’s teeth.

I can say that I have had some very useful discussions with the minister and the minister’s office, and I appreciate that. I have sought further information as to the extent to which like-for-like treatments could be funded in South Australia for chronic dental conditions in relation to the proposed new scheme that is currently in abeyance. I have also sought information on how many South Australians with chronic dental needs would lose out due to these changes and how many new treatments would be afforded for like-for-like treatments. I accept in good faith that the government will be providing me with those details in due course. However, I think there are some legitimate concerns raised by the opposition and by the Greens about this. I think more needs to be done to convince me that this is the way to go. So, on balance, I cannot support the government’s position on this, but I look forward to further discussions and perhaps a further commitment from the government in relation to the matters of concern that have been raised in the course of this debate.

Steve Fielding (Victoria, Family First Party) Share this | Link to this | Hansard source

Regrettably, the government has made this debate a choice between one dental health program and another. That makes it an enormously difficult decision because both the Rudd government’s Commonwealth Dental Health Program and the previous government’s Allied Health and Dental Care Initiative have merit. One helps people with chronic disease with their dental problems, while the proposed new government scheme helps with reducing dental waiting lists. If you look at both of those you think, ‘Gee, they are both pretty important things.’ And when you look to see which one has more merit than the other, there are arguments for going both ways.

We have been in discussion with the minister and we are aware that there are winners and losers, which is unfortunate with this particular issue. Dental services in Australia have been mammothly underfunded for many years. People have been suffering while governments dither about providing enough money and resources to fully tackle this problem. There are more than 480,000 people waiting for public dental care, with waiting times averaging between one and 1½ years. There are reports that some patients have waited for 10 years to see a dentist. I will say that again—there are 480,000 people, and some of them have been waiting for 10 years to see a dentist. That is in Australia—it is not another country; it is in Australia—and that is a disgrace. And here we are today, squabbling and saying that you can have one and not the other.

We have had a lot people contact our office on this issue. There are strong merits for both schemes. The Rudd government’s proposal to put money into the dental system will see a reduction in the waiting lists. It is nowhere near enough money, but I do not think that anyone in this place would deny that the Rudd government’s system would reduce the waiting lists. It has also become clear that the previous government’s scheme, the chronic disease dental scheme, was actually serving a need for Australians who have debilitating chronic dental needs. We could say that we could let go of the chronic disease dental scheme if the new proposal by the Rudd government would help those people with chronic dental diseases. We have sought some assurances from the minister about priorities being given to people with chronic dental diseases. We have had some assurance that the needs of people with chronic dental diseases would be factored into the waiting lists.

I am swayed both ways but, at the end of the day, I think there is enough money in the system to allow both schemes to run. That is the conclusion that Family First has come to, and it has not come to it lightly. Frankly, I think both systems have merit and both seem to address different issues. Ultimately I really believe that Family First would continue to seek the continuation of both. If the government wants to force us into choosing one or the other, I think that they are going to find that we will hold onto the chronic disease scheme now and see whether the government can put more money into the system. There is money there and they can put it in if they want to. It is a choice that they can turn back on themselves; it is a choice that they can make as to whether they actually do something about the waiting lists. But I think the needs in the chronic disease area are also real. I would just say that dental services in Australia have been mammothly underfunded collectively and we need to work out how we can have both. With the resources we have in Australia, I think we can have both.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I will take the opportunity to close the debate on this matter. This afternoon we have heard contributions from a range of senators in this place. One of the issues I want to address is that raised by the theme that went through all of the debates—that there is a need to address the dental issues in the Australian population. Those needs have not been addressed by the Liberals in the last 11 years. They did not take the matter seriously. In fact, in 1996, they withdrew substantial moneys from the system. We now have a view, expressed at least between the minors and the Greens, that the issue does need to be addressed.

Prior to the election of the Rudd government we took a responsible position by making it perfectly clear that we would abolish the former Howard government’s poorly targeted and failing chronic disease dental scheme. It was not working. It was not providing the benefits that people should have received. What it was doing was targeting those who would otherwise not need the service. For those who did need the service, such as pensioners and people on concession cards, it was not adequately, and in some cases not at all, addressing their dental needs. We had a clear choice that we took to the election, which was either a scheme that the Labor minister for health had put forward or a scheme that the former government had maintained. And the choice was made. The public chose in favour of Labor’s better targeted dental programs. The choice was necessary to maintain our budget surplus, and it is clear that that is still facing this Senate.

In a perfect world we might all be able to give everyone perfect outcomes. This is not a perfect world. There are choices that need to be made and there are tough decisions in tough economic times that need to be made. The Rudd government has put forward a perfectly proper process. Prior to the election it took an economically responsible path to maintain both a strong budget surplus and make tough choices. It did not take the easy way out of promising everybody an outcome. You cannot do that because all you are then doing is contributing to blowing out a multibillion dollar hole in the budget. The Charter of Budget Honesty provided a system where we would be costing our election promises and, having done so, it then provided the way forward where we could say that these included savings from the Liberal’s failed scheme in order to pay for Labor’s better policies. That is the process we took forward. Our commitment, compared to the previous government’s record of ripping $100 million a year from public dental services and leaving 650,000 people languishing on public dental waiting lists, was a clear vote at the last election for Labor’s policies.

We are now in the process of ensuring that we can proceed with ours while shutting down theirs. So, in response to Senator Xenophon’s arguments about some of the process issues around our scheme, we are happy to engage with senators in respect of the detail of how our program will be rolled out. What we are doing today is shutting down the existing scheme. It is not economically sensible to try to maintain both schemes. It was not what we tried to do before the election. We made that clear. The public made a choice about that. We then ensured that at the first opportunity we would roll out our new scheme and, of course, the savings from the existing scheme to be closed down would be used to fund election commitments. Why? It was to maintain a proper surplus of $22 billion to ensure that we could be responsible economic managers and also address the dire needs of those people who need dental assistance. To do that through our programs, which are targeted and designed to assist those people who need assistance, is the Labor way. It is the Rudd government’s way to ensure that we have the proper outcome. It is not about waving a magic wand, unfortunately, and hoping that everybody can benefit with the two schemes still running. That is not the position we are in. We have before us today the opportunity to shut one system down and give the Rudd government the opportunity to roll out its scheme to address dental issues that exist in the community and to start to target it to those people who are in need. That is the position we are now in.

In terms of the arguments that have occurred in this chamber, the main one from the opposition was held during the election campaign. Senator Conroy earlier this afternoon went through the reasons why their program was in dire need of closing and still needs to be closed down. It had failed abysmally. It had also been wrongly targeted and it allowed people to gain access to a system that they did not need because they could afford it themselves. It is a program that needs to be closed down and it needs the Senate to do so. It can only be done through this system that we have before us. When you look at the Liberal’s chronic disease dental scheme, you see that it was highly skewed, with many states receiving far less than a fair population share. One in five concession card holders lived in Queensland—18.9 per cent—but it only received 4.4 per cent of benefits under the chronic disease scheme. That is just one example of the scheme that the Senate will maintain if it does not support Labor’s position. To continue that scheme would be unfair and unjust for those people. The money could be better spent being targeted by Labor’s proposal.

This government does not have a magic wand to wave around and say, ‘We can maintain all of the schemes; we can maintain all of the programs of the Liberal government.’ To do that would not recognise that in truth there was a change at the election. There was a change for the better. The population voted for the Rudd government’s plans not only in dental care but in health and a whole range of other programs. The opposition are stalling in respect of this matter. They have to accept that we do have a mandate in this issue and we should be allowed to get on with managing these schemes. The opposition can take the opportunity to be critical of our scheme but they should support our mandate to allow us to govern and to provide the outcomes that we said we would, to provide the election commitments that we said we would and to provide the savings to maintain the strong surplus that we said we would. I was not going to take up much time in respect of this matter. It is coming up to the time for another debate to occur. On those words, I urge the Senate to close down the existing Liberal scheme.

Question put:

That the motion (Senator Conroy’s) be agreed to.