Tuesday, 18 September 2007
Health Insurance Amendment (Medicare Dental Services) Bill 2007
Can I open by acknowledging the member for Gwydir and wishing him and his family all the best in the future. I acknowledge that his final speech in this House contributed not only to the quality of debate in this House but to the national discourse.
I take the opportunity this evening to speak on the Health Insurance Amendment (Medicare Dental Services) Bill 2007 and to outline why I support the ALP’s position in opposing this bill. The bill amends the Health Insurance Act 1973 in order to provide for the expansion of the government’s Medicare dental program for people with chronic conditions and complex care needs. The bill seeks to make amendments because, as the Minister for Health and Ageing acknowledged in question time today, the government got the original program so wrong that it was seriously insufficient. The government now seeks to amend the bill to correct those failings and in doing so perpetuates the very reasons it failed in the first place.
The amendments proposed in this bill enable a monetary limit on Medicare benefits for dental services to be introduced for eligible patients. The limit of $4,250 over two consecutive calendar years will be set out in a ministerial determination made under section 3C(1) of the Health Insurance Act. The original scheme for people with chronic conditions and complex care needs was established by this government in July 2004, eight years after this same government had axed the Commonwealth dental health scheme—eight years during which this government vehemently denied over and over again that they had any responsibility for the suffering of an increasing number of people who no longer had access to a Commonwealth dental health scheme.
I did wonder what amazing event had occurred at that point in time to change those denials of eight years. What was so significant in July 2004? It did not take very long to realise that it was only a few months before an election. And, no surprise, only now, over three years later, does the minister acknowledge that there are serious problems with the 2004 scheme and seek to amend the act. What is so significant about this timing? We are once again only a few months, perhaps weeks, away from election day.
Because the 2004 version of the scheme has been defined by an extremely low take-up, due to the complexity of the referral system it created and the high copayments, the government announced in the budget this year that it would pour an additional $377 million into the failing program. This government is dragged reluctantly, protesting, to any serious addressing of the dental health problems our communities face. It only ever responds immediately before an election. It comprehensively fails to understand that the rising cost of dental care is a major cost-of-living issue for families and has contributed to a national dental health crisis that has left one in three Australians avoiding dental care simply because of the cost. The reality is that the targeting of the program to only those with chronic conditions and complex care needs has resulted in a very limited uptake of the program to date, with only 7,228 Australians over those three years being able to access help with their dental problems.
The proposed amendment before the House seeks to increase to $4,250 the level of Medicare funded dental treatment able to be accessed over two consecutive calendar years. This may assist in reducing the high copayments, but the retention of limited eligibility to people with chronic conditions and complex care needs will necessarily mean that only a small proportion of the population will be eligible to access this assistance. For the wider community there will be no change to the cost or availability of dental treatment as a result of this bill, and certainly no assistance will be provided to the 650,000 people currently on the public dental waiting list, who sit there because they cannot access this government’s current scheme and so will not be assisted by these proposed amendments at all. That is 650,000 sufferers left waiting yet again.
In its very first year in office this government axed the Commonwealth dental health scheme, which was providing $100 million per year for public dental services. This has directly led to the 650,000 men, women and children who now sit on the waiting list, and is evidenced in the sharp deterioration in dental health standards amongst low-income people and young children. As a member of this House from a New South Wales seat I would also like to identify that within that 650,000 figure are 178,876 people from New South Wales, as at 31 May 2007, and that 45,000 of these are children. This is disgraceful. Any parent who has a child suffering dental pain knows that every day waiting is unacceptable. Indeed, the government’s chronic disease dental program has, over the past three years, only assisted 14 preschoolers and one child under five.
A report produced in 1999 by the University of Adelaide reported that Australian children had the ‘world’s best’—that is their words—teeth during the 1990s. Sadly, this has not been universally sustained. Between 1996 and 1999, five-year-olds experienced a 21.7 per cent increase in deciduous decay. The New South Wales Chief Health Officer’s statistics also show that hospitalisation rates for children under five for the removal or restoration of teeth increased by 91 per cent between 1994-95 and 2005-06. This worrying development was further confirmed by information released in February this year by private health insurer MBF, which showed a 42 per cent increase in children being treated in private hospitals for dental cavities.
Not only have waiting lists become a problem under this government; the average cost of dental treatment has also increased well in excess of inflation, putting it beyond the reach of many low-income people. The Australian Institute of Health and Welfare in its report entitled Australia’s dental generations: the national survey of adult oral health 2004-2006, found that the 30 per cent of Australians reported avoiding dental care due to cost. That is 40 per cent of Australians not going to the dentist when they needed to simply because of the cost. 20.6 per cent said that costs had prevented them from having recommended dental treatment and 18.2 per cent reported that they would have a lot of difficulty paying a $100 dental bill—and to be quite honest, given the current cost and the increase in the cost of dental services, I think they would be doing pretty well to find anything that cost them only $100 to start with. Most of them know that they are up for quite a bit of money and, clearly, from these figures 40 per cent are not even seeking dental advice because they know that they are just not going to be able to afford it, and 20.6 per cent seek the advice and then are not able to follow through on the full service because they cannot afford it. That is an unsustainable and disgraceful situation.
Over the 11 long years that this government has persisted in justification and reluctant, ill-conceived policy activity on dental health, the states and territories have more than doubled their funding to public dental health in an effort to alleviate the pain left by this government’s abandonment of the field in 1996. Time and time again the Howard government has asserted that the states are wholly and solely to blame for the dental health crisis, in complete contradiction of the constitutional allocation of jurisdictions. Indeed, the Prime Minister said today that before the Hawke-Keating government took a role and met their responsibility, dental health service had ‘since time immemorial’—to use the Prime Minister’s own words—been provided by the states. For a Prime Minister who so recently announced that this government has to stop talking about the past and focus on outlining plans for the future, they spend an awful lot of time investigating further and further into the past when asked to debate any particular issue of concern to the community today. On that sort of basis, heaven help the development and rollout of new technologies if this is to be the approach of this government to taking responsibility for any matter.
The public dissatisfaction with the removal of the Commonwealth Dental Health Program has not abated over the intervening long 11 years. Indeed, in my own region I have supported the work of local community activists and would like to particularly acknowledge the work of my colleague the member for Throsby, who has provided extensive support to these local people in advocating in this parliament for the return of a Commonwealth dental scheme over the preceding years. Local groups in our area have united in the Illawarra Dental Health Action Group, and organisations such as the Combined Pensioner and Superannuants Association have maintained their determination to see the return of a scheme that was so critically important for the people they represent and on whose behalf they advocate so strongly. I would like to mention the outstanding leadership offered in this campaign by locals such as Alice Scott, Tom Ward and Edna and Eric Stevenson, but I also acknowledge that they are only able to maintain their efforts because of the support of so many other local people who join with them in the campaign. Such community people, as well as the 650,000 still waiting on public lists, would have no trouble understanding why Labor would oppose such a bill as that before us today. It will do so little to address the public dental waiting lists and nothing to make dental care more affordable and accessible to Australian families and pensioners.
When the budget announcement was made, Labor announced that we would be likely to use this money to invest in a dental care scheme that actually provided real benefit to the ordinary Australians who expect, and indeed deserve, so much better in health policy from a federal government. Today federal Labor took up that expectation and made a significant announcement on dental health. The federal Labor leader, Kevin Rudd, and the shadow minister for health, Nicola Roxon, announced that a Rudd Labor government will re-establish a Commonwealth dental health program and provide funding for up to one million additional dental consultations for Australians needing dental treatment. This commitment pledges up to $290 million to such a Commonwealth dental health program as a first instalment in Labor’s overall commitment to dental health. Under this plan, to be introduced by a Rudd Labor government, up to one million people will finally receive, over the three years, their much-needed dental treatment.
This is in comparison to the Howard government’s chronic disease scheme that has failed to assist 650,000 people who still sit on the waiting list, the scheme that over the three years of its operation has only provided some relief to 7,000 people because of the barriers of its complex eligibility process and referral criteria. Federal Labor is not interested in the cheap-shot blame game that the Howard government has played with this issue. We are just committed to clearing the backlog and relieving the pain and suffering of those people caught in this backlog.
This money and the services it will purchase will supplement existing public services or purchase private sector appointments for these people. Under the Rudd Labor plan, the state and territory governments will be required to meet new standards of dental care as part of their commitment to ensure that this additional Commonwealth funding arrests and reverses our failing dental health standards, particularly amongst the most needy and vulnerable in our communities. State and territory governments will be required to meet the new standards, which include providing priority services to individuals with chronic diseases affected by poor oral health, providing timely service for preventative and emergency services and maintaining their current efforts.
I have absolutely no doubt that the Rudd Labor announcement will be resoundingly applauded and welcomed by local groups in my area who have been fighting on this issue for all the years since this government axed the scheme. I commend the Labor leader and the shadow health minister on understanding the needs of communities like mine and making a real and practical announcement on such an important health issue. This will bring significant relief to so many people in Cunningham. I note that in the contribution of my colleague the member for Throsby she outlined the fact that in our own area there are approximately 7,000 people on the waiting list. The member for Throsby, like me, has regular contact with those people, and we are particularly and pertinently aware of how frustrating it is for them to deal with the pain and suffering and other ongoing physical effects of their poor dental and oral health. I know each and every one of those people will be extremely pleased when we inform them of the announcement of Labor’s commitment today and that they will absolutely understand that we are committed to providing a real, direct service, the sort of service they got up until 1996 and which had been so successfully attacking the long public dental waiting lists. By its axing we have now seen the situation get to the point where 650,000 of these people across our nation are unfortunately unable to get access to the public health service that they need.