Nick Champion (Wakefield, Australian Labor Party) Share this | Hansard source

It is a great opportunity to speak on the Dental Benefits Legislation Amendment Bill 2014. This is a relatively uncontroversial bill but we are obviously having an important debate about dental care in our country. As the member for Ballarat said, oral health care is the missing link out of Medicare. I think there is a great deal of truth to that.

Oral health has been left to the states for a long time. What we have seen really out of the states' administration of this area is a system of haves and have-nots. We have seen over the last couple of decades the federal government, by necessity, become increasingly involved in the area of dental care. We can go right back to when I joined the Labor Party. I can remember the Keating government embarking on a program to reduce state waiting lists for public dental care, because those waiting lists had grown so long—not just the time you waited to get seen but the time you waited to actually get the treatment. So, there were often two waiting lists: the waiting list to get an assessment and then the waiting list to get the treatment. And they blew out, particularly in New South Wales at that time. The member for Kennedy talks about people removing their own teeth. Sadly, sometimes people were going to that extreme, taking drastic action themselves, because of these terrible waiting lists.

So there was an endeavour by the Keating government at that time to address this matter, and we saw even the Howard government—no friend to Medicare, no friend to universality or to getting involved in state responsibilities—embark on the CDSS. We know that that was a poorly targeted scheme. It was meant to cost $90 million a year and ended up costing $80 million a month. Now, maybe that is because there is vast demand out there; I do not know. But one of the things we also know about it is that more than 20 per cent of the recipients were not concession card holders, were not pensioners, and more than 20 per cent of the spending was on high-cost restorative services. So, that was the record of the Howard government. They were getting involved in this area, I guess out of necessity, because the states were doing such a poor job. We all know that there were problems in that scheme, and those opposite should not try to run from them.

The previous Labor government, of course, embarked on a $4.1 billion scheme, and that was designed basically to clear waiting lists to create a workforce—and not just a workforce in capital cities but a workforce outside of capital cities—and also focused on children's health. Children's health is particularly important. The member for Ballarat in her speech talked about some terrible statistics—that 20,000 children under the age of 10 are hospitalised each year because of avoidable dental issues and that by the age of 15 six out of every 10 kids have tooth decay. We know that this is not just because they do not have toothbrushes or because of sugary drinks; it is because they do not see a dentist. A dentist is an integral part of oral health care.

The impact of oral disease is particularly important. The Department of Health, on its website—the National Advisory Council on Dental Health—talks about the National Oral Health Plan for 2004 to 2013. It says:

Oral health is fundamental to overall health, wellbeing and quality of life. A healthy mouth enables people to eat, speak and socialise without pain, discomfort or embarrassment. The impact of oral disease on people’s everyday lives is subtle and pervasive, influencing eating, sleep, work and social roles. The prevalence and recurrences of these impacts constitutes a silent epidemic.

It goes on to talk about the international research that indicates associations between chronic oral infections and lung disease, stroke, low birth weight and premature birth. Associations have been made between periodontal disease and diabetes in international literature as well.

So, we know that oral health is vital to the health of the rest of the body. And the statistics that are there scream out for a shift away from the system of haves and have-nots that is endemic in allowing the states to retain responsibility over this area. We know they have not done a good job. They have not done a good job for decades; this is not something that has sprung up overnight. I remember when the Rann government came to power in 2002 one of the things we acted to do was to aim to reduce the waiting list for public dental care, and that is because in electorates like mine I am often shocked—and I do not have great teeth—by just how bad some people's teeth are, and often they are desperate to get treatment. There are a whole lot of impacts, obviously, on their lives. It is very hard to seek work and it is very hard to socially engage if you have got really poor teeth. Obviously it is very painful and affects your overall health.

The statistics are very serious and pretty brutal. In 2010 nearly half of children aged 10 had experienced tooth decay in their permanent teeth. That is out of the Australian Institute of Health and Welfare and the University of Adelaide's Oral health and dental care in Australia: key facts and figures trends 2014. So we know that those statistics are not good. In terms of tooth decay in adults there is the effect of geography as well. The proportion of people with untreated decay varied from 23.5 per cent in major cities to 37.6 per cent in remote and very remote areas. An obvious point that we know about our health system is that the further you are from the GPO, the harder it is to get health treatment generally. We know that prior to the previous government's opening of cancer centres there were some pretty horrendous figures in relation to cancer and degrees of remoteness—the further you were away from the GPO affected your treatment—and it certainly does in dental as well.

There is an income barrier as well. In 2004-06, the proportion of people with untreated decay was higher for those with a household income of less than $12,000 a year and lower where the household income was $100,000 or more. A higher proportion of uninsured people, 31.1 per cent, than insured people, 19.4 per cent, had untreated decay. So there is a gap related to geography and there is a gap related to income.

Mr Briggs interjecting—

You might learn a thing or two, Member for Mayo. I talked about the states before. I talked about their poor record—all of them, Labor and Liberal—in this area. So let us share the blame around. I know the member for Mayo is a centralist in his heart, just like his old boss, John Howard—a great believer in the federal government. We saw that in their ideology in Work Choices—the commitment to a single, central system in this country. It is something that I think is spread in the coalition. We would like to see that.

But back to the statistics about dental. About one in three cardholder adults had untreated decay, 32.9 per cent, compared to less than one in four non-cardholders, 22.9 per cent. Obviously there are big impacts related to geography and income in your ability to access dental care. These are all mapped out in the Australian Institute of Health and Welfare and the University of Adelaide's report. It notes similar things in terms of gum disease, where age has an effect, gender has an effect and geography certainly has an effect. In terms of gum disease, 36.3 per cent of those living in remote areas had gum disease compared to 22.1 per cent living in major cities. In terms of income and gum disease, people on lower household incomes generally were more likely to have gum disease than those on higher incomes, varying from 42.3 per cent for those in households earning less than $12,000 per year to 14.3 per cent for those in households earning $100,000 or more. A lower proportion of the insured, 19.4 per cent, than the uninsured, 27 per cent, had gum disease. Cardholders had higher rates of periodontal disease than non-cardholders—some 33.6 per cent compared to 19.5 per cent, respectively.

These are pretty stark figures. We know that what this government is doing will not help these figures. We know that. We know of their plans in health generally—some $50 billion worth of cuts and the GP tax. It is a tax which cascades from your GP waiting room into the place where you get your blood tests and into the place where you get your scans. And if you have to go back through the process to see your doctor again to get more tests, to get more scans, then the $7 cascades over and over again. We know that those opposite are committed to that GP tax and they are committed to the $50 billion worth of cuts.

We know that one of the things they did in the last budget was also basically to defer a $390 million partnership. There are 400,000 people on dental waiting lists around the country and in some states this funding has helped to cut waiting lists by half. We know that if you let those waiting lists blow out the problems get worse. I have heard other speakers say, 'Why did the previous government start with children?' That is because prevention is better than cure and universality is an important thing. One of the things it does is it lets people see their doctor or their dentist before problems get out of hand, before people have to have more extensive work and before they have to be, God forbid, hospitalised. We talk about some 20,000 children across the country being hospitalised for avoidable dental operations and interactions, you know that prevention is better than cure. It is much cheaper, too—that is the thing. There is a saving in it for the Commonwealth, there is a saving in it for the states and there is a saving in it ultimately for the community.

We know that the delay of the $390 million national partnership programs is going to be a disaster. Griffith University Professor of Dental Research Newell Johnson said:

It's certainly going to make it worse for people who rely on the public system. It's high time we realised that dental health is as important as any other part of the body.

Australian Dental Association President Dr Karin Alexander said waiting lists could double or triple, depending on the delay:

Then the waiting lists are going to grow and you are going to have people sitting there in pain at once again.

It is not good enough for this nation, which is wealthy, which has experience of universal health care in Medicare—a reform that was hard fought for in the Whitlam era. It was hard fought for then; it was hard fought for by the Hawke government, which went down the Medicare path and managed to institute it into our public life, make it untouchable for those opposite—and they will find the GP tax that they are so committed to will be their undoing. But it is not good enough to simply say that dental care should be left out of Medicare, that it should be a haves and have-nots system, that it should be a system where your health is dependent on your income and your ability to pay for a service that is vital for your interaction with the community, for your place as a citizen in this community. And if there is one thing we should learn from this debate it is that these schemes where the Commonwealth is fiddling about, trying to fix up what the states have not the wit, the inclination or the resources to do is an error. We should look at putting dental care in its rightful place in our public health.

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