House debates

Monday, 17 September 2007

Health Insurance Amendment (Medicare Dental Services) Bill 2007

Second Reading

Debate resumed from 16 August, on motion by Mr Abbott:

That this bill be now read a second time.

7:44 pm

Photo of Nicola RoxonNicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | | Hansard source

The purpose of the Health Insurance Amendment (Medicare Dental Services) Bill 2007 is to amend the Health Insurance Act 1973 in order to provide for the expansion of the government’s failing Medicare dental program for people with chronic conditions and complex care needs. Labor will be opposing this legislation. Labor has consistently and loudly highlighted not only the weaknesses of this particular policy but also the Howard government’s negligent approach to the dental health needs of Australians over the last 11 years. A decade of Howard government neglect cannot be fixed by throwing millions of dollars at this failing policy.

There is little doubt that Australia is in the midst of a potentially catastrophic dental care crisis. Currently, there are 650,000 Australians on public dental waiting lists around the country, many waiting years for treatment. Thirty per cent of Australians reported avoiding dental care due to the cost. Dental workforce shortages mean that Australians simply cannot get in to the dentist when their teeth need attention. In the public sector it means long waiting lists; in the private sector it means not being able to get in to see a local dentist at short notice. These dental workforce shortages are particularly felt in outer metropolitan, regional and rural areas, where there are very few dental professionals.

These problems with accessing affordable dental care are contributing to Australia’s deteriorating dental health. The deterioration of the oral health of Australians is the most worrying factor in this debate today. Tooth decay ranks as Australia’s most prevalent health problem, while gum disease ranks as the fifth highest. Untreated dental decay in the Australian adult population stands at over 25 per cent—that is, more than a quarter of Australians are not getting the dental care that they require. A recent study found that one in six Australians had avoided certain foods during the last 12 months because of problems with their teeth. About 50,000 Australians a year are being hospitalised for preventable dental conditions which have escalated into more serious problems because they have not been able to access treatment when needed.

Perhaps the biggest indictment of all is that, while Australian kids had world’s best teeth during the mid-1990s, there are now pockets of real concern. For example, between 1996 and 1999, five-year-olds experienced a 21.7 per cent increase in deciduous decay. This was matched by soaring hospitalisation figures for the removal or restoration of teeth. According to statistics of the New South Wales Chief Health Officer, between 1994 and 2004, hospitalisation rates for children under five have increased by a staggering 91 per cent. Think about that for a moment: over a decade there has been a 91 per cent increase of hospitalisation rates for our children with dental health problems. This finding was confirmed by disturbing claims information, recently released by the health insurer MBF, which showed a 42 per cent increase in children being treated in private hospitals for dental cavities.

It is clear that Australians need action on dental health. But, rather than addressing this range of issues to improve accessibility to affordable dental care and therefore improving the oral health of Australians, the Howard government have instead spent much of the past decade cynically playing the blame game on dental health. Time and again, Prime Minister Howard and Health Minister Abbott have deflected criticism onto the states and territories, reiterating that Australia’s public dental crisis and deteriorating oral health standards are entirely a state and territory problem.

In seeking to blame the states and territories, the Prime Minister and the Minister for Health and Ageing have conveniently ignored two key facts. Firstly, it was the Howard government which scrapped Labor’s Commonwealth Dental Health Program in 1996, ripping $100 million a year from Australia’s public dental system. While state and territory governments have more than doubled their investment in public dental care over the past decade, the impact of the Howard government’s decision in 1996 is still reverberating today, not least on the hundreds of thousands of Australians languishing on public dental waiting lists. But let us be clear about this: dental care in Australia is in crisis because of the underfunding that I have mentioned and the workforce shortages. I emphasise these twin issues, because our current dental crisis is far more complex than the all too familiar Howard government one-liner, ‘It’s all the states’ fault.’

The Howard government seems to have forgotten that the training of dental professionals is uniquely a Commonwealth government responsibility. The Howard government’s neglect in this area is longstanding, and it is not as though it has not had sufficient warning of what was coming. A national oral health training strategy for oral healthcare providers and other health professionals was recommended by the Senate Community Affairs References Committee as long ago as 1998, but the Howard government has failed to act.

In 2003, researchers highlighted that there would be a shortage of 1,500 dental professionals by 2010 unless action was taken. In 2004, dental graduation levels were found to be at their lowest level for over 50 years. Belatedly, the government recently increased dental training places at Australia’s universities, and Labor welcomes the recent budget announcement of a new dental school at Charles Sturt University. But comprehensive and strategic national policies are required to ensure a long-term solution to this crisis. Not enough has been done to address in particular public sector shortages and regional and rural demand for dental professionals.

To give the House an example, I recently visited Bathurst, where I heard from locals how hard it was to get in to see a dentist, with many clinics having closed their books to new patients altogether. Meanwhile, those who relied on public services faced long waiting lists for attention from the dental clinic run by the Greater Western Area Health Service. More than 5,700 people were waiting for a public dental assessment, with another 2,200 people on treatment waiting lists, despite having been clinically assessed with a range of oral health problems. The public dentists were doing their best within their resources, but they were simply run off their feet. In Cairns it was a similar story, where the Edmonton clinic in the southern part of Cairns had 4,000 people on their waiting list. When you consider that the Cairns region has a population of around 130,000, and there are nine public dental clinics in the broader region, that waiting list of 4,000 at just one service really hits home. Everyone I spoke to in Cairns about the dental crisis pointed to workforce shortages as the key issue: the region simply cannot attract the dental professionals they need. The story was the same again in Burnie in Tasmania, where I visited in April. A fully equipped public dental clinic was there, in good condition, to be used, but there was insufficient staff to run the place. As a result, there were almost 4,000 people on the general waiting list in Northern Tasmania.

I give these examples to show that there are two reasons for the crisis in dental care in Australia. It is an underfunding and resourcing issue which is severely exacerbated by the actions of the Howard government, and it is a workforce shortage issue, which is entirely the responsibility of the Howard government. It would be reasonable to expect that in these circumstances the Howard government might be looking to develop effective policy solutions to address these areas and to tackle the dental health needs of Australians. But, alas, we do not see solutions to any of those problems in the bill that is before us today.

After all, when we are discussing these facts and figures about waiting lists and preventable hospitalisation, workforce shortages and clinics that are closing their lists to people who need to see a dentist, we must always remember we are talking about people. We are talking about Australians who sometimes have such severe dental problems that not only their health but also their entire work and social lives are affected. These are people who may be having trouble eating, who will not go to visit friends, who will not socialise, who cannot apply for a job or who cannot get a job—simply because they cannot get the dental treatment that they need.

Unfortunately, the Howard government is far more interested in playing the blame game than it is in providing solutions for this dental crisis. The Howard government’s dental health initiatives have been limited to the subsidies of 30 per cent or more for those with private dental health insurance—rebates that Labor supports—and this ineffective Medicare dental program for people with chronic conditions and complex care needs.

This program was initially announced in March 2004 and commenced in July that year. According to the minister’s media release of 10 March 2004, which announced the inclusion of dental services in the government’s enhanced primary care program, this was ‘a health care measure, not a dental care scheme and will only be available where dental treatment is required to treat a chronic medical condition’. Under this policy, Australians were eligible for assistance with their dental care if they had a chronic medical condition, like valvular heart disease, diabetes or malignancies of the head and neck, and they had poor oral health or a dental condition which was exacerbating their chronic and complex disease, and they were being treated under a multidisciplinary care plan. These complex and restrictive eligibility criteria, which limited the program to people with chronic conditions and complex care needs, have severely limited the uptake of the program in the three years it has been operating.

Extremely high out-of-pocket expenses have also proven to be a significant barrier to uptake. Under the original policy, patients could claim up to three items in one calendar year, at a cost of $220 per year, for a program of treatment. But, according to 2005-06 data released earlier this year, the average out-of-pocket expenses for assessment or treatment by a dental specialist under Medicare item 10977 was a whopping $692. It is hardly surprising that this has adversely affected the program’s take-up.

Complex referral processes between GPs and dentists have also been cited as a significant problem. In evidence to the Senate Standing Committee on Community Affairs, which examined this bill, the Australian Dental Association stated that the paperwork in the initial system was ‘a bit cumbersome’—a significant understatement—and that the administration of the scheme, most particularly practitioners’ unfamiliarity with Medicare, continues to cause concern. The AMA noted in their submission to the committee that there was ‘some ongoing concern that GPs have difficulty locating a dentist who will accept the rebates as full payment when referring patients’.

To get an idea of just how poorly this program has been executed, I refer again to the minister’s media release of 10 March 2004, when the program originally commenced. It stated that the new dental services would provide ‘for up to 23,000 people under multidisciplinary care plans’. In fact, in the three years between its introduction in July 2004 and June 2007, the program provided for around 7,000 patients at a cost of $1.8 million—well, well under estimates and certainly seriously underspent for the allocation that the government had made.

As I said earlier, Labor has consistently and loudly highlighted the weaknesses of this policy: its restrictive nature and the small number of people it is able to help. The government explicitly introduced this measure three years ago as a healthcare measure, not a dental care measure. But, on any assessment, this program has failed spectacularly as either. Although the health minister has on occasions openly acknowledged this failure, the government announced in this year’s budget not that it would look at addressing the restrictive eligibility criteria of the program, not that it would replace this failing program with something more effective and not that it would look more broadly at how to tackle Australia’s dental crisis. No, the government announced that it would pour an additional $377 million into an expansion of this failing and flawed program—and that amount has subsequently been increased to $384.6 million. A program that is so flawed that it has managed to spend only $1.8million in three years has now been allocated $385 million over four years. It almost defies belief that, without changing the criteria or a range of other problems with this program, it would be possible for the government to spend this sort of money in the program the way it is currently designed.

The budget announcement included a change in the benefits available under this program, but this was also subsequently adjusted. If this bill passes through the parliament, from 1 November eligible patients will be able to access up to $4,250 worth of Medicare funded dental treatment over two consecutive calendar years. I admit that this might sound good to a casual passer-by, and the change might go some way to addressing the out-of-pocket expenses incurred by eligible patients, but the key problem of how few people are eligible remains well and truly in place. Given the extremely poor take-up to date, the bad design of this program and the lack of its utilisation to date, Labor has no confidence that the extended program will be any better, particularly because the government has failed to address the range of other problems besetting this Medicare chronic disease dental program. Most importantly, the eligibility criteria remain totally unchanged by this legislation.

Further, the government has failed to address the complex and restrictive referral processes identified as cumbersome by dentists and doctors alike. In fact, the department revealed to the recent Senate committee examining this legislation that the current three Medicare items will be expanded to more than 450 Medicare items under the extended programs. It hardly sounds to me that that is actually simplifying the process for doctors and dentists. Labor is not convinced that moving from three Medicare items to 450 Medicare items can possibly simplify this program or encourage greater take-up by patients or practitioners.

Mr Deputy Speaker Barresi, we know what this means. It means that people in your electorate, people in my electorate and people in the electorates of everybody who sits in this House will not be able to be assisted by this program. Throwing hundreds of millions of dollars at this failing program is not just an appalling piece of public policy. Labor objects to the continuation of a policy that not only is failing on its own narrow objectives but also will do very little to address Australia’s public dental waiting lists, will do nothing to make dental care more affordable and accessible to Australian families and fails to even contemplate Australia’s dental workforce crisis.

What do this bill and this policy do for our children? What do they do for older Australians in aged-care facilities? What do they do for those on really low incomes or working families with not a lot of extra cash to spare? What does this policy do for most Australians? The answer to all of those questions is: absolutely nothing. Labor considers that it is plainly inadequate to provide funding for acute dental services after the government has removed its contribution to general and preventative dental care, as was provided through the Commonwealth dental program previously.

The Prime Minister says that Australians have never been better off—but tell that to the Australians who cannot chew their food. Tell that to the people in Bathurst, in Cairns, in Burnie or in any of our seats around the country who have been waiting for years to access basic dental care. A decade of Howard government neglect cannot be fixed by throwing millions of dollars at this failing policy. It is Labor’s view that an investment of the magnitude proposed by the government should be directed towards a broad based Commonwealth scheme that better addresses the priority oral health needs of those groups in the community most in need of assistance. For these reasons, Labor will be opposing this bill.

The bill itself is actually very brief. The provisions simply provide the legislative framework for the policy detail still to be fully revealed by the government. The bill makes amendments to the Health Insurance Act to, firstly, 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 subsection 3C(1) of the Health Insurance Act. Secondly, the amendments provide for Medicare benefits to be paid for the supply of dental prostheses, such as dentures, under the new dental items.

According to the explanatory memorandum, details such as the Medicare dental items, including the schedule fees, the eligibility requirements for dental providers and patients, and other administrative requirements will all be set out in a ministerial determination under subsection 3C(1) of the HIA. Perhaps when we see the rest of that detail we will be surprised by the policy developments outlined by the government, but for now Labor is not convinced that this policy is worthy of our support. Pouring hundreds of millions of dollars into a failing program which has not even been able to spend $2 million over the last three years of operation is not good policy and will not help the hundreds of thousands of Australians in need of dental care.

Rather than support a failing policy, Labor will instead draw on these funds to support Labor’s own dental policy. Rather than focus on a policy with such restricted eligibility, a Rudd Labor government will re-establish a Commonwealth dental program and ease the cost pressures on working families by contributing to the cost of dental care. Rather than constantly blaming the states for the crisis in Australia’s dental health, a Rudd Labor government will end the blame game and work with the states and territories to fix Australia’s dental care system, to provide services for those people in our communities who are desperately in need of dental care and to ensure that working families who are currently under pressure to choose whether they get the dental care that they need, whether they pay their childcare costs or whether they pay for their groceries or their petrol will not be put in the position where their children cannot get the basic dental care that they need. It is for these reasons that we oppose the bill and think that the money could be much better spent on a program that supports working families.

8:04 pm

Photo of Wilson TuckeyWilson Tuckey (O'Connor, Liberal Party) Share this | | Hansard source

It is interesting that, in the last seconds of the speech that was made by the member for Gellibrand, we were actually given some inkling of what Labor’s alternative policy is. We did not actually get the detail—though the member for Gellibrand had another 10 minutes of speaking opportunity—but we did get that they are going back to the Paul Keating system. In her opening statement on the Health Insurance Amendment (Medicare Dental Services) Bill 2007, the member for Gellibrand chose to mislead the House by attacking the Howard government for a piece of Keating legislation which, if she had been around at the time or observant she would know, was Labor government policy for four years.

The Keating legislation to which she referred was introduced with a four-year sunset clause. The Howard government did nothing to cancel that program; it cancelled itself by legislation which, if the member for Gellibrand had been present at the time she would know, was passed by a Labor government under then Prime Minister Paul Keating. So why not tell this House the truth? What substance is there in your rhetoric when you cannot even take the blame for your own actions? It was always possible for the Howard government to reinstate that program. As I recollect, it expired in the first three years of the Howard government. But what was the Howard government trying to do at that time? It was trying to save Australia from the ‘recession we had to have’. There was no money for people’s teeth; there was no money for anything. The government of the day owed $96 billion.

They lecture us now as to how they might spend the surpluses, which were generated, through a lot of political pain, by something that was introduced by the Howard government in difficult times. That is what the member for Gellibrand is talking about. I never stopped taking notes. She had to introduce the blame game argument—that is about as far as their policy initiatives go. You cannot blame the states. I was not around at the time of Federation, but I have read a lot about it. It was not the Australian government in its initial stages that decided that it would not have responsibility for dental treatment. That was a decision of state governments. They were the ones who said, ‘This is what you the Australian government’—the Commonwealth—‘can do.’ They had the power, and they kept dental treatment for themselves. They also retained income tax, but could not hand it over quickly enough during the Second World War. When Malcolm Fraser offered it to them, one of their luminaries, Mr Wran, started a public campaign about double taxation.

In the end, the Howard government had to introduce the GST—at great political cost, I might add—for very good tax reform reasons but also to prop up the states and give them some money. What did the Prime Minister say during that campaign? This is a response to the blame game argument—‘We are going to take the political pain of introducing a new tax regime so that there is a source of money, the GST, a growth tax, so that the states can meet their fundamental chosen responsibilities.’ Those responsibilities were not imposed upon them; they were chosen. And what were they? They were public health, public policing and education.

We have a potential federal minister, a shadow minister, explaining to us why there is some fault in a government that continues to try and restrict the exposure of the Australian taxpayer to something that state governments chose as their own responsibility. She says that we have a shortage of people and that that is all the Howard government’s fault. It is like the shortage of doctors. After the Hawke government implemented the original bulk-billing arrangements, they were so generous that one doctor was able to buy an AFL football team with the proceeds of his business. They were so panicked about that that they cut—

Photo of Brendan O'ConnorBrendan O'Connor (Gorton, Australian Labor Party, Shadow Parliamentary Secretary for Industrial Relations) Share this | | Hansard source

Mr Brendan O’Connor interjecting

Photo of Fran BaileyFran Bailey (McEwen, Liberal Party, Minister for Small Business and Tourism) Share this | | Hansard source

Fran Bailey interjecting

Photo of Phillip BarresiPhillip Barresi (Deakin, Liberal Party) Share this | | Hansard source

Minister and member for Gorton, you are very audible.

Photo of Wilson TuckeyWilson Tuckey (O'Connor, Liberal Party) Share this | | Hansard source

She is the same minister that I complained about once before. She never stops talking. But we will deal with that matter tomorrow.

Photo of Fran BaileyFran Bailey (McEwen, Liberal Party, Minister for Small Business and Tourism) Share this | | Hansard source

Fran Bailey interjecting

Photo of Wilson TuckeyWilson Tuckey (O'Connor, Liberal Party) Share this | | Hansard source

No, I am sorry: you do it all the time.

Photo of Ian CausleyIan Causley (Page, Deputy-Speaker) Share this | | Hansard source

The member for O’Connor has the floor.

Photo of Wilson TuckeyWilson Tuckey (O'Connor, Liberal Party) Share this | | Hansard source

Thank you for your protection from the chatterbox. The fact of life is that all of these things were implemented because there was no money left. The Australian people and parliament had a debt of $16 billion in 1991. By 1996 it was $96 billion—it went up $80 billion. There was no hope of the Australian government under Mr Howard re-establishing a program that the Labor government of the day implemented for only four years. It was a catch-up program. The Labor Party did not want the responsibility. They will make Paul Keating a hero one day; they did it with Gough Whitlam—he was the last Prime Minister to be elected on an ‘It’s time’ platform. It only took Australia about 30 years to get over his first 28 days of government. Anyway, there is no blame.

Because of the chatting of the minister, I lost my thought for a minute. The facts of life are that, in response to the growth in the bulk-billing sector, the Hawke government reduced the intake to universities by 4,000. As everyone knows, 10 years is the minimum time for a GP to hang out their shingle independently. And you wonder why there has been a shortage thereafter. It is a matter of record how many new places have been opened up. But what are the state governments doing about trying to encourage people to enter the dental profession? It is fairly highly rewarded. They are doing nothing. And what do they say to the nurses and doctors whom they employ? ‘Take a two per cent wage increase.’ Half of those doctors and dentists that have been fully employed by Labor state governments would be better off going up to the Pilbara and driving trucks.

We are told that if we elect Labor all the workers at McDonald’s are going to get a pay increase. But what are they going to do for the dentists? What are they going to do for the nurses? There is a good reason why there is a high proportion of unionism in the public sector. They are primarily workers employed by state governments, and they think that they need a union to protect them. Those who choose a private sector employer have long had the opinion that they do not need a union. When we talk about union heavies—and they will populate this place in ever-increasing numbers after the election, whatever the outcome—we find out that the last two presidents of the ACTU, the incumbent and the other one who has already secured a position here, were school teachers. Where are the miners? Where are all those people who used to think that it was necessary to be protected by a union?

The whole presentation of the member for Gellibrand was about the blame game. Their colleagues in state governments, who—by their own decision 100 years ago—are obliged to provide dental services to the community, do not want to provide such services. They so grossly underpay their nurses, their incumbent doctors, their in-house doctors and their dentists that no-one wants to work for them. Then they tell the poor old Australian taxpayer: ‘Well, you stump up for it. We’ve got all the money from the GST out of you and it’s not enough.’

Since the advent of what I call the McGinty-McTiernan government, 18,000 public servants have been employed in Western Australia. A couple of former leaders of the Labor Party who were just frontmen found that they were dispensable. Change them over and you have a revolving-door process of state Labor government leaders. They build up their superannuation to a point where it cannot be improved and they get feelings of disability. Premier Gallop got worried about himself, for which he had good reason: about five or six of his ministers were going to get the chop after there had been accusations of corruption. They were all in the Burke faction. But the fact is that these people have a fundamental responsibility. It is not a blame game.

Let me say something about private industry. As a youth, I had the opportunity to apply for a cadetship with the scientific section of CSR. At that time this was a common practice, as there were no free universities and no HECS. You got a Commonwealth scholarship; otherwise, your parents had to put you through university. Industry stood up, as did state governments—in particular in forestry, as I recollect—and it provided cadetships. Cadetships meant that young people could go to university on a small wage, which was provided by their employer, and be trained. The employer paid the universities fees, whether they were government or private sector, but during the so-called holidays you went back to work for your employer. It was a wonderful scheme.

Then everybody got lazy when Whitlam said, ‘We’ll have free university training.’ You do not get free apprenticeship training; you get a wage that is usually inadequate—and, of course, you pay for your TAFE fees. That is how the working class is treated. We have seen argument after argument from the frontbench of the Labor Party that the elite, the people who go to university, need special treatment. But where is a state government dentistry cadetship? I hope the next speaker on behalf of the Labor Party, if they have one, will explain to us where they are.

Photo of Brendan O'ConnorBrendan O'Connor (Gorton, Australian Labor Party, Shadow Parliamentary Secretary for Industrial Relations) Share this | | Hansard source

There are plenty more to come after you.

Photo of Wilson TuckeyWilson Tuckey (O'Connor, Liberal Party) Share this | | Hansard source

I am pleased to hear it. I hope the next one who stands up to speak will tell us how they are going to deliver their policies. When it comes to the blame game, Paul Keating—who, as I said, might one day become one of their icons—said that whenever you have to give money to state governments make it specific. I plead guilty that our choice was to do otherwise. We took the political pain for the GST and gave it all, without conditions, to state governments. As I have said, in Western Australia there are 18,000 new public servants, but nearly all of them are in jobs where they are told, ‘Don’t come tomorrow.’ I will tell you what: they are going to stop that.

I was reading the BRW as I travelled back to Canberra and I found it interesting to see that Australian mining companies have now invested $18 billion in Africa. And I might add that the interest being shown to the mining sector by South Australia, to its credit—and there is no-one here to take that credit—now exceeds that being shown by Western Australia, the great mining resource state, because that state government has gone into lockdown. It cannot approve anything and it worries about everything. The Chinese communist president had to go there the other day to tell it to get its bureaucracy into gear. Fancy an Australian state government having to take advice on bureaucratic management from a communist. We like the Chinese and the man is only demonstrating that modern communism can have a business orientation. But it is pretty rough when one of our nation’s state governments has to be given a touch-up by the president of the communist Chinese about providing the Chinese with the opportunity to buy things off us—because that is all they want to know: ‘Can we buy from you?’ Of course, nothing is happening in Western Australia under that state government.

What are we talking about today when we talk about the blame game? A responsibility of state governments, under our Constitution, is to deliver dental services, but how can they if they have no programs to assist people to access such services? Past governments, Labor and Liberal, from my recollection, just to quote a case, used to employ forestry cadets—and I am sure that the member for Lyons would think that is a good idea, considering his constituency—but no more does that happen. However, when you get down to it, if state governments need workers, such as qualified medical practitioners in their hospitals, what are they doing about it?

I have to say that I am just as highly critical of industry. They thought the taxpayer would pay up. In these green chambers, you can make any promise that you would like to make, but each and every one of them is a burden on the taxpayers—and, of course, the massive union generated growth in wages has only benefited the tax office. When I was a youth, my father paid very little tax. He earned £6 a week, raised four kids and owned his own home. What have we achieved in this country since then? Anyone now in his job has to earn $1,000 a week and that is only half of what they need to keep their family—and those opposite will stand up and say, ‘We want more of that.’

But what are the government doing? They are showing compassion. Paul Keating showed some compassion. He thought he could put up some money for four years to let the states catch up. We thought we could put money to local government for local roads to let the states catch up, but the minute we provided the money they cut back on their contribution to local roads. This legislation is quite simple. What does it do according to the explanatory memorandum? The explanatory memorandum says:

The purpose of the Bill is to amend the Health Insurance Act 1973 ... in order to increase access to dental treatment under Medicare for people with chronic conditions and complex care needs.

These people do not just need a filling. Maybe they should have that before they go to Bali. Maybe they should, because they are struggling families that are forced to earn 100 to 150 grand a year to survive, still notwithstanding the significant reductions we have delivered and the attack of the opposition on people in those wage brackets as some sort of wealthy elite. Everything I hear from the opposition on Work Choices is all about the McDonald’s economy. If you are working at Spotlight or McDonald’s that is the area of their care. But there are a lot of people with similar qualifications earning 150 grand a year in Western Australia working on mines—and we want to go back to the situation where those people are going to be dictated to by trade unionists so that we can lock up our customers from getting product for five and six weeks! I have seen it all. They say, ‘We’d better invest in Africa; we’d better invest in Brazil because you can’t trust Australia.’ Are we going back to that? Is that what we are voting about?

It struck me the other day that people better start giving more value to their vote, if the polls are correct, than selecting a babysitter. You would be very careful about who you selected to look after your kids, yet people seem to think they can offer the management of their country to a mob of people whom I referred to the other day as including an inexperienced public servant, an ambulance chaser and a rock singer.

This is good legislation and it is worth while, and it is going to help people in chronic need. It is not taking over responsibility of state governments. (Time expired)

8:24 pm

Photo of Dick AdamsDick Adams (Lyons, Australian Labor Party) Share this | | Hansard source

We will move on to the Health Insurance Amendment (Medicare Dental Services) Bill 2007and the dentists all suffering under Work Choices legislation. Dental services have been an issue for nearly 12 years now. In Tasmania, particularly in the seat of Lyons, I have hundreds of constituents who just cannot get in to see a dentist, let alone afford dental treatment, and it is severely affecting their health.

This bill amends the Health Insurance Act 1973, which of course was a Labor bill, in order to provide for the expansion of the government’s Medicare dental program for people with chronic conditions and complex care needs. It also puts a monetary limit on Medicare benefits for dental services to be introduced for eligible patients. The limit is $4,250 over two consecutive calendar years, and it will be set out in a ministerial determination made under subsection 3C(1) of the health insurance amendment.

Medicare benefits will be paid for the supply of dental prostheses, such as dentures, under the new dental items. The government’s Medicare dental program for people with chronic conditions and complex care needs was initially established in July 2004 and has been hampered by extremely low take-up due to complexity of referrals and the high copayments involved. It is very difficult for people to get hold of these benefits.

The government announced in the last budget that it would pour an additional $377 million into this failing program, probably knowing that it would not be spent. The budget announcement included an annual diagnostic consultation and increased the maximum benefits available for dental treatment to $2,000 in benefits for each calendar year. The government subsequently announced that eligible patients would have up to $4,250 worth of Medicare funded dental treatment over two consecutive calendar years, increasing the cost of the program to $384.6 million over four years—but referrals, copayments and restricted eligibility would all remain.

There will be no impact on the cost or availability of dental treatments to the wider community, including families, from this bill or the policy changes that underpin it. No assistance will be provided to most of the 650,000 people on public dental waiting lists. When the Howard government scrapped Labor’s Commonwealth Dental Health Program, it could quite easily have continued it. There was a need; the assessment was that there was a need, and it should have continued. It led to the public dental list blow-out, and there has been a sharp deterioration in dental health standards among low-income people and, of course, young children. Despite the states and territories more than doubling their funding to public dental care since the CDHP was abolished, the Howard government has constantly asserted that the states and territories are totally to blame for Australia’s dental care crisis.

The Howard government’s initiatives on dental health have been limited to subsidies of 30 per cent or more for those people with private dental health insurance and the ineffective Medicare dental program for people with chronic conditions and complex care needs. The targeting of the existing program to people with chronic conditions and complex care needs has severely limited the uptake of the program to date, with only 7,228 Australians helped with their dental care between July 2004 and June 2007. While I am very pleased we have been able to help those people, that is only just over 7,000 out of 650,000. The need for high copayments from patients and complex referrals from GPs have been additional impediments that have stopped more people taking up this program.

Nationally, the rising cost of dental care is a major cost of living issue for families and has contributed to a national dental crisis which has left one in three Australians avoiding dental care because of the cost. The increase mentioned earlier to $4,250 worth of Medicare funded dental treatment over two consecutive calendar years 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 able to take up this assistance. So there will be no impact on the cost or availability of dental treatment to the wider community, including families, from this bill or the policy changes it underpins. No assistance will be provided to most of the 650,000 people on public dental waiting lists.

Labor have been highly critical of the program and we indicated at the time of the budget that, in government, we would be likely to use the increase in funding to invest in dental care for the benefit of ordinary Australians. Australia is facing a crisis in dental care, with one in three people reporting that they avoid dental care due to the cost and with more than 650,000 on waiting lists for public dental care, some waiting years for treatment. In recent years we have seen a dramatic increase in kids’ tooth decay and up to 50,000 hospitalisations annually for preventable dental conditions. People are ending up in hospital because their teeth have gone bad. Talk about a health system that needs some help! But it is not only young people; most people on age pensions and self-funded retirees have been leaving their teeth out of their health care with disastrous results. I have had a number of cases recently where people have given up on public dental waiting lists and are trying to access private ones, but are taking out loans to have their teeth done. Others simply cannot eat anything hard. This is an awful situation.

One of the first acts of the Howard government when it came to power in 1996 was a shameful decision to abolish the Commonwealth Dental Health Program, ripping $100 million from public dental health. The state and territory governments have doubled their investment in dental health care over the past decade, but John Howard and Tony Abbott continue to blame the states for Australia’s dental crisis. The impact of the increased need for health services for dental health is an appalling state of affairs and one that can only be laid at the feet of the Howard government—and, if that was not bad enough, it has ripped money out of the health system as well. The Howard government has failed to meet the rising costs of providing health care by providing adequate funding and so the states have had to find and spend more money.

My electorate has been affected harshly by this. Because of the withdrawal of dental and health funding, the people of Lyons are suffering. Because of the lack of funding from the Howard government, the sustainability of many services in Lyons is under threat. Dental services are at a bare minimum. A lack of health funding has resulted in the communities of Ouse, Beaconsfield and Rosebery facing closures, and some elderly people have had to move away from their local area. Dental services across the electorate of Lyons are lacking. Many people must travel to major centres for dental and health care. There is no reason why the provision of dental health services could not be undertaken through a multipurpose health care approach to health care delivery. Is the Howard government interested in this approach? No.

I have been working with a number of communities concerned about health services, particularly the Ouse community. This community wants to extend services in its local area, not close them down. This community wants to build independent living units and continue to provide additional health promotional services. I see no reason why dental services could not be added to the list. On 21 August I presented my policy ideas to that community for discussion, sending information to the Mayor, Deirdre Flint, and to the Chair of the Medical Subcommittee of the Central Highlands Council, Ann Jones. The ideas for discussion included using the concept of multipurpose health centres for care delivery in regional areas of Tasmania, particularly in Lyons. Labor developed the idea of the multipurpose health centre and, in fact, the first one was built in my electorate, at Oatlands. The Howard government has failed to be innovative and extend this concept in any way. The Howard government has been too busy taking away funding from the dental health scheme to worry about health in regional Tasmania. My ideas presented for discussion also raised the issue of improving transportation, undertaking a comprehensive health needs analysis and improving community education regarding the problems our health system is facing. While Medicare benefits for the supply of dentures is a good idea, it is not much use if you cannot get to the dentist in the first place.

After 11 years of playing the blame game and denying that dental care was its responsibility, in its last budget the Howard government took a small step towards addressing the national dental crisis. Why can’t we have innovation? Why can’t we have multipurpose health centres delivering a whole range of health outcomes and drawing money from state and Commonwealth governments, the community and anywhere else that they can source income opportunities? Unfortunately, this belated and long overdue measure to supply dental care to people with chronic diseases will do nothing for the vast majority of people on public dental waiting lists around the country, nor will it make dental care any more affordable. Labor believes Australia should use its prosperity to help people get the basic dental health care they need and deserve. That is why Kevin Rudd announced in December 2006 that a Rudd Labor government would restore Commonwealth funding for dental care. It is on the table.

Photo of Kym RichardsonKym Richardson (Kingston, Liberal Party) Share this | | Hansard source

Mr Richardson interjecting

Photo of Dick AdamsDick Adams (Lyons, Australian Labor Party) Share this | | Hansard source

I hope your constituents who need dental care know that Labor will deliver. Labor is committed to ending the blame game and working cooperatively with the states to deliver better dental care. Labor will reinstate the Commonwealth dental program to make sure working families can get decent dental care. It is about time what has been ripped out of health and dental care is put back in. It is obvious that the Howard government is incapable of understanding why this should happen or doing anything about it. This is a tired government. The speaker who came before me, the member for O’Connor, did not mention anything about the future; he just attacked his own minister at the table. His speech was that of a member of a tired government and of a government lacking any direction. I think it summed up the government quite well. He did not look at the bill or offer anything by way of innovation or the broader picture. His mind was locked into other matters. It is unfortunate that we have a government that has failed. It is a tired government that has run out of time. It is lacking any policy direction or policy ideas. It is time for new leadership in Australia; it is time for a Rudd Labor government to restore the balance in both health and dental care.

8:40 pm

Photo of Kym RichardsonKym Richardson (Kingston, Liberal Party) Share this | | Hansard source

I rise today in support of the Health Insurance Amendment (Medicare Dental Services) Bill 2007. I am very proud to stand here today and contribute to the debate on this very important measure, which was introduced by the coalition government in the last budget. Since my election three years ago, I have come to understand a problem I did not really know existed before the good people of Kingston brought it to my attention: the problem of the South Australian state Labor government completely dropping the ball when it comes to publicly funded dental treatment.

State governments are responsible for the provision of state funded dental services and some of our most vulnerable and disadvantaged citizens rely on them to provide this service. I do have one state government funded dental service in my electorate of Kingston; however, its complete lack of resources and appropriate funding from the state Labor government has led to an influx of complaints to my electorate office like nothing before.

Given the vulnerability of a number of these cases, my staff and I did all we could to assist them and, in a number of situations, it was simply the case that misunderstandings had occurred between the service and the patient because no-one had the time—and the centre certainly did not have the resources—to listen to the full story from the patient. My staff and I used to contact the service on a case-by-case basis to try to resolve the individual problem or misunderstanding. But not long before we announced the federal dental scheme in the last budget, the state Labor government and one of the local state Labor members instructed my local state government funded dental service that they were not to speak directly with me or my staff, leaving the constituents of Kingston with nowhere to turn once they were abandoned by the state Labor government. I was very worried for my constituents, who were left with no-one to rely on for assistance with their dental health other than a state Labor government who simply did not care about their plight. I wrote to both the federal Minister for Health and Ageing and the Prime Minister, explaining that, while this was a state issue, the people of my electorate were suffering and asking that they please do something to address the issue.

This government—the Howard government—responds to the needs of the Australian people. I was thrilled, therefore, when this announcement was made on budget night. This bill seeks to introduce that very important budget night announcement. It will increase access to dental treatment under Medicare for people with chronic conditions and complex care needs—the young and the old. From 1 November 2007, new items will be introduced onto the Medicare Benefits Schedule, which will enable patients to receive $4,250 in Medicare benefits over two consecutive calendar years for dental service. Importantly, though, this bill and this program go even further. The amendment will also allow Medicare benefits to be paid for the supply of dental prostheses, including dentures. This measure is vital for older Australians who rely on their dentures and many of whom suffer great discomfort and fail to eat proper and balanced diets because of the pain caused by inappropriate dentures. This measure is possible only because of the strong and disciplined economic management of the Howard government—strong economic management which is beyond the grasp of our Labor state governments.

It is that failure of Labor state governments to grasp the basic principles of disciplined economic management that has meant state governments cannot afford to provide the basic services they are responsible for like hospitals, roads, public transport and, in this case, basic dental services. It is the state Labor governments’ failure to grasp basic principles of disciplined economic management which has meant our frail, sick and elderly have been long-suffering victims of failing state dental systems. Above all else it is the failure of state Labor governments to manage their budgets—as would be the fear with a federal Labor government, if Rudd were to be successful, with federal Labor’s poor financial track record—that has made this measure and therefore this bill so very necessary.

Members opposite will stand here and whinge and complain about the abolition of dental assistance to the states in 1996. But this government, under which more funding has been handed to the states than ever before, inherited a $96 billion Labor debt when it came to power in 1996. And we had to make some tough spending choices to pay that back. The abolition of dental assistance to the states was this government telling the states that it was simply not going to pick up their slack anymore. The time had come for the states to pay for that which they were and are responsible for.

Then came the GST. This year the South Australian government is expected to receive $3.9 billion in GST revenue. This federal government mistakenly believed that when the states started receiving their GST windfall they would actually start providing decent levels of service in the areas they were responsible for. But, when it came to trusting Labor premiers with money, we were very wrong. To this day the state Labor governments are letting down the constituents of their states and still failing to provide basic levels of service.

This brings me to why this bill is so very necessary. The federal government can no longer sit back and watch as Australians suffer at the hands of these irresponsible state Labor governments. Too many sick and elderly Australians were suffering because the states would not provide a decent dental service, so once again we the federal government have been forced to step in and pick up the slack. Over the next four years this measure is expected to cost $384.6 million across the entire nation, and yet the South Australian government has effectively told the South Australian people that it cannot possibly find enough money in its $3.9 billion in GST revenue to provide a decent dental program. That said, this government manages to find the money for things like a tramline extension in the city which no-one wants. You really do have to question the South Australian state Labor government’s priorities.

Nonetheless, the residents living in the southern suburbs in the electorate of Kingston, South Australians in need—and, in fact, all Australians in need—will now have access to a decent and effective program which will provide for their dental health because of the hard work, responsible economic management and correct priorities of the federal government. This is yet another ever-present reminder of the fact that the Australian people simply cannot trust Labor with money. No Labor government, state or federal, can be trusted with money as all have a poor financial track record. Fortunately, we do not have a federal Labor government at this time. Surely we all hope that that does not occur. Fortunately, as we do not have a Labor federal government, we can afford to bail out the Labor states over and over again. In the interests of the Australian people and the fine people of Kingston, who I am proud to represent, I commend this very important bill to the House.

8:51 pm

Photo of Brendan O'ConnorBrendan O'Connor (Gorton, Australian Labor Party, Shadow Parliamentary Secretary for Industrial Relations) Share this | | Hansard source

I rise to speak to the Health Insurance Amendment (Medicare Dental Services) Bill 2007 and to raise my concerns about the way in which the government has gone about looking after people in the dental health area. Having listened to the member for Kingston suggest that a state Labor government is at fault for almost everything in this world, I have to say that what he said is a bit of a joke. In fact, I would expect a member of the government in this House, a member who said he was concerned about the constituents of Kingston, to front up to a minister of this government, not a minister in the chamber in South Australia, and ask, ‘Why did this government’—and this is a fact—‘abolish the dental scheme that Labor introduced well before the election of 1996?’ Why hasn’t the member for Kingston even considered talking to the Prime Minister or the Minister for Health and Ageing and asking them to make sure that the constituents of the electorate of Kingston are looked after in the dental health area?

All he has managed to do in the last 10 minutes is talk about another level of government and talk about the problems that he says are the concern of state legislatures. The reality is that in the end the member for Kingston has no regard for the dental health needs of the constituents of his electorate. The reality is that if the member for Kingston were to concern himself more with the dental health concerns of his constituents he would be asking the Prime Minister why—and this is a fact—Labor’s dental scheme was abolished in 1996, why the 600,000 beneficiaries of that scheme were no longer beneficiaries and why there are 650,000 people now on waiting lists. There is no point in the member for Kingston coming in here to tell this community, via this chamber, that after 10 years the government has chosen to introduce a bill on dental health and that it is okay as the last 10 years did not matter. That is effectively what has been acknowledged here today by the government. The government has introduced a bill that acknowledges that fact. The member for Kingston is leaving the chamber. He does not want to listen to this debate. He comes in here with a speech written by somebody—I do not know whom—in which he wants to blame other governments. If only he were a vigilant member, if only he were to concern himself with the concerns of the thousands of constituents in the electorate of Kingston who have been queuing up and waiting for years for their dental problems to be attended to and if only he had listened to this debate, but he has walked out of the chamber—he has now left the chamber after giving his little rehearsed speech.

The reality is that for 10 years this government has failed to attend to the dental health concerns of this nation. We know that the last Labor government had in place a dental scheme that actually attended to those concerns. Indeed, the fact is that in the last 10 years the Prime Minister and the ministers in turn responsible for this particular area have refused to accept any responsibility whatsoever for it. They have failed to accept that it is their responsibility, in conjunction with the states, to look after people’s dental health.

This bill will in some way attend to the concerns of the people in my electorate of Gorton. I have people, and I am sure you do as well, Mr Deputy Speaker, who have been waiting for some years to have basic dental needs attended to. Because this bill is going to provide insufficient support in this important area, Labor will not support it. But this bill also underlines the fact that there has been no support by this government from 1996 until now. The basis upon which the government has failed to support the nation’s dental health was that supposedly it was not its responsibility. The government was lying then or it is lying now when it says it did not have to attend to such things. This bill, which proposes to commit $384 million over four years, is welcome but has been a long time coming and there are still so many other things that the government must attend to.

We know, and I think the community is becoming increasingly aware, that dental health is critical. Poor dental hygiene, poor oral health and related problems not only affect people’s teeth and gums but indeed have the potential to affect people in so many other ways such as the compounding chronic conditions of diabetes and cardiovascular disease and cancer. So, looking at the health area holistically, any doctor, whether it be a dental specialist or a general practitioner, would say that if a country did not spend sufficient funds and provide sufficient resources to allow people to have proper dental health care then there would be consequences in other health areas. The fact is that this is a very belated effort by this government in the shadow of an election to introduce a bill that goes to dental services, it having denied its responsibility for a decade.

So, while the member for Kingston and other members of the government can blame the state governments all they like, it is incumbent upon government members, not only opposition members, to tell ministers and the others in the executive—and, indeed, the Prime Minister when he is not consumed by his own ambitions and his own survival—that they must listen to the community in each electorate that has been crying out for support in this area. There has not been any effort by government backbenchers to put any pressure whatsoever on the executive to have it attend to this very important area of public policy. I believe that the member for Kingston and other members who have spoken so far on this bill have been disingenuous in their efforts to ensure that funding is properly provided for this area. I have no complaint with their criticising state governments where it is due, and I have no complaint with their criticising state governments over this area, but to solely blame state governments for a lack of provision of dental health services is absolutely absurd. Indeed, the job of federal members in representing constituents in this House is to tell the executive to attend to the concerns of their constituents. I know that in my electorate and I know, from what other members have told me, in other electorates dental health is critical to so many people: it has been a policy failure of this government and the government has been in denial. The government has been so for more than 10 years and now, at the death knell and in the shadow of an election, it is choosing to introduce a dental health scheme. 

Debate interrupted.