House debates

Wednesday, 19 September 2012


Dental Benefits Amendment Bill 2012; Second Reading

12:41 pm

Photo of Bob BaldwinBob Baldwin (Paterson, Liberal Party, Shadow Minister for Tourism) Share this | | Hansard source

I rise today to speak on the Dental Benefits Amendment Bill 2012. Although the coalition will not be opposing the bill at this stage, we believe there should be an inquiry with respect to dental issues, for this bill on its own is not the whole story. What the government has not trumpeted is its announcement that Medicare benefits under the Medicare Chronic Disease Dental Scheme will close to all patients on 1 December 2012. There might be people out there thinking the government is replacing one scheme with another and asking, 'So what's the big deal?'

Unfortunately, the big deal is that Labor's new plan will not start until 2014. This means that from 8 September 2012, when no new services under the existing scheme will be provided, it will be 13 months before children receive government assistance with their dental care, and 19 months for adults. In a peak of political cynicism at its worst, 650,000 people will be left on the public dental waiting lists—many of them with chronic disease, who are most in need of dental treatment and who were relying on the MCDDS to help pay for their dental treatments, without any assistance in the meantime. The department's notice to patients reads:

Patients will need to meet the full cost of any dental service provided on or after 1 December 2012 - Medicare benefits will not be paid for these services.

The government has not even listened to the Australian Dental Association, which raised concerns that some patients will not be able to complete their necessary treatments by 30 November, which could lead to dire circumstances for these people.

You have to ask yourself: why does the government need to introduce a bill now for a scheme that does not start until 2014? You may have noticed that the Labor government have decided to adopt the smoke-and-mirrors approach—that is, they make an announcement they think will distract the electorate or a stakeholder from what they are really up to, which in this case is to make a saving on the backs of those who are most in need of dental treatment. We know it is political cynicism because the government has passed up all bipartisan efforts to refine and improve the MCDDS, including a process for providing high-cost items, such as crowns and bridges. These were just rejected.

Under this scheme, there are two parts—one for children and one another for low-income adults and those who live in rural and remote areas. This bill provides for a means-tested family tax benefit part A entitlement for children aged between two and 17 years, which seeks to target the provision of subsidised dental care for children through private dentists with a reduced $1,000 capped benefit over two years to eligible children. Greater access to dental care for children is always a welcome aspiration. Unfortunately, one only needs to look at the GP superclinics program to see what happens with Labor promises. Only 27 of the promised 46 have been delivered. And I have to ask, where are the much-vaunted early psychosis prevention centres? Not one of the promised 16 has been delivered—not one.

The coalition's Medicare Chronic Disease Dental Scheme, in which 80 per cent of services have been provided to concession card holders, stands as a monument to our ability to deliver extra investment and dental health. Indeed, the coalition is the only party to deliver a Medicare dental scheme that enables Australians to access treatment, despite all of Labor's promises.

There can be only two reasons for the government wanting to abolish this scheme. The first reason is that the scheme was one of the major health initiatives of the Howard government and was introduced by one Tony Abbott. It has been a tremendous success in improving access for treatment, providing $4,250 in Medicare dental benefits over a two-year period to eligible patients with chronic health conditions.

Do not take my word or it. Ask the one million patients, since 2007, who have taken advantage of this scheme. They have had over 17 million treatments, which they would have had to pay for themselves or, worse still, continue to suffer. Labor's spin on this has been that the coalition's MCDDS has seen expenditure blow-outs. Yet the average claim per patient, according to the Department of Health and Ageing, is only $1,716. That is 40 per cent of the scheme's allowable limit of $4,250.

The second reason for closing the scheme is that accounting tricks alone will not be enough in the Gillard government's quest to find their elusive surplus. They will have to make real cuts. However, they believe that if they make future promises no-one will notice these cuts. We recently had announcements on the National Disability Insurance Scheme, and now there is this Dental Benefits Amendment Bill. The problem for Labor is that the public have begun to ask: where is the money coming from to fund the government's $120 billion black hole?

The government is not even pretending to know. Minister Plibersek ventured that this scheme was not even in the forward estimates and that 'We need to fund a new $4 billion.' According to the Prime Minister, the announcement of the dental scheme was actually about a 'large saving'. When you take a second look at what the government's scheme is likely to achieve, in the cold light of day, it does not look that impressive. Firstly, it will be set up by funding dental care through state governments. The aim is to provide access to public dental care for low-income adults and those in rural and remote areas. However, unlike the MCDDS, it does not target patients in most need of dental treatment, namely those with chronic disease.

As Mark Foster, Chief Executive Officer of Hunter Medicare Local, says: 'Disadvantaged patients may be able to access care through public dental clinics but waiting lists may be an issue for patients with urgent problems.' He went on to state, 'While there were some issues with the old program, it is disappointing to see it scrapped and to wait for 19 months until the new one is in place.' If the government cared as much about dental care as they claim, they would have—as the Association for the Promotion of Health has called for—increased access for dental care for children but kept the existing MCDDS in place for adults. They could have tightened the criteria and provided additional support, through Medicare Locals, to dentists for improving compliance with program guidelines until such time as the program could be modified.

The bill also does not address the problems there are in accessing trained dental professionals, particularly in rural and regional areas such as in my electorate of Paterson. I appreciate it takes time for such dental infrastructure to be put in place. But where are the guarantees or independent assessments that such capacity will be in place to provide timely treatment for all those currently on public dental waiting lists?

Capacity increases could be achieved through the Flexible Grants Program for dental infrastructure; however, this will not come online until 2014. Someone has to ask: how many additional patients will be treated when the scheme comes into operation in 2014? The coalition estimates that the unfunded cost of it will be another $225 million. The lack of preparation seems to demonstrate that this dental benefits scheme will be yet another unfunded promise. The unfunded costs for children in this bill are estimated to be $2.7 billion, with adults covered under the scheme having an unfunded cost equivalent to $1.3 billion—all part of the $120 billion unfunded black hole.

If it were just about politics, that would be one thing. However, what this government often fails to realise is that its policies affect real people. I recently received an email from Marian Sampson, of Nelson Bay, who is a parent and carer. She told me about Brendan, her 15-year-old boy, with multiple chronic diseases, who is a long-term cancer survivor. When his chronic conditions are managed, she says that he is a healthy, contributing member of the community. His treatment has included extensive radiation to his head and neck. The price of this life-saving radiation has been that, on the left side of his jaw, his teeth are crowns only. As a result of chemotherapy and radiation, he has a serious immune deficiency and a bone structure equivalent to an elderly person—and at 15 years of age.

'What has this got to do with dental care?' you might ask. No dental surgery is set up to deal with someone with Brendan's conditions. Yet an infection when treating his jaw, or even a simple clean, could lead to a long period of hospitalisation or worse. Blood poisoning could kill him as a result of his immune deficiency and adrenal insufficiency. Due to these issues Brendan goes to a special clinic at Sydney's Westmead Hospital, as do all the children who have had bone marrow transplants. Without the MCDDS, kids like Brendan could end up costing more, through long periods of hospitalisation and other treatments. Marian says, 'Sometimes the cost of dental treatment for the chronically ill can be a cost saving rather than a cost.'

Sadly, Brendan is not an isolated case. Josh Oram, a constituent of mine from Forster, wrote to my office saying that in 2008 he had been diagnosed with a cancerous tumour in his jawbone that had never been seen before in this country. This led to his having a 30-hour surgery, where half of his jawbone was removed and replaced with a fibula or tibia bone and the calf muscle of his right leg. Undergoing such a challenge would have exhausted most people, but this government has presented Josh with yet another challenge. Because of his surgery and follow-up radiation treatment, Josh requires regular dental treatment every few months and has been receiving this. However, Josh has now been told that he only has two months of treatment left until the government's dental benefits scheme comes into effect. Is it any wonder that Josh says he feels that cancer patients are regarded as second-class citizens?

Margaret Rylands from Forster, in my electorate, has diabetes, which she has endured for 52 years. With her husband having had to undergo five bypass operations in recent years, they have little money coming in. They both have problems with their teeth, and Margaret now fears that without the MCDDS they will have little prospect of being able to afford to fix them. She said that the closure of the dental scheme was very unfair. I ask the government to take on board the desperate situation of having to forgo necessary dental treatments that people like Margaret, Brendan, Josh and thousands of others could find themselves in with the end of the MCDDS. This is just a handful of the personal challenges that have come before my office. Their situations remind us that the division between general and dental care is an artificial one.

Mark Forster, Chief Executive Officer of the Hunter Medicare Local, explained to me that dental problems can have a broad range of effects on patients with chronic diseases. They can affect nutrition, which is particularly important for patients with chronic diseases. Chronic infections have a deleterious effect on general wellbeing, which can have a significant impact on patients already unwell due to chronic disease. Dental infections can spread infection through the bloodstream, which can have a significant impact on patients already unwell due to a chronic disease. Surgery to have a prosthesis inserted will normally be delayed until a dental infection is resolved to avoid these complications. There can be significant delays in accessing this care through public clinics. Patients may suffer from severe joint pain and incapacity or face the risks associated with delays in cardiovascular surgery.

It is the need to help people such as Brendan and Josh that makes it so important that governments do not waste limited resources. As my colleague Andrew Robb pointed out in a speech last Wednesday, on the sad case of a constituent with Pompe disease, 'In 2007-08 Australia ranked 10th best in the world in terms of wastefulness in government spending, but by 2012-13 Australia had slumped to 48th in the world.' Today it is those who rely on government assistance when they find themselves in desperate situations that they have no ability to control, such as Margaret, Brendan and Josh, who are the human faces paying the Labor price for this government's profligacy. Chasing short-term savings in a quest for the ALP's elusive surplus, even when those savings are likely to create even greater expenses in the longer term, is bad policy from a seriously bad government.

Without the pink batts fiasco, the NBN cost blow-outs, the Building the Education Revolution rorts—and the list goes on—this government would not have had to leave thousands of Australians who badly need urgent critical dental care without that dental care due to the closure of the coalition's Medicare Chronic Disease Dental Scheme. As I said, this is bad policy from a bad government which affects those most in need of support in our community. I urge the government to rethink its position. Leaving people without access to supported dental programs for 14 months is criminal in itself.

12:55 pm

Photo of Laura SmythLaura Smyth (La Trobe, Australian Labor Party) Share this | | Hansard source

I am very pleased to contribute to this afternoon's debate on the Dental Benefits Amendment Bill 2012. I begin by responding to some of the points made in the member for Paterson's contribution. At one point he referred to the government and its consideration of its policies as they affect 'real people'. I should put on record that, in the member for Paterson's electorate, the real people who will be affected by virtue of the announcements made last month by the government in relation to dental health and by virtue of the arrangements in the bill before us today, are some 18,000 children, who will have access to better dental programs as a result of this measure, and roughly some 9,500 families.

When we consider the impacts of this government's policies on real people, we are very clear about our desire to provide better dental health care and better health care overall for the very many people of whatever political persuasion in electorates right around this country. The member for Paterson's electorate, my electorate and all electorates stand to benefit in a very considerable way when it comes to the measures that have been contemplated in the bill before us and in the package of dental health measures announced by the Minister for Health last month.

The member for Paterson also mentioned 'some issues' in relation to the CDDS, the Chronic Disease Dental Scheme. I can confirm that there were certainly some issues with the scheme. The member for Paterson will know, as all members in this place will know, that the government have maintained a policy of shutting down that flawed scheme for some time, in fact since we were elected in 2007. That is because that scheme is fundamentally flawed. It is not means-tested, which has meant that people on extraordinary incomes can get access to over $4,000 worth of free dental care. It is not targeted, which means that patients can get things like caps, crowns and often cosmetic work at the taxpayers' experience, while those who actually severely need dental assistance and dental care may not have access to dental health care.

It was much reported, appropriately, that the cost of the Chronic Disease Dental Scheme blew out by an extraordinary amount. When the Leader of the Opposition was health minister, he estimated that the scheme would cost around $90 million a year, but it has ended up costing us $1 billion each year. Yet we still see, as I will come to shortly, an extraordinary number of people who still face lengthy delays for dental care. We still see circumstances where the dental health of children across Australia leaves much to be desired. It is for those reasons that we have sought for a long period of time to shut down what is a fundamentally flawed scheme and a poor piece of public policy. There have been more than 1,000 complaints lodged about the CDDS. So, when we talk about 'some issues', in the words of the member for Paterson, it is something of an understatement in relation to this very flawed scheme. There has been widespread misuse of the scheme and it has taken us a great deal of time to try to resolve these issues and arrive at a much better set of arrangements as are contemplated in this bill and in the dental package announced by the minister last month.

This is an extremely important initiative, and the bill before us today contemplates a very important part of the $4.1 billion dental reform package, which includes a commitment of $2.7 billion for around 3½ million Australian children who will be eligible for funded dental care, and a commitment of $1.3 billion for almost 1½ million additional services for adults on low incomes, including pensioners and concession card holders and those with special needs, who will have much better access to dental health care in the public system as a result of these measures. And, notably, it includes a commitment of $225 million to expand dental services for people in rural, regional and remote areas. As I will mention shortly, some of those people living in rural and remote areas face very significant deficiencies when it comes to dental health care currently. It is entirely appropriate that the measures, both in this bill and in the package as a whole, respond to those concerns.

In my electorate the measures in this bill and in the overall package will reach more than 20,500 children and around 11,000 families. As someone who goes out and visits schools regularly and meets with children and with many young families who are in my growing electorate, I know very well that this will be extremely well received. It will give a great amount of assistance to parents who might otherwise have to delay or possibly even defer dental treatment for themselves or their children because of the expense associated with that.

In this bill the particularly important measures relating to children are emphasised by some of the findings of the Australian Institute of Health and Welfare's report, Oral health and dental care in Australia: key facts and figures 2011, and it really does make for sobering reading when it comes to the dental health of children and young adults in particular. Amongst the many things that it reveals, the report finds that almost 20,000 children under the age of 10 are hospitalised each year as a result of what should be entirely avoidable dental issues. For children who face hospitalisation it is traumatic, it means that they are likely to have had to endure significant health problems prior to getting to hospital, and it is disruptive for them and their families—and it is a cost for our health system to have increased rates of hospitalisation in circumstances where dental health measures which are fairly basic could have been taken. That is one of the many reasons why prevention in relation to dental health is so important.

The report by the Australian Institute of Health and Welfare estimates that by the age of 15, six out of 10 children will have tooth decay. That is an incredible rate. Very importantly, the report also considers financial barriers which prevent people from visiting a dentist. It found that the proportion of those who avoided or delayed a visit to a dentist due to cost was 28.2 per cent in 2010.    For children aged between five and 14, this was around 14 per cent on average. But if you look at the situation of children aged between five and 14 in families with a household income of less than $60,000, the proportion ranges between around 15 per cent and over 31 per cent. That means that in some of our lowest income households—some of the very poorest Australians—almost a third of children do not get to a dentist or do not see a dentist in a timely fashion. That is entirely unacceptable and that is the reason this Labor government has prioritised real action on dental health, particularly for children and particularly for those people who are on low incomes.

In the general population, the Australian Institute of Health and Welfare's report found that around 19 per cent of people would have a lot of difficulty paying a $150 dental bill. This figure is significantly higher in relation to households with an annual income of less than $60,000. This bill, and the package of measures announced by the government last month in dental care, respond directly to this issue of financial restrictions meaning people defer, delay or avoid entirely taking their children to the dentist or going themselves to the dentist.

Another of the things considered in the report is that, while untreated decay and fillings are at similar rates across income ranges, there is a big distinction between the haves and the have-nots in our society when it comes to missing teeth. The report found that if you earn more than $60,000 a year, you have, on average, seven more teeth than Australia's poorest people. That is a terrible statistic. The report also reveals that you are more likely to be missing teeth or facing dental issues if you live in outer regional and remote areas, particularly if you are one of Australia's poorest people.

I encourage members to look at this report in the context of the dental package that has been announced, because these really are statistics that bear reading by members in this place when they are considering health in Australia and preventative health, particularly preventative dental health. The report paints a very stark picture of the difference between the dental health of those who are on higher incomes and those who are on lower incomes, children and those who live in remote parts of Australia.

According to the report, around 45 per cent of 12-year-olds had decay in their permanent teeth. In 2007, just under half of children aged six attending school dental services had a history of decay in their baby teeth. These are all precursors for poor dental health and increased dental intervention for adults. All of these things that happen at an early age in dental health have very significant impacts on adults' dental health—and for their general health as a consequence.

I know that when my family arrived here from Ireland we certainly did not have a lot of money, and it was a struggle for my parents to meet the costs of sending three children to the dentist. Unfortunately, I know too well that the same struggle to meet dental bills happens in families right across my electorate and right around the country. It is awful to put parents in the position where they have to forgo or delay dental treatment for their children, knowing that it might be causing discomfort or other illness. It is an absolutely awful position to put parents in. I suspect that it has often resulted in parents forgoing things, and I suspect that it often means that a parent will delay a visit to the dentist because they give priority to their children's health.

This bill starts to respond to all of those deficiencies that we see in children's dental health, and it does so in a very significant way. The package as a whole and the measures contemplated by this bill are targeted appropriately, which was not the case in relation to the Chronic Disease Dental Scheme. These are targeted at people who we know are going to receive the greatest benefit—people on lower incomes, people with children and people in remote and regional parts of Australia. It is appropriately targeted, it builds on the significant amount that has already been committed by this government and it is something that comments from the opposition in this debate and in the broader debate outside this place more generally has not been recognised.

In the budget this year the government committed over $515 million to dental spending, including $345 million specifically to take care of adults on public dental waiting lists. So this money is already committed, and it will be available to state and territory public dental systems from January of next year—just one month after the closure of the Chronic Disease Dental Scheme. It is appropriate to reflect on that in the context of some of the comments made by the shadow minister and others during this debate. This is a very significant investment and it will also mean that some 3.4 million children whose families receive family tax benefit part A, Abstudy, the carer payment, the disability support pension, the special benefit payment, youth allowance, the double orphan pension, or payments under the Veterans' Children Education Scheme or the Military Rehabilitation and Compensation Act Education and Training Scheme will qualify for the new scheme, dental for kids.

The provisions in the bill before us and the overall package mean that families will be entitled to receive $1,000 per child every two years over the life of the package. As I have said before, that means more than 20,000 children and around 11,000 families in my electorate will be eligible to receive these payments. In a growing area of Melbourne where people are trying to make ends meet in the family budget, it is a very significant amount being contributed to dental health care. It will mean a bit more peace of mind for a lot of parents and families who would otherwise struggle to meet the costs of dental care.

This package and this bill reflect an investment in prevention. This government is building on a range of initiatives that it has put in place to focus on preventative health, so that we not only improve the health of our children and adults but we also improve the circumstances of our health expenditure into the future as our population ages.

This is an extremely important package and one that I am very proud to stand and speak on here and back in my electorate. I know that it is currently well received. I know that it will continue to be very well received as parents and as children start to see the benefits of it. Accordingly, I commend the bill and the package of measures to the House.

1:10 pm

Photo of Jane PrenticeJane Prentice (Ryan, Liberal Party) Share this | | Hansard source

I rise to speak on the Dental Benefits Amendment Bill 2012. The coalition supports investment in dental health. When the Leader of the Opposition was Minister for Health and Ageing in the Howard government, he introduced the Medicare Chronic Disease Dental Scheme, CDDS, in 2007, a program of which the coalition is very proud, in terms of it giving access to dental care to those who need it most. This program is now being dismantled by the Gillard government and will be replaced, eventually, with their Child Dental Benefits Schedule and a program for adults that is not intended to start until July 2014—after the next election and 19 months after the CDDS closes.

As a result, we in the coalition are very concerned that many patients receiving treatment under the CDDS will be forced to forgo treatment during this gap period. My office has received many calls from constituents about what services they will be able to receive under their GP care plan and whether they are in danger of being cut, because they are receiving very mixed messages from this government.

The closure of the CDDS has been in the Labor Party's plans for many years indeed. In this instance, it is not another broken promise from the Rudd and Gillard governments. But their reasons for wanting to close down the member for Warringah's dental scheme have been political from the beginning, and it is a political attack on an effective policy which provides up to $4,250 over two years for eligible patients. We are talking about a scheme which has provided approximately 20 million services to over one million patients since 2007.

The government has form when it comes to this dental scheme. In 2008, Labor proposed the Commonwealth Dental Health Program, which it never delivered. The program promised one million services by providing funding to the states and territories. Since that time, it has been revealed in Senate estimates that the Commonwealth did not assess the capacity of the public dental workforce to provide the projected services and the number delivered might have been significantly lower than that promised.

Fortunately, the coalition and the Greens were able to block Labor's plans to abolish the scheme, but there is the fear that this is now a done deal with the formation of the Labor-Greens coalition government. It was the Minister for Health and the Greens health spokesman, Senator Di Natale, who on 29 August announced not only the closure of the CDDS but the unfunded $4.1 billion dental program that is not due to commence until 2014. The government announced then that no new patients—that is, those Australians without a pre-existing GP care plan—would be able to access services after 7 September 2012.

The most prominent concern is where the money to fund the program is going to come from. Australians are right to be concerned, when they have a health minister saying she does not know where the money is coming from and a Prime Minister simultaneously telling the media that the health minister has announced a 'savings measure'. Depending on who you listen to from Labor, this is either a good move or a bad move for the budget. As much as Labor wishes it to be true, it cannot be both an unfunded cost measure and a savings measure, and the health minister has reiterated that the government had previously accounted for the closure of the CDDS—thus, these dental measures are indeed cost measures that are unfunded.

The Labor Party has indicated that it will cost the government $4.1 billion, split into three categories. Following the closure of the CDDS on 30 November 2012, there will be, firstly, the means-tested family tax benefit entitlement for children aged two to 17 years, which will commence in January 2014. This will be 13 months after some children will have lost access to the CDDS. The proposal is to provide a $1,000 capped benefit over two years to eligible children. The government claims 3.4 million children will be eligible and the unfunded cost for this measure will be $2.7 billion.

Secondly, the proposal for adults will not commence until 1 July 2014. This will be 19 months after the CDDS closes. Funding will be provided to state governments for public dental services. Services will no longer be available for adults through private dentists under Medicare. The unfunded cost for this measure will be $1.3 billion. Thirdly, an invitation to apply for funding under the Flexible Grants Program for dental infrastructure—both capital and workforce—will not commence until 2014. The unfunded cost for this measure is $225 million.

The government is rushing this bill through the parliament without having the necessary detail and without the proper scrutiny by parliament, even though it is not scheduled to commence until after the next election. I note that a specific schedule of services, fees and details of how the scheme will be funded is still not available. Even worse, the explanatory memorandum, for billions of dollars of spending, is just three pages long.

There is real concern in the community and with the Association for the Promotion of Oral Health, which the minister has acknowledged, that services for most children will cost less than the proposed $1,000 cap, but—and it is an important 'but'—there will be children on the Medicare Chronic Disease Dental Scheme who will require more services. As it stands at the moment there is no provision to ensure they continue to receive adequate treatment, especially in the period before the bill commences.

I understand that more than 60,000 services have been provided to children through the CDDS. When it closes on 30 November, there will be a 13-month gap for the children currently receiving treatment. These are children in the middle of treatment who will not be able to have their treatment completed by 30 November. With many unable to afford the full cost of private treatment, this will potentially have serious health, economic and social ramifications for these people. As such, it is those families that will have nowhere to turn.

The shadow minister, the member for Dickson, has already called on the health minister and the Greens to explain why these children must suffer for 13 months with unfinished treatment and no certainty of the schedule of services that are to be provided, even if the government actually delivers on its unfunded promise after the next federal election. Going on recent form, it is highly dubious that a Labor government would actually deliver on its promises.

The coalition does have legitimate concerns, and many members have raised their concerns today. The coalition has in the past offered to work with the previous health minister to refine and improve the scheme, including through a process for providing high costs items such as crowns and bridges, but these offers were rejected. As I have noted, we are also concerned about the children who will lose access to treatment on 30 November with the closure of the CDDS. We are also concerned about the children who will not be able to complete current treatment by 30 November. And we are concerned about the unfunded $2.7 billion cost of the measure. Equally concerning is that the schedule of services and fees and other essential details are not available, as the bill is being rushed through parliament. Therefore, the coalition proposes an inquiry with respect to these issues and then reserves the right to consider the findings and then will provide a policy response as required.

There have been claims that there were some dentists rorting the CDDS, and some use this as a justification for its repeal. I would say first that rorting has never previously concerned the Gillard Labor government, despite many warnings, in the pink-batts fiasco, in solar panel subsidies, or in the Building the Education Revolution. However, as a result of these claims, dentists have been pursued for minor and inadvertent paperwork mistakes. Of course, the coalition never supports rorting and does support this in any way. What we do support is a transparent and appropriate audit process to detect fraud and the misuse of taxpayers' funds. In most cases, the dentists being caught by the audit process did provide appropriate services to patients in need but merely did not comply fully with a technical requirement to provide general practitioners with treatment plans and patients with treatment plans and quotations for services prior to commencing treatment. As this was many of the dentists' first interaction with Medicare, you would expect some adaptation problems along the way to occur—teething problems you might say.

The information that we do have available from the Department of Health and Ageing is that the average claim per patient is $1,716, well below the allowable $4,250. Some recent estimates suggest that average cost per patient has fallen to below $1,200 per patient. It is reported that 80 per cent of services under the CDDS have been provided to concession card holders, and the evidence suggests that dental services have been predominantly utilised by low-income Australians. Many of these people would have otherwise been forced to go without treatment or added to the already 650,000 people on public dental waiting lists.

The government's vague promise of providing money to states and territories for public services is not due to commence until mid-2014, still leaving a gap of service provision. There are already 650,000 people on public dental waiting lists. Yet the health minister has said that Labor's plan will only provide 1.4 million additional services over six years. There are significant concerns that the lack of infrastructure, particularly in the public system, will impede the capacity to deliver the projected number of services as promised by Labor. The coalition will move to disallow the closure of the Chronic Disease Dental Scheme to protect patients who will otherwise have to go without treatment for at least 19 months for adults and 13 months for children.

The health minister's recent announcements and today's legislation are a political attack on an effective policy set up by the Leader of the Opposition. I note that the coalition has renewed its commitment to work with the government to refine the Medicare Chronic Disease Dental Scheme and will work closely with providers and the public to ensure that real action is taken in the provision of dental care. We will build on the very proud record of the Leader of the Opposition's previous role as health minister.

Today's measures are not scheduled to come into effect until after the next federal election. The choice at that next election will be to vote for the coalition to provide hope, reward and opportunity for sick Australians requiring dental care.

1:22 pm

Photo of Sharon GriersonSharon Grierson (Newcastle, Australian Labor Party) Share this | | Hansard source

I rise to speak on the Dental Benefits Amendment Bill 2012. Fundamentally, this bill aims to give Australians better oral health, healthier mouths and brighter smiles. It will amend the existing Dental Benefits Act to establish the Child Dental Benefits Schedule. Our government values the importance of healthy teeth and oral hygiene for our kids, ensuring that they do not encounter problems later in life—problems that, if exacerbated, could end up costing them and our economy much more: up to $2 billion per year. What we are debating here today is a great Labor investment in health, one that follows our historic tradition of health reform, including the establishment of Medicare.

As Emma Connors wrote in the Australian Financial Review last month, 'dentistry has largely operated in isolation from the rest of the health system in this country, even though the links are only too obvious to anyone on the front line.' Our government is seeking to put dental services at the forefront and seeking to address these as health issues. We want to create a generation of kids for whom visiting a dentist will be like visiting their regular GP, not a luxury item that many families cannot afford.

The bill extends the age range of those eligible to receive dental care, from children aged two to 17 years of age in families receiving the family tax benefit part A, Abstudy, carer payment, disability support pension, parenting payment and other social security payments—around 3.4 million kids in families earning less than $112,000; those are the people who will benefit. Current legislation provides dental checks for teens aged between 12 and 18 under the Medicare Teen Dental Plan.

This bill will replace that plan with the Child Dental Benefits Schedule, ultimately providing more services to many more children, with the Commonwealth taking on primary funding responsibility for basic children's dental services. Basic care will include such services as check-ups, cleaning, scaling, fluoride treatment and fillings. The services will be established under the Dental Benefits Rules, to be established at a later date, which will provide basic dental prevention and treatment services up to $1,000 for each child over a two-year period. We are strategically and fairly targeting low- and middle-income families who have gone for too long without adequate dental care. In my last newsletter I noted that, according to the Hunter Valley Research Foundation, who have been doing a wellbeing survey for some years now, more than 20 per cent of Hunter residents reported dental problems that had gone untreated in the previous 12 months—one in five people who do not attend to needed dental treatment. That is not good enough, but we have now taken these important steps to a better dental health system in Australia.

In addition to services for children, $1.3 billion of this funding will deliver 1.4 million extra services for those on low incomes, pensioners and those with special oral hygiene or oral health needs. The $2.7 billion Child Dental Benefits Scheme is part of our Labor government's $4.1 billion dental reform package, which was announced in August and funded over six years. We want to make it just as easy to visit the dentist as it is to visit the doctor for families, and we want to make dental care accessible to those people in the community who require it the most.

This package comes in addition to the $515.3 million public dental blitz that we announced in our 2012-13 budget. As we know, there are over half a million Australians on dental waiting lists, with many waiting for over a year to receive treatment. As a nation that prides itself on its health outcomes, this can be dramatically improved and we are moving towards that. By getting these people treated as soon as possible we are preventing problems from becoming exacerbated and escalating into something with more serious health implications down the track. The President of the Australian Dental Association, Dr Shane Fryer, has said that 'if dental care can be provided to children then their long-term dental health will be significantly improved'.

Our federal Labor government is boosting the public dental service workforce by funding additional training and improving infrastructure for practitioners in non-metropolitan Australia. We have stated this is a priority for our government and we are pleased that progress is being made. For too long there has been a city/bush divide in Australia when it comes to health care, and our government's reforms aim to bridge that gap through relocation grants and upgrades of dental facilities in those areas that require it.

This funding also provided $10.5 million to assist in the promotion of oral health, as was recommended in the report of the National Advisory Council on Dental Health. A 2007 report by the Australian Institute of Health and Welfare's Dental Statistics and Research Unit at the University of Adelaide informs us that Australians born after 1970, the 'fluoride generation', have generally half the level of decay experienced by their parents' generation. The post-fluoride generation has made many gains when it comes to oral health; however, this has in some instances come at a cost of increased complacency. The oral health of Australian children has been in decline since the mid-1990s. By the age of 15, six out of every 10 children have experienced tooth decay. That is a fairly staggering statistic.

The Australian Institute of Health and Wellbeing reports that those earning more than $60,000 per year have, on average, seven more teeth than Australia's poorest people on incomes less than $20,000. Filtered water and too much sugar, cordials and soft drinks, often a staple in the 21st century diet for many young children, are proving to be detrimental to the health of this generation's teeth and gums. By putting the public gaze back onto dental health we can make significant gains by simply reminding people to brush and floss regularly, watch their sugar intake and get their check-ups when needed. This announcement also provided $450,000 over three years to NGOs to assist with pro bono dental service to people with limited means, including homeless people, Indigenous Australians, women and children in shelters as well as refugees. Those opposed to our dental benefits amendment reform package—and that of course is those on the other side of this place—have frequently stated that we are spending too much on dental health, which ignores the fact that this is an investment that will end up saving in the long term.

I was interested to hear the member for Ryan saying that our moving of this policy and legislation was a political act. Well, for us it is not about politics. It is not about protecting the reputation of the member for Warringah, which the other side seem to think they have to do. It is about economic management, about fairness and about addressing a social agenda item that for too long has been neglected.

There has been lots of fear mongering about where the money is coming from and how we can possibly afford a social agenda that includes such wonderful things as the NDIS, aged care, dementia and dental health. Well, a country like ours, with a credit rating of AAA from the three international credit rating agencies—for the first time ever, and it was achieved under a federal Labor government—can afford this and has to make responsible cuts so that we can afford these important social initiatives. I quote the Prime Minister:

If you have the right values, the right priorities, you can budget responsibly and you can help the people who need it most. What we don't ever do is conduct ourselves like the conservatives who enjoy delivering the cuts.

I like what she said and I agree with it. Labor governments cut dental schemes for millionaires; Liberal governments sack ambulance officers. I do not buy the argument that this great nation cannot afford this, that we cannot make responsible adjustments in our budget that will allow us to afford this.

I notice that Piers Akerman wrote in the Sunday Telegraph that the Labor government was scrapping a hugely successful policy in favour of a dismally bad policy, which could not be further from the truth. He is of course referring to the member for Warringah's Chronic Disease Dental Scheme, which we are scrapping. It is a policy that is far removed from the description that Piers Akerman provided.

The Chronic Disease Dental Scheme, designed by the Leader of the Opposition, Tony Abbott, when he was health minister during the dying days of the Howard government, is the scheme we are scrapping, and rightly so. I was here then, unlike a lot of members on the other side, and I remember the rock-solid promises the member for Warringah failed to keep when it came to health care for this nation. This policy of his is a dud. It has been one of the most widely rorted health schemes ever implemented by an Australian government. As Health Minister Plibersek has stated, the Howard-Abbott Chronic Disease Dental Scheme was projected—and these are the projections of those supposedly financially responsible mangers on the other side—to cost $90 million per year. However, due to misuse and the lack of strategic targeting of that policy it ended up costing $80 million a month. And those opposed to our plan say that we are wasting money. Shame. It is costing $80 a month and it is not strategically directed at the people who need it most and, unfortunately, that scheme, whilst it definitely has assisted pensioners and those who could not afford treatment, has seen millionaires claim over $4,000 worth of free treatment on the taxpayers' wallet. This treatment even could have been purely cosmetic, such was the looseness of that policy. The scheme was not means tested, which is the way of the conservative government, and has seen many crowns for millionaires paid for by the taxpayers. These are people who should never, ever be on the teat of the government. They should never be exploiting a government policy that is aimed at people who cannot afford good dental care. In some cases, dentists were filling out paperwork and claiming rebates for work that was never actually done. So, if that dog's breakfast of a policy, designed by the Leader of the Opposition, is anything to go by, it shows what might happen should he ever return to government. The Australian people would be the losers from such a dreadful event.

Those who cannot afford treatment under our scheme will still be able to access it through the public system. But by ending the Chronic Disease Dental Scheme we are making significant savings that would otherwise have seen the well-off receive subsidised treatment. This is a nation of fairness, and it is always disappointing when people rort. We know that governments are there to share out the wealth of this nation, but do it in a way that is fair. That is what we expect and that is what should happen.

Currently in Australia around 20,000 children under the age of 10 are hospitalised every year because of poor oral health. These of course are just the children we know about and who then receive treatment, for there would be many more going undetected. Of children aged 12, 45.1 per cent have experienced decay in their permanent teeth, not their baby teeth but their permanent teeth. The Australian Institute of Health and Welfare tells us that in 2007 around 46 per cent of six-year-olds who attend school dental services had a history of decay in their baby teeth. The National Advisory Council on Dental Health has reported this year that one-third of Australians are dependent on the market based fee-for-service system as they are not eligible for public dental service, and nor do they have private health insurance. In 2011 the Brotherhood of St Laurence's End the decay report stated that there are around 50,000 hospital admissions due to dental issues. These are hospital admissions that are preventable, as long as we make significant and required investments into the system.

Sadly, over 85 per cent of Australia's 11,000 dental practitioners work in the private sector, a statistic that is not representative of those who can afford treatment in such a system. Our government's reforms will ensure that the oral health of Australia ceases its decline. They are bold, cost-effective investments into the oral health of those who need it most, helping individuals lead healthier, happier lives, and ultimately being a benefit to the whole of society.

We are proud of our legislative reforms in dental health, because we know they will put a brighter smile on the face of millions of people across the country, including many for whom a visit to the dentist is a rare occasion—that is, if they can afford to visit at all. Good oral health means a healthy body and healthy mind and a very healthy society. I commend the bill to the House.

1:37 pm

Photo of Andrew LamingAndrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | | Hansard source

We could detain this House for a long time traducing each other's dental policy. What we are talking about here today, in this debate on the Dental Benefits Amendment Bill 2012, is exactly what this federal government is doing to dental care in Australia over the next 19 months. This government, which is responsible for continuity of care, has abandoned it with its program—a program launched to great fanfare but which is completely unfunded. That is right. Absolutely no financial arrangements have been made for the dental package it announced a couple of months ago. Why? This is a clever government with no money left. This government borrows every dollar it needs from the Middle East or overseas—because this nation is in debt to the tune of more than $100 billion a year. But this government will keep making billion-dollar promises until the polls improve. That is the reality of what is happening on that side of the chamber.

I will run through a quick history lesson in the seven minutes we have available. We know that state funded public dental care has long waiting lists. Up to three-quarters of a million people are waiting for care. What is the reality of that? With state funded dental care, unless you have a massive dental emergency, you simply do not get seen. Seniors who have chronic dental disease never get a chance—they have to roll up to private services. Australia has a private dental model. The 10,800 dentists around the country are almost exclusively in the private sector. How mad would you be to work in the public sector when you can make so much more money in the private sector? In Tasmania, as an example, there is a 30 per cent shortage of dentists when assessed against the per capita need—and dentists there earn 30 per cent more. It is a completely supply constrained private dental system.

It is true we are graduating 600 dentists a year and it is true we are graduating 300 hygienists and oral health specialists and therapists. But those numbers are not increasing fast enough—and there has not been any effort on that side of the House to look at what jobs can be done by the people who work with dentists. If that work were done by allied health professionals, it would free up dentists to do the work which can only be done by them. This is a government which has abandoned that frontier.

This is also a government which has abandoned the Chronic Dental Disease Scheme. That scheme was conceived by the current Leader of the Opposition, Tony Abbott. He started from a simple proposition. He said that, if people are genuinely sick and dental issues are part of that chronic disease, they deserve treatment. That is placing the needs of the sick first. This Labor government are supplanting that. They are saying, 'No, it does not matter how bad your teeth are; if you are poor, you go to the front of the queue.' In a developed economy like Australia's, the reality is that dental disease is relatively evenly spread throughout the community. Having a concession card does not suddenly make your teeth bad. Earning a salary or getting a job does not suddenly make your teeth good. This is a government which has replaced a system designed to meet the needs of the sick with a system designed for the poor. The reality is that you have to look after both.

But this is a government which says—at least to adults—'For the next 19 months, if you have dental pain, our political pain comes first.' That is right. They are saying: 'We need a surplus, so you can all wait. You can all go back on the state dental lists and rot.' That is the reality. We know what states invest in dental care. We know that the ACT and NT lead the way. We know that New South Wales and Victoria are the poorest investors in state dental care. Those are the states where you wait the longest. In fact, you do not wait—because you never get the care. That is because the Labor state governments which set up those systems underfunded public dental care and have done so for eons. This mob over here says, 'We will find $1½ billion two elections from now and we will hand it to the state governments.' What will the state governments do with that money? This government will just hope the states spend it on dental care.

If you have a dental emergency, you can turn up to public state funded care and get that tooth pulled. If you need preventative care, those places will turn you away. What did Tony Abbott's scheme do? You went straight to the GP, you established that you had a chronic disease and your teeth were fixed through Australia's 95 per cent private dental system—immediately. It cost around $2,220 on average. For kids with chronic disease, it cost $2,125 on average. What did Tony Abbott's scheme do? Tony Abbott's dental plan slowly worked its way through the sickest Australians, fixing their teeth. For mental health patients, who have never known a health system to help them out, Tony Abbott's scheme put them at the front of the queue, got their teeth done, fixed their gingivitis and fixed their bridges and crowns. It got people with severe chronic disease teeth they could be proud of for the first time in their life.

Were there are a few cosmetic procedures in that scheme? Yes, there were. Was there a health justification for them? Yes, there was. Those of you on that side of the chamber talk about rorting—one in 1,500 cases. Does it happen any less with doctors than with dentists? Surely it happens in Medicare with doctors. Of course it does—probably in roughly the same proportions. Doctors are no different from dentists in that respect. It is part of the trust built into a universal system.

The state public dental waiting lists were reduced by Tony Abbott's scheme. The waiting times in New South Wales were cut by 40 per cent thanks to Tony Abbott's scheme. We have a GP centred health system. We allowed the GPs to work out who was sickest and who needed dental care most. That was the justification for Tony Abbott's scheme.

What was the second justification? The cost of getting your teeth fixed through the Chronic Dental Disease Scheme was indeed $2,225 per patient. What was it this year? It had fallen to $1,117. Why? Because all the serious work was done. We were seeing the scheme drop down a level to perform the role of surveillance, monitoring and long-term care of Australians' teeth. The hard work had been done.

That all stops now. That all stopped on 9 September when a government with no money left evoked an image of dental care 19 months from now—and they said: 'Our political pain is greater than your dental pain. If you have a dental problem, you can wait. Go back to the public scheme.' But the public scheme is already overrun because state governments underfund it. Let us go back to 1996 when the coalition government, inheriting someone else's economic mismanagement—Paul Keating's—said: 'You know what? That is the end of providing money to state governments, who don't use it well.' That is why the Howard government cut the scheme—because the more money you gave the state governments, the less got done. Nothing has changed. This government will see the same thing under their arrangement. They do not understand how dental economics works. The people who most need this care will not, if they do not have a concession card, get that care.

This government criticise dentists for overcharging, but then they conceive a scheme which gives $1,000 every two years to young people. Do they think that won't be open to abuse? Their scheme is exactly the same as Tony Abbott's scheme—except that it is treating kids instead of chronically ill seniors. It is a political shift to kids—doing that was worth more votes to the Prime Minister. Good luck to those kids who get a thousand dollars worth of care. But the government have not addressed any of the risks of overcharging in the system. Preventative dental care for teens and young kids, which could be done by hygienists, is being done by dentists at double or triple the cost. The government have not created any more oral health graduates—the numbers have increased by only a few per cent and the number of dental therapists has fallen by six per cent. So the work which could be done by allied health dental workers is being done by dentists at a much greater cost. At every level this is an unfunded, imaginative scheme that may never happen. It has been planned by a government that is trying to survive to the next election and that has in the same process traduced a scheme that looked after the chronically ill seniors who needed it most.

Debate interrupted.