Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Ageing, Disabilities and Carers) Share this | Link to 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. As indicated in the debate on this legislation in the other place, Labor will be opposing this bill. Labor will be opposing this bill because it is an election year patch-up job by a government that has presided over 11 years of neglect in dental health. 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 a failing policy. Failing policy cannot be made effective simply by pouring more money into it. The basis of this policy is wrong, and that is why Labor will not support it.

There is little doubt that Australia is in the midst of a potentially catastrophic dental care crisis. Let us look at some of the facts. Currently there are 650,000 Australians on public dental waiting lists around the country. Many wait years for treatment. Thirty per cent of Australians have reported avoiding dental care due to cost. Dental workforce shortages mean that Australians simply cannot get in to see a dentist when their teeth need attention. In the public sector that means long waiting lists. In the private sector it means not being able to get in to see a local dentist on short notice. These dental workforce shortages are particularly felt in outer metropolitan, regional and rural areas where there are simply not enough dental professionals. These problems with accessing affordable dental care are contributing to Australia’s deteriorating dental health. Tooth decay ranks as Australia’s most prevalent health problem, while gum disease ranks fifth highest. Untreated dental decay in the Australian adult population stands at 25.5 per cent—that is, a quarter of Australians are not getting the dental care they need.

A recent study found that one in six Australians had avoided certain foods during the last 12 months because of problems with their teeth. Some 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. And perhaps the biggest indictment is that while Australian kids had the 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 the NSW Chief Health Officer’s statistics, hospitalisation rates for children under five have increased by 91 per cent between 1994-95 and 2004-05—a finding confirmed by disturbing claims-information recently released by health insurer MBF that showed a 42 per cent increase in children being treated in private hospitals for dental cavities.

It is clear that Australia needs action on dental health. Rather than addressing this range of issues to improve accessibility to affordable dental care, the Howard government have instead spent much of the past decade cynically playing the blame game on dental health. Time and time again Prime Minister Howard and the Minister for Health and Ageing, Mr Abbott, have deflected criticism onto the states and territories, saying, curiously, that Australia’s public dental care crisis and deteriorating oral health standards were entirely a state and territory problem. We have seen more of it this week, with all of the carry-on that occurred in the other place on Tuesday afternoon.

Of course, in seeking to blame the states and the territories, the Prime Minister and the health minister 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. Make no mistake about this: the government axed it, abolishing the scheme as one of their first acts in government. Do not believe the revisionism exercised by the minister for health this week when he said that the Howard government did not review the Commonwealth dental health program. The program had a year to run, and the government cut off the last year of funding.

While the state and territory governments have more than doubled their investment in public dental care over the past decade, the Howard government has withdrawn $1.1 billion in public dental services over the last 11 years. The impact of the Howard government decision in 1996 still reverberates today, not least within the hundreds of thousands of Australians languishing on public dental waiting lists.

But that is not all that the government has done. Dental care in Australia is in a crisis because of underfunding and because of workforce shortages. The Howard government seems to have forgotten that the training of dental professionals is entirely a Commonwealth government responsibility, but its neglect in this area is of long standing. The Senate Community Affairs References Committee recommended a national oral health training strategy for oral health care providers and other health professionals 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 were taken. In 2004, dental graduation levels were found to be at their lowest for 50 years.

Belatedly the government has recently increased dental-training places at Australia’s universities, and Labor welcomed the recent budget announcement of a new dental school at Charles Sturt University, but a comprehensive and strategic national policy is required to ensure a long-term solution to the crisis. Not enough has been done, in particular to address public sector shortage and regional and rural demand for dental professionals. While we are talking about dental schools, I place on the record my support for James Cook University’s desire to establish a dental school in my home town of Cairns. I commend them for the work that they have done. It is unfortunate that they were overlooked and Charles Sturt was successful; they can be assured I will continue to advocate on their behalf.

We have needed training for dental professionals for some time. Affordability is also part of the issue. Over the last four months I have been conducting forums for older Australians around Australia. In every single one of those forums the issues of dental health, affordability of dental services and access to dental services have been raised with me. When you talk with these older Australians about the systems in place—the measures that the government introduced some three years ago—firstly, they are not aware of them. Then you explain how they work, and they say, ‘That wouldn’t help me anyway because I can’t afford the copayment.’ These are people who are on pensions. They simply cannot afford the copayment. If you need evidence, you just need to talk to older people who are on pensions and fixed incomes. They will tell you very clearly that the current policy approach of the Howard government simply is not working.

The other thing that I do is ask people from the community what the waiting lists are like at public dental clinics. By way of example, I can report to the Senate that the small community of Edmonton, south of Cairns, a community of around 6½ thousand people, has a waiting list—the worst I have heard of—of 4,000 people. That is 4,000 people out of a community of not more than 6½ thousand. Admittedly, the collection area is probably larger than that, but there are 4,000 people on the waiting list. I did not ask how long it took for them to gain treatment.

Unfortunately, though, this government is far more interested in playing the blame game than in providing solutions for Australia’s dental crisis. The Howard government’s initiatives on dental health have been limited to the subsidies of 30 per cent or more, depending on the person’s age, for people with private health insurance—rebates that, I have to say, Labor supports. But the other initiative that the government has undertaken is the ineffective Medicare dental program for people with chronic conditions and complex care needs, which is the focus of this legislation. This program was initially announced in March 2004 and commenced in July of that year. Under this policy, Australians were eligible for assistance with their dental care if they had a chronic medical condition, like heart disease or 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. You had to jump through three hoops to get into the system.

These complex and restricted eligibility criteria, limiting the program to people with chronic conditions and complex care needs, have severely limited the uptake of the program. 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 the 2005-06 data released earlier this year, the average out-of-pocket expense for assessment or treatment by a dental specialist under Medicare item 10977 was $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. The Australian Dental Association, in evidence to the Senate Standing Committee on Community Affairs, which examined this bill, stated that the paperwork in the initial system was ‘a bit cumbersome’ and that 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 media release of 10 March 2004 from the Minister for Health and Ageing, where he 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 a mere 7,000 patients, at a cost of $1.8 million. The minister predicted that 23,000 people would be supported under that program; only 7,000 people were.

Labor has consistently highlighted the weaknesses of this policy. The minister for health has himself, as recently as Tuesday, in the other place, openly acknowledged the failure of this policy. This makes it all the more remarkable, then, that the government announced in the budget in May that it would pour an additional $377 million into an expansion of the failing program. This figure was subsequently increased to $384.6 million. A program that is so flawed that it has only managed to spend $1.8 million in three years has now been allocated $385 million over four years.

The budget announcement included a change in the benefits available under the program, although, again, it was subsequently adjusted. 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. 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.

Given the extremely poor take-up 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 the 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 Senate committee which recently examined this legislation that the current three Medicare items will be expanded to more than 450 Medicare items under the extended programs.

Labor is not convinced that moving from three Medicare items to 450 Medicare items can possibly simplify the program or encourage greater take-up—by patients or practitioners. Throwing hundreds of millions of dollars at a failing program is 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.

It is for those reasons that Labor will be opposing this bill. This is a very brief bill. 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 enable a monetary limit on Medicare benefits for dental services to be introduced for eligible patients. 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. Perhaps we will be surprised by the policy developments outlined in this detail, but for now Labor are not convinced that this is a policy worthy of our support. Pouring hundreds of millions of dollars into a failing program is simply not good policy and will not help the hundreds of thousands of Australians in need of dental care.

As announced by my colleagues Labor leader Kevin Rudd and Nicola Roxon earlier this week, rather than propping up the Howard government’s failing and narrowly targeted dental scheme shambles, Labor will draw on these funds and redirect them to Labor’s own dental policy. In the first instalment of Labor’s plan, we have committed $290 million to supply up to one million additional dental consultations and treatments for Australians needing dental care. As part of federal Labor’s determination to take national leadership and end the blame game in dental health, this funding will be available for the states and the territories to help clear the waiting list backlog. States and territories will utilise their existing infrastructure to either supplement their existing public services or purchase private sector appointments for the hundreds of thousands stuck on their waiting lists.

Labor’s Commonwealth dental program will ensure that Commonwealth investment is directed towards a broad based scheme that better addresses the priority oral health needs of those groups in the community most in need of assistance. Labor’s approach stands in sharp contrast to the Howard government’s failing chronic disease scheme—a stark choice between helping one million Australians with their dental care or the dismal 7,000 who are offered assistance under the government’s failing 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 pressures on public dental waiting lists. (Time expired)

Lyn Allison (Victoria, Australian Democrats) Share this | Link to this | Hansard source

It was encouraging to see that money was finally being allocated to dental care in the 2007-08 budget—or, more correctly, to assist those people who do not have private health insurance. The government spends about $400 million a year in paying 30 per cent of the cost of dental care for those able to afford private ancillary dental health insurance cover. The Minister for Health and Ageing has consistently argued that dental care was not his responsibility and that it was all up to the states. He conveniently ignored the Constitution, which clearly recognises the role of the Commonwealth in the delivery of dental services. Of course, once it looked like dental health was going to play a part in the federal election, the coalition was forced to do something to take the heat off. That is their standard response when it comes to health: wait until there is a public hue and cry, and make some quick announcement that will quieten things down and then move on. Unfortunately, these announcements do not usually tackle the real issues or provide any long-term solutions, and this announcement is no exception.

Ten years ago the Howard government shirked its responsibility for dental care by walking away from the former Labor government’s $100 million-a-year Commonwealth dental scheme and ordinary Australians had to face the consequences. Hundreds of thousands of people are on waiting lists for public dental care around Australia. Estimates put that figure at 650,000 people, with an average waiting time of 27 months. So that it is one in every 30 Australians, and it is probably an underestimate because anecdotal evidence suggests that lots of people are simply not joining the list because they do not think there is any point. Those 650,000 do not include the many who are not eligible for the public system—people who do not have a health card but cannot afford the private system, where dentists can charge whatever they like.

Dental fees have increased much more quickly than other health services and faster than the CPI. Too many people put off attending to preventive treatment and fillings and cavities, as more urgent bills pile up at home—and their oral health continues to deteriorate. A recent survey by the National Oral Health Alliance estimates that as many as 40 per cent of Australians could not access treatment when they needed it because of costs and a severe shortage of dentists. By 2010, Australia will be short 1,500 dental workers, mostly dentists—that is 3.8 million dental visits that will not happen. The shortage of dentists is already acute in rural and remote areas.

The Australian Dental Association recently released figures showing that on average Australia had 47.4 practising dentists for every 100,000 people. A breakdown of that figure shows that while major cities might have 56.2 dentists per 100,000 people, remote areas had just 22.9 dentists for the same number. Regional areas do not fare much better either. Inner regional locations have 33.6 dentists and outer regional areas 26.6 dentists per 100,000 people. So there is a growing inequity in dental health and care in Australia, whether we are talking about geographic inequalities between rural and urban Australians or between socio-economically disadvantaged communities and their wealthier counterparts. Low-income adults without private dental insurance are 25 times more likely to have all their teeth extracted than high-income adults with insurance. Children in lower income families now have twice as many rotten teeth as those in wealthier groups. Dental health is an area which very clearly illustrates one of the major problems with Australia’s health system: the lack of priority given to prevention and early intervention.

Rather than spending money on education, checkups and early treatment, the federal government is spending millions of dollars a year on GP visits and hospital care for dental problems. It is very difficult to get good data, but reports suggest that up to one in 10 GP visits are for dental problems, costing Medicare hundreds of millions of dollars a year. People come in for repeated prescriptions for antibiotics and painkillers because they cannot find and cannot afford dentists. If you are in pain with a dental infection, it makes sense that of course you would go to your local GP for drugs. But that sort of treatment does not work, which is why people turn up over and over again. GPs cannot fix teeth, they can prescribe antibiotics and pain relief, but the underlying problem remains and it keeps coming back. Eventually things get so bad that people end up in hospitals. More than 30,000 people are hospitalised every year because of a dental condition.

And they are not all older people. The No. 1 reason why children under the age of five are admitted to hospitals is for their teeth. Of course, there is increasing research and awareness of the connection between oral and general health. We know that the failure to treat dental problems can lead to or exacerbate other illnesses elsewhere in the body. Poor oral health has been linked to arthritis, diabetes and cardiovascular disease to various degrees. And this is not a failure of policy. In 2004 the national oral health plan, called Healthy mouths healthy lives, was a comprehensive approach to improving oral health and was endorsed by all health ministers. But three years down the track there has been very little improvement. Unfortunately, the changes to the Medicare enhanced primary care scheme for people with chronic and complex conditions proposed in the Health Insurance Amendment (Medicare Dental Services) Bill 2007 will do little to fix the underlying and ongoing problems. On the surface it seems as if, at long last, the Howard government is acknowledging its responsibility for dental care, but it has allocated the money in such a way that most people will not be able to get the help they need. The government has selected one group of people to help, and they will have to go to a doctor and show that they have a condition with complex care needs and receive care under a written management plan.

And then they will have to show that they have a dental problem which significantly adds to the seriousness of their medical condition so they can get permission to see a dentist and get some care. The existing dental items in the enhanced primary care scheme have not been a roaring success, and even that has been acknowledged by the government. There has been a very poor uptake, attributed in part to the administrative complexity of the scheme and the restrictions on age eligibility. So it is hard to see how increasing from three Medicare items to 450 Medicare items will make the system any easier for people to use.

Finding dentists who would accept the rebate as the total payment has also been a problem, meaning that lots of people still face out-of-pocket expenses they cannot afford. It is true that there will be higher rebates under this system but co-payments are still allowed and some eligible patients will not be able to afford to pay the co-payment. The new system will also have a cap on it of $4,250 over two years and people will then have to cover all of the costs for any ongoing dental treatment after that. It is difficult to assess what impact this bill will have; after all, most of the detail, including the eligibility criteria for dental providers and patients, will be up to ministerial determination. But we do know that it will not help those who need to receive their dental care in a hospital environment. These patients will be ineligible for the Medicare rebates.

There are many special needs patients who, for a variety of reasons, cannot be treated in a dental surgery, whether it is because of a mental health problem, an intellectual disability or a physical illness such as cancer, leukaemia or haemophilia. Those patients with special needs that would require them to be under general anaesthetic in hospital or require other hospital-level assistance while undergoing dental treatment will miss out. Dental care is largely primary care and deserves federal funding. This is not a case of the Commonwealth taking over dental care; it is a case of it simply paying its fair share. This means more than simply extending a program that will do nothing for most of the people in direst need.

There should be specific Commonwealth funding for low-income people to get access to free basic dental care, not just people with complex and chronic conditions. The report into health funding by the Commonwealth dominated House of Representatives Standing Committee on Health and Ageing recommended way back in December last year that the federal government supplement dental care for those in disadvantaged positions. And we should extend Medicare to cover medically necessary dental care for the medically compromised—those patients who, because of their medical, physical or mental state, cannot be treated by general dental practitioners in the private or the public setting and require treatment to be undertaken within the safety and resources available in hospitals.

This group, which includes the severely immunosuppressed—such as organ and bone marrow transplant recipients, patients who require replacement heart valves and those needing radiotherapy treatment to the neck and the head—need medically necessary dental care and this should be funded by the Commonwealth. Equally, those people with intellectual or psychological disabilities that necessitate hospital based dental treatment should be covered by the Commonwealth. And there should be a much greater focus on preventive oral health programs, including dental health promotion and public education campaigns. This would include screening and dental hygiene programs in all primary schools. We should not be simply flinging money at repairing and replacing teeth. This does not fundamentally improve dental health in the country. Once a tooth is replaced or repaired it needs ongoing regular maintenance. To be effective, we need to address the major cause of oral health dysfunction—tooth loss.

We need to be supporting preventive practices, including dental-office-based fluoridation, diet assessment and education, and cleaning and scaling. And we need to fix the lack of a workforce to provide oral health care. We need long-range dental health workforce planning and more university places for dentists and dental hygienists. The federal government has increased dental training places to address the shortage of dentists, but more graduates are still needed to make the dental labour force adequate. And we need more Commonwealth supported dental places.

We also need incentives to encourage graduates to work in rural and remote areas and the public sector, and this means better salaries and conditions for all dental workers working in the public sector. We should be looking at more scholarships for dental students from rural and remote areas and exploring debt forgiveness for dental graduates who agree to provide their services in regional, rural and remote areas or in the public sector. We need to think about providing financial support for dental intern programs, as has been successfully undertaken in Britain. This would allow the immediate creation of an extensive oral health workforce in public hospitals and dental clinics, available to the most needy, as well as ensuring the availability of dentists in rural and regional areas.

We could look at providing salaried, speciality training positions for orthodontics, oral surgery and periodontics, with the requirement of one to two years return of service in a public facility—again providing better access to specialist services in public settings. There should be outreach programs for Indigenous Australians, people with mental illness, homeless people, prisoners and the chronically ill. And we need more dental health assessment and follow-up by dental hygienists in residential aged care. We do need more money to tackle the disastrously long waiting lists for basic dental services, for the relief of pain and the repair and replacement of teeth. But we also need to look to the future and prioritise training, prevention and research if we want to see real long-term gains—that is, gains that go beyond an electoral cycle.

Ruth Webber (WA, Australian Labor Party) Share this | Link to this | Hansard source

I seek leave to incorporate speeches by Senators Sterle and Polley.

Leave granted.

Glenn Sterle (WA, Australian Labor Party) Share this | Link to this | Hansard source

The incorporated speech read as follows—

Health Insurance Amendment (Medicare Dental Services) Bill 2007

Mr President I rise to speak on the Health Insurance Amendment (Medicare Dental Services) Bill 2007.

I wish to speak on this Bill for a number of reasons, mostly because it’s important that the appalling record of the Howard Government in regard to health and dental care is not forgotten.

Mr President, the measures in this Bill are a weak and pathetic attempt to paper over the catastrophic damage that the Howard Government has done to the tradition of Government supported dental care since coming to office 11 long years ago.

One of this Government’s first actions was to abolish the Commonwealth Dental Health Program.

This was nothing less than an act of political bastardry. It had nothing to do with health care. It was intended as a kick in the head of the Labor Party. It was about belting up the States and to hell with the consequences for people on low incomes. To hell with people with disabilities. To hell with the elderly of this country.

This action in 1996 was the first step in Mr Howard’s long held dream to dismantle Australia’s public health system.

If things had gone as planned, the abolition of the Medicare would have been the next step.

In 1996 the Howard Government had the dismantling of Medicare in its sights and let’s not beat about the bush, it is still on their agenda.

I have no doubt that the Prime Minister would enjoy striking at the heart of Medicare if given half the chance.

Remember that prior to the last election the Prime Minister and all that lot in the Cabinet gave no inkling that they were going to wreak havoc on Australia’s industrial relations system. On past form it is hardly likely that he would telegraph his intentions to dismantle the Medicare scheme at the first real opportunity.

Mr President, the measure contained in this Bill is nothing more than a con.

The Howard Government’s way is to cause problems and then make a huge noise about how it fixes the very problems it created.

But it now looks like the trusted old strategy is going off like a bucket of prawns in the sun.

Let’s look at their current leadership chaos. As the story goes the member for Mayo was given the task to sound out the Cabinet for support of the Prime Minister’s leadership.

The alleged plan was to murky the waters around the leadership issue and then clear the waters by throwing in a chlorine bomb to fix a fungus that never actually existed.

But I’ve got news for you—the truth is its more like a toxic algal bloom.

What a farce. What a hopeless mob.

Mr President, as it has been said before, you can get away with fooling a few people all the time, you can even get away with fooling all of the people some of the time. But Mr President, you sure as hell can’t get away with fooling all of the people, all of the time.

The majority of Australians have had a gutful of this tricky and unfair Government.

One of the great contributions to dental care in this country has been the State Government School dental schemes that have been an important feature of dental care for decades.

Don’t just take my word for it, take the word of a recent President of the Australian Medical Association. This is what Dr Bill Glasson, the then AMA President, said when interviewed on radio in March 2004:

“preventative dentistry is what its all about, and we certainly practise that in our children and it’s a great success in this country.”

How’s that for a ringing endorsement of State Government school age dental care schemes?

Dr Glasson went on to say:

“I think a dollar spent on dental care saves us three dollars or more in the health system down the line.”

Dr Glasson further stated:

“What I would like to say is there is a certain percentage of our population out there who probably should have zero gap, in other words, there is probably five percent or ten percent of the population that need to be picked up, supported, full stop.”

Given that school age children make up approximately 20% of the population, in effect, what the President of the AMA was saying was that almost a third of Australia’s population require access to Government funded general and preventative dental care.

In 1996 we had such a system—with school children covered by State Government school dental services and adult Commonwealth concession card holders covered by the Commonwealth Dental Health Program (CDHP).

A Senate Inquiry into public dental services in May 1998 found that the CDHP was, and I quote:

“successful in meeting its aims, especially in terms of providing greater access to dental services for low income and disadvantaged groups in the community.”

The Senate Committee’s Report went on to say:

“since the cessation of the program access to dental care has been reduced with increasing public dental waiting lists. There are now over half a million on waiting lists for general dental care throughout Australia.”

Mr President, a recent count now puts the number of people on public dental waiting lists at approximately 650,000. Here we are, 9 years after the Senate’s Report and we have an even greater number of Australians unable to obtain affordable and timely dental care.

This year, the Federal Government funded Australian Research Centre for Population Oral Health at the University of Adelaide and part of the Australian Institute of Australian health and Welfare, published the Report of the National Survey of Adult Oral Health 2004–2006.

This survey interviewed over 14,000 people aged 15-97 of which five and a half thousand were dentally examined.

The survey found 1 quarter of Australian Adults had untreated tooth decay. The survey also found that this figure varied by no more than 5% among the generations. In other words the rate of tooth decay did not vary according to age.

This means that the Howard Government can’t simply blame past governments for this problem—it’s a problem owned and caused by the Howard Government front and centre.

It’s a problem that has been caused by those opposite and their accomplices in the other place.

The survey also found that the levels of untreated decay were more than twice as high among indigenous Australians.

In addition the survey found that approximately 20% of people had moderate or severe gum disease.

These findings point to a massive failure in Australia’s preventative dental services.

As a past President of the AMA, Dr Bill Glasson said in 2004:

‘Preventative dentistry is what it’s all about … money spent on dental care will save money.”

If the high level of untreated and oral health disease in the adult population is not addressed urgently, the result will be much greater health costs in the future.

Government health experts, health and medical academics, the AMA and the Australian Dental Association have been making this point for years, backed up by reputable research.

The Howard Government’s response, apart from tinkering around the edges of the problem, like the measure in this bill, has been to blame the States and Territories for the lack of needed publicly funded dental services.

The 2004-2006 National Survey of Adult Oral Health found that 30% of Australians reported avoiding dental care due to cost.

Approximately 20% of people said that cost had prevented them from having the recommended dental treatment.

In other words, the Howard Government has presided over the establishment of significant access barriers to needed dental care, including preventative dental care.

The Survey found that the financial barriers to dental care were greatest amongst uninsured people and indigenous Australians.

If you are an adult indigenous Australian or a person on a low income, who can’t afford private dental insurance, you might as well forget it. The chances that you will ever be able to afford preventative dental care are now almost zero.

The survey found that people without private health insurance were twice as likely to have difficulty in paying a $100 dental bill than people who had private health insurance.

In 1996 the Howard Government dumped uninsured people.

It’s been a hallmark of the Howard Government that if you are a low income person you are a loser and a whinger. Also anyone who stands up for a fair deal for low income people is accused of promoting the culture of envy.

Mr President, we on the Labor side of politics are proud of our tradition of promoting the cause of the less well off in the community and we are not going to be intimidated by the self-centred silver tails opposite.

We on the Labor side will always call it as it is.

The performance of the State and Territory Governments in the provision of public dental services has been exemplary despite bad mouthing by Howard Government Ministers.

In the period 1995/96 to 2004/05 Australian Institute of Health and Welfare figures show, State and Territory government expenditure on public dental services increased by approximately two and a half times.

Don’t tell me that the States haven’t been pulling their weight.

Australians know who the absconder from public dental care is—the mean and tricky Howard Government.

The Howard Government, by abolishing the CDHP effectively took federal dental care services money from the least well off in the community and handed it over to the better off members of the community.

In 1995-96 the Commonwealth was contributing through the CDHP approximately $100 million per annum to public dental services.

By 2005-06, having slashed and burnt commonwealth funded public dental services, the commonwealth were spending close to 4 times the cost of the CDHP on private health insurance dental premium rebates.

I would find it quite incredible to believe that even the most stone-hearted Tory would think this was justice, that this was a fair thing.

Why was it necessary to trade off Commonwealth support for public dental services for low income people for private health insurance premium rebates? It make absolutely no sense.

The fact is, this sort of caper has become par for the course for the Howard Government. This mean and tricky Government has made these types of tricky deals an art form.

Mr President, sadly this sordid story doesn’t end here. There are two other culprits in this merry tale of incompetence—first the private health funds.

In 1995-96 private health fund benefits for dental services were approximately 58% of total member cost of dental services. By 2005-06 the value of private health fund benefits for dental services had fallen to approximately 49% of total member cost of dental services.

However, when you look more closely you find that the real story is that fund own sourced benefits for dental services are now only approximately 33% of member dental costs compared to 58% in 1995/96 with the difference being picked up by the taxpayer.

On a fund member basis, per capita fund benefits for dental services, after taking account of the federal government private health insurance rebate, fell by 6% in the period 1995-96 to 2005-06.

On the other hand over the same period, fund member out of pocket costs for dental services increased by approximately 200%.

The stark reality is that neither the private health funds nor the Howard Government have eased the direct cost burden of dental services to fund members over the last decade.

This is a major policy failure by the Howard Government.

What the Federal Government’s private health insurance rebate policy has done has been to make life simpler and easier for the private health funds.

No wonder the private, for profit sector is lining up to get a piece of the action. Who could blame them for clambering to get into a high profit, no risk business subsidised by the Federal Government with a guarantee that you can increase private health insurance premium prices by at least the CPI every year.

You don’t have to worry about such a thing as a productivity dividend.

The other beneficiary of the Government’s largese has been the private dentists.

Again you can’t seriously blame them. If there’s enough room to shovel your snout in the trough then why wouldn’t they muscle in?

In the ten years to 2004-05 total private dental expenditure increased by 130% compared to an approximate 100% increase in private medical expenditure in the same period.

Obviously, private dentists have done very well out of the Commonwealth’s assault on public dental services even when compared with the almost perpetual winners in the income stakes, the medical profession.

The situation with dentistry in Australia is simply another example of inequality of access to health care being sponsored by the Howard Government.

Mr President, I was very encouraged to read that the current Federal President of the AMA who is from WA, Dr Rosanna Capolingua, in announcing the AMA’s health policy priorities for the 2007 federal election had this to say:

“Australia has a good health system by world standards, but it is not providing equal access to all Australians to high quality health care and services.”

I strongly agree with these comments.

Dr Capolingua is a person who does not hesitate to speak out robustly on problems with Australia’s health care system.

I must say, however, that I was more than a little surprised to read this statement from a President of an organisation that traditionally has been a natural supporter of conservative governments—particularly so close to a federal election.

This gives a measure of how seriously the Federal AMA views the failure of the Howard Government’s policy management of Australia’s health system.

Also I was a little disappointed that, unlike her predecessors, no mention was made of dental health in the AMA’s 2007 federal election health policy priorities.

I know dental services are not a front line responsibility of medical practitioners but, as we know, the lack of adequate preventative dental care and treatment almost inevitably flows on to more serious medical conditions.

As far back as seven years ago the AMA had this to say:

“The Australian Medical Association has commended the ALP for its commitment to re-establishing the Commonwealth Dental Health Program for the benefit of low-income Australians and pensioners who are suffering immeasurably since the scheme was scrapped 4 years ago and called on the Howard Government to match the commitment.”

Dr Kerryn Phelps, the then Federal President of the AMA stated:

“Dental care should not be treated as a privilege—it’s fundamental to health care overall ...

It is essential for the Commonwealth Government to share its responsibility for those Australians who cannot afford dental care.”

What has changed since these words were spoken by the Federal President of the AMA way back in August 2000?

Mr President, in fact things have got worse.

A few days ago the professional body of Australia’s Dentists, the Australian Dental Association (ADA) called upon the Howard Government to address the mal-distribution of the current dental workforce. Dr John Matthews, the Federal President of the ADA had this to say:

“A mal-distribution in the current supply of dentists make timely and affordable access to dental treatment a difficult proposition for a number of Australians.”

Dr Matthews went on to say:

“Australians living in rural and remote areas have comparatively poor oral health compared to their urban counterparts due to the lack of access to dental care. This is totally unacceptable. There are 650,000 people on waiting lists for public dental care with an average waiting time of 27 months.”

And then he said:

“Just allowing the market to solve the problem is not going to work. We need positive government action to solve this crisis. This is another case where the Federal Government must show leadership and work co-operatively with the States.”

Dr Matthews is absolutely correct. This is exactly what Labor has been saying for years.

Mr President, Labor is opposing this Bill because it simply continues the political fraud that the Howard Government has foisted on low income people who have been shut out from access to dental care.

In stark contrast to the current regime a Rudd Labor Government:

• Will re-establish a Commonwealth Dental Program;
• Will ease cost pressures on working families by contributing to the cost of dental care;
• Will keep people out of hospital for preventable dental conditions;
• Will end the Blame Game and work with the States and Territories to fix Australia’s dental care system.

Under Labor, State and Territory Governments in exchange for additional funding will be required to meet new standards of dental care. These will include:

• Providing priority services to individuals with chronic diseases affected by poor dental health; Providing timely service for preventative and emergency services; and
• Maintaining the current effort.

The facts are as clear as day—the Howard Government has made a complete shambles of its dental care policy and there is nothing in this Bill that changes that.

Helen Polley (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

The incorporated speech read as follows—

I rise to speak today on the Health Insurance Amendment (Medicare Dental Services) Bill 2007.

In 1996, the Howard Government scrapped Labor’s Commonwealth Dental Health Program.

Effectively, this took $100 million per annum away from public dental services. Public dental waiting lists have now blown out to 650,000 people around the country.

Of particular concern to me is the sharp deterioration in dental health standards among people with low incomes The rising cost of dental care is a major cost of living issue for families.

The statistics demonstrate this very clearly: One in three Australians avoid going to the dentist because of the cost.

The states and territories have doubled their funding for public dental care since the CDHP was abolished, yet the Howard Government have consistently asserted that the states are to blame.

It’s high time the Howard Government stopped the blame game with the states and took some real responsibility for the health needs of Australians.

Australians are in dire need of a solution to this problem ... There are 50,000 hospital admissions for preventable dental conditions every year. 1 in 6 Australians have avoided certain foods because of problems with their teeth in the last year.

The Government’s announcement in the 2007 budget to put 377 million dollars into the expansion of its dental program will do very little to address the public dental waiting lists and will be nothing to make dental care more affordable for everyday Australians battling with the rising costs of petrol, interest rates, and childcare.

The Howard Government has neglected dental workforce issues.

Kevin Rudd on the other hand has a vision for Australia. He understands we need to stop the blame game and deliver positive health outcomes for Australians.

Fixing our dental crisis goes beyond throwing money at the industry. We need to look at the long term—how many dentists do we need, and how will we train them.

In the year 2000 there were 49.9 dentists per 100,000 population. This is a disgrace. In my home state of Tasmania, the figures are worse... just 29.8 dentists per 100,000 people. Australia was ranked 19th in terms of practising dentists per 100,000 population out of 29 OECD countries for which data was available. A disgraceful ranking.

Furthermore, the distribution of dentists is very uneven, with particular shortages in the NT and as I mentioned before, my home state of Tasmania.

Between 1989-90 and 1998-99 dental fees increased at rates substantially higher than the CPI and other health services: between 1989-90 and 1998-99 dental service prices increased by 50.8 per cent, while the increase in health prices over the same period was only 22 per cent.

There are only six dental schools in Australia—one each in NSW, Victoria, WA and South Australia, and two in Queensland. The University of Griffith only commenced taking dental students in 2004.

I oppose this bill.

Brett Mason (Queensland, Liberal Party, Parliamentary Secretary to the Minister for Health and Ageing) Share this | Link to this | Hansard source

I agree with Senator McLucas and Senator Alison that dental health is a big issue in this country. There has certainly been much debate both in parliament and throughout the public in recent times. It is an important issue but clearly it is an issue primarily for the states. I sometimes wonder, with all the money that we give the states through GST payments—

Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Ageing, Disabilities and Carers) Share this | Link to this | Hansard source

Senator McLucas interjecting—

Brett Mason (Queensland, Liberal Party, Parliamentary Secretary to the Minister for Health and Ageing) Share this | Link to this | Hansard source

Senator McLucas asked the question. Let us take, as an example, my home state of Queensland. Queensland receives billions of dollars more than it would have received under the old taxation arrangements yet it cannot provide sufficient primary dental care for Queenslanders. Why is that? They receive more taxation revenue from the Commonwealth than they have ever received in the history of the federation and more than they would have received if the Labor Party had stopped the GST going through, which is what they tried to do. But, because the GST went through, the great state of Queensland receives more money in revenue than they would have ever received under the old arrangements.

All of us know that, yet they cannot provide adequate services for Queenslanders, and the Labor Party stands up here and says that it is all the Commonwealth’s fault. Well, it is not. I would like to talk about some of the problems that we have with dental health care, but I would like to say, by way of parenthesis—and I suspect I may even get bipartisan support on this—one of the big issues in Queensland over the last 10 years is fluoride. Fluoride has been a local government issue but also it has been raised in state parliament. I suspect that it is not an issue that is just about partisan politics. We have not even got fluoride in Brisbane city.

Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Ageing, Disabilities and Carers) Share this | Link to this | Hansard source

What did you do about it?

Brett Mason (Queensland, Liberal Party, Parliamentary Secretary to the Minister for Health and Ageing) Share this | Link to this | Hansard source

Senator McLucas, if you heard me, I said that this was not a partisan issue, but Mr Beattie has not done anything about it. He certainly has not enforced it. We should have done more and, quite frankly, that initiative alone would not only save a lot of money but also, far more importantly, would save a lot of pain, discomfort and agony for Queenslanders. It is a very minor thing that would cost very little, and yet we have not done it. It is not a partisan point but it is something we should have done, and I suspect even Senator Allison would agree with that. It is something we should do and we have not done.

Senator McLucas outlined the Labor Party’s proposal, which was recently enunciated by Mr Rudd, and spoke about waiting lists and how the Labor Party will assist in cutting down those waiting lists. Conceptually, that policy is quite incoherent. Let me say, by way of warning, that it is fiscal quicksand. The difference with the coalition policy is that our policy is conceptually coherent. We think that if someone’s dental health impacts upon their general health, which is ultimately the responsibility of Medicare, then the Commonwealth should provide for it. Nibbling away at the edges of waiting lists will not solve the problem. It will not make the states take responsibility and certainly will not solve the more general issue of chronic disease coming from bad oral care. That is the major problem.

I do not know what the Labor Party is on about here. Indeed, their proposal on dental care is not even as generous as the coalition proposal. It is quite an unusual proposal: not only is it less generous but also it nibbles away at the edges of a huge problem rather than engaging in a conceptually coherent policy, such as the coalition’s. The coalition’s policy is that, where oral health impacts upon general health, the Commonwealth will take responsibility.

Through the Health Insurance Amendment (Medicare Dental Services) Bill 2007, the Commonwealth government will provide substantial support to people with chronic conditions such as cancer, diabetes, cardiovascular disease and complex care needs so that they can access dental treatment under Medicare. This will help to improve the oral health of those Australians with long-term serious illness. Passing this legislation will enable eligible Australians to access up to $4,250 in Medicare dental benefits over two consecutive calendar years. If this bill is passed, the new arrangements will commence from 1 November this year. Patients will be able to receive Medicare benefits for a comprehensive range of dental treatment, from diagnosis, preventative services and fillings to more complex treatments such as major restorative work. Older people requiring dentures will particularly benefit from these new arrangements.

The Senate Standing Committee on Community Affairs has recently considered this bill and concluded that it is a ‘fundamentally important step in improving access to dental services and care for many Australians’. The committee recommended that this bill be passed. This Medicare initiative is a substantial investment in private dental treatment by the Commonwealth government of about $385 million over four years. It complements, but does not replace, state and territory governments’ responsibilities to provide public dental services.

I was listening carefully to what Senator Allison said before and I want to remind her that the new Medicare items complement other initiatives announced in the 2007-08 budget that are designed to increase access to dental treatment and support the dental workforce. These include investments in a new school of dentistry and oral health at Charles Sturt University, more rural clinical placements and dental scholarships for Indigenous students. The government has looked very closely at that. The new Medicare items complement other Commonwealth initiatives announced in this year’s budget. Together, these initiatives will strengthen dental care in Australia, and I commend the bill to the Senate.

Question agreed to.

Bill read a second time.