Senate debates

Wednesday, 24 November 2021


Dental Benefits Amendment Bill 2021; Second Reading

10:53 am

Photo of Carol BrownCarol Brown (Tasmania, Australian Labor Party, Shadow Assistant Minister for Infrastructure and Regional Tourism) Share this | | Hansard source

In August 2012 the Gillard Labor government introduced the Dental Health Reform Package to the Australian people. A key part of this package was the Child Dental Benefits Schedule, delivering means tested financial support for dental services for children between two and 17 years of age. Families that have children between two and 17 years old and receive benefits such as family tax benefit part A, the parenting payment, the double orphan pension, a carer payment and other benefits are eligible for the child dental benefit. It provides more than $1,000, over a two-year period, to cover dental services such as examinations, routine cleaning, fillings and root canals.

Since Labor introduced this reform, it has provided over $2.3 billion in benefits and delivered more than 38 million services to over three million Australian children. Thanks to this program, three million Australian children have avoided worsening physical and mental health impacts from untreated dental conditions, with massive flow-on benefits for their families, their communities and the broader Australian society—including the government's bottom line—from avoided downstream medical costs.

This was a great reform—under the Gillard government, and led by the member for Sydney who was then the health minister—and it's delivering great health outcomes to millions of children and teenagers across Australia. It was informed by a great amount of evidence presented by the dental advisory group that was chaired by the formidable former public servant Mary Murnane. It was also informed by some very disturbing evidence from the Australian Institute of Health and Welfare—a great institution, the AIHW—which showed that as many as 42 per cent of five-year-olds had decay in their baby teeth, 61 per cent of nine-year-olds had decay in their baby teeth and, as a permanent feature of poor oral health, as many as 58 per cent of 14-year-olds had decay in their adult teeth.

The reform is a great demonstration of what a government focused on working to make Australians' lives easier can achieve. This bill represents an important extension of a great Labor legacy. But this is a legacy which, over eight long years of this government, has been threatened repeatedly by a Liberal Party that has never fully supported this reform. That threat is consistent with years of the Liberal Party's opposition to Labor's introduction of Medibank and then Medicare. The child dental benefits scheme was not immune from the Liberal Party's attempts to cut health services for Australians.

It remains in place due to the efforts of Labor—in particular, the member for Ballarat for having consistently fought attempts by this government over their eight long years to abolish or cut the scheme. It was when the current Prime Minister was Treasurer that the government intended to cut the scheme entirely. Labor successfully opposed that attempt to abolish the scheme. The Liberal government then brought before the parliament a proposal to cut, by 30 per cent, the payments that would be received by children and teenagers under the scheme. Rather than the $1,000 payment the scheme provides for, it was proposed by the current Prime Minister, who was Treasurer at the time, that this payment be cut to just $700. It's unbelievable. This attack on the dental benefits scheme was also successfully opposed by Labor, led by the shadow health minister, the member for Ballarat, Ms King. We are very glad the government hasn't persisted in attempts to cut or abolish this scheme and has now been converted to expanding its scope.

This bill represents a welcome reform to the Child Dental Benefits Schedule and Labor supports it as an extension of Labor's legacy. The bill extends coverage of the schedule to children from birth to 17 years of age, removing the lower age limit on eligibility. It is well known and accepted by parents that promoting and practising good oral hygiene with children from a young age will aid in the prevention of more serious dental decay and associated health impacts as they grow up. The bill will help deliver a positive initial dental experience for more Australian kids and help curb the unfortunate negative stigma around dental practitioners and oral hygiene.

As a result of this change, each year an additional 300,000 Australian children aged between zero and two will become eligible for the Child Dental Benefits Schedule. From 1 January 2022 it is estimated that each year 15 per cent of children in this newly eligible age group, 45,000 children per year, will now be able to and will access the Child Dental Benefits Schedule. That is 45,000 kids with better oral health and better physical and mental health as a result. It means up to 45,000 families will have fewer worries about being able to pay for the dental care their kids need. And it means 45,000 kids will have a better relationship, experience and view of dentists, having been exposed to a dentist early in life, with benefits flowing through the rest of their lives. That is why Labor supports this bill and commends it to the Senate.

10:59 am

Photo of Jordon Steele-JohnJordon Steele-John (WA, Australian Greens) Share this | | Hansard source

[by video link] The Greens support this bill, the Dental Benefits Amendment Bill 2021; however, we believe that this bill could go much further to enable more members of our community to access dental care under Medicare. I want to flag at the outset of my contribution that we will be moving an amendment to this bill which seeks to expand access to the Child Dental Benefits Scheme. Our amendment would remove eligibility criteria and allow children and adults to access free dental care when and where they need it.

Before I go any further, it's really important to place the legislation before us in its proper context: the scheme that it seeks to modify and the overall question of publicly funded dental care. The 'Denticare' scheme, as it is commonly known in the community, is a proud Greens achievement. It is a legacy of a period of power-sharing between 2010 and 2013, and it is a program that I am really proud of personally and that I know has done so much good for members of our community. It seeks to address at its core one of the great gaps in our publicly funded medical system. We can be really proud of the Medicare system here in Australia. It is one of the better public health systems in the world BUT it suffers from a really nonsensical gap, which is to say that it looks at the human body and takes into account the fact that most human beings will need some kind of publicly funded health support for most parts of our bodies, including our mental health. And yet, when it comes to the teeth, our publicly funded medical system suddenly doesn't seem to register the existence of the mouth on the human body—it doesn't cover it in any great or meaningful way. That is a disconnect that means that many in our community are not able to get the support they need for a basic, ongoing medical need—that is, good, high-quality dental care.

The Denticare scheme which currently exists gives people an ability to access publicly-funded dental care between the ages of two and 18. The amendment we are moving before the Senate today seeks to change the eligibility criteria to enable people between the ages of zero and 18 to access publicly-funded dental treatment. And that is a good thing: people should be able to use their Medicare card to go to the dentist, just like they can for so many other vital procedures and health based supports. But we can't stop there. The reality is that the teeth are not things that spring into existence between the ages of two and 18 and then vanish for the rest of people's lives! Dental care and dental based supports are things which are needed through the entirety of someone's life. That is the reality, and our policy settings should meet that reality. We should enable all people to access affordable dental care under the Medicare system. They should be properly funded and supported to get that work, that support and those services, because we know the transformational impacts for people who have access to those supports and, conversely, the terrible impact of not being able to access those supports. And that is so much the case for so many in our community.

To drill down in a little bit more detail on this, there's been a recent survey in the electorate of Griffith where people have had the opportunity to share the impact that the currently very constricted system has on them—basically, what impact does the absence of publicly funded dental care under Medicare have on people's lives? The results are really quite stark, and I think they paint a clear picture of the problem here and the impact on people.

Some 86 per cent of respondents had delayed seeing a dentist because of cost. The average amount that people spent just on their most recent dental bill was $809. That is the best part of $1,000. That is not money that most people just have lying around. It has a real financial impact on individuals, families and communities. In this survey, the longest period that a respondent had skipped seeing a dentist because of cost was some 20 years. Can you imagine what it feels like to sit in agony with an unresolved dental issue for two decades?

It is beyond belief that, in 2021, in Australia, with all of its riches that are so effectively siphoned off by corporate Australia and the billionaire class, we have a publicly funded healthcare system which does not recognise the basic reality that people have teeth which need to be cared for. It is an absolute disgrace that this is the reality in 2021.

The amendment offered by the Greens today gives both sides of politics, Labor and the Liberal Party, the opportunity to join with the Greens to correct this problem—to give people access to the support that they need and to make sure that nobody has to endure the terrible pain and discomfort that comes from poor dental health—so that every child, every teenager, adult and older Australian is able to get access to dental support and dental care when and where they need it, without having to worry about whether they have enough money saved in the bank to enable them to do it.

We know that this will have so many good, positive effects on our community. We know that it will support people being active in the community. We know that it will support people pursuing different career paths and goals, doing different types of work, being active members of their community and living life free of pain, which should be the basic expectation of all people in our community.

These changes can be so easily funded by making the big corporate entities that have made billions, if not tens of billions, through the course of this pandemic pay their fair share of tax. At the same time, we can make sure that we do not waste tens of billions, if not hundreds of billions, of dollars on unnecessary defence expenditures and on tax measures which seek to put more money in the hands of people like Gina Rinehart and Clive Palmer. All these things are possible.

The amendment before the Senate today enables the Labor and Liberal parties to get on board with the position which the Greens have been advocating for decades which is that Medicare should cover your mouth. You should be able to get support for your dental health through Medicare regardless of your age. You should be able to do so in a way that enables you to think solely about the medical support you need, not what the current balance of your bank account is. I commend the amendment to the Senate.

11:08 am

Photo of Wendy AskewWendy Askew (Tasmania, Liberal Party) Share this | | Hansard source

I rise today to make a brief contribution in support of the Dental Benefits Amendment Bill 2021, which was introduced to the House of Representatives on 4 August this year. The Dental Benefits Amendment Bill amends the Dental Benefits Act 2008 to allow eligible children to access the Child Dental Benefits Schedule from birth. It delivers on the government's 2021-22 budget commitment to lower the age eligibility restrictions in the Child Dental Benefits Schedule and is based on recommendations from the Report on the Fourth Review of the Dental Benefits Act 2008 as well as extensive stakeholder feedback.

While this amendment is minor, it will allow any eligible child aged under 18 years to access dental care. As a parent and now recently a grandparent, I appreciate how important this amendment is and know it will allow children to start a positive relationship with dental health professionals earlier in their lives. Positive dental experiences for children early on would instil the importance of good oral hygiene at a young age. It would also stop the negative stigma around dental practitioners, which could be reinforced if initial dental experiences required serious treatments.

Healthy teeth, mouth and gums are all important aspects for a person's general health and wellbeing. Good dental health means you can eat, drink and speak without pain or discomfort. Dental health has been something that successive Australian governments made a focus over the past three decades. Adding fluoride to drinking water has helped reduce tooth decay in both children and adults, but statistics from the Australian Institute of Health and Welfare show we can still improve. For example, in Australia three in 10 people delay or avoid seeing a dentist because of the cost, one in four children aged between five and 10 years have untreated decay in baby teeth, and one in 25 people aged 15 and over have no natural teeth left.

The Commonwealth works with state and territory governments to fund dental services like the Child Dental Benefits Schedule to improve dental health. Each of these governments has agreed to the National Oral Health Plan 2015-2024, with the goal of improving health and wellbeing across the Australian population by improving oral health status and reducing the burden of poor oral health. This plan sets out six foundation areas: oral health promotion, which covers a range of initiatives to reduce the occurrence and impact of oral disease, such as community water fluoridation; accessibility of oral health services—and I note that, in my home state of Tasmania, Oral Health Services Tasmania services 29 clinics across the state; systems alignment and integration of oral and general health systems supplied by public, private and non-government organisations to improve effectiveness and health outcomes; safety and equality, with the National Oral Health Plan arguing for stronger consumer engagement in developing performance standards and collaboration of outcomes; workforce and the capacity to meet the community's needs for prevention and treatment of poor oral health now and in future, including in locations where oral health services are needed; and, finally, research and evaluation to inform the development of appropriate, effective and sustainable oral health services.

The National Oral Health Plan shows that oral conditions are the third-highest reason for acute preventable hospital admissions in Australia. More than 63,000 Australians are hospitalised because of oral conditions each year, with many of these requiring dental treatments under general anaesthetic. These cases include young children with high levels of dental disease and adults with complex medical conditions. The Dental Benefits Amendment Bill increases access to prevention and treatment services for children, which supports parental promotion and modelling of good oral hygiene from a young age. All this helps to prevent serious dental decay as children develop their full adult teeth and also promotes healthy dental habits into adulthood.

The Child Dental Benefits Schedule provides initial dental benefits, such as examinations, X-rays, cleaning, fillings, root canals and tooth extractions. It was established in 2014 and has delivered more than 38 million services to over three million children. This represents more than $2.3 billion in benefits over seven years. When the indexation rate is updated on 1 January 2022 the benefit will increase from $1,013 to $1,026 per eligible child, applied over two calendar years. The scheme is available in both the public and the private sector to support the broadest range of services, provider choices and locations. The Dental Benefits Amendment Bill will add an extra 300,000 children to the scheme and will cost $5.4 million over four years. This is a significant contribution that supports dental access for children from a very young age. The Australian government will continue to work with public and private providers to improve the delivery of dental services to our children. I commend this bill to the Senate.

11:14 am

Photo of Janet RiceJanet Rice (Victoria, Australian Greens) Share this | | Hansard source

Getting dental care for kids into Medicare is something that we, the Greens, achieved when we were in balance of power in the Gillard government in 2010. And getting dental care for everyone, for adults as well as children, is something that the Greens are continuing to campaign for, continuing to push for. Indeed, as Senator Askew's contribution just told us in great detail, the benefits of everybody being able to access dental treatment under Medicare are outlined there—huge benefits. It just makes sense.

Getting dental care for kids included under Medicare in 2010 shows the fundamental change you can see when you put a genuinely progressive party into balance of power. We know that that achievement has stood the test of time; hence this bill today that is extending free dental care for kids now down to the age of zero. In fact, what is very clear is exactly the same arguments as to why dental care should be included under Medicare, should be available for free for kids, hold for adults. The impact of poor dental care has massive impacts on people's health and on their ability to contribute to society. When we talk about our platform of putting dental care under Medicare, being able to go to the dentist with your Medicare card and get your dental treatment, when we talk to people out in the streets or on the doors, they say, 'That just makes sense, yes; that's what we need to do,' because people realise that the impacts on their lives by not being able to afford dental care are significant.

I remember when I was a councillor in the City of Maribyrnong working, supporting and representing a lot of people who were really doing it tough, living on income support, living in public housing. One woman I remember in particular. We got to know each other quite well, she talked to me about the issues she was facing and I was there advocating for her on council. Every time she talked to me she would hold her hand over her mouth like this because she was incredibly embarrassed about the fact that she didn't have any teeth anymore and couldn't afford to get dentures. She couldn't afford to go to the dentist. She was on a waiting list for public dental treatment, but it was going to be years off. The impact on her life was a feeling of embarrassment every time she was out in the street. She couldn't actually participate and feel proud of the way that she looked. She felt she had to cover her mouth like this every time she spoke, and that really got to me.

I have another friend who is long-term unemployed: a man in his late 50s. He told me he has just managed to get to the dentist and have a tooth removed, which has been aching and giving him the most amount of pain for well over 10 years. The waiting lists at the moment for public dental care are extraordinary. In fact, he saved up his money, living on JobSeeker, which is a really difficult thing to do, in order to afford to get a private dentist to remove his tooth. This is the impact that poor dental care has on people.

This bill we're talking about today is great; it's extending dental care for kids down to zero from two. But we need to be going far further. We need to be genuinely looking after the health and wellbeing of people, and that's what the Greens are fighting for, to actually say, 'Yes, if you are concerned about the wellbeing of ordinary people, we need to have measures like getting dental care included under Medicare.' The reality is doing that would actually fit into a broader push for social justice, for fighting poverty, and that's what the Greens will always be fighting for. It is why we are calling for the government to lift income support payments above the poverty line so that people don't need to be struggling, caught up in a world full of poverty. We saw what happened in the experiment during the COVID outbreak last year, when JobSeeker was doubled and suddenly people realised that they could afford to spend things on what the rest of us just consider the basics. They could afford to put food on the table for three meals a day, they could afford to put shoes on the feet of their children and they could afford to have the kids to go off on school excursions, so the need for government action is more urgent than ever to be not just extending dental care for kids down to the age of zero but to be taking real action on lifting people above poverty, real action on giving people the basic building blocks so that they can be living happy, successful, meaningful lives.

On the issue of the broader need for income support, I want to highlight a number of figures from a recent report from the Australian Council of Social Service, which puts so starkly the situation that so many in our community are currently in. Their report, Faces of unemployment 2021, finds that 80 per cent of people receiving JobSeeker payments, a record high of 826,000 people, have had to rely on income support for more than a year. The current figure is more than double the previous peak of 350,000, after the 1991 recession, which prompted a billion dollar investment in employment assistance, including wage subsidies and training. Among people on income support for more than two years, over half have a disability and almost half are over 55, underscoring widespread discrimination in the labour market against people with disability and older people. People's chance of securing full-time paid employment within the next year falls from over 50 per cent when they are unemployed for less than three months to less than 25 per cent once they're unemployed for over two years.

We have an inequality crisis in this country. That inequality crisis is something that can be fixed, because poverty is a political choice. Just as we could be making the political choice now to put dental care into Medicare so that you could get free dental treatment by showing your Medicare card, like you use your Medicare card at the doctors, we could be choosing to lift people out of poverty. We could be choosing to raise income support so that people aren't struggling like they currently are. We could be choosing, as our inquiry into the disability support pension has shown, to support people with a disability to get the support they need to live a good life. As the inquiry is showing, the government at the moment is leaving people behind. It's leaving behind people on the DSP, who are facing enormous challenges. Rather the trying to enable people with a disability to get onto the DSP, the government is actively trying to force them off it. These actions by this heartless, cruel and callous governments, leaving people in poverty, have a devastating impact. As Anglicare's Asking those who know report shows, what that means is not just that people can't afford dental treatment; it means that 44 per cent—almost half—of people on JobSeeker reported skipping seven or more meals a week and only 38 per cent said they felt supported by their government.

This is horrifying. It's not the Australia that I want to live in. It's not the Australia that most Australians want to live in. We can make that choice. We can choose to support people across the country, to lift income support above the poverty line and to put dental care into Medicare for everyone. These are the choices that we should be making. Instead of spending billions of dollars on subsidies to fossil fuel companies, cutting corporate tax rates and allowing billionaires to get off without paying any tax at all, we could be making a difference to the lives of ordinary Australians, allowing them to live a decent life, rather than having people in the desperate straits of living in poverty.

11:23 am

Photo of Sarah Hanson-YoungSarah Hanson-Young (SA, Australian Greens) Share this | | Hansard source

I rise today to provide a short contribution to this piece of legislation, the Dental Benefits Amendment Bill 2021. I think it's an important step forward to make sure that we are expanding the number of people—children from zero to 18—that have access to good-quality dental health care. Being able to use your Medicare card when you go to the dentist is something that should be available for everyone. We've seen throughout COVID-19 just how important universal health care has been, and we know, if we listen to the doctor, that dental health is an extremely important part of making sure the rest of our body is healthy. But, of course, there is a disparity between what is accessible under our universal health system and what isn't. If you've broken your jaw, you can use your Medicare card to go to the doctor but not to go to the dentist to get the tooth fixed. That is just bonkers. It's time for Australia to move forward and to ensure that we properly fund dental health care for everybody.

The Australian Dental Association has a look each year at the average cost of dental health care and totals it up. For a regular check-up for a regular Australian, the average cost of going to the dentist to get an examination, a scale and clean, and some fluoride treatment is $215 a pop—$215 a pop to make sure you stay healthy so that the rest of your body doesn't start to deteriorate. It is just crazy that under our wonderful Medicare and healthcare system in Australia we don't allow dental to be included. So it's $215 on average—some are more than that, of course, depending on what dentist you choose—just to go and have a check-up and make sure everything is okay. If things aren't okay and you need a filling, it might cost you an extra $250 on top of that. If you need a tooth extraction, we're talking about another $200. If you need root canal, we're talking $425 on average. The bills keep going up and up. By the time you get out of the dentist, you might be paying $700, $800 or $900.

Australians deserve better than that. We have a tax system and a system of universal health care in this country. It is time for dentistry to be included. You should be able to go to the dentist, whip out your Medicare card and have your dental health covered. You can go to the doctor with your Medicare card. You should be able to go to the dentist. It's as simple as that. It's important that we do this for children, of course, but every Australian deserves to be able to use their Medicare card to go to the dentist and keep their teeth and their mouths healthy. And you wouldn't want to be in a situation of emergency, because, if you need a crown, the average cost for a crown is $1,500. You can't put that on Medicare. You can't write that off on tax. That comes straight out of your pocket, and, as we know, there are many, many Australians in this country who simply can't afford that. So what happens? You don't go to the dentist, and your teeth get worse, which starts to have other health implications, or you do go to the dentist and have to go into debt.

The Greens have been arguing for a long time that we need to put dental health into Medicare. You should be able to use your Medicare card at the dentist just as you can at the doctor. Everyone knows it makes sense. We just have to get it done.

11:27 am

Photo of Michaelia CashMichaelia Cash (WA, Liberal Party, Deputy Leader of the Government in the Senate) Share this | | Hansard source

CASH (—) (): I thank all senators for their contributions to the debate and I commend the Dental Benefits Amendment Bill 2021 to the Senate.

Question agreed to.

Bill read a second time.