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Wednesday, 19 September 2012
Page: 11208


Mr BALDWIN (Paterson) (12:41): 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.