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Monday, 16 June 2008
Page: 4807


Mr HOCKEY (12:01 PM) —I appreciate the undivided attention that so many members of the government are giving to the debate on the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008! The coalition certainly understands the burden of dental disease in our society. It is thought that the rate of tooth decay in adults in Australia is close to 100 per cent. Worldwide estimates for the prevalence of severe periodontal disease generally range from 10 to 15 per cent. There is a complex interplay between dental disease and general health. Each impacts on the other. Diabetics, for example, get more dental disease, and chronic dental disease can make diabetes worse. Anybody whose illness prevents them engaging in good oral hygiene is at risk of significant dental disease. Those with gout, arthritis in the hands, depression or other mental illnesses, dementia, neuromuscular disorders, and drug and alcohol dependency will be at higher risk of dental disease.

On the flip side, dental disease causes problems in its own right. Fifty thousand Australians are hospitalised each year with preventable dental disease. Dental disease directly contributes to other complex medical conditions, such as cardiovascular disease and some cancers. Oral, gastrointestinal, lung and pancreatic cancer are all linked to tooth disease. Being unable to chew your food can cause malnutrition and advancement of chronic disease. If dental disease is not a direct cause of these disorders then it may be a major contributor. Dental disease can be destabilising in other ways. There are Australians out there suffering severe chronic dental pain every single day. This pain keeps them out of the workforce, affects their relationships with their families and affects their relationships with their colleagues.

It was after recognising the strong link between dental disease and complex health conditions that the coalition government decided to introduce dental care into Medicare. It was also, I might add, a direct result of the failure of the state governments to do what they are tasked with doing, and that is to provide dental care through the public hospital system to those most in need. From November 2007, patients who were assessed by their GPs as having complex medical conditions became eligible to see a private dentist and receive $4,250 worth of treatment over two years. The need for this sort of service has been palpable since the program started. The uptake in the first two months of Medicare dental in November and December 2007 alone was 16,000 services. Then in January 2008, according to Medicare, 20,443 services were administered through the scheme. In February 2008, 40,497 services were administered and, in March 2008, 94,617 services were administered. The total number of dental Medicare services administered from July 2007 to March 2008 was about 172,000. We discovered through the estimates committee of the Senate that in fact the total number of services to date is well over 300,000. Yet the Minister for Health and Ageing said on 2 March that only 13,000 services had been provided in four years. I am not sure which planet she is on, but this planet is earth and even her own people are talking about dental services in excess of 300,000 under the scheme introduced by the Howard government.

Also contrary to the assertions in this House by the Minister for Health and Ageing, these figures show an approximate doubling of dental Medicare services each month. These figures were available to the minister in March when she spoke in parliament about the poor uptake of Medicare dental as justification for axing this vital program. Either the minister for health inadvertently misled the House or she simply does not understand that a program that doubles in intake each month and has a total uptake of up to 300,000 services, or even over that, is not an unnecessary program. It is in fact the scheme which saw countless needy Australians access the dental care they needed. It was a scheme which finally allowed those weighed down by chronic dental pain to get their teeth fixed. It was the only opportunity for pensioners to get their teeth fixed up, if they had substantial dental problems, so that they could eat a balanced meal.

I am talking about real people with real illnesses—people like Chris Planer. Chris is a 28-year-old man who had cancer on the floor of his nose and the roof of his mouth. After therapy for his cancer, Chris was able to access Medicare dental to have restorative dental therapy. This is an interesting fact. The Insight program on SBS has footage of Mr Planer actually claiming his dental rebate from a Medicare office, even though on 12 March the Minister for Health and Ageing insisted quite firmly that Chris was not entitled to make such a claim. It is quite concerning the Minister for Health and Ageing seems to have slashed a program that she did not understand. The minister believed that people like Chris Planer could not benefit from the scheme. The minister believed that Australians did not want to or need to access dental care through Medicare. Over 300,000 services were delivered through the Howard government’s scheme, and that does not suggest it was an unnecessary or unwanted program.

The reason the Medicare dental program was so popular is that the average Australian could get little access to dental clinics run by their state Labor governments. Of course, waiting times to get into dental clinics are state secrets. Despite several attempts to obtain this information from a variety of sources, the states have not been forthcoming with their data. What a surprise. So with thanks to Ms Clara Pirani, an investigative journalist from the Australian, the most accurate guideline we have is from 2005. At that stage, Ms Pirani found that there were 650,000 Australians on waiting lists for dental care across the country. More than 20,000 Australians were joining the queue each year. Waiting lists for treatment were up to four years.

Let me go through some of the numbers. I quote these from the information provided to the Australian newspaper: there were 197,810 people on dental waiting lists in Victoria, 167,367 in Queensland, 68,691 in South Australia and 20,701 in Western Australia. In my own state of New South Wales, which the honourable member at the table, the member for Charlton, is familiar with, there were 181,453 people waiting for dental services. That was in 2005. At that stage, we saw 650,000 Australians on dental waiting lists, but that number was growing at the rate of 20,000 per year. So we can assume today, if the trend has continued, that around 700,000 Australians are waiting four years for treatment for painful, debilitating and even dangerous dental conditions.

Waiting too long for dental treatment can mean the difference between treating the tooth and having to have the tooth pulled out. It is these vulnerable Australians who need an alternative to hanging around for years in a state government waiting queue. They need another way to stop the cycle of pain, being unable to eat and being unable to get on with their lives. They need a way to stop their dental disease making them sicker. Medicare dental was the best way forward for vulnerable patients in need to access a dentist for treatment. This government has sought to axe the program unceremoniously, leaving 650,000 Australians languishing.

Today fewer than 10 per cent of dentists work in public dental clinics. I say it again because it is a very interesting stat: fewer than 10 per cent of all dentists work in the public system. Over 90 per cent are in the private system—this is clearly different, obviously, to doctors and general practice providers, many of whom do work in the public system. Therefore, even if you throw more money at public hospitals and the state government system, which this federal government is doing, unless dentists are prepared to work 24 hours a day, seven days a week in order to address the backlog or there is a movement of dentists from the private sector to the public sector, the waiting lists are going to remain very significant. It is unrealistic to expect that the Labor state and territory governments could manage dental disease across the whole country, even if they put in an enormous injection of capital and even if they could pull a rabbit out of the hat and start managing their hospitals efficiently. Does anyone here truly believe the state governments are going to manage their hospitals more efficiently, let alone attract more dentists to the public hospitals to provide the sort of treatment that patients expect? So I ask the obvious question: where are all the dentists who will be moving into the public system going to come from?

One thing people are not going to do is turn to their private health insurance for the provision of dental cover, because, as we know, the Rudd government has taken a baseball bat to private health insurance as well. There is a concerted attack by the government on private health insurance providers—that is, of course, unless they are buying the private health insurance providers, as we saw in the Financial Review on Friday with Medibank Private’s purchase of AHM for $300 million. Can you believe it? Not only do the government oppose privatisation; they support and fund nationalisation—the buying of a private health insurer by a very committed public private health insurer, Medibank Private.

Private health insurance is obviously not going to be the answer for people with severe and chronic dental pain because of the initiatives that came out of the government in the budget. The Medicare levy surcharge threshold was raised from $50,000 to $100,000 for singles and from $100,000 to $150,000 for families. In this one budget measure, the mask that the Prime Minister wore to the election came off. The Prime Minister made firm assertions prior to the election that he supported private health insurance. What we discover now, from the mouth of Medibank Private alone, is that this initiative by the government in the budget is actually going to cause between eight and 10 per cent of the members of Medibank Private to leave, which will in turn put significant upward pressure on private health insurance premiums.

Just to remind you, Mr Speaker, because you are a very wise man, the Medicare levy surcharge formed part of the coalition’s three key policy pillars to support private health insurance. They included the private health insurance rebate, the Medicare levy surcharge and Lifetime Health Cover. These three pillars saw private health insurance taken up by almost 10 million Australians—in fact, somewhere around 9½ million—or 44.6 per cent of the population by March this year. That is the highest level of private health cover since the introduction of Medicare.

When the coalition came to government in 1996, private health insurance membership was around 35 per cent. Under the Howard government it increased from 35 per cent to nearly 45 per cent. Before the election, the current Prime Minister, the member for Griffith, told the Australian people, ‘Don’t worry—I’m the same as the Howard government on private health insurance.’ Then, out of the blue, came this initiative. Driven by the Prime Minister’s office, we understand, the Medicare levy surcharge will be changed, with the government saying, ‘We will spin it to Australians as tax cuts, but in fact it is a budget savings measure because we are paying out less in the 30 per cent private health insurance rebate and the net impact on the private health insurance industry is of no concern to us.’ That is what the government said. Well, it is going to be a concern to the government, because there are going to be significant premium increases.

My understanding of private health insurance is that the Department of Health and Ageing and the various statutory bodies that advise on these things are actually involved in quite micro details relating to the content of policies that can be offered to customers of private health insurers. Therefore, not only does the government control the impact of various macro policy initiatives on private health insurance uptake; it has significant impact on policies offered to consumers. On the one hand, consumers are going to be looking for private health insurance to fill the gap in the absence of Medicare dental, because this government has now abolished Medicare dental without any subsequent support for those who still need dental work. At the same time, if those people go to their private health insurer to take out a policy that will provide them with coverage for potential dental disease, they are going to have to pay higher premiums as a result of this government’s policies.

So I do not know what the narrative is from the government in relation to better dental care for Australians. It is certainly more rhetoric than it is substantial policy. When it comes to policy initiatives, there is no doubt that those people who want to invest in their own health care through taking out private health insurance are going to get no easy passage from the Rudd government. I think what we can look forward to—and we do not look forward with any great hope or pleasure—is private health insurance premiums under the government increasing dramatically as a result of their budget initiatives. Furthermore, their proposal to put more money into the public hospital system to address public hospital waiting lists is going to have minimal impact. They are going to set up a screening program for teens which in part duplicates some of the programs that already exist in some of the states. Thanks to the Rudd government, parents will receive funding for a voucher to find out that their 13-year-old child has dental problems, but they will receive no funding to get the problem fixed—whereas under the Howard government up to $4,250 was available for those people with chronic dental problems to get them fixed as soon as possible by a private provider given that the public system has a shortage of dentists.

We see a shortage of good health policy narrative from the Rudd government. There is going to be a direct attack on the private system as a result of various government initiatives, with the net impact on the public system of driving people from private health and private dental care, even with the assistance of Medicare, into a public system that is already under enormous strain. The public dental clinics are simply unequipped to deal with another influx of dental patients. When it comes to chronic dental problems, it is vitally important that all age groups have access to emergency care—all age groups: not just teens, even though they are vitally important, but pensioners and self-funded retirees who are unable to afford treatment for their chronic dental disease.

Labor’s election promise was for two initiatives. One was the Teen Dental Plan. Prior to the election Labor promised $510 million over three years, but the budget delivered $490.7 million over five years, a dramatic reduction. For the Teen Dental Plan, the Rudd government is going to provide ‘up to’—these are new words—$150 per eligible teenager for a voucher towards an annual preventive check. So we actually do not know how much each child will realistically receive by way of vouchers. Eligible teenagers include those aged 12 to 17 years in families receiving family tax benefit part A and teenagers in the same group receiving youth allowance or Abstudy.

Labor’s own press release prior to the election of 2007 clearly stated that a comprehensive check-up will cost $290, so that will leave parents out of pocket to the tune of $140. The Labor Party proclaimed that their initiative would provide free teenage dental check-ups. The Labor Party are only providing up to $150 when their earlier policy said that a comprehensive check-up will cost $290. Maybe they are subsidising the check-up of the top teeth and not the bottom teeth, or the front teeth and not the back teeth. How beneficial it would be if a teenager did not have 50 per cent of their teeth because then they would get all of their teeth covered! It is ironic but sad that the government promised the Australian people better dental care but have failed to deliver it in their own budget.

If the dentist finds dental disease, including dental challenges in particular patients, what can the dentist do about it under Labor’s plan? Frankly, the dentist has two choices: he can direct patients’ parents to the nearest queue at the local public hospital dental clinic—there the child can wait up to four years for treatment while the problem gets worse—or he can offer to fix the problems himself for a fee. This is the question that a lot of parents are going to be asking: how will they feel if they cannot afford to have their children’s dental problems fixed once they have been identified? These are the same parents who are already under enormous financial strain at the moment. I think both sides of the House agree that families and households are under enormous strain with rising petrol prices, rising grocery prices and rising interest rates or rising rent—rising interest rates and rising rent are fingers on the same hand. Then along comes this government voucher, which does not cover the full cost of a check-up for the child, and obviously if the child does have a dental problem then there is going to be an enormous obligation on the parent to do something about it. Very few parents would identify that their children have health problems and then refuse to do something about them. Now that the government has abolished Medicare dental—taken dental out of the Medicare system—there is no safety net.

The Teen Dental Plan is an example of a program that is doomed to fail. It does not cover all of the costs. It duplicates the system that is meant to be provided by some states. It does not provide any services; it simply identifies the problem without putting the money in place to fix the problem. Ultimately, all it does is give people vouchers. It does not mean they are going to have better health care. The flip side is that the government say they are going to provide additional money to the state governments to address the hospital queues, to address the demand for dental services in the public hospitals. Yet, as I said, unless you have an enormous movement of dentists from the private sector to the public sector then you are simply not going to have the people there who can address the waiting list.

We should for a moment as individuals think about what a dentist provides. If you go into a dentist surgery, you will see an enormous amount of equipment. Let us compare a dentist with a doctor. The cost of the equipment in a dentist surgery is enormous. They have everything from X-ray machines right through to the highly specialised equipment for all sorts of treatments. I do not know about you, Mr Speaker, but I have certainly heard the fearsome sound of a dentist’s drill. My experiences at the dentist have never been cheap; rather, they have been, like so many others, pretty expensive exercises.


Mr Combet interjecting


Mr HOCKEY —Well, it is a danger. Dentists in the private sector have these huge costs associated with their businesses. Ultimately, dentists, like all other professionals, are businesspeople; they are running a small business and they have to charge for their costs. The Howard government scheme of Medicare dental actually did address some of that challenge. The new government scheme says, ‘No, we’ll do it all out of our public hospitals,’ which can only be described as ‘challenging operations’ under the existing system, let alone when more people pour into the public hospitals in search of dental care.

I say finally on this bill and more generally on health: the Prime Minister said before the election that the buck stops with him. He said that he will do something about hospitals in Australia. The coalition will keep him to his word. The now Prime Minister said, ‘We will fix the hospitals.’ He committed, ‘If the hospitals are not fixed by 2009’—not ‘if in 2009 the government does not have a plan to fix them’—‘then the buck stops with me.’ ‘We will have a referendum,’ the Prime Minister said, ‘to take over the hospitals from the states.’ We are in the process of supporting a number of government initiatives in relation to health, but the government is on notice that, when it comes to that promise, we will hold the Prime Minister accountable for every single word and we will ensure that he honours his commitment to the Australian people to fix the health system.

But on the form that has been shown by the government to date—with the sustained attack on private health insurance, which is going to put more people into the public hospitals; with the demolition of Medicare dental, which is going to put more people into the public hospitals; and with the flimsy commitments of the government to ongoing demands from the states in relation to better accountability in statistical collection and in the day-to-day operations of the hospitals—I can see no way the Prime Minister is going to meet his commitments to provide Australia and the Australian people with better quality hospitals and better health services. I expect that in 2009 and beyond the Prime Minister’s words that ‘the buck stops with me’ will come back to haunt him.