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Monday, 16 June 2008
Page: 4825


Mr WINDSOR (1:24 PM) —I expect that everybody in this place will be supporting the Dental Benefits Bill 2008 and Dental Benefits (Consequential Amendments) Bill 2008, but I do have some specific issues that I would like to raise in relation to dental health. I listened quite intently to the last speaker, particularly towards the end when he was suggesting that people find it difficult to understand why they can go to a doctor and be covered under the Medicare arrangement, yet in most cases they cannot go to a dentist and achieve the same outcome. I think there is an issue of priority that is developing in health care. I understand it has been based, historically, on the state-Commonwealth relationship when Medicare was first drawn up. At that particular time the states wanted to maintain some degree of control over dental care, so dental care was not included with the rest of our bodily health.

I attended a television program a few weeks back where the previous Minister for Health and Ageing was in the audience. He would remember a lady at that event who at one stage made a comment about the funding of dental care. I think the comment was: ‘You can access Medicare for a boil on your bum, but you cannot access it for a boil on your gum.’ That encapsulates an issue that is out there in the community that really needs to be addressed. I do not think the legislation that we are debating today addresses that broader issue. It addresses some coverage for teenagers and allows a teenager to be part-funded to go to a dentist for a check-up but it does not allow for any money to change hands to actually do any work. So there is a little bit of an anomaly there. There is also some money going to support the states in their dental care arrangements, and I am sure that will be very welcome to the states.

Most members would know that there are something like 650,000 Australians who currently need public dental treatment. I think the underlying problem here is one of priority. If you ask most people prior to any election what the important areas are to them as family members, as parents, as members of our society, they would say health and education. Health and education are the two most important areas. But we still have a situation in our very wealthy country where there are 650,000 Australians who cannot access public dental care, and there are a number of reasons for that. One of those reasons is the fact that dental care is not included under the Medicare arrangements. I have not had it explained to me sufficiently by anybody why our teeth are treated as some sort of out-of-body part of our bodies. Our teeth, our mouths and our gums are, in legislation, not part of our body in the way in which Medicare funding is accessed. I was told that 20- or 30-odd years ago when Medicare was struck up the states wanted to retain control of dental care, but that is a historical context. That is not a reason why the Commonwealth should not be involved or why Medicare should not be accessed in these modern times.

I would have thought, given the economic circumstances such as surpluses et cetera in recent budgets, that a reprioritisation of dental care as part of our bodily care should have been a major priority at the last election instead of this. Even though I am supporting the legislation, it is really a revamping of funding that was put in place by the former government in a slightly different way.

The former minister for health is with us today and he would be familiar with the debate that took place over the last few years about getting some inclusion of dental care in Medicare. He introduced a scheme which related to people being able to access Medicare payments if they had a certificate from their doctor suggesting that they were chronically ill because of their dental health and that, because their dental health could impact on the health of the rest of their body, they should be able to be treated under the Medicare arrangements. That was greeted with some acclaim, and quite rightly, because it was a move in the right direction. What was really going on was that if people were chronically ill from a lack of adequate dental care they ended up in hospital where Medicare provided for the treatment. In a sense, the former minister was short-circuiting that problem. He should accept my congratulations for doing that. But it did not address the root cause of this problem. It made many people think, ‘I have to get really sick before I can get treatment. I am in a queue of 650,000 people trying to see a dentist in the public system. I cannot afford to pay for the private system. Even if I could, it is unlikely that, depending on where I live, I would be able to get into some of the practices.’ This legislation has not taken away that issue. All this legislation has done is revamp the former minister’s proposal, put a similar amount of money back into the state system and created this teen dental care procedure where teenagers can get a check-up but no treatment—unless their parents pay for it, of course.

The other issue that I think needs to be addressed is the cost of Medicare provision of dental care. The underlying question is: why have governments in the past—or the present government—not addressed that? One of the real problems that we have here is that if you suddenly allowed 650,000 Australians to access dental care they would not be able to find a dentist. That brings home quite clearly the amount of spending that has gone into training dentists in this country. I think the average age of a dentist in Australia is one year older than the average age of a farmer. There are a few farmers in the gallery today. They do not look average to me! I think the average age of a farmer is about 58 years old. I am told that the average age of a dentist is roughly the same. I am also told that, in dental schools in Australia, such as, for example, at Sydney university, a large proportion of the dentists who are trained either go into research or are foreign students who go back overseas to practice in their country of origin. So the rate of return of people who are trained in dentistry in our universities is much lower than what is required to replace the dentists out there at the moment and will not be able to compensate for an onrush of treatment, even though 650,000 Australians require some degree of treatment.

I think that is another message to the government about something that the former government neglected for most of its term. To its credit, towards the end of its 10 or 12 years the former government introduced a dental school in the country based on what I think was the wise theory that if professional people are trained in the country—whether they be dentists, doctors, vets or whatever—they are more likely to stay and practice in the country and develop formative relationships within that country environment. The former minister for health would well remember his trip to my electorate. He was instrumental in the formation of a medical school at the University of New England, in conjunction with the University of Newcastle. They have a very good relationship based on the University Department of Rural Health concept. I remember him coming and visiting the people in Tamworth behind the University Department of Rural Health. I think that was a great success and in no small way led to the extension of a full-blown medical school in that relationship between the University of Newcastle and the University of New England.

But we need more of those sorts of initiatives in dental training as well as medical training. In the latest budget I do not see any sign of that activity happening. If we do not do that, if we do not invest in those professional training areas and if we do not invest in locating some of those professional training areas in the country, we will have not only a deficit in the number of dentists available to treat people, if in fact they could access treatment financially, but also the ongoing difficulty with age. As I said, the average age of a dentist now is the same as the average age of a farmer. I know farmers have difficulties today. It is a bit like pulling teeth—getting the Rudd government to address their particular issue of the single-desk marketing arrangements that are currently before the Senate. That will obviously lead to some degree of decay of their bargaining power in the global market.

So I would hope that the government would look at not only the farmers’ problem but also the issue of dental training. Dental training, I am told by the various academics involved, is very expensive. Given the decline in the last decade or so in the amount of money that the universities are getting for their courses, I have been told by various academics, ‘It’s more profitable for us to be pumping out lawyers and others, low-cost graduates, rather than investing in high-cost graduates such as dentists and vet scientists.’ In dentistry particularly there is a lot of hands-on training. The capital facilities are obviously very expensive. But there again I think it gets down to the priorities of the nation, and we should include dental care under the universal healthcare arrangements that Medicare provides.

The current Minister for Health and Ageing took issue with me on a particular television program recently on how much it would cost—that it is all very well for Independents to jump up and down and say, ‘Let’s have this; let’s have that.’ But I have taken the time to conduct a survey in my electorate on a number of occasions now to see whether people would be prepared to pay a bit more—a substantial bit more—on the Medicare levy to have basic dental care covered under the Medicare provisions. The government may argue from time to time that here is a difficulty that, if we spend more money on dental care, we are going to have to spend less on something else. Let us remove that as an issue, because I believe, and other surveys have shown, that most Australians would be prepared to pay a little bit more to have dental care covered under the Medicare arrangements. None of us know when we or one of our family or friends or someone we know down the street is going to require some degree of dental treatment.

That could come from a whole range of areas. It does not necessarily come from neglect or genetics. Other health related factors will cause dental health problems. So a quite substantial amount of money would be required, and in a lot of cases people do not have that. Until they get chronically ill and enter the hospital system, where they will be treated under the universal health obligations, they will just suffer in silence and in pain. So I would suggest that in coming budgets the government not only have a close look at the allocation of their own funds to various priority areas but look very seriously at this issue of including our mouths as part of our bodies.

I know there are a number of members of this House, including the Prime Minister, who have had various heart treatments at different times of their lives. If you talk to a dentist, one of the first things that happens if you are having a major operation, particularly a heart operation, is that your mouth, your gums and your teeth will be checked. If there is an infection of any sort, the operation will most probably not take place. So I think, if nothing else, that establishes some link between our mouths and the rest of our bodies. I have heard the former Minister for Health and Ageing on a number of occasions talk about people being responsible for what they eat et cetera and that parents have an obligation in terms of the food that their children eat. I could not agree more, but they eat with their mouths and there are various problems that do occur from time to time. I think we as a parliament neglect some of the issues by not including our mouths with the rest of our bodies.

In conclusion, in the survey that I did within my electorate to see whether people were prepared to pay a bit more on their Medicare levy to cover dental health, 81 per cent of people said they were more than happy to pay a bit more and, in that sense, have universal insurance against the occasion when some quite costly dental treatment would be required for them or their children. I would very much argue against cosmetic dental care being included in any form of state contribution, but basic oral health should be included as part of that. A figure of 81 per cent in any survey would indicate that the great majority of people are in favour of a particular issue. I note with some degree of interest that in the surveys into the changes to wheat marketing, for instance, well over 80 per cent of grain growers are in support of a single-desk system, and that has been completely ignored by the Labor Party and completely ignored by the Liberal Party in this place. Both are issues where members of parliament should actually pay some attention to what their constituents are saying. When you are getting those sorts of percentages and when constituents are calling out in those sorts of numbers, whether it be for a single-desk marketing arrangement or for Medicare to cover oral health, I think it is appropriate that this parliament actually listen to what those people are saying and, more importantly, act upon what they have said.