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Monday, 16 June 2008
Page: 4871


Mr TUCKEY (4:49 PM) —Mr Deputy Speaker, prior to question time I raised the issue that I think is fundamental to this debate on the Dental Benefits Bill 2008 and the government’s decision to change the mechanisms by which this Australian parliament delivers assistance to persons suffering due to the need of dental treatment. I was making the point that it was the Keating government who had previously made a genuine attempt with $100 million a year over four years to assist the states in catching up with a huge backlog of waiting lists of persons requiring dental treatment who obviously otherwise could not afford it. Dental treatment costs have escalated significantly in recent times, and those of us who attend dentists from time to time soon learn about that. The government changed during the provision of that money and at the end of the period it is my clear recollection that the waiting lists had not decreased for the $400 million of Australian government taxpayers’ money that had been expended.

I pointed out that in his address today, and in fact opening the response of the opposition to this bill, the member for North Sydney pointed out that the reality is that less than 10 per cent of the Australian dental workforce is employed in the public sector. In that circumstance, the government’s response, which is to give cash to the states to upgrade and dissolve these waiting lists, is a case of you can put the wages up of the existing staff but you cannot double their output, and therefore it is misconceived. That became patently obvious to the Howard government and, in looking at that particular problem, the Howard government came up with an alternative. It was to create dental services on a referral from a GP—they were not just wide open; they were for persons who could anticipate serious health problems and had a Medicare number. Now that meant such moneys as the Australian government spent were spent on a scheme over which it had control and, therefore, which made a very significant difference to the outcomes. Above all, as is consistent with Medicare, it gave those on the waiting lists access to private practitioners—the 90-plus per cent of the dental workforce. The member for North Sydney, as I recollect, informed us that somewhere over 300,000 services have been granted over what is a very short span of possibly nine months. The other tragedy is that some of those people are only halfway through their treatment and, as I understand it, they are now denied completion of that service and must go back in the queue waiting for the under-resourced state entities to get on with the job.

The Deputy Prime Minister frequently tells us about all the wonderful training initiatives that are being implemented. There will not be a doubling of the Public Service workforce coming out of university next week or next year. I have no understanding that the government, in producing this compromise, promoted it during the election. It is an interesting point that we get lectured in here at question time every day about attacking the so-called $20 billion surplus, but it appears to me that the issues which we are debating with the government are those for which the government had no mandate. I believe this is one of those occasions. I do not recollect at any time during the election campaign—and a following speaker can correct me if they have the evidence—the government telling the people that on election it would cancel this very effective Medicare initiative and go back to something that has been tried and failed.

The first of two ministerial statements we have just heard was about the tragedy that has occurred in the gas industry in Western Australia. I do not know what proportion of this $250 million will get to the WA government, but it struck me that they cannot even run gas for their hospitals sufficient to do the laundry. Of course, it is the lack of pressure that the government put on by building cheap electricity generators running on gas instead of keeping with a system that was going to produce another coal-fired power station in Collie—where they have strong political support, I might add—that has created the problem. The problem is not for Western Australians; even in this depleted nature, that problem has now stopped the manufacturing of bricks, stopped the manufacturing of plasterboard and put a lot of people out of work. The reality is that it need not have happened if there had been better administration of the energy facilities in Western Australia, and here we are debating sending money to those same people—and, if they deal with it in the fashion they have dealt with energy management, do not hold your breath if you are on the waiting list.

Another initiative raised in this composite legislation relates to teen dental services. This is an initiative which can be applauded as a concept. The problem is that in Western Australia there is a school dental program already. That should be applauded. The issue relating to this proposed section of the legislation is, as I understand it, that a maximum of $150 will be available for teens to have their teeth checked. If in the process the dentist says, ‘Yes, there is the tooth that is giving you this dreadful toothache, but you will have to pay me to take it out or fill it because that is not allowed for; I can only check and tell that you have crook teeth,’ I am wondering what the benefit is. Typically, if you go to a dentist and they find that there is work to be done, they do not charge you for looking; they just charge you quite a large fee for fixing it. But we now have this rather amazing process where the government is saying to people, ‘We will pay to have your teeth looked at, but if they are found to require treatment we will not give you any money or assistance for it.’ Hopefully, it will not happen very often with young people. Under the previous legislation introduced by the Howard government they could have had a free check-up and, if it were serious, they could get a referral from their GP and have up to $4,200 available for the treatment that was necessary. That makes a huge difference.

It is really a test of this government’s capacity to manage. I spoke recently on health matters and talked about measuring excellence by expenditure. From my observations over a long period in this place, I have noticed that both sides of the House pay too much attention to the money they have spent and too little attention to the outcomes. More particularly, I have found myself in debate in times gone by with otherwise capable public servants who were most anxious to just send the cheque, and I frequently wanted to know a bit more about what the taxpayer was going to get for this money. It is still an issue with me and I think it is amazing that we have this philosophical hang-up within government and the Labor Party that, if the government does not do the job, it will not be done properly. That is not the view of the common citizen. Whenever they can possibly afford it, they send their kids to a private school. Whenever they can possibly afford it, they take out private health insurance when they know there is a need. Nevertheless, that will be proved quite a tragedy because of this attack on private health insurance and the private hospital system. We will see an escalation in premiums that will start to make the whole scheme unviable for the simple reason that the non-claiming young will decline to continue to be members of a private health fund.

Anybody who chooses to do the numbers—and the minister at the table, Minister Emerson, claims to be one of them—and wants to sit down and find out how you could improve the cost to government and the service to consumers should look at this. Instead of spending huge amounts of money sending cheques to state governments to run hospitals you could in fact use that money to subsidise—up to 100 per cent in deserving cases—the private health insurance of many individuals. Then (a) the cost of overall insurance would drop because everybody would be in the system and (b) everybody would have the same access to hospital services. Hospitals—be they government or otherwise—would become anxious to give the service because they would get paid for the service. They would not get, as applies with this legislation, a lump of money which they would then have to budget and which would mean that patients—be they dental or hospital—would become a liability. You do not want too many of them. That is the way that governments fund their hospitals.

It is commonly known amongst senior hospital administrators—and I have heard it said publicly—that waiting lists are part of the budgetary process. I reminded the House the other day of the complaint of a senior New Zealand administrator at a conference I attended years ago. Having said just that, she complained about the administration of the waiting lists. This is the other problem. She pointed out that, if you have a sufficiently energetic member of parliament—and I guess this applies to some degree with dental waiting lists—you get pushed up the list, to the detriment of others who do not. I gave the example of a member of parliament who did not have private health insurance but whose wife got private hospital treatment and, what is more, her doctor of choice. People who want to do a bit of research will find out who I am talking about. This is the bad side of this type of service. It is a tragedy that, without warning to the Australian people, a clearly beneficial and practical response to those in need of serious dental treatment is being taken away and replaced with something that history has proven does not work.

Mr Deputy Speaker, I assume the gentleman who has just entered the House is the next to speak. If not, I would not want to leave the opposition in trouble. Is that the truth?


Mr Dreyfus —Indeed it is.


Mr TUCKEY —Fine. Thank you very much.