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Monday, 16 June 2008
Page: 4877


Mr JOHNSON (5:20 PM) —I am pleased to speak in the parliament today on the Dental Benefits Bill 2008 and the related bill. The bills go to a subject of great interest to me as both a citizen of this country and, of course, the federal member for Ryan. I represent the great people of the seat of Ryan. Ryan is a federal seat in the western suburbs of Brisbane. In the six or seven years that I have been the federal member, I have had the chance to meet many local residents who have certainly raised with me issues of health, including dental health.

Before I go to the contents of the bill, I want to say that I largely agree with the thrust of the member for New England’s observation that perhaps dental care should be part of the overall health profile of a person. I am not quite sure why we treat dental care as something unique and different to the rest of someone’s health. It really is very important to someone that their dental care is up there with the rest of their health care. I certainly think that is an observation worthy of consideration at some future point, particularly by the professionals in this area. Of course, that is not in any way to diminish it as a specialty or as a profession; in fact, it acknowledges that it is very significant, because dental care is very important. It is part of overall health and someone’s capacity to engage in the community and the workplace and to go about their daily life and their daily work.

I refer also to the comments of the previous speaker, the member for Isaacs. He referred to the previous government ‘abandoning’—I think that was his word—the funds that would have gone to this area and the overall health architecture of our country. If one turns one’s mind back to 1996, when the Howard government was first elected, I do not think too many Australians would need to be reminded that, at the time, the incoming Howard government faced a massive budget debt. In fact, such was its scale that almost no area of government expenditure was left untouched. Certainly members of the parliament would know—I know that the people of Ryan know full well—that when the Howard government came to office it faced a $96 billion budget debt. There was no way that any responsible government could go forward with all kinds of worthy programs and yet have a $96 billion debt hanging around the neck of future generations.

Interestingly, I just came across a paper that referred to 21 April 2006 as being the official date that the Commonwealth’s debt was repaid. So it took almost a decade to pay off this whopping $96 billion of debt. Of course, we do not face that problem now. The Commonwealth does not face the problem of how to pay off debt. It has a massive $22 billion surplus—and it is good that we have this surplus. It is good that the Commonwealth can spend these funds on important areas of the community. I know that the government claims that it has raised $22 billion in surplus in six months of office. I think even the little plastic turtle in my front garden would not be convinced of that. Quite frankly, it is just remarkable that the government, after six months in office, claims to have created $22 billion of Commonwealth surplus. But, anyway, it has $22 billion of funds and I certainly commend any program that goes to issues of the health of our fellow citizens. We in this parliament are perhaps privileged that we have access to schemes, private health insurance and dental specialists if we need them whereas so many of our fellow Australians do not. As I say, any scheme that tries to redress that is a good thing.

Labor promised in the campaign to provide funding to establish two dental programs if it were to win office: the Commonwealth Dental Health Program and the Teen Dental Plan. In fact, it promised up to $290 million to fund a dental program that it claimed would assist up to one million Australians to access public dental treatment. Under the proposal, funding would be made available to states and territories to assist them to clear public dental waiting list backlogs by funding up to one million additional dental services over the next three years—waiting lists, I might add, that are really the creation of the state Labor governments around the country. Certainly all states and territories are the primary delivery mechanisms for public dental care, through public dental clinics or through the hospitals. During 2005-06 the combined expenditure on public dental health services by state and territory governments was just over $500 million. In fact, it was a measly $515 million, and that is notwithstanding the fact that the states receive every single penny of GST revenue. Every single dollar of GST revenue goes to the states, and yet collectively across this country state and territory governments were only willing to spend a measly $515 million.

Eligibility for public dental services is often means tested so that it is targeted at concession card holders and those on low incomes who cannot afford to access private dental services. The Rudd government’s new Commonwealth Dental Health Program, the CDHP, is, interestingly, modelled on the former Keating government’s Commonwealth Dental Health Program. Speaking of the former Prime Minister Mr Keating, I understand that he is going to be the face of Australian tourism. I note that it has certainly raised a lot of eyebrows already that the former Prime Minister will be the face of Australian tourism. I thought we were trying to attract tourists to this country, not turn them away. But, as I said, this Commonwealth Dental Health Program is going to be modelled on the Keating government’s Dental Health Program. But, unlike the former program, which targeted adult concession card holders, the new program will require the states and territories to target other priority groups—specifically those with chronic diseases, Indigenous Australians and preschool children.

Full details of the allocation of funding for the proposed CDHP to the states and territories do not appear to have been set in stone yet. The Minister for Health and Ageing described discussions with the states and territories as being well advanced, but it seems that these have not been finalised, so I am not sure where we stand in relation to that. I would have thought they were pretty fundamental to this being an effective scheme.

From 1 July 2008 eligible families—that is, those in receipt of family tax benefit A, roughly 1.7 million people—and teenagers in receipt of Abstudy or youth allowance will be provided with a voucher to allow them to access an annual dental preventive check for teenagers. These teenagers will be aged between 12 and 17. The voucher will provide a dental benefit for a service up to the value of $150. I understand that the dental check-up can be delivered by either a public or a private dentist.

It is proposed that the Teen Dental Plan would operate in a similar way to the Medicare arrangements through a new dental benefits schedule also to be established by this bill and to be administered by Medicare Australia. The government estimates that around 1.1 million teenagers would be eligible for the vouchers in any one year. The bill proposes billing arrangements that are similar to what currently occurs under Medicare, which would allow for a range of billing practices. Under the proposed assignment of dental benefits, as I understand it, the bill provides for three means of payment. The first option allows provider dentists to bulk-bill Medicare Australia for the check-up service, which is then considered a full payment for the service, so the teenager would pay nothing. The second option allows the dentist to bill the teenager, who can then request a cheque from Medicare Australia to be issued in the name of the dental provider, up to the value of $150. The teenager would then be responsible for providing that cheque to the dental provider. As to the third method of billing proposed under this bill, it would appear that the teenager pays the dental bill and then makes a claim to Medicare Australia for a rebate, again up to $150.

Of the three billing mechanisms in place, I would have thought that only one—the bulk-billing option—would guarantee that the teenager or family would pay nothing for the service. As the Rudd government’s own estimates suggest, the cost of a dental check-up is around $290 and dentists are free to set their own fees. Patients accessing dental benefits who are not bulk-billed may be exposed to significant out-of-pocket costs. So you are covered up to $150 under the scheme, but the cost in reality is $290. To me, this really highlights the Rudd rhetoric and does not meet the Rudd promise. This is not universal dental care for young people; this is really a scheme that is going to see a lot of young people fall through the cracks. I just do not see how 1.1 million teenagers who may be eligible for these vouchers in any one year are going to enjoy the full benefits of the dental check-ups covered by this legislation.

The other fundamental flaw in this bill, of course, is that beyond the $150 there is nothing. So, a teenager goes to see their dentist and is told that they have decay or need massive work done on their teeth or gums, but then there is nothing else. There is no subsequent financial coverage; there is no further support mechanism. If they want to go back and see the dentist again, as they might need to, they would have to find their own financial means. This is an example of the government trying to look as if it is doing something serious but not really doing anything—because the check-up does not lead to anything at all. It is like going to hospital and being told you are really unwell with, for instance, bronchitis or pneumonia but that there is no bed in the hospital or subsequent care available for you. You just have to go home and take care of yourself.

The Chairman of the Association for the Promotion of Oral Health, Professor Hans Zoellner, who is at Sydney university, argues that funding the two proposed replacement programs is ‘money poorly spent’ because there are no strings attached for the funding to the states and the dental checks for teenagers do not include treatment services. I think that goes to the nub of this piece of legislation. It is a check-up—and that is fine for what it is worth—but why not provide financial services and assistance for teenagers who are professionally advised that they need further dental care? As I said at the outset, the Commonwealth government has $22 billion in its bank account. Why not spend some of that money on young people—in fact, on anybody who is disadvantaged—to help them with something pretty fundamental to their capacity to fully engage in our country?

The Australian Dental Association has raised similar concerns. I take the opportunity of quoting a media release of 13 May 2008 from the President of the Australian Dental Association, Dr John Matthews, in relation to this issue. It goes to the subject, first of all, of the states and territories’ responsibility:

For far too long, the States and Territories of Australia have failed to meet their obligations to ensure proper delivery of dental care to poor and disadvantaged Australians. This Government had the opportunity to rectify some of the specific deficiencies that existed by introducing some coordinated plans that are able to be built upon or modified to meet future needs.

He said further:

Instead it has provided the State/Territory Health Services with additional funding [less than provided more than 10 years ago] to prop up schemes that have not delivered to date. It’s a Band-Aid solution at best.

So there you go. That is not coming from a politician, from a member of the coalition, from someone who does not have expertise or from someone who has no professional or personal interest in this area—this is coming from the Federal President of the ADA. He has no claim to any special treatment; he is giving a professional opinion. He says it is a bandaid solution at best and points out that the funding is less than was provided more than a decade ago. That, I think, speaks volumes for the attitude to this bill of those who count.

The ADA also has concerns that the Teen Dental Plan is too narrow and fails to provide a ‘complete course of treatment’, which it argues could lead to teenagers who require more treatment moving back onto public sector dental waiting lists. If this occurs and substantial numbers of teenagers move onto public dental waiting lists, it is not clear if the proposed new CDHP would be sufficiently resourced to provide public dental services for the new groups that the government now wants it to target. These include those with chronic diseases who would no longer have access to the AHDCI, preschool children and, importantly, Indigenous Australians. State based public dental programs already provide services to people on low incomes and to students through school dental services, but, as has been noted, there are substantial waiting lists for many of these services and, although the government has committed $290 million over three years for the new CDHP, this is less than was provided to the states under the former program by the Howard government. Again I emphasise to the constituents of Ryan, who would be very interested to know this, that this $290 million is less than was provided to the states under the former Howard government.

While the minister has allowed for public sector dentists to provide the preventive dental check-ups, it is not clear how these will be provided in a timely manner, given the already long waiting lists for public dental services and the level of funding for the proposed scheme. Instead of the coalition’s very successful Medicare dental scheme, the Rudd government is going to allocate $290 million to push dental patients into the overburdened and inefficient state health system. We should be encouraging people out of the public health system by encouraging those Australians who can afford it to take out private health insurance, not be encouraging them to go into the state health system.

Queenslanders will certainly take no comfort from this. Any Queenslander listening to this debate would be fully aware that the Queensland health system is in a really appalling state. Given that we have a Prime Minister from Queensland, I would like to think that he will come to the aid of the Queensland health system. Of course, the Labor government in Queensland has been in power for almost 20 uninterrupted years—nearly two decades—yet we have so many flaws in that system. I have said in the parliament previously that I have a brother who is a neurosurgeon and a sister who is a doctor, so I am not speaking without some degree of informed knowledge here. This bill is no major long-term solution to teenage dental health care problems.

In conclusion, I take this opportunity to encourage the students in my electorate of Ryan to, as far as they can—they are young people, of course—keep to a minimum eating things like lollies, candy and cakes. I encourage you to look after your teeth. It is very important that you do that because in your professional working and adult lives it is very important to be a healthy Australian and to set a good example for others. I say to any young person in the Ryan electorate listening: look after your teeth and drink plenty of milk because milk has a lot of calcium and it is very good for young people. (Time expired)