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Monday, 16 June 2008
Page: 4912


Mr ZAPPIA (8:07 PM) —I too rise to speak in support of the Dental Benefits Bill 2008 and theDental Benefits (Consequential Amendments) Bill 2008. These bills are further examples of the Rudd government delivering on yet another election commitment, and doing so very quickly in this term of government. This substantial commitment of $780 million is made up of $290 million towards the Commonwealth Dental Health Program and $490 million for the Teen Dental Plan. The need for this expenditure is urgent, and it is important that this policy be delivered as quickly as possible because, as we have heard from speakers on both sides of this House, the number of people on waiting lists for dental treatment, and the compounding financial and health costs and the deteriorating quality of life of those people, continues to rise. The quality of their lives continues to suffer.

I can speak firsthand about this because I have met a number of the people that fall very much into that category and I have seen the impact it has on their lives. People who have problems with their teeth cannot eat certain foods and that, in turn, has compounding effects on their general health and, quite often, other health complications arise. As has been proved time and time again by the medical profession, poor eating habits are frequently the cause of other medical problems. I have also seen the social impacts on people. One pensioner was telling me in the lead-up to the election campaign about how the fact that he could not get a new set of dentures—he could not afford them—meant that he had to start cutting out part of his social life. He felt entirely uncomfortable in going out and doing the sorts of things that he had been doing, firstly, because he could not enjoy the food and, secondly, because he did not like the way his teeth looked. It caused him to lose a lot of self-confidence.

In the second reading speech, the Minister for Health and Ageing highlighted how some 650,000 Australians are on public dental waiting lists and how 30 per cent of Australians are reported to avoid dental care because of the cost of those services. On almost a daily basis we hear concerns raised by families, by people on low incomes and by pensioners about how difficult it is to face cost-of-living pressures. There is no question that that is happening, and we know that there are a lot of people out there doing it tough—so you can very easily understand how 30 per cent of Australians are actually avoiding dental health care because they simply cannot afford to go to the dentist. It becomes one of the low priorities of their expenditure when it perhaps ought to be one of the high priorities. But, because it is something that they can make do with and learn to live with in the short term, they keep putting off the expenditure. Sadly, the fact that they do so means that, ultimately, the expenditure that they incur further down the track is much, much higher as a result of the consequent health issues that arise. So, whilst they might think at the time that they are putting their money into something that is more urgent, perhaps they are actually making the wrong choice about that.

We also heard from the minister how 50,000 people end up in hospital each year because of preventable dental conditions. Every time this happens it means that someone else has to wait in line for services that they also need. These people would not have to wait in line if the dental care were there and the 50,000 people had not been forced into hospital through neglect of their dental health needs. The minister also talked about how tooth decay is Australia’s most prevalent health problem. I am not surprised to hear that, given the withdrawal of funding from the Commonwealth Dental Health Program by the previous Howard government. Clearly, if you are going to withdraw $100 million a year from a service, someone is going to suffer. Ultimately, the people that are going to suffer are the people that are in need of that service. When you consider that $100 million in funding was withdrawn over a 10-year period and when you consider that dental health is the second biggest health expenditure of Australians—in the latest figures that I was able to obtain some $3½ billion was spent on dental health in one year alone; I think it was 2005-06—you can understand how dental health is one of those areas where people do spend a lot of money. The withdrawal of a billion dollars, or thereabouts, over a 10-year period can make a huge dent in the services that are provided to people that need those services.

The minister also talked about how, between 1996 and 1999, five-year-olds experienced a 21.7 per cent increase in deciduous decay. That is effectively a 21.7 per cent increase over a four-year period. Isn’t it interesting how that increase coincides with the withdrawal of the Commonwealth dental service? I might come back to that a bit later on because I want to say something about some of the remarks that I have heard from speakers on the other side of the House about who is responsible for dental health services in this country. Those statistics that the minister referred to are appalling statistics and they highlight both the urgency of this legislation and the rightful, widespread condemnation of the Howard government for axing the Commonwealth Dental Health Program and in doing so, as I said a moment ago, ripping $100 million per year from the public dental health system. The overwhelming numbers of people who make up the statistics that I referred to earlier are the people who are already the most disadvantaged in our society. They are the pensioners, those on low incomes and the children of parents on low incomes. Those children end up being the victims of all of this because, unlike even their parents, they have had no say in this matter whatsoever. They are the most vulnerable that you could refer to.

Quite understandably, it is those people who miss out because, quite frankly, if you are better off you are likely to be able to afford the dental services that you need and, as you need them, you access them from the public system or the private system. But if you cannot afford them you are the one who is going to go without, just as you have to go without in so many other areas. It begins a downward spiral in your life, because if you do not access the services you need when you need them, as I said earlier on in my remarks, it starts to create other health issues and on it goes. The importance of this bill is that not only does it deliver the $780 million I referred to to the dental needs of Australia but it delivers to those people who most need the money and the support and who would most likely go without if the federal government were not providing this level of support.

I want to talk about another matter, though. I hear speakers from the other side say time and time again that when it comes to the provision of dental services the responsibility lies with the states—as if dental health is not part of overall good health. I was pleased that the member for Moreton reminded me about the Constitution and that section 51, part xxiiiA specifically refers to dental health being an obligation of the federal government. But putting that to one side for a moment, I think that every Australian would quite rightly believe that the federal government has some responsibility when it comes to the provision of health services, and to suggest that dental health is not health but something totally different is totally mind-boggling. The extraordinary absence of logic in suggesting that one part of your body does not come under the broad scope of health because it is dealt with by a specialist who is referred to as a dentist totally baffles me. I have to say that I cannot understand the logic in using the line that it is a state responsibility because dentists are, for some reason, a special category, and I suspect that no-one else in Australia can either.


Mr Price —Certainly the pensioners.


Mr ZAPPIA —Exactly—the pensioners. I have to say that it would not only be the pensioners. I wonder how the dentists and the other dental health professionals feel about that when they hear it. Are they too not referred to as health professionals? Is dentistry not a health service in their eyes? I suggest that they would not be terribly impressed when members opposite suggest that people who study dentistry or nursing in the dentistry field are not considered equal to those who study other forms of medicine. I know a number of dentists. They study dentistry—therefore a medical field—and they do so for a number of years. It is one of those areas in which you have to specialise. The dentists with whom I have had experience I fully commend as absolute health professionals in their field.

There is another element to this business of where the states should be responsible for a service and where they should not. Again, it is interesting that the opposition members continually blame them for the state we are in when it comes to the number of people who are on waiting lists and that they supposedly are to blame for all the woes we face when we talk about dentistry. In my state of South Australia between 1996 and 2002, when some of the statistics escalated the most, we had a Liberal government in power. So I wonder whether the members opposite also direct their criticism at the Liberal government of the day when they throw that criticism at the state governments. I doubt very much that they do. They are simply using that excuse to try to blame the state Labor governments. As we have said time and time again, they play the blame game on a matter on which they themselves were extraordinarily negligent.

What we did see, though, is that in 2004 the Howard government started to panic on this issue because public opinion went against the government of the day. The opinion was that the federal government was not doing enough to assist people with dental needs. In particular, it was the pensioners who were raising the matter the most. So we saw the Howard government bring in some of its own legislation, referred to as the Commonwealth dental scheme, in 2004. But, as other speakers have said time and time again in this debate, the referral process and eligibility criteria were so complex and so restrictive that in my own state, over the four years that the Howard government scheme was in place, I understand that no services at all—and I stand to be corrected if members on the other side can prove me wrong on this—had been provided to children up to the age of 14; that is, absolutely zero. That was the take-up rate of that scheme for children under 14 in the four years that the scheme was in place. It shows how poor the scheme was and how miserably it failed. And because it failed—again, not surprisingly—come the 2007 election, dental health became a major issue which I well recall campaigning and doorknocking and speaking to community groups about on a regular basis. No-one has to convince me that dental health was a major election issue, because I was confronted with it on a regular basis by people I spoke with who were demanding that the federal government reinstate the Commonwealth dental plan and do more than what was being done. As a result of that, and as a result of a government that was beginning to panic because it could sense the mood of the people out there—and with an election looming in 2007—we saw the federal government amend its own scheme and make further changes to it in order to try to establish some credibility on this issue with the voters. It was too little and it was too late. By that stage, voters had had enough. By that stage there were too many people out there who had been waiting too long for assistance. They were not prepared to wait any longer, and they were not prepared to give the Howard government another three years to see what kind of additional scheme it was going to implement. They were not prepared to give the Howard government another three years of bringing in a scheme which, again, would probably not suit their needs. Not surprisingly, they voted with their feet in 2007.

I said earlier that I had met a number of people in the course of my campaign who drew my attention to their need for dental health services. Not surprisingly, when I was elected as the member for Makin the very first constituent who came into my office was a constituent who wanted assistance with respect to his dental needs. I am pleased to say that I was able to assist him and he was able to get the kind of support that he deserved, needed and had been waiting for for some time. That was the very first constituent I had come into my office. Since that time, I have had a number of others come in with similar problems, again, having been on waiting lists for too long and literally in dire need of dental assistance. Again, I did whatever I could for them. But what I can say to them now is that, as a result of this $780 million committed by this government, the waiting lists will be reduced and the services will be out there for them to access when they were not there in the past.

A number of the matters that I would have otherwise spoken on in this debate have already been addressed by other members. I am not going to repeat all of the issues that were raised by members, particularly on this side, in support of this bill, but I do want to respond to some of the issues that were raised by members opposite. One of the criticisms has been that we do not have enough dental professionals in the public system and therefore, regardless of how much money you throw at the system, people will not be able to access the services. Why don’t we have enough dental professionals in the system?


Ms Rishworth —Because they kept ignoring it.


Mr ZAPPIA —Absolutely. For 10 years the Howard government did absolutely nothing about ensuring that the future needs of the dental profession were being met by our universities. That is why we have a shortage. But there is another reason why we have a shortage, and that is that when you pull $100 million a year out of a service then of course the waiting lists are going to grow. Had we invested that money over the last 10 years into the service, the waiting list today would not be so long and therefore the professionals who are out there today would be able to cope with the demands that are being placed on them. It is quite simple. You do not have to use an extraordinary amount of logic to work out that, if you had been servicing people for the last 10 years, you would not have had the accumulation of people on the waiting lists that we now know we do have.

But it goes further than that, and I am pleased that other members, including the member for Moreton and the member for Charlton, have referred to the James Cook University and the establishment of a dentistry school there. This government is aware that there is a shortage of dental professionals in the field. We are very much aware of that, and that is why there has been this investment in the James Cook University—again, to try to increase the number of professionals that are required throughout the communities wherever you go in Australia.

I guess the other matter is that, when it comes to the health checks, there is no reason why those health checks cannot be done by private practitioners. It does not have to be a dentist in the public system. They can in fact be done by private dentists, and I am sure that many of them will be. Whilst I am speaking on the Medicare Teen Dental Plan, can I say this: as a parent of children who are now in their 20s, I can well recall when my kids were in their teenage years. I can recall that it is in those years that young people tend to neglect their health needs the most when they should in fact do quite the opposite. Not surprisingly, the statistics show that between the ages of 18 and 21 is when young people generally have the worst and most dental problems. Why? Because at the time when preventive measures should be taken they are being ignored—for a whole range of reasons. I am sure that anyone in this House who is a father or a mother would understand how kids grow up and how they tend to commit their time to other things and neglect the things that perhaps they should not be neglecting. The reality is that that is when they ought to be looked at, and so the Medicare Teen Dental Plan is not simply a $150 payment that is going to create a check-up. What it is going to do is create the preventive action that will save those families money later on and ensure that those kids have much better health as a result of it.

Quite frankly, this legislation goes a long way to doing a lot for a lot of people. I commend it to the House, and I am pleased to see that, as I said earlier, this government has introduced it so early in its period of government.