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Tuesday, 17 June 2008
Page: 5079


Mr NEVILLE (7:32 PM) —It gives me pleasure to rise tonight to speak in this debate on the Dental Benefits Bill 2008 and related bill but no pleasure to listen to some of the claims that have been made by the government, to the breast-beating that has been going on and to the talk of the blame game. It is as if the government have been wound up like toy soldiers when everyone comes in and trots out the same line. The line is about the blame game: ‘Let’s look at the blame game.’ With the exception of a four-year period in the early nineties, dental services have, since Federation, been the sole responsibility of the states. It is plain and simple. It has never been any different. That is my first point.

What happened in the mid-nineties? In its dying days the Keating government plucked a program out of the air—much akin to some of the moves that Mr Rudd, the Prime Minister, has pulled in recent days in association with his Asian tour—following a paper called the National Health Strategy background paper. Out of that the Prime Minister of the day, Mr Keating, designed the Dental Health Program. It was mentioned in the 1993-94 budget and it started in January 1994. It was available to both private and public dental practitioners. It was only available to people over 18 who had various types of cards—health cards, benefit cards, pension cards, DVA cards and the like. Its estimated cost was $278 million, and it delivered 1.5 million services over the four years.

By the admission of the government of the day, it was a catch-up scheme. Again, this is plain and simple. It was never intended to be an ongoing program for dental care. How do we know this? We know it because no mention was made of it in any forward estimates. In the years following the introduction of that scheme in the 1993-94 budget it could have been updated and rolled on into the future but it was not. The Keating government, if re-elected, almost certainly would have dropped it. There was no provision made for it.

And we are told that this dreadful coalition government cut it out! That too is incorrect, because this so-called terrible Howard government actually completed the program. In fact, over that period $245 million was spent. So let us get that first myth out of the way. It was never meant to be an ongoing program; it was a program to help the states, which had got behind, to catch up. There was no intention by the Keating government to take that over on a permanent basis. Indeed—and I will come to this further in my address—if the Rudd government had intended to really enter the field they would have done something more substantial than introduce the program that we are debating tonight.

The coalition introduced, in two stages, a dental program to help people whose health was affected by bad teeth. The whole business of dental care needs to be handled by one or the other levels of government—either all by the state or all by the Commonwealth—or it needs to be very carefully segmented. You cannot have bits and pieces here and there, because inevitably, when you go down that route, some people miss out. Under the coalition government’s program, which had really only just got started, $41.4 million was to be spent in the first year. Over four years it was to be $377 million, and the current government projected forward another year for a five-year program of $491 million—which is amazingly close to the cost of the teen dental component of the government’s overall program.

I do not knock the idea of helping teenagers to have good dental health albeit that this is confined to a certain extent by means testing. What does it deliver when you really get down to the nitty-gritty of it? You receive a voucher, you go to a dentist and you can get up to $150 worth of work done. In one sense this is commendable—everyone in that category, if they want to take it up, will be able to get an assessment done. But that is all they will get. They may get a cleaning and scaling of their teeth but that is all that they will get. It is estimated that some dentists charge up to $190 for a first comprehensive assessment, so $150 is at the lower end of the spectrum. So those children or young people will get their dental assessment, but if the family cannot afford dental care and cannot get into a dental hospital in their state then where do they go from there? What has the net advantage been for anyone? The assessment could say, ‘You’ve got to have four teeth seen to,’ but mum might say, ‘We can’t afford it.’ So you have a $150 assessment and nothing else.

As I said, this plan is commendable in one sense, but if it had included, say, two occasions of service—or even just one occasion of service—then a kid with a broken tooth, an abscessed tooth or whatever it might be could at least be treated for those particular immediate ailments. I have heard the government tonight talking about people being in desperate pain. My understanding of it is that all state dental hospitals are supposed to see people with acute pain immediately, and if that is not happening then they as members of parliament should be doing something about it; because, let me tell you, even though I am a federal member, if I see something unfair happening at the state level then I am not frightened to step in—not frightened for a second.

We are going to spend the equivalent of what would have been cut out of the Howard government’s program for five years on this teen dental health program. I would think that, for that amount or for a similar amount of money, you could get a lot better value if you extended the dental program for primary schools into secondary schools. I know that not all states have that. I understand that South Australia, Queensland and one of the other states have these dental fixtures—sometimes they are permanent fixtures in the school grounds, such as a small brick building, and sometimes they are a caravan that alternates between three, four or even five schools. They are generally run by a supervising dentist and dental therapists. I know that might mean some changes to dental therapy training because when you are dealing essentially with milk teeth—as you do with a lot of primary school children—the level of dental expertise required is probably less. But I would have thought that if the government wanted to put all kids on the road to good dental health then it might have considered spending that amount of money—or perhaps up to $1 billion—on equipping the states with dental clinics for schools. If you could not contain that within that price range then could you not use your CCD sociological profiles of areas and say the schools in the areas with the poorest profiles would get the dental clinics first? In other words, you would essentially get the dental care to those people in most need and have kids leaving school at 18 or thereabouts with reasonable dental treatment—it may not be the ant’s pants, but certainly preventative dental care would have taken place.

At the age of 18 the kids can either go to uni or—as for perhaps 70 or 80 per cent of them—go out into the workforce to apprenticeships, to work in shops and other jobs in the community. They will be earning money of their own. If they come out of school with some pride in their teeth then isn’t it more likely that they might wish to look after them and budget from their own savings to do that? Let me tell the House that when I started my first job I had to do that and I do not feel any the worse for it. It was difficult. It was an impost. I have crooked teeth and I have always had trouble with my teeth. It used to cost me a fair slice of my meagre income at the time for a year or 18 months. I have never regretted that. I do not think that kids, given the opportunity of having their teeth looked after by the state until they are about 18, would do anything else but respond positively—getting the resources while they were 19, 20, 21 or 22 to be able to keep it up. So, whilst I think that symbolically this Teen Dental Plan is very good and will help some people with assessments, I ask the question: what will it do for people in real terms?

The government is going to put another $290 million into the states—which was essentially what the Keating plan did. Actually the figure there was to be $278 million. In fact, it is not as much, on adjusted figures, as the Keating government was to put into actual dental care, albeit with a means test. It worked to varying degrees. I am sure it did do some catching up. It is said that 200,000 families got into the system and that there were 1.5 million occasions of service. I think that is about 7½ services per family treated. So, obviously, it did get to a small segment of the market, and it probably looked after those kids and families well—but it depended on the goodwill of the states. One state minister, who shall remain nameless, said to me: ‘Wasn’t this Commonwealth stuff the greatest joke of all time! As fast as the Commonwealth put it in the top, we took it out the bottom.’ That was the attitude of the states. It was just a top-up. Rather than say, ‘Oh, look, let’s match this and get a lot more done,’ I bet you that the attitude in every state was, ‘Well, we are getting all this Commonwealth money; we will not have to go so hard in the next budget with dental care.’ It would be interesting to do a study on the extent to which the states over that period of the Keating plan—and I do not deride the Keating plan other than to say that it was a catch-up program—increased their dental care and whether they kept it in line with CPI or with the general cost of health. That would be a very interesting exercise. Another aspect of this—and I am not straying from the subject, let me assure you, Mr Deputy Speaker—


Mr Ripoll interjecting


Mr NEVILLE —I am sure the member for Oxley will be quite relaxed when I tell him what I want to talk about. I want to talk about health insurance and the fact that the government is raising the threshold from an income of $50,000 per annum to one of $100,000 per annum. I am not against the lifting of the threshold. It has not been lifted for some years. I would have been reasonably relaxed about it if the threshold figure had been fixed at $65,000 or $75,000 per annum, having been taken in line with a growth figure per year in the health budget or with CPI. But to take it up to $100,000 is definitely going to cause a lot of people to drop out of private health insurance. It is probably going to affect the younger married sector who are pretty healthy and who say, ‘Oh well, we don’t really need this and we’ll drop out.’ The government estimates that 500,000 families will drop out of private health insurance as a result of lifting that threshold—in other words, they will no longer have to pay the levy. Various other sources—economists, commentators, the AMA and so on—estimate the figure as somewhere between 800,000 and one million. That is nearly twice the figure estimated by the government.

Here is the point I want to make—I am sure the member for Oxley will understand it now: amongst that one million people are people who are taking the extras on their private health insurance, including dentistry. I do not know the percentage figure—I would like to know it; I think I would find it very enlightening—but that means that when they drop out they also drop out of having the capacity to pay for dental care. As a result of this, a proportion of those people will shift to the state system. Not all of them will. Some will still say, ‘We can put a bit aside for dental care because we do not have to pay the health insurance premium,’ but most of them will probably say: ‘We will now go on to the state system. We are not going to have private health insurance. We will go on to Medicare for our normal health services and on to the state system for other dental care.’ That is going to add to the number of those seeking dental care.

I also question whether the government has really thought through—and this also impacts indirectly on this dental matter—the idea of the superclinics. I have not found a community yet—although this may not be the case in the outer metropolitan suburbs with which I am not familiar—where anyone wants one of these superclinics. There are perfectly well-run, bulk-billing clinics in Bundaberg that are seven-, eight- and nine-doctor practices but which have only four or five doctors. What possible good would it be to build a superclinic in Bundaberg where we cannot get doctors in the private sector? We cannot get enough doctors in the public hospital. How in heaven’s name are we going to be able to get the doctors into these superclinics? I am told that the government may consider tendering these things out. That would introduce a third level of compliance. You would probably have private doctors, public doctors and these superclinic doctors. The government is equivocating even about that program. It was going to be $5 million, but now it is up to $5 million. Now it may not be a new superclinic; it might be the renovation of a building—in other words, they might do up the old outpatients’ building somewhere that has been closed for a few years. But why would you invest the quantum that would be required to do that at the expense of what could be going into dental care?

I recognise, all Australians recognise, that dental care has not been as good as it might be. We all recognise that. But we need to have a wider strategy that involves, for one thing, the fluoridation of water in those states that do not have it. I would like to see an examination of the ability of dental health clinics to be used in secondary schools. I would like to encourage people to stay in private health insurance and even encourage people to take up dental benefits within that private health insurance. I think that in that way we can share the burden fairly and give the state clinics a better chance of catching up and doing the job that they were destined to do. They are interesting bills, symbolically good; but in practice, in delivering things on the ground, no, they fall very short.