Clare O'Neil (Hotham, Australian Labor Party) Share this | Hansard source

It is a real privilege tonight to speak on the Dental Benefits Legislation Amendment Bill 2014 and I want to thank the member for Ballarat for moving her second reading amendment, which allows me to speak a little bit more about what is an incredibly important area of public policy in Australia. It is one that concerns literally thousands of people that live in my electorate, one I am often contacted about when I talk with the people that I represent.

All of us in this House know that dental care in Australia over many, many years has really been a poor cousin of health care. Many Australians who are able to privately paid their own dental care probably do not realise that there are thousands of people around the country who are having to bear very substantial costs which they are often not able to meet; living in intense pain that comes from issues with their oral health; and, importantly that the burdens of the way that the legislation has worked in this area have fallen so unfairly on different groups within the community.

I know that Australians who are struggling with dental problems have watched over many years while the problem has been passed from government to government, some of them making real attempts to reform and change in this area and others who have, unfortunately, gone backwards. I know that the situation that we are dealing with—particularly that the Rudd government was dealing with—was a situation in Australia where we had these very significant and very fundamental divides between the funding of health care. We saw completely different dental care being provided for people who had private means in Australia versus those who were relying on government services. We saw staggering differences in the dental health of people whether they were lived in the city, whether they lived in outer metro areas or the country, Even between young and old there were different sorts of policies that applied.

Indeed, I think that one of the fascinations of public policy in Australia when we come to these points is really that there is no reason why it is that the kind of overall profound strong foundation that we have for health care in Australia has not extended to mouth care, just by one of those little quirks. It is a bit of quirk because we know that the health of people's teeth is actually incredibly important to their overall health. So issues with tooth care can lead to lots of other health problems in the individual. It is associated with some specific conditions around poor nutrition, stroke and diabetes—even cardiovascular disease. We also know that poor dental health is an incredibly important social issue in the sense that it is tightly linked to socioeconomic status. I think there is no accident there, because we all know how expensive it is to go to the dentist. We also know that those costs have increased, when we look back in time, much, much quicker than the cost of living has increased. So in that sense for people who are struggling or living in poverty, that is a thing that often just falls off the agenda—the thing that they just cannot afford.

Labor has some incredibly proud reforms that it put in place when it was in government. I know that all of us in this House, if we had all the budget in the world, would probably want to make the perfect system—universal, top-quality dental care like we often see in our health system. But obviously that is not a situation we usually find ourselves in when in government. So that last government made a really strong commitment to do what it could with the limited funding available and made some very important reforms that really moved us in the right direction at least. I want to talk a little bit about those reforms. I want to just mention that it is important to see that they were done in the Labor way—that is, accepting that we do not have all the money in the world and accepting that because of that we need to target reforms very tightly, put dollars where they are going to count the most, make sure that those dollars are going to the people who are most in need. And that was certainly how this issue of trying to fix the dental care system was approached.

In 2012 Labor announced a dental reform package of $4.1 billion, which was the biggest investment in dental care since Federation—a really amazing achievement. It was essentially set out in three large elements. The first was the Child Dental Benefits Schedule; $2.7 billion for 3.4 million Australian children. That is fantastic for 3.4 million Australian children. A lot of the motivation to focus on children was not accidental; it was linked to some very disturbing evidence that came to light around 2009 when the Australian Institute of Health and Welfare showed that the dental health of young people in Australia was going backwards. So while we had so much prosperity and while we were growing much wealthier as a country, dental health in young people was actually going backwards. The Australian Institute of Health and Welfare reported that 58 per cent of 14 year olds had permanent tooth decay and 20,000 children under the age of 10 were hospitalised each year because of tooth decay—it is an absolutely astounding fact. So the centrepiece of this beginning, of trying to fix this big issue in Australian public policy, was a program for three million Australian children aged between two and 17. The idea was that for those children going to the dentist would be just like going to the doctor, with the same level of ease and support.

The first element I mentioned was the Child Dental Benefits Schedule, but there was also the $1.3 billion for additional services for low-income adults. That was for 1.4 million low-income adults around Australia to get the dental care that they so urgently needed. I mentioned before that we know there are links between people's dental care and their socioeconomic status. You would be interested to learn that if you earn more than $60,000 a year you have seven more teeth on average than Australia's poorest people. Now that is fundamentally unfair and I do not think we want to see that situation in Australia. That was the big second tenant of this reform package—that is, services to low-income adults.

The third element was a very important piece that I do not want to get lost, which was about workforce planning. It is much harder—and I think remains much harder despite these efforts—to get good, affordable dental care outside of the inner areas of our major cities around Australia; It is even hard to get it in the outer metro areas, much less regional, rural and remote areas. It is just simply much harder to find a dentist there. We know in Australia that the number of dentists in our major cities is actually double those in outer regional areas and triple those in remote areas, so we have to accept that the funding element is very important here. It is a critical piece of the puzzle. But it is also important that people who need to go to the dentist are able to find one. I know that for people living in outer metropolitan electorates like the Lalor electorate, whose member is sitting here behind me, these would be big issues that are facing her constituents. These are the things that Labor was really focused on when it was in government and putting in place this huge reform package.

Of course that was not all that was done on dental. We know that when the Rudd government was elected public dental waiting lists were absolutely ridiculous. We are talking years and years that people, often pensioners, were waiting for help with dentures and other types of things like that. It was just absolutely untenable that we saw this sort of thing in our system. In the 2012-13 budget, Labor committed $550 million in funding of the public dental waiting list. In 2013, 200,000 patients around Australia received much needed dental care just because of that funding.

You can probably tell that I am very proud of these reforms. I think it was some of those really pivotal things that that government was able to do that affected the lives of literally millions of Australians and, in many instances, Australian children. When we look at all of the different areas we deal with in this parliament, it really is Labor that goes forward and makes these reforms. Those on the other side of the House talk a little bit about reform, but they really do only move in one direction—that is, making cuts. They sometimes increase services, often looking to improve supports for the wealthy; however, what we do see time and time again is moves to take away supports that are needed for those who need them most. And not surprisingly we do see this when we come to dental. The coalition have had to be dragged by their heels into supporting moves to progress and enhance the sustainability and the level of dental care that is provided around the country.

As it stands, most dental care has historically been funded by individuals, and we know, unfortunately, that is how the coalition likes it without regard to whom that person might be. I will digress for a moment: we really see this in the cuts that have been attempted on Medicare at the moment. We were absolutely promised in the election there would be no cuts to health, no new taxes, and yet what do we see? At the very first opportunity the attempts to put these additional costs into the system—always pushing the burden onto individuals when we are trying to get public services to world-class standards. We know there are changes to pathology and changes to other tests, all of these types of things. We see it in Victoria: the ongoing industrial issues with ambulance workers, with nurses; there is not a health worker that that state government has not picked a fight with at some stage in the last couple of years.

I digressed to that topic because I fear that this is where we are going to go on the dental question, and we heard some very concerning rhetoric from the minister when he first presented this legislation into the parliament. He talked about 'early concerns that he had with this program', saying things like 'we will monitor this program very carefully'. We have all heard this story before: we heard it on university funding; we heard it on school funding. The truth is that you just cannot trust these guys with anything because, as I said, unfortunately the coalition only know how to do one thing. When you look at Labor's very proud record in this area, we can see that dental care and the terrific reforms that were made are absolutely worth protecting. They protect many of your constituents, Madam Speaker, and they protect many of mine.

I will turn to some of the specific provisions in the bill itself. Much of what is in this bill is tidying up elements of the existing scheme. Of course we are very happy to support moves to do that. So the Medicare Chronic Disease Dental Scheme was closed from December 2012.

Debate interrupted.

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