Thursday, 21 June 2012
Health Insurance (Dental Services) Bill 2012 [No. 2]; Second Reading
In a number of the contributions I have heard from members of the government now I detect a theme in what they say is the government's agenda—that it is the government's agenda to deal with dental health in this country. The theme very much tends to be, as it historically is with the Labor Party, about funding systems—large numbers, large bureaucracies giving money to waiting lists, or blitzes on waiting lists that, hopefully, might be more successful than what they have done with our public hospitals in recent years.
I will go into what has particularly surprised me about the government's contribution. The difference with this particular program is that it is patient driven. It is not about a government throwing a few hundred million dollars at a state bureaucracy to go on a waiting-list blitz. It is not about a program to get trainees or hygienists in; it is actually very much focused on patient need and patient demand. If we have a criticism of the program it is that it is not as accessible for people in remote Australia as it is for people in the city, and the same criticism can be made of Medicare. With Medicare more generally, and access to GPs, let alone specialist services—we know the data on cancer survival rates tells us the same thing—we do not say we are not going to have a Medicare program because people in remote Australia do not have as much access to it. We try to ameliorate that.
The flaw in the government's argument is that it contradicts the very point that Labor once made about the universality of Medicare. The point they make, and they have made it with respect to psychologists as well, is that because this program is not means-tested certain people are benefiting more than others, people who might not need as much public subsidy. That completely contradicts the very philosophy of Medicare—and I see government senators nodding. The very philosophy of Medicare was about universality; it was about not means-testing it. Yet what we have here are members of the Labor Party, the people who claim that Medicare and Medibank were their inventions, saying, effectively, that we should be means-testing access to this program. You cannot offer a criticism of a Medicare program by saying it benefits some people more than others—those who might not have the same need from an income perspective—without undermining the universality of Medicare itself. That is the complete contradiction in what the Labor Party are proposing.
No-one is denying the possibility of events of fraud in any government program. We might have one or two examples of fraud in this program—and if they are proven those cases should be prosecuted to the nth degree of the law—but no-one is alleging that the services were not needed by patients or that they were not delivered to patients. What we are talking about here are administrative issues. Just because the previous speaker, Senator Urquhart, said that there were examples of fraud in the system does not mean the program should be closed down. The same logic would suggest that bulk-billing fraud in the GP system means we should shut down bulk-billing for GPs—and access for the three-quarters of Australians who use GPs who bulk-bill. That argument simply does not make sense. What we need to do is ensure that there is as little fraud as possible and prosecute those who are responsible.
But this is not about fraud. What this is about is this government's agenda to try to shut down a program that was instituted by the previous government, a program that has been successful. This program has delivered dental services to those in need—they have just been delivered to a group of people different from those the Labor Party would prefer had access to those services. The Labor Party's programs to address dental health have not succeeded. This program has been a success. The fact that there have been one or two instances of fraud does not in any way suggest that we should remove the program. Hundreds of thousands of Australians have accessed dental services that are important to their health.
It is conceded that administrative oversights have occurred, but no-one is arguing that that represents a substantial flaw in the delivery of dental services. I know a number of dentists who have provided these services and it is clear to me that one of the reasons there has been more administrative hassle in the provision of dental services than in the broader Medicare program is that dentists are not particularly familiar with the Medicare system. Dentists are not part of Medicare—unlike GPs, specialists and other service providers. So it is entirely understandable that dentists do not have the systems or the experience to allow them to process the forms on time, submit them by their due date and comply with the bureaucratic paperwork and procedures of Medicare Australia. That is not to say that we should not aspire to those administrative criteria being met, but what we are saying here is that there is no need to unwind the entire system, a successful system, purely because of some paperwork errors. Again, we go back to the point that no one is alleging these services, in the overwhelming majority of cases, were not delivered to patients in need. The fact that some people in need do not get access to a service does not provide an intellectual case for stripping it from others who are also in need. We do not use that logic with the broader Medicare system. Instead, we try to tailor additional programs.
One of the previous speakers talked about training numbers and how we need more dentists. That is true. There is a substantial need for greater numbers of dentists—an increase in numbers would generate a supply-side impact that would both reduce costs and increase availability. One of the challenges in dental care is that the level of unutilised dental services is not high. In my home state, the major facility for training dentists is the dental hospital associated with the University of Melbourne. When the old dental hospital moved to the new dental hospital site, most Victorians noted that it was no bigger. It may, in fact, even have been smaller. There was no expansion in the number of dental places. My home city of Melbourne has grown by almost a million people in the last 15 years. In this morning's paper I read that, according to the most recent census data, Victoria's population has grown by just under half a million people over the last five years, yet there has been no expansion in the number of dental training places.
I point out that this new dental hospital was built and opened under a Labor state government. As with everything else in our health system, there was no focus on increasing the supply of services to meet the substantial increase in population which has been taking place in Victoria over the last decade. That is one of the flaws in our dental system and it is something the current state government is actually doing something about.
This bill is important because it will put the Medicare Chronic Disease Dental Scheme back on a solid footing. It will do this by giving the minister the responsibility and the flexibility to make sure the focus is again on dentists delivering services—rather than trying to penalise them for services that have been delivered but for which bureaucratic requirements have not been met.
In a bill about the powers of the Auditor-General debated in this place earlier this year—guillotined, in fact—I raised a number of concerns about the new powers being given to the Auditor-General to investigate anyone who was in receipt of Commonwealth money. I raise that in relation to this bill because dental surgeries are genuine small businesses—sole operators or partnerships employing a handful of people. Some dental surgeries are larger, with maybe half a dozen staff, but basically they are all still small businesses in the classic Australian sense. At one dental surgery in Melbourne I went to, I saw requests for information from Medicare Australia that did not show any understanding of the paperwork requirements those requests were going to place on this particular practice. For a number of weeks this practice had to devote their most experienced dental nurse to doing nothing other than Medicare Australia paperwork. I take the point that this is all because there were some requirements for administrative oversights. However, I made the point earlier that dentists do not have the greatest amount of experience with Medicare, and so part of the flaw may well be the requirements we have placed upon them—unlike people in general practice or specialists, they do not have a great deal of experience in operating with Medicare Australia and those requirements. The whole point is that taking a senior dental nurse away from patients to spend a month pulling together paperwork for Medicare Australia to do one of these audits struck me as a perverse use of limited dental resources.
I make the point about the powers of the Auditor-General in passing because under the bill I referred to earlier the Auditor-General now has the power to audit any small business in Australia that is in receipt of commonwealth funding. It is not just state governments—it could go down to a person who, maybe under education program funding, paints a school building. They could be audited by the Auditor-General. I did not get the opportunity to speak in that Auditor-General debate at length because it was another one of those bills that the Greens and Labor guillotined, and the bill and amendments were put to a vote without any debate in this chamber. What is happening to dentists all around Australia who are being subject to Medicare Australia audits, without the facilities, or experience or otherwise the wherewithal to deal with requests for information, is something that small business in Australia should be concerned about. While the current Auditor-General, Mr McPhee, has made clear he does not intend to use the powers in that way, my concern has always been that when you grant someone power you cannot always guarantee that at some point in the future someone else will not inadvertently or otherwise create the same problem that you are afraid of and that you were promised would not occur.
This bill gives the minister the power effectively to waive or amend the administrative requirements in such a way to ensure that dentists can continue to deliver the services their patients need. What concerns me about the approach of Labor, and the speakers I have heard before me in this debate, is that we hear about constant funding for systems. This approach relies on GPs referring people to dentists for needed medical care. No-one has yet mounted a case for how that system fails to serve the needs of patients. The only criticism of it so far is that the government would prefer money to be spent treating different people. In a previous life, the Labor Party, under the Keating government, had a three-year program for reducing dental waiting lists. That program was not renewed in 1996.