If you want evidence about what a co-payment will do – have a look at dental

The bill before the House deals with two particularly important schemes—the Medicare Chronic Diseases Dental Scheme and the Child Dental Benefits Scheme. They both deal with the way in which the Commonwealth government supports public dental services. In the case of the CDDS, it is about chronic diseases—or it was about chronic diseases. In the case of the CDBS, it is about children's dental services and, particularly, what the Commonwealth can do to prevent the onset of chronic diseases within children at a very young age. There is agreement before the House on the passage of these bills but there is a very different approach between the major parties on how we deal with dental health and dental health care, and the public support for dental health care in this country.

Before addressing some of these issues, it is worth going through some of the key facts around dental health in this country. Many may not be aware that in 2010 government survey data showed that more than one-quarter of people aged five or older avoided or delayed visiting a dentist due to cost—that is, more than one in four aged five or over delayed visiting a dentist because of cost. From 1994 to 2010, there was an increase in the proportion of adults avoiding a visit to their dentist from 25 to 30 per cent—again, because of cost.

As we contemplate health policy in this country and the introduction of price signals into the primary healthcare space, if we want to see the impact of a price signal on the delivery of health care in this country, we need look no further than the delivery of dental care. Here you have a fantastic dataset on the impact of a price signal when it comes to people accessing affordable health care, in this case dental care. What is the result? One in two 12-year-olds are experiencing tooth decay in their permanent teeth. In 2010, the proportion of children who visited a school dental service who had decayed, missing or filled baby teeth varied from 48 per cent for five-year-olds through to a massive 63 per cent for nine-year-olds. That is the Australian Institute of Health and Welfare data.

Normally when you see an improvement in the wealth and incomes of a country and improvements in health standards overall, you would expect that to flow through to all areas of health. But in dental care, we are not seeing that. Clearly something is going wrong. Only two in three people aged five and over visited a dentist in the last 12 months. Clearly we have some issues that we have to deal with.

If you look at the links between dental health, oral health and chronic health conditions, the research is quite clear. Dental decay is the second most costly diet related disease in Australia with an economic impact comparable with heart disease and diabetes. We know that there is a clear link between oral health and other chronic health diseases. Indeed, more than 63,000 Australians are hospitalised every year for preventable dental conditions. It is the third highest reason for acute preventable hospital admissions. Oral cancer is the eighth most common cancer in Australia. Dental disease has been linked to cardiovascular disease, diabetes, respiratory illness, stroke, dementia and low birth weights in babies.

Dental Health Services Victoria CEO Dr Deborah Cole has told that National Advisory Council on Dental Health:

Oral health can no longer be ignored. We have to protect natural teeth from decay and disease because these diseases are not limited to the mouth, they affect people's general health and wellbeing.

That is a national survey, but if you attend your mind to the situation in rural and regional Australia, the numbers are far worse. It might surprise you to know, Deputy Speaker, that over the last two decades we have actually increased the number of dentists who are practising in this country. Unfortunately, over 79.7 per cent of those are employed in our nation's major cities. Just like in all aspects of the health system, people who are living in rural, regional and remote areas are at a disadvantage when it comes to access to a dentist and when it comes to affordability. Less than one per cent of dentists are employed working in remote parts of the country. People in rural and remote areas also suffer the highest rates of gum disease—36.3 per cent compared to just 22 per cent in our major cities. The same goes for tooth decay—a massive 37 per cent in remote areas compared to just 23.5 per cent in major cities. When you look at the Indigenous demographics in remote Australia and compare that to non-Indigenous in both remote and rural areas and major capital cities, the gaps are greater still.

This is an issue that the parliament needs to grapple with. Clearly, we cannot just simply leave it to the market. If the market was going to fix this, we would not have the glaring gap in services between rural and city. We would not have the glaring gap in health outcomes between rural areas, remote areas and city areas. Clearly, the market is not going to be the solution to resolving these chronic health issues.

Perhaps mindful of this issue, former Prime Minister John Howard set up the Chronic Disease Dental Scheme in 2007. Perhaps it was this massive problem that we had with chronic dental disease issues that moved the former government to set up the scheme in 2007. The scheme paid up to $4,250 over a two-year period for dental treatment for people whose teeth had become so bad that it was affecting their general health. A good idea in addressing chronic health issues, but unfortunately the CDDS was fundamentally flawed, poorly targeted, open to rorts within the system and did not provide support for the majority of Australian families struggling to afford dental care.

The Department of Health conducted an audit of the CDDS and found that there was a high rate of noncompliance with provider-reporting requirements. Debts were raised against dentists found to be noncompliant through the audit process and indeed some of those debts have led to the legislation before the House today. We know that there were rorts going on. More than 20 per cent of the recipients were not pensioners or concession card holders. That is not a rort and I make no criticism of dentists for that. That is just an incidence of bad design. Each and every member of this House would have had constituents come before them over the period of the operation of the scheme and have complaints raised with them—complaints such as overcharging, poor workmanship on the design of dentures.

I have had people come to me in my electorate office on no less than a dozen occasions with problems that they had in accessing services and problems with the services that were provided under this scheme. It might have been a good idea, but it was certainly very poorly targeted. The checks and balances were not in place. You can only imagine: if it were a Labor government scheme, we probably would have had a royal commission into the matter by now. It was these reasons that led Labor in government to review the system and then to transition it to a closure.

We have a proud legacy when it comes to dental health care. In government, we announced the biggest dental package ever, the $4.1 billion Dental Health Reform Package, introduced by the then health minister, Tanya Plibersek, which came on top of nearly half a billion dollars in measures committed in the 2012-13 federal budget to address the oral health needs of Australians and to be provided over six years. The scheme Labor put in place was endorsed by the Australian Dental Association, the National Rural Health Alliance and the Australian Medical Association. It recognised the flaws in the previous schemes and targeted, on the one hand, preventive measures in young people providing a scheme to look after school aged kids and putting in place additional funding to reduce the waiting lists on the state-run public health systems, putting in place improved funding and assistance for capital works and training for future dentists.

What did the Abbott government do on winning office? You might recall I mentioned the big gaps we had in the number of dentists practising in rural and remote areas when compared to those practising in the cities. One of the first things the Abbott government did when coming into power was to cut $40 million from the Voluntary Dental Graduate Year Program, designed to assist people take up the option of practising in rural and regional Australia—$40 million, one of their first acts, axed out of that program. That was only a curtain raiser for what was to come in the subsequent budget because then we saw over $390 million cut from the national partnership agreement struck to help reduce the public dental waiting lists. It was designed to deal with the sorts of chronic diseases that the member for Bass spoke about in his contribution to this debate.

Whenever I hear the member for Bass give one of his fiery retorts in this place I have to wonder whether it was as fiery as the intervention he makes in his own caucus room. I wonder whether he got up in his own caucus room to denounce the $390 million cuts to dental programs ushered in by his own health minister and his own government as one of their first acts. I suspect the answer is no.

Before entering a debate on health, I always have a look at what the National Party has had to say on this issue because, as the so-called champions of rural and regional Australia, we always expect them to always have something to say and then to follow through with their actions. I looked at the policy platform which they took to Australians before the last election where they said at page 49:

We will give priority to the states in their efforts to improve the current public dental services and expand their ability to provide services beyond the basic emergency care.

There you have it: a commitment, a promise to expand the current public dental services. They go on to talk about their long-term goal being extending Medicare into dentistry services. You have to ask yourself: where are the National Party members today. Are they going to stand up and condemn their coalition partners for the $390 million worth of cuts to those programs, which they were talking about defending? I look forward to those contributions. The Liberal and National parties have good form around this issue. If you are going to deal with dental health you have to do deal with prevention and fluoride is the key. A former Queensland Premier had put in place a program to ensure fluoridation to Queensland. One of the things you are going to see in Queensland in about 20 years time is a phenomena known as the 'Campbell Newman grin' because one of his first acts when he became Premier was to axe the $14 million set aside by the former Labor government to introduce fluoridation to Queensland water. As a direct result, we are going to see dental health for Queenslanders, who have one of the poorest outcomes anywhere in the country, going backwards. I am looking forward to the contributions from the Queenslanders and the National Party members to this important debate on dental health care.