Ow! Labor’s dental plan has some serious holes
It was a week where both sides of politics trashed each other’s dental policies. But if you are sick with bad teeth, only one thing mattered. The current Chronic Disease Dental Scheme (CDDS), having treated a million Australians, faced the chop from the federal government.
Thanks to a disallowance motion in the parliament by Coalition Health Shadow Peter Dutton, it may be saved and debate is underway.
Coalition MPs lined up for their suffering constituents. Independent Bob Katter also strongly backs this effort to ensure chronic disease sufferers can get the dental treatment they need. Rob Oakeshott and Tony Windsor are considering their positions.
Labor enjoyed initial support for its dental scheme but that is fast eroding. First, their alternative plan is delayed 19 months simply to help their hunt for a surplus. Worse, they tried to kill off the CDDS 19 months before starting their own, dumping millions of patients onto state dental hospitals, emergency departments and GPs.
The twisted logic means that Labor’s debt pains trump the nation’s dental pain.
The Coalition’s CDDS was pilloried for cost blow-outs, for dental rorting, treating the wealthy and for ignoring those who didn’t have chronic disease.
Cost-blowouts mostly reflect the program’s success with around 40 per cent of the New South Wales public dental waiting lists getting treatment through the CDDS they would never get otherwise.
Average CDDS treatment costs per adult have fallen from $2400 to $1170 reflecting declines in untreated disease. Within two years, Associate Professor Hans Zoellner estimates the CDDS will fall back to a manageable $340 million per annum. Comparable to what Health Minister Tanya Plibersek is offering state governments - but massively more effective.
Simple refinements could have reduced the annual cost by $330 million a year, but Labor passed them up, preferring political point-scoring to practical improvements.
Minister Plibersek’s attacks on the integrity of dentists was also unfair. Only one in 1500 services showed irregularities. All professions have “cowboys” and we have audit sections in Medicare for that purpose. After traducing dentists, Labor’s new children’s schedule possesses all the same flaws, allowing dentists $1000 free rein every two years for the children of family tax benefit recipients.
“Treating millionaires” - it is now standard Labor fare for a waning government to turn to class warfare for a poll boost. Millionaires don’t dream of idyllic days in dental chairs. People with chronic disease and terrible teeth do. Over 80 per cent of all CDDS treatments were concession card holders. These are the real victims of the government’s cuts.
There are no GPs, specialists, dentists or even dental workers in Labor’s caucus, so Treasury designs Labor social programs and there is little informed debate prior to policy announcements. Their fixation with public dental provision is verging on the pathological, because Australia’s dentistry is 95 per cent private and without them, there is no solution.
Labor’s plan has two parts. The first is an injection of $1.5 billion into state dental hospitals. They tried the same thing in 1994 and waiting lists barely changed. That was because state dental services are mostly haphazard visiting programs run out of urban teaching centres, which are slow and assiduous but unable to reduce waiting times.
Public dental services are a disaster for regional Australians who need to visit major cities and only get treated if their disease is worse than the appalling oral pathology which queues up in major cities.
The $1.5 billion allocation is actually only $220 million annually, to be divided eight ways between states and territories. Victoria and New South Wales’ allocation still leaves them spending less than every other state and territory does right now. The boost to South Australia, WA and Queensland still leaves them spending less than the Northern Territory does now.
There are three types of dental patients and Labor risks mismanaging all three. Children mostly need early and preventive interventions, 90 per cent of which can be performed by supervised oral health workers, technicians and hygienists. But Labor now pays the private dentists to do this work, most of it minor. Meantime the oral health workers are sidelined and dental technician graduate rates are actually falling.
Private dentists are best deployed with the second groupm, the poor and chronically ill adults. But Labor wants to kill-off the CDDS - that very program. This will lead to an avalanche of work hitting GPs for scripts, emergency departments for pain relief and dental hospitals with one-to-three year waits.
The third group, severe disease requiring complex care is best done in dental hospitals. But those unfortunate souls are now battling everyone else for treatment, given that our 95 per cent private dental workforce is left on the sideline.
The other component of the government’s dental program is $2.5 billion for children to be treated privately. But the $1000 over two years is a cut-price version of the current CDDS which allows up to $4250 for severe disease. Labor’s plan excludes serious work like stainless steel bridges, crowns, orthodontics and root canal work. Aboriginal kids with severe caries are likely to have their teeth pulled instead of conserved.
The Gillard Government has replaced treating the sickest first, with huge subsidies for the poor, regardless of the disease severity. Ripping a billion dollars out of Medicare is now Minister Plibersek’s legacy.
On the surface, this week’s dental debate brought out the worst elements of our two-party system, with both major parties tearing away at each others’ schemes with barely an inch conceded.
More subtle but far more importantly, independents and key groups including the Dentists Association sided with the Coalition.
For patients with dental disease who only now realise the Labor plan included the death of the CDDS, waiting in pain for 19 months and a federal election will look less attractive every day.
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