29 April 2019

Labor vows to put money where the mouth is

Aged Care Policy TheHill

Labor has taken the first step towards truly universal healthcare with its promise to fund dental care for the elderly, says policy analyst Stephen Duckett.

“I support what Labor has done in proposing a move towards universality,” said Professor Duckett, health program director at the Grattan Institute, which last month released a report calling for population-wide Commonwealth-funded dental coverage.

“This is a major expansion of public money into dental services. It’ll be a major benefit to pensioners and seniors card holders.”

Bill Shorten promised at the weekend $2.4 billion to give those groups $1000 of free dental care every two years, in what he called “the next step towards Labor’s vision of universal access to dental care in Australia”.

A benefits schedule will be drawn up to ensure standardised charging for eligible services, which will include examinations, X-rays, cleaning, fluoride treatment, fissure sealants, fillings, root canals, extractions, periodontal treatment and dentures.

Dentists who join the scheme will have to commit to bulk-billing. Aboriginal Medical Services will be able to access the program.

Health Minister Greg Hunt said there was no detail in the commitment, which risked causing a multi-billion-dollar budget blowout – echoing his response to Labor’s promise to reduce out-of-pocket costs for cancer patients.

The Grattan Institute’s “Filling the Gap” report called for the Commonwealth first to take over funding of existing public dental schemes, injecting an extra $1.1 billion per year, and enable private-sector providers to deliver publicly-funded care. “Coverage should then be expanded – first to people on Centrelink payments, then all children,” the report said. “After that, the Commonwealth should take the final step to a universal scheme, ideally within a decade.”

It said there was “no compelling medical, economic, legal or logical reason to treat the mouth so differently from the rest of the body”.

“I think that’s an artefact of the 1960s and 70s that’s still with us,” Professor Duckett told The Medical Republic.

“What we proposed in our report was a different place to start, but I don’t think it matters really, as long as [Labor has] a clear vision on how to get from here to there.

“They haven’t done a plan yet [for complete universality], which is logical because then they’d have to cost it.”

He took with a grain of salt Mr Hunt’s claim that the promise would in fact cost $6 billion.

“What we’ve seen already in the campaign is the Liberals saying ‘we think the costs are this’, and the whole point of having a Parliamentary Budget Office is that you have people with the detail doing the costings.”

The Greens last month promised their own version of Denticare, starting with under-18s and rolling out progressively to the elderly and welfare recipients, and also promising $1000 worth of free care every two years.

Last week the party said its health reform package would also do away with the private health insurance rebate, which it would reinvest in the public system.

Professor Duckett wrote in The Conversation last month that it was time for Labor to decide what to do about the $6.5 billion rebate, which he said constituted a greater industry subsidy than manufacturing got at its peak in the late 1960s.

“Labor approaches private health insurance a bit like one might approach a dead cat on the table – as an issue that has to be dealt with, but that everybody wishes would just go away,” he wrote.

If Labor thought that much of the private health insurance expenditure was on services that were non-essential or complementary, it could not justify the subsidy and should redirect those funds, Professor Duckett wrote. But if the use of private insurance was largely substituting for services that would otherwise be borne by public hospitals, thus reducing demand on them, the $6.5 billion might be better left where it was.

Labor has not touched the rebate issue this election campaign, announcing instead that it would cap premium rises at 2% per year.

Professor Duckett said yesterday the wisdom of the Greens’ proposal depended entirely on what proportion of those currently with private health insurance would drop it in the absence of a rebate, and how much extra pressure that would put on the public system.

“My view is that it does require a whole lot of work to figure out exactly what you should do with the rebate,” he said.

“The National Health and Hospitals Reform Commission didn’t look at the question 10 years ago, but did say we should leave it unchanged for 10 years – well, that 10 years is up. It’s a good initiative to refer to the Productivity Commission and not make any decisions without good, solid evidence.

“Obviously some people will drop their private health insurance. I haven’t done the numbers to say what proportion will drop their private insurance if the rebate goes, but we’d expect a whole lot of people to keep their insurance even without the rebate.

“It’s that balance – what proportion keep it, what proportion drop it – that is the critical question.

“The Greens may well have done that modelling [privately]. But it has to be done, thoroughly.”

The Greens have also promised to establish a Preventive Health Commission – replacing the Preventive Health Agency scrapped by the Coalition in 2014 – and a single funding agency to stop cost shifting between federal and state governments.