Dabbling in DIY dentistry, going abroad to get cheaper dental procedures and taking out loans - these are the extreme measures some Australians are taking to fix their teeth.

As dental fees rise, a third of Australians say cost is the main reason they put off seeing a dentist.

Have Your Say: Should dental treatment be covered by Medicare?

This week's Insight reveals that some dentists are being offered incentives by finance companies like GE Money to broker loans to struggling patients.

"If we put through three successful applications we get a Village Cinema pass and if we put five through we get two Village Cinema passes and a $50 Myer voucher," Perth dentist, Graham Wheeler, tells Insight host Jenny Brockie.

President of the Australian Dental Association, Dr John Matthews confirms that his organisation receives around $20,000 sponsorship and funding for research from GE Money.

Join Insight this week as we bring together politicians, dentists and patients to ask; Why is Australia's oral health in decay? Why does going to the dentist cost so much? And should dental work be covered by Medicare?

Watch the show online in three parts:

Pulling Teeth - Part One

Pulling Teeth - Part Two

Pulling Teeth - Part Three

• Why are dentists so expensive?
• Government dental plan has teeth
• The Budget - Health facts

TRANSCRIPT

When was the last time you saw a dentist and how much did it cost? According to the Institute of Health and Welfare, nearly a third of us say the cost of a trip to the dentist stops us from getting treatment. 50,000 Australians end up in hospital each year with preventable dental problems. Around 500,000 are on public waiting lists. So why are the nation's teeth crumbling?


JENNY BROCKIE: For some reason, we treat our teeth as separate to the rest of our bodies when it comes to health care. Insight will talk about that a bit later but, first, some of the desperate measures people are taking to fix their teeth. Welcome, everybody, Thanks for joining us tonight. Colin Yarwood, you're a pensioner from Wollongong. You had a toothache two years ago. How bad was it and what did you do?

COLIN YARWOOD: It was very bad. It got to the stage where I just couldn't handle it so I rang up the number I had to ring for Illawarra health. I was told there was a 3-month waiting list. So after about...that was it. So after about November it was, ah, about a month later I decided to go up the club, have a couple of bourbons and get home and went into the shed.

JENNY BROCKIE: Show us what you did.

COLIN YARWOOD: Got my pliers and I thought I've got to get it out, anyway. I had no teeth each side of it so it was easy enough to get the pliers around it.

JENNY BROCKIE: How many bourbons did you have, Col?

COLIN YARWOOD: How many bourbons? Not many at the club but I had a couple of stiff ones when I got home. But I had to get it out. It was not a real joke. I had to get it out. So I just got the pliers and I just got it around like that and snapped it. It stayed in. I heard the crack, and the pain, it just shot up and it was indescribable, the pain, and I pulled this out.

JENNY BROCKIE: That's the tooth. My goodness.

COLIN YARWOOD: Yeah, a bit shaky at the moment.

JENNY BROCKIE: Yeah, I'm not surprised, I'm still feeling a bit shaky just listening to it. Why didn't you go to a private dentist? Why didn't you just go and pay and get it done?

COLIN YARWOOD: Well, I was on the pension for 10 years previous and I've always gone to a private dentist and saved or tried to get to a private dentist. And this time I had no money, um, I just had to go and do it myself.

JENNY BROCKIE: Evangaline, you have done a bit of do-it-yourself dentistry as well, I gather.

EVANGALINE DE LA RUE: Yeah.

JENNY BROCKIE: What did you do?

EVANGALINE DE LA RUE: Well, I went to the hospital to get a tooth pulled out but I got a student that had only been there for a month or two. She pulled the majority of it but she left a fragment in and to go back and get it fixed, it was going to mean I had to wait for about eight weeks and I couldn't wait that long. So, because it was already dead, I kind of worked it out myself slowly, gradually, and eventually it came out.

JENNY BROCKIE: Not with pliers, I hope.

EVANGALINE DE LA RUE: No, not with pliers. Just brushed them and just kind of wiggled it until it eventually naturally came out, but it was already dead, that little fragment, but I just couldn't wait any longer for it to get fixed.

JENNY BROCKIE: Hannah, you're 12 and you've been on the public waiting list for three years to get braces. What's it like for you in the meantime?

HANNAH KAY: It's kind of a bit embarrassing and sad to make me wait that long and stuff. But I also, like..

JENNY BROCKIE: How do your teeth affect you? Are your teeth being crooked actually affecting you?

HANNAH KAY: Yeah, sometimes it hurts my teeth.

JENNY BROCKIE: Denise Simpson, how have you found the public system? You've had a different experience, I gather.

DENISE SIMPSON: I was one of the lucky ones. I rang up and got in straightaway, virtually within two days, so I don't know why.

JENNY BROCKIE: And what did you need to have done when you rang up?

DENISE SIMPSON: When I went originally it was a toothache, um, and then when I went in, um, I had to have all the teeth removed because I had, um, a bone problem and all the bones were wearing away.

JENNY BROCKIE: But you were happy, unlike Colin, who ended up doing what he had to do. You didn't have the same experience.

DENISE SIIMPSON: No, I was straight in straightaway.

JENNY BROCKIE: Donna Stewart, what about you? How long have you been on the public waiting list and what's happened to you in the meantime.

DONNA STEWART: Well, they told me I gum disease in 2003, and I'd need dentures, but they did not treat me in between.

JENNY BROCKIE: And so what happened?

DONNA STEWART: In between I took my own teeth out, like, just by hand. Straight out, my big back teeth, roots and all.

JENNY BROCKIE: You took them out yourself?

DONNA STEWART: Yeah, by hand, just bang, just came straight out.

JENNY BROCKIE: Hans Zoellner, there are different public dental systems in every State. What's the average waiting time for people and why is it taking so long?

ASSOC. PROF.HANS ZOELLNER, ASSOC. PROMOTION OF ORAL HEALTH: Well, I mean, the waiting time will vary a lot from circumstance to circumstance. Different States, different area health services will have different numbers of dentists available to deliver treatment so the waiting times vary from two, three, four years, sometimes up The longest I've heard is seven or eight years waiting to get in. So there's no..

JENNY BROCKIE: Seven or eight years to get into a dentist if you're a public patient?

ASSOC. PROF. HANS ZOELLNER: There are patients in that situation. Why is it like that? I think it's really because, I mean, the public system is only really funded to employ about 10% of the dental workforce. So 10% of the dentists are actually trying to treat up to 50% of the population who are eligible for public dental services so there's this big mismatch between the actual service capacity of the public system and the funding that goes into it.

JENNY BROCKIE: And the numbers of people who are wanting it.

ASSOC. PROF. HANS ZOELLNER: That's right.

JENNY BROCKIE: So how would you describe the system as it exists now for low-income people?

ASSOC PROF. HANS ZOELLNER: It's dysfunctional. People haven't got reasonable access to basic dental services but even just putting more money in isn't going to solve the problem. Because there's a workforce shortage, people don't want to work for the public system. There's so much work out there in the private sector where you can earn lots of money but people don't really particularly, or dentists don't particularly want to work for the public system.

JENNY BROCKIE: Is that right, Ainsley? Because you're a dentist and you worked in the public system until last year but you left to go private, didn't you?


DR AINSLEY MARSH: Yeah.

JENNY BROCKIE: And what quality of service do you, were you able to provide as a public dentist?

DR AINSLEY MARSH: Um, well, the treatment that you can provide is very limited, usually depending on the cost and the time involved in doing that treatment. So usually in the public system you tend to do more extractions rather than trying to save the teeth, which isn't necessarily what's best for the patient at that time, especially when they're young, young patients.

JENNY BROCKIE: Stephen, you had a problem with a wisdom tooth. You put it off having it dealt with and eventually you went to a private dentist who suggested an X-ray. What happened next?

STEPHEN MORTIMORE: I went I wasn't working at the time so when I went to the dentist, she told me it was going to cost me about 190 bucks just to look at it and I couldn't afford it but she said to go get the X-rays. So I had the X-rays and then, because I couldn't afford it, I'd just started my job and I was hoping I'd be able to put it off until I got paid and the pain just got that bad and I was really swollen in the side of the face so I went to the hospital, and the hospital was really good. They took me in straightaway and, um, when I woke up I was actually in intensive care because I had a really bad infection and they had to put a drain in me neck through to the gum to drain all the stuff out and I was in there for about five days and they were really good in the hospital but they were the only ones that would look at me with no money.

JENNY BROCKIE: Joe Hockey, most of these things happened on your government's watch. Do you think it's acceptable that the dental system is in this kind of state, that people are going through these things?

JOE HOCKEY, MP, OPPOSITION HEALTH MINISTER: Well, I don't think it's acceptable and, having said that, you've got to look at a bit of the history of dental services in Australia. Hans is right - 90% of the dentists are in the private system. The 10% that are in the public system are in the State public hospitals. Now, there was a backlog in the early 1990s and Paul Keating as prime minister, to his credit, provided a 4-year plan full of funding to the States to address that backlog. Now, that funding finished, we finished it. The program came to an end.

JENNY BROCKIE: The Howard Government scrapped it.

JOE HOCKEY: No, the program came to an end and we said, "Hang on, there's been no tangible difference in the funding and in the outcomes for dental health, "and so the States, through the public hospitals, "have primary responsibility." Now, when we could afford to do it, we introduced a new program last year which the new government has now abolished, quite sadly.

JENNY BROCKIE: Tony Windsor, what do you think of the relative performance of the Labor and Liberals over dentistry in Australia?

TONY WINDSOR, MP, INDEPENDENT, NEW ENGLAND: No, I don't think either of them have recognised the real nature of this issue. I don't think either of them have done enough.

JENNY BROCKIE: I'd like to have the current government here, by the way, but unfortunately they didn't make anyone available to talk about dentistry, which is a shame. Lyn Mayne, until a few weeks ago, you were the only flying dentist in Australia for the Flying Doctors. Now there are two of you for the whole country. What are you seeing when you go out?

DR LYN MAYNE, ROYAL FLYING DOCTOR SERVICE: Um, well, much the same as what you're hearing here, I suppose, because it's really the public dental system, but, yeah, we've recently increased our numbers by 100%, being two of us now, which I'm really pleased about.

JENNY BROCKIE: Two for the whole country and that was only a couple of weeks ago, yeah? So until then you were the only one?

DR LYN MAYNE: Yes, for the last 10 years I've been doing it full-time. With the second dentist coming on board, we're now doing the public dentistry in Broken Hill itself as well, so, not only flying to the outreaching areas, but also in Broken Hill.

JENNY BROCKIE: How would you describe the teeth you're seeing?

DR LYN MAYNE: Well, you know, it's unfortunately the people on the stations who are far out. I might travel 1.5 hours on the plane and they might travel 2.5 hours in a car. So, for them to spend that day to come to the dentist, everything else must be right for them and their dentistry comes below their farm, below their medical health, and it's the last thing.

JENNY BROCKIE: So the teeth are reflecting that, yeah?

DR LYN MAYNE: Yeah. I mean, I had one gentleman who put battery acid on it to stop the pain. But, hopefully, I'm making a difference. But, um

JENNY BROCKIE: Does battery acid stop pain?

DR LYN MAYNE: Yeah, it stopped the pain. I wouldn't recommend it.

JENNY BROCKIE: We're not recommending that to anyone - please, please. Chris Cole, you're a private dentist in Armidale, in northern New South Wales. How hard is it to get private dentists to go to the bush?

DR CHRIS COLE: Well, it's certainly not easy.

JENNY BROCKIE: And how high is going to the dentist on the list of priorities for people in your area?

DR CHRIS COLE: Armidale's a fairly sort of affluent town and area so I think it, as a country town, is sort of quite well off with dentists. There's a lot of other places that are sort of..

JENNY BROCKIE: So how would you describe dentistry in rural areas in general? Are you aware of what it's like elsewhere?

DR CHRIS COLE: Oh, yeah. It's just appalling. Like, if you want the country to go ahead you've got to get people out of the coastal areas and decentralise.

JENNY BROCKIE: Hans, you say there's a shortage of dentists. How short are we?

ASSOC. PROF. HANS ZOELLNER: It's really hard to really say properly. I mean, there is...there was a study published a while ago that estimated that by 2010, compared with the year 2000, it would be roughly 1,500 clinicians short in Australia. The truth is that was just compared with the year 2000, which wasn't a great year for dentistry at all. Um, if you look at the number of dentists per 100,000 population, say in the North Shore of Sydney, where we are now, it's around about 69 dentists per 100,000 population. If the whole of Australia had the same concentration of dentists we'd need about a 38% increase in the number of dentists, about 3,900 more dentists in Australia, and that's not likely to happen real soon.

JENNY BROCKIE: Is that right, John Matthews? Do you think there's a shortage?

DR JOHN MATTHEWS, PRES. AUST. DENTAL ASSOCIATION: I think one of the good things that come out of the last election was fluoride in the water, the F-word up in Queensland, positive, preventative things, and four new schools in the last decade which will produce enough dentists by 2015 to cover this shortage, but there's this awful lag time we've got to wait for this to happen but essentially we've, we're bringing in up to 200 overseas dentists per year, estimated. And we've opened four new universities, so and that's all happened in the last decade.

JENNY BROCKIE: But people like Colin are still taking their teeth out with pliers.

DR JOHN MATTHEWS: Yeah, I had a talk to Colin about his technique, we’ve come a long way.

JOE HOCKEY: Don't have a talk to me about it. I don't want to get caught between the two of them.

JENNY BROCKIE: Watch out, Joe.

DR JOHN MATTHEWS: You can't underestimate that and if I can say the man with the wisdom tooth, there was a fatal infection where the airway was blocked off in South Australia last year, so these are very serious consequences.

JENNY BROCKIE: That says something, doesn't it, about something being wrong with the system if you've got people ending up in hospital with that serious problem because they can't afford to go?

DR JOHN MATTHEWS: Indeed, we've got a workforce shortage and we've got a funding problem.

JENNY BROCKIE: Is that the only problem?

DR JOHN MATTHEWS: Isn't that enough?

JENNY BROCKIE: Well, I mean, you know, is there not a problem with the system structurally that people just can't afford to go to the dentist, they can't afford to go and get the services from your members?

DR JOHN MATTHEWS: Well, 60% of people go to the dentist regularly every year and find their way. It's that 40% that we have to look at and focus on.

JENNY BROCKIE: But 40% is a lot of people. 40% is millions of Australians.

DR JOHN MATTHEWS: Oh, yes.

JENNY BROCKIE: Hans.

ASSOC. PROF. HANS ZOELLNER: The truth is that the capacity to supply dental services is here and the demand is way up there. That's the way it sort of is now and, as a consequence, if you look at these sort of market indicators, you get all the predicted outcomes. Costs are high and highly variable. You know, there's no real competition by dentists for patients so they cling to the cities. They don't want to move to the country because it's easier. There's plenty of patients in the city. One in four Australians with untreated tooth decay, you know, there's somewhere between 30,000 and 50,000 hospitalisations a year for preventable denting infections. I mean, those market indicators indicate that there's no way that we're anywhere near to the sort of workforce that we need in this country and so frankly, I mean, anything, anything other than recognising that as a fact, it's just denying the facts before us.

JENNY BROCKIE: Insight is going to look at how far some people are prepared to travel to get their teeth fixed and with dental costs rising faster than the CPI, some people are now finding it cheaper to get their teeth fixed overseas. Here's Anne Worthington.


GRAEME TAYLORS’ STORY:

REPORTER, Anne Worthington

GRAEME TAYLOR: You can see here again I'm not smiling.

When Graeme Taylor got married, there was no way he'd flash the camera a smile.

GRAEME TAYLOR: I'm smiling but certainly with a closed mouth.

LISA TAYLOR: Just me doing all the smiling.

GRAEME TAYLOR: Obviously very self-conscious about it, even, like, no smiling again. You didn't marry me for my teeth, did you?

Last year he found an article in the paper about Australians travelling abroad for cheaper dental work. He decided to look into it.

GRAEME TAYLOR: Look, I think, honestly, if you do your due diligence and you investigate as much as you can about the clinic, if at all possible, go and actually see the clinic for yourself, don't just book a ticket and go over there and, you know, expect to get a great job done. Um, I think, if you do your homework, then I think the risk is obviously a lot less.

LISA TAYLOR: Good luck.

A year later and Graeme is a seasoned traveller. So where does he go? Thailand, the country marketed as the Land of Smiles. Dental tourism is booming in Thailand, with dozens of clinics offering cheaper dental work to foreigners. This is the fourth time Graeme has travelled to this Bangkok clinic for dental treatment.

GRAEME TAYLOR: Hi, Dr Lily. How are you? How are you?

DR LILY: Nice to meet you again.

GRAEME TAYLOR: Nice to see you.

DR LILY: We're going to do a lot of work today.

The clinic is totally catered to travellers' tastes and, although not registered under her name, Dr Lily is the front woman for the business. She's been in trouble with Thai dental authorities for over-promotion but Dr Lily has no shortage of patients as she cashes in on the Western desire for perfect teeth.

REPORTER: How many Australians have you treated?

DR LILY: Um, it's about 1,000 Australian have been treated with our centre, um, during the past seven years.

Graeme has been treated by several dentists in this clinic and today he's having the final touches put in place. All up, he's spent $10,000.

GRAEME TAYLOR: So this is just the picture of how my teeth used to look and you can see the, you know, the incisors were very long, the front two teeth were chipped and, you know, quite uneven. There's a large gap there and there's gaps here as well. And, you know, quite discoloured as well, so quite yellow, and just, you know, very unattractive-looking.
And this was the teeth after the treatment. So, you know, really night and day. This is a bridge just in the centre so they've had to widen the gap here and put the bridge in and then we've got veneers and crowns. All the gaps have been filled and, you know, the thing's been pared back and it's all been evened off. So now it's almost the perfect smile.

He's happy with his new smile and he's smiling even harder about the savings.

GRAEME TAYLOR: I've probably saved, um, I would say about $30,000 but, with the work I've had up to now, it probably would have cost me here about $35,000 to $40,000.



JENNY BROCKIE: Well, Lisa, unfortunately your husband, Graeme, couldn't be here tonight but I understand your 6-year-old son Campbell is having a few dental problems. Will you send him to Thailand as well?

LISA TAYLOR: Yeah, I probably would. He obviously had to have something done quite urgently. He had one tooth, a root canal done because he had a huge abscess in his cheek so I obviously couldn't wait for that but, um, yeah, if I, you know, I'd obviously have to check because he's got to have a general anaesthetic, so, yeah, I'd be quite happy to send him over there as well.


JENNY BROCKIE: And how did you find about going away to get it done rather than getting it done here?

LISA TAYLOR: Um, well, we'd lived overseas for a while and we'd had lots of friends who'd gone over to Thailand for other things besides just dental so we were quite open to the idea and Graeme's always pretty thorough and he does his research so he's always wanted to have it done, and that way he could afford.

JENNY BROCKIE: Caroline Crossman, you're from Queensland. You went to the Philippines to get work done on your teeth. Why, and what happened?

CAROLINE CROSSMAN: I went, Jenny, because I didn't find it affordable for the work to be done here. Um, I was quite happy with what had happened. I was there for a period of three weeks, where I had a holiday in between the preliminary work and the final work, and everything was lovely. My smile looked great when the dentist finished and, um, after being home for a matter of weeks - six to eight weeks in fact - one of my teeth snapped.

JENNY BROCKIE: One of the teeth that had been treated?

CAROLINE CROSSMAN: Yes.

JENNY BROCKIE: And then you had other problems after that, didn't you?

CAROLINE CROSSMAN: I had another one snap a matter of a month later. Fortunately I'd chosen to go to my local dentist in Caloundra at the time, rather than go back to the Philippines for the work to be done.

JENNY BROCKIE: How much has it cost you to get your teeth fixed up after going to the Philippines?

CAROLINE CROSSMAN: I spent $3,300 for extensive work. All of my teeth are veneered and that included two bridges, top and bottom. Um, so that was $3,300 and the work that I had done here amounted to about $2,200.

JENNY BROCKIE: So would you go away again to get your teeth done?

CAROLINE CROSSMAN: I would recommend people look into it.

JENNY BROCKIE: Even after having those problems?

CAROLINE CROSSMAN: Yes, yes, I think so.

JENNY BROCKIE: Eli Schwarz, you've looked at international dental systems and the way they operate. How does the quality of dentistry in some other countries, in Thailand, in the Philippines, stack up against Australia and why is it so much cheaper over there?

PROFESSOR ELI SCHWARZ, FACULTY OF DENTISTRY, SYDNEY UNI: Well, the countries are much cheaper in general. I mean, groceries and so on. I mean, it's just a much cheaper country to go to and I think that it's very difficult to make these comparisons simply because, as you saw in this film before, this clinic is set up purely for foreigners. It's not actually catering for Thai people at all.

JENNY BROCKIE: For local people.

PROFESSOR ELI SCHWARZ: And obviously they would pay much less even. I mean, it's just that their whole, um, cost level is much smaller in Thailand and in the Philippines.

JENNY BROCKIE: But how does the quality stack up?

PROFESSOR ELI SCHWARZ: She might even have been educated in Australia. I mean, who knows? We train a lot of dentists from the South-Eastern Asian countries who are going back to their countries and working there. But I think that that's really not the issue. Where would you go? I mean, where would you go and complain? What are the complaint systems in...?

JENNY BROCKIE: In those countries.

PROFESSOR ELI SCHWARZ: In Australia. I mean, it could happen, obviously, in Australia as well but at least you have a Dental Board you can go and complain, so you have a dental association, you have a court system that you know of and I just - even though medical tourism is becoming very, very prevalent all over the world, I think there is an enormous amount of risk just doing it without knowing what's come out.

JENNY BROCKIE: John Matthews, why is it so expensive to go to the dentist here? We've got these figures from the Institute of Health and Welfare that said a third of Australians say cost is stopping them from going for regular check-ups and from going to the dentist, and people nodding their heads all over here. Why does it cost so much?

DR JOHN MATTHEWS: Well, I think for a lot of Australians to find $150 or $200 to get something done is expensive and difficult. But dentistry is an expensive service to provide.

EDNA KAY: I'd like to know where most people have the $200. If you're on a pension you only get $253 a week. By the time you take your rent and food out of it, you haven't got $200 to go and see a dentist, and they'll delay it.

JENNY BROCKIE: Anyone else like to say something? Lady up here.

WOMAN: I just feel it should be included on our Medicare, that's all. I just feel general dental, fillings and cleaning, should be included on our Medicare. There's a lot of people out there that can't afford it. I mean, it's just it's so sad.

JENNY BROCKIE: John Matthews, doctors have scheduled fees. Is there such a thing for dentists? Is there a standard fee that a dentist is supposed to charge?

DR JOHN MATTHEWS: Under current competition law, we couldn't dictate fees. That would be against the law.

JENNY BROCKIE: You could recommend them, couldn't you?

DR JOHN MATTHEWS: No, not even that.

JENNY BROCKIE: You can't suggest a standard fee?

DR JOHN MATTHEWS: What we do is we survey all our members and we find out what their average fees are and we publish them.

JENNY BROCKIE: But the dentists then can effectively charge whatever they like?

DR JOHN MATTHEWS: Yes.

JENNY BROCKIE: Hans, are we paying for high standards?

ASSOC. PROF. HANS ZOELLNER: I think possibly. I mean, I think one of the problems that we have in Australia is that it's not entirely clear what our standards are. We don't actually have, like, national standards for diagnosis, national standards for treatment plan. If you go to 10 dentists, you’ll get 10 different treatment plans ranging from relatively non-invasive treatment plans to really quite invasive and expensive treatment plans. Now, somewhere in there, there must be an optimal treatment plan, you would like to think, but we have no national guidelines for this. That would have been one of the advantages of Medicare. It would have helped to establish some sort of guidelines for dentists to work within.

JENNY BROCKIE: Graeme Wheeler, you own a private clinic near Perth. How often are your patients struggling to pay?

DR GRAHAM WHEELER: I think on an average everybody, obviously, when they ring up wants to know cost, which is pretty normal, basic thing. Some people, I'd call them shoppers, shopping around for the price. But I guess if I had to put a figure on it, 25% to 30%.

JENNY BROCKIE: Now, you're offering loans to people. How does that work?

DR GRAHAM WHEELER: Well, through GE Money, it's a minimum $300 and for three months and it's interest-free for 12 months. After three months, the merchant service fee I pay is 1.75%. For six months, it's 5.25% and for 12 months it's 8.75%.

JENNY BROCKIE: So you're offering the loan on behalf of GE and GE is taking a cut of the money you get?

DR GRAHAM WHEELER: Yes. And where it makes it better is the fact that we get paid within two days of completion and then the contract to chase the money up is between GE and the patient and they get a little white card which they, I believe, can also use at a vet's.

JENNY BROCKIE: Did GE approach you or did you approach them?

DR GRAHAM WHEELER: No, they approached them.

JENNY BROCKIE: They approached you. And how many people have you offered these loans to?

DR GRAHAM WHEELER: Probably about five over the last... It's a bit hard to say. I've done two, two so far this year and probably about three or four last year.

JENNY BROCKIE: Do you get other incentives from GE?

DR GRAHAM WHEELER: There used to be better ones but now if we put through three successful applications in May we get a Village Cinema pass and, if we put five through, we get two Village Cinema passes and a $50 Myer voucher.

JENNY BROCKIE: A $50 Myer voucher as well as the cinema pass for effectively brokering the loans for the company as a dentist?

DR GRAHAM WHEELER: Yes.

JENNY BROCKIE: What happens if someone defaults on the loan?

DR GRAHAM WHEELER: Well, then I presume that's when GE come in. Like, I imagine it works like these Harvey Norman ones where you don't pay any interest for 48 months but, if you don't pay it, then that's when they hit you, I presume.

JENNY BROCKIE: Hans, what do you think of this?

ASSOC. PROF. HANS ZOELLNER: I mean, I can't comment on the specific circumstances.

JENNY BROCKIE: No, I mean the broad idea of loans for dental work.

ASSOC. PROF. HANS ZOELLNER: To me, it's a potential conflict of interest. I mean, this is a health expenditure. It's not a discretionary expenditure. Like, I'm not buying a washing machine.

JENNY BROCKIE: Or a plasma TV.

ASSOC. PROF. HANS ZOELLNER: If a health professional tells you you need this service to protect your health, well then, you're going to go into the loan. So, to me, I'm not making any comment about your particular practice or anything, but I would say that if that's something that we do as a profession, then it's going to create opportunities where there may be other servicing and people can be brought into debt unnecessarily.

JENNY BROCKIE: John Matthews, what do you think of this idea?

DR JOHN MATTHEWS: It's not something I introduce in my own practice.

JENNY BROCKIE: So you think it's OK?

DR JOHN MATTHEWS: My personal opinion?

JENNY BROCKIE: Well, you're not here in a personal capacity. You're here in the capacity as the head of the association, so what's the association's view?

DR JOHN MATTHEWS: The association's view would be that they were still financing dental treatment and, if it was done in a moral and ethical way, it's just another form of financing, just as extending your credit card. It might even be a better alternative than joining a health fund and waiting to collect until you have the wisdom teeth out or whatever. So it's in the raft of things and I think all dentists have their own style and ethical framework in which they work and that would be our advice to our members.

JENNY BROCKIE: What do some of the people here think about the idea of loans?

STEPHEN MORTIMORE: At the time when I was in pain, I would have taken the loan for sure because I had no money, I had no job, I was virtually living off my girlfriend and we just didn't have the money, and the pain was that bad I would have took the money from anywhere.

JENNY BROCKIE: John Matthews, your association has a relationship with GE, doesn't it?

DR JOHN MATTHEWS: Yes, we accept sponsorship of functions from them.

JENNY BROCKIE: How much sponsorship would it be worth a year?

DR JOHN MATTHEWS: They generally sponsor dental research, actually, the money that goes into dental research, so they would be looking to present an ethical face to the profession but they're just people who pay to advertise in our magazines and the like.

JENNY BROCKIE: But how much money? A dollar figure on how much goes into research each year?

DR JOHN MATTHEWS: Look, maybe $20,000 a year. It's not big stuff.

JENNY BROCKIE: What do you think of this, Joe? What do you think about the idea of the loan business being in dentistry? Do you think it's appropriate?

JOE HOCKEY: I don't think it's the dentist's core business but I also accept that 90% of dentists are small businesspeople and they've got huge costs associated with the equipment and they're looking at ways to pay for it. I mean, the point that is meaningful to me is that people use their credit cards to pay for dentistry and, if this is another way of helping them to get treatment, so be it. But I think..

JENNY BROCKIE: It's a sign that something's wrong, though, isn't it? If people have to take out a loan just to get their teeth fixed in a country as affluent as ours, something has to be wrong?

JOE HOCKEY: And you're right and what I'm pretty angry about is each of the State health ministers, and they happen to be one political party at the moment, but they're both sides from time to time, the State health ministers aren't here because they're the ones that are responsible for the public system. It's not even the Federal Labor Government. It is the State Governments that individually are responsible for the public system. Now, we went to put dental services onto Medicare last year and the State, the Federal Labor Government has just abolished it.

JENNY BROCKIE: Ok, Tony.

TONY WINDSOR: It highlights the absurdity of the process, you actually have to be chronically ill to get assistance in a country like Australia, recommended by a doctor and if you didn’t get that assistance you would be admitted to hospital with much higher cost of treatment for the debilitating diseases that could accrue and that would cost the system through Medicare a much greater amount of money. So I think everything we're hearing is highlighting that our oral health is part of our body. We can get a polyp in our rear end treated but we can't get an ulcer in our front end.

JENNY BROCKIE: Very beautifully put, Tony.

TONY WINDSOR: That's what people are wanting. They want treatment under Medicare arrangement. All these affordability issues that people are talking about, a medical health system takes care of that. The same applies with normal bodily health and it should apply to oral health.

JOE HOCKEY: Do you know how much it would cost, Tony?

TONY WINDSOR: There are a number of figures.

JENNY BROCKIE: We're going to get to this.

JOE HOCKEY: Well, this is the Independent's choice - Independents like to be critics of everything. How much would it cost?

TONY WINDSOR: Well, there's a number of figures that have been talked about and people in this room would tell me. Somewhere between $600 million and $5 billion.

JENNY BROCKIE: That's a fairly big range.

JOE HOCKEY: That's a big range.

JENNY BROCKIE: Tony, I'm going to stop you there because we're going to look at why our teeth aren't part of the general health care system and whether dental work should be covered by Medicare and the Rudd Government is spending $780 million on health, on dental health, but has scrapped a Medicare scheme which helps chronically ill people with dental problems. Here's Anne Worthington.


CHRIS PLANERS’ STORY:

REPORTER: Anne Worthington

DENTIST: How's everyone?

CHRIS PLANER: Good, yeah.

DENTIST: The family's well?

CHRIS PLANER: They're all outside.

For Chris Planer, visiting the dentist is all too familiar.

CHRIS PLANER: What you doing now there that preserve them?

DENTIST: We're hoping to hang on to that tooth long-term.

He was 25 when he was diagnosed with cancer in the floor of his nose and roof of his mouth. He underwent a marathon operation in a public hospital to get rid of the tumour.

REPORTER: How much has the treatment for your cancer cost?

CHRIS PLANER: Look, I don't know the exact cost but I anticipate that it would have been, you know, over $100,000. When we're talking about a 16-hour operation, and the number of surgeons I had there - I had an ear, nose, throat surgeon, plastic surgeon, oncologist.

Three years later, Chris is free of cancer but the radiation and chemotherapy has taken its toll on his teeth.

CHRIS PLANER: With the surgery to remove the palate, which has left a hole in the roof of my mouth, has actually taken away a lot of the nerve endings of the front teeth here and the radiotherapy has made a fair few of my top teeth in particular brittle.

Chris's teeth are dying and are wobbly and his self-esteem is suffering.

CHRIS PLANER: I hate the look of my teeth now. I used to have straight teeth. When I was a kid, or when I was a teenager, I had braces and my teeth were straight and since I've had the surgery and, um, yeah, since I had the surgery, um, my teeth have sort of like gone backwards, you know, they're sort of like a little bit crooked.

He's also starting to have trouble eating hard foods and the dentist has warned if he doesn't have regular dental work his teeth will start to fall out.

REPORTER: How often will you be having to see a dentist?

CHRIS PLANER: Well, at the moment I'm seeing him every two weeks, two to three weeks, I'd say at least monthly. If things continue the way they are and my teeth keep, um, as brittle as they have been, I'm anticipating that maybe every three weeks to a month I'll be seeing my dentist.

REPORTER: For the rest of your life?

CHRIS PLANER: Yeah, for the rest of my life. If I lose my top teeth, I don't have anything for the plate to actually latch on to, to be able to cover that hole. That plate helps me to speak probably and stops me from swallowing food, food going up through the back of the nose and water and whatever I drink. So I do need to have the regular treatment to make sure that I keep those top teeth. If I don't have them, I don't have a plate or anything to put the plate on.

Chris has been having his dental costs covered by Medicare under a scheme introduced by the Howard government, which allows just over $4,000 worth of work for the chronically ill. The current government has decided to drop the scheme.

CHRIS PLANER: I'm not trying to sound ungrateful because I really appreciate that and would have been a lot more money for me out of pocket but just a bit disappointing that now where I need the regular treatment for my teeth that I can't, I'm possibly not going to be able to get it after July 31.

With a mortgage and young family, Chris is worried he won't be able to afford the dental work he needs.

CHRIS PLANER: I'm just a bit concerned about, yeah, how things are going. I mean, as I said, the mortgage's going up. I need to make sure that I meet those payments and things like that first and provide my son and my family with the best possible, um, life and lifestyle. I'd hate to think that, you know, they would have to suffer because of my medical condition or my treatment having to go ahead.




JENNY BROCKIE: Well, Chris, how are you going to afford to go to the dentist every month once the scheme ends at the end of June?

CHRIS PLANER: It will be tough. I really don't know, I mean, a lot of things, as I said, are going to have to be put on the backburner. Going out with my family for things like coffee and dinner are obviously going to have to be put aside to try to be able to afford the regular cost of going to the dentist. So, yeah, I mean, I don't know how I don't know what I'm going to do, yes.

JENNY BROCKIE: Joe Hockey, the Government says it scrapped the scheme because it wasn't means-tested, it was open to abuse and the extra funding it's now providing to the States is going to help people like Chris anyway.

JOE HOCKEY: We introduced this to help those people that needed acute treatment and were not being covered, properly treated by the people that were responsible, which is the State hospitals. And this scheme providing, you know, on average 5,000 people a month with the sort of scheme that we just heard about has now been scrapped, and I think it's wrong.

JENNY BROCKIE: Hans, what do you think? The Government says these people are going to be helped by the $290 million spending to top up the States under the Commonwealth dental plan?

ASSOC. PROF. HANS ZOELLNER: The community, the population is made up of the individuals like this gentleman, like Chris, who have needs now. We can't say, "Oh, we're going to prevent your dental problems sometime in the nebulous past." They've got problems now. So the $290 million scheme is at most going to give the States $4.69 per year per person to treat people in the public dental health system. If you spend every cent of that money on people with chronic diseases, people like Chris with his oral cancer, that would be a whole $47 to be spent in the public dental sector to help them. I know what I'd rather have. I'd rather have $2,125 to see any private dentist of my choosing in any suburb rather than $47 to stand at the end of a public dental waiting list and hope that maybe one day, if I ever get to the front, I'll get treated.

JENNY BROCKIE: Joe Hockey.

JOE HOCKEY: Can I just make this point? It was made a little bit earlier. 90% of dentists are in the private sector and what we did by putting dentistry into Medicare was allow people to go to those private-sector dentists.

JENNY BROCKIE: You didn't put dentistry into Medicare, Joe. You put chronically ill people had access to Medicare.

JOE HOCKEY: The first time anyone has ever put a significant dental treatment into Medicare.

JENNY BROCKIE: But it's for the chronically ill, which is where I think people are getting very confused.

JOE HOCKEY: By putting it into Medicare, people could go and see their dentist, which makes up 90% of the dentists. But now the new Government has come in, it's taken it out of Medicare, it's giving the money to the States for the public hospitals. We know those public hospitals are already massively overburdened, with the net impact that they're driving people away from private-sector dentists into the 10% of the market.

JENNY BROCKIE: But you didn't do anything about them being overburdened when you were in government. You abolished the Commonwealth Dental Scheme in the first place in 1996.

JOE HOCKEY: Well, no, I'm sorry. Just again to correct the record. We actually... The scheme came to an end in 1996. We said to the State hospitals..

JENNY BROCKIE: You didn't keep it going.

JOE HOCKEY: If I can just finish. We said to the State hospitals and the State governments we will give you increased funding as part of the Commonwealth-State agreement, and part of that funding has to go to dental treatment.

JENNY BROCKIE: But the hard facts are that that's when the waiting lists started blowing out. As soon as that scheme stopped, the waiting lists blew out.

JOE HOCKEY: No, no, and that's not right. Effectively, I think what you'll find, Jenny, look, the buck will stop with Kevin Rudd. He said when it comes to health the buck stops with him. If they have the magic solution in pushing people into public hospitals rather than going to their local dentist, having it covered by Medicare, so be it, we'll see.

JENNY BROCKIE: Tony.

TONY WINDSOR: The buck will stop with the Prime Minister in terms of health and I think that's an admission that oral health is part of bodily health. There's no doubt that the Howard government's plan in terms of chronically ill people was a good plan. It was better than anything that's been out there, but it's not enough. It's not enough. If we're all prepared to spend $200 a year to maintain our dental health, that is equivalent to $4 billion. I think most people would accept an increase in their Medicare levy if they were guaranteed basic dental care. That's what the...that's the message I'm getting in the electorate.

JENNY BROCKIE: Would you? It's easy to say yes in theory but when the money starts coming out of your pay every week, what do people think? Gentleman up the back.

TED PLANER: In Chris's case he had good teeth, he took care of his teeth and no-one can forecast what disease is going to hit them or strike them at any time in their life. Now, to say that you go onto a waiting list to have this treatment done in a public system is absolute crap. The view I get here at the moment is the Federal Government, there's no representative from them here tonight, they just have apathy towards the whole dental system and I think it's disgraceful that someone couldn't find their time to come here tonight and answer the hard questions.

JENNY BROCKIE: Chris Cole, the new government and they didn't come, I might add We did make a very open invitation for the Health Minister to come. We wanted to have her here tonight. Chris Cole, the Government, though, has introduced a teen dental scheme which it says is going to provide a million free check-ups for teenagers aged 12 to 17. Is that a good idea?

DR CHRIS COLE: Well, it's an idea. I don't think it's the greatest idea they've ever come up with, that's for sure, because it's a bit like having a skin cancer sort of screening sort of thing. You can go and get your skin checked and say, "Oh, you've got cancer but there's no money to treat you."

JENNY BROCKIE: Hans, what do you think of the teen dental scheme?

ASSOC. PROF. HANS ZOELLNER: I think it's being sold as a preventative program. OK, they're saying you're going to get a preventative dental examination. That's complete nonsense. There are dental examinations that diagnose disease and to develop a treatment plan, and then there's actually preventative treatment, and there's not one cent for actual preventive treatment in the teen dental program. It's a really expensive way to do absolutely nothing.

JENNY BROCKIE: John Matthews.

DR JOHN MATTHEWS: Teen plan, it was a mystery to us. Who thought of this? It just came to us on a Sunday afternoon like as an election-winning gimmick for parents of teenage kids. It's been a disappointing start, I've got to say, for a party that led off with dentistry when K. Rudd became leader. Barry Humphries said he looks like a dentist, I thought that's a good start.

JENNY BROCKIE: Not necessarily.

DR JOHN MATTHEWS: Oh, no, compassion, caring. And they led off, they said, you know, not enough's being done. They're not doing enough now. I think we'd all agree with that.

JENNY BROCKIE: Do you think the previous government did enough either?

DR JOHN MATTHEWS: I think the EPC scheme had some really good points to it.

JENNY BROCKIE: EPC scheme, for the benefit of people at home.

DR JOHN MATTHEWS: Enhanced primary care scheme for chronically ill.

JENNY BROCKIE: That only came in just before the election and it came in minutes before the election.

DR JOHN MATTHEWS: And I think the Labor Party shamed them into having a decent policy.

JENNY BROCKIE: You had 11 years, Joe.

JOE HOCKEY: And that's what everyone says. The bottom line is at a certain point when you have the money available you can expand existing schemes and that's why we were able to expand Medicare.

JENNY BROCKIE: John Matthews, should teeth be covered by Medicare?

DR JOHN MATTHEWS: I think if, if we want to spend the sort of money, the $5 billion-type money, yes, if we're prepared to pay 2% extra on our tax and so forth.

JENNY BROCKIE: Would your association support that?

DR JOHN MATTHEWS: We think there are better ways of spending public money by targeting, by targeting needy groups. See, one of the things that Denticare, or Medicare with dentistry, probably will only cover basic care, so the girl there with the requiring the orthodonture for speech and so forth would not be covered. So this sort of low-level care, I don't know whether that's the best way to look after the public. So we would say target. Find your groups and target them.

JENNY BROCKIE: Hans, what do you think?

ASSOC. PROF. HANS ZOELLNER: If you have appropriate guidelines you can have appropriate treatment and indeed why should we say that Medicare has to be the lowest level of service? If I lost my hand today I would expect a proper prosthesis. I wouldn't expect the 18th-century equivalent. I wouldn't hope that they'd come to me with a hook and say, "Here you go, mate. That will do." So perhaps today we have to accept that some treatments will be expensive but if there are proper guidelines that we dentists can then follow, then that can be sensibly put into Medicare.

JENNY BROCKIE: Tony Windsor, Joe Hockey's right, isn't he? It's easy for an Independent to say spend $4 billion on putting dentistry under Medicare?

TONY WINDSOR: It depends on whether they want to listen to the public or not. I would have thought in a nation as developed as this is that some of the stories we're being hearing tonight should never have happened, and Joe might like to explain to me why my mouth and teeth are different to the rest of me in terms of health care.

JENNY BROCKIE: Joe.

JOE HOCKEY: I mean, look, we sit here and we listen to these stories and you say, as a compassionate society, how can we help? But according to your own maths, Tony, you said $200 per Australian - $4 billion a year. Well, as we heard a little bit earlier, $200 gets you an examination, it doesn't get you any treatment. So let's be fair dinkum about the figures. If people are prepared to spend $20 billion, $30 billion a year extra in Medicare - great, no problem.

TONY WINDSOR: Joe, you're the Shadow Minister. How much would it cost?

JOE HOCKEY: Well, I mean, according to your statistics it would have to be at least $20 billion a year, at least $20 billion a year.

JENNY BROCKIE: $20 billion?

JOE HOCKEY: Of course it would because if you're talking about treatment, as Tony said, minimum treatment, $200 a year for 20 million people, for 20 million people, that's $4 billion, right? So obviously if people need regular treatment and you think how much it costs you every time you go to the dentist, I know it costs me money, it costs, you know, so many people, money, how, if that's all covered by Medicare, how much are we looking at?

JENNY BROCKIE: Eli, can you make some sense between these two positions? What do you think?

PROFESSOR ELI SCHWARZ: Obviously it doesn't need to cost $4 billion. I mean, the dental care in Australia today costs somewhere between $4 billion and $5 billion as it is. That's the money that people are using, the money that the States and the Commonwealth are using all together on dental care.

JENNY BROCKIE: So what would you like to see the new government do?

PROFESSOR ELI SCHWARZ: I would like to see somebody talk to each other. At the moment, nobody talks to each other. I mean, the Commonwealth has definitely not asked anybody that I know about whether a teen program or another Commonwealth dental program would be a good program.

JENNY BROCKIE: And what about Medicare? Do you think it should be ultimately under Medicare?

PROFESSOR ELI SCHWARZ: It doesn't matter which program. I mean, you can build a parallel program - it doesn't really matter. The dentists are not in the Medicare at the moment so you would need to sit down and discuss with the dentists how can we integrate a public-funded program into a centrally private system.

JENNY BROCKIE: John, what do you want the Government to do?

DR JOHN MATTHEWS: We all sat down in 2004 and wrote the national dental health plan, which was done with the States. We hoped to attract the Commonwealth's interest. It wasn't too high. There's a plan already out there which is targeted, I must say, so there's one plan, yet they could look at our website, the ADA website.

ASSOC. PROF. HANS ZOELLNER: Was that costed?

DR JOHN MATTHEWS: No, it wasn't costed because we were worried about upsetting the Commonwealth too much.

JENNY BROCKIE: Goodness me. Meanwhile, all our teeth are rotting all this is going on.

DR JOHN MATTHEWS: They were very sensitive. Dentistry - you needed a visa to get into Canberra if you were a dentist because they didn't talk to us and the department has no idea of dentistry.

JENNY BROCKIE: Joe, a few problems.

JOE HOCKEY: Well, I'm here to talk. I'm here to listen, you know. It's part of it. But, look, you know, if there was a magical solution I'm sure someone would have come up with it.

JENNY BROCKIE: But clearly neither side here has handled this well. Would you agree with that?

JOE HOCKEY: Jenny, if, as you say it, and when you hear these stories, of course. But the bottom line is we can spend whatever we want as a nation. Someone has to pay the bills and, as Shadow Health Minister, I would say this is great. I mean, getting this out, dealing with the issues is good. Let's address it somehow.

JENNY BROCKIE: So what are you going to do for dentistry?

JOE HOCKEY: I can take it back but I tell you what - I'm not come on the program now and I'm not going to tell you exactly what our policy is.

JENNY BROCKIE: Why not?

JOE HOCKEY: I'd love to share it with you and your audience, Jenny, but I've even got limitations about what I can tell you.

JENNY BROCKIE: Lady here, final comment from you.

MARJALYN HENSON: I think all we hear is blame and shifting from one to another.

JENNY BROCKIE: How unusual in this country of ours with all these State and Territory governments and a Commonwealth Government too.

MARJALYN HENSON: There has to be recognition that your teeth are part of your whole body. If the Government accepts responsibility for providing care for the rest of the body, then it must accept responsibility for the teeth.

JENNY BROCKIE: Meanwhile, Colin, what are you going to do next time you get a toothache?

COLIN YARWOOD: I won't be using these pliers again. I don't know. If I have to, I have to. Um, I, it shouldn't have to come to that. Like, it wasn't fun. I put up with it and, as I said, I pulled it out. But the evaluation process, if I could say, needs to be looked at straightaway. When you make a phone call you ring this number they ask you questions, that's it, the lady does not know what it looks like or how really bad you are.

JENNY BROCKIE: Or how you're feeling and that you’re desperate enough to go and have the bourbons and get the pliers out.

COLIN YARWOOD: Put up with the three months with the tooth. Every time I ate it was painful and I had to do it but it was just.. You do get to a stage where you have to pull it out. And there's other people around here that have done it too.

JENNY BROCKIE: There are indeed and we are going to have to leave it there. It's been good to talk to everybody. Thank you very much for joining us tonight. Thank you to our politicians who chose to join us, and that is Insight for this week. I should just mention again that no-one from the Federal Government was prepared to join us tonight to talk about dental health.