Political Roundup: Labour’s decaying policy on free universal dental care

Grant Robertson has once again ruled out implementing a popular Labour Party policy: free universal dental care. He did so yesterday on RNZ’s Morning Report, citing the cost factor. The Acting Prime Minister suggested that spending on dental care wasn’t a priority for the Government and that the health budget had more important areas for funding.

Robertson’s continued stalling on free dental care essentially contravenes his own party’s policy. At the 2018 annual conference, Labour agreed to implement free universal dental care for all adults – extending that available to those under the age of 18 years. This decision was made when the party was only one year into government. The announcement was greeted with great enthusiasm.

Four years later, Labour’s dental policy seems to be decaying, almost rotten. Behind the scenes, officials have worked on the policy and come up with ways to implement it. But the politicians lack the will to prioritise the spending.

Although Robertson cites a $1bn price tag for universal dental care, there have been suggestions of ways that the policy could be incrementally introduced, beginning with either low-income adults or a younger population. For example, if the Government wanted to start by extending free dental to those up until their 27^th birthday, the Ministry of Health has estimated it would cost just $148m, and they have come up with many other ways in which various other groups could be cheaply afforded free dental.

Increased dental funding would be popular

There is no doubt that the policy is extremely popular – with numerous surveys showing that the public wants free dental implemented. A 2020 Colmar Brunton survey showed that 64 per cent of the public backs free dental care. The most recent poll, carried out by Newshub’s Reid Research in May, asked “Do you think the Government should subsidise dental care to make it cheaper for adults to go to the dentist?” 84 per cent say yes.

At the time, the Minister of Health, Andrew Little responded by saying, “It’s an area we need to give attention to at some point” and that “there is a lot of room for improvement” in government funding of adult dental care.

Yet Labour’s shifts on this have been only tiny so far – increasing dental grants available through Work and Income. This is an improvement for those that can access them, but is no substitute for the proper reform promised by Labour.

Universal dental care back is on the agenda

The policy of free universal dental care is back on the agenda after the Association of Salaried Medical Specialists (Toi Mata Hauora)  – the union representing dentists – released a report this week recommending that the free and universal policy be implemented as soon as possible by the Government. The union complained that although Labour had committed to action back in 2018, there has been “radio silence since”.

The union’s report, “Tooth be told”, showed that unmet dental treatment had become so bad that out of 11 comparable countries, New Zealand now fared the worst. The report showed that unnecessary tooth decay is leading to a quarter of million New Zealanders having teeth pulled each year. This is because 40 per cent of New Zealanders can’t afford to go to the dentist. And it’s getting worse – there has been a 31 per cent increase in those needing hospital medical interventions as a result.

Some dentists have been speaking out about this recently. For example, last week Timaru dentist Fraser Dunbar went on TV3’s The Project to describe the heartbreaking job he has of taking out people’s teeth in hospital due to people not being able to afford to go to the dentist.

He says there has been a large increase in people in their 20s needing all their teeth removed. Dunbar said that “it’s not unheard of for him to take out 100 teeth in a morning at the local hospital” and that this includes “three or four patients getting full clearances”.

The release of the report was also supported by the Auckland City Mission (Te Tāpui Atawhai) because the issue relates so clearly to inequality and poverty. Because private dental treatment has become so prohibitively expensive, the problem feeds directly into overall inequality.

According to the report, 42 per cent of adults cannot afford dentist visits. And of course, for some ethnic minorities, it’s much worse – 53.7 per cent of Māori adults and 51.5 per cent of Pasifika don’t access dental care under the current system.

The dental problem is therefore its own “crisis”, and a key part of the overall inequality crisis that the Government is failing to combat. And this “crisis” categorisation was borne out earlier this year when the international website for dental news, Dental Tribune International, reported, “New Zealand’s oral health crisis rages on”. And it’s not just related to the Government’s lack of funding, but also to a declining dental workforce – New Zealand now has one of the smallest per capita dentist and dental specialist workforces in the OECD.

Cheaper to provide full universal dental care

The Salaried Medical Specialists union argues that the Government is misguided in taking a short-term approach of rejecting free, universal dental services on the basis of the price tag. The union says that the opposite is the case – that the price of neglecting this area of healthcare is actually producing greater costs for the taxpayer and society.

The union argues that any large expenditure on dental health will yield significant savings in the longer term. The head of the union, Sarah Dalton, says that by spending on dental care, “there’s a whole bunch of way more serious, way more expensive conditions, health conditions that would disappear”. Alternatively, chronic conditions like cardiovascular disease end up costing much more to deal with down the track.

In fact, the New Zealand Dental Association has carried out a cost-benefit analysis, using Treasury tools, and found that the Government would get back an extra $1.60 on every dollar spent on extended dental care.

The problem, however, for Grant Robertson and Labour is that such wins for the public would be further down the track than the next election, or even the one after that. So, the politicians have clearly done their own cost-benefit electoral analysis and decided not to invest, even if it would be a sensible way to reduce misery and inequality.

In this sense, the unheeded case for free, universal dental care is a clear case study illustrating the decay of the Labour Party as a force for progressive change. Unfortunately, the rottenness in both dental health and politics seems set to continue.

Further reading on universal free dental care

Background reading:
Bryce Edwards: Is it time for Labour to introduce public dental care?
Bryce Edwards: The missing election policy on free dental visits
Bryce Edwards: Pulling teeth – the fight for free dental care
Bryce Edwards: Time to campaign for free universal public dental care

New material today:
RNZ: Single-step move to universal dental care cost-prohibitive – Grant Robertson
Will Trafford (Te Ao – Māori News): Dental access stats worst for Māori; terrible generally
Jayden Holmes (Today FM): Dentist worried too many desperate kiwis pulling own teeth out
No Right Turn: Grant says “no” again

Other items of interest and importance today

RMA, HOUSING
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Anna Whyte (Stuff): Overhaul of ‘broken’ resource rules set to ‘tame’ planning departments, speed up builds
1News: Govt vows cheaper, faster resource consents in ‘broken’ RMA overhaul
Geraden Cann (Stuff): Industry supportive of RMA reforms but concerns remain
Russell Palmer (RNZ): RMA replacements find few fans on cross-benches
Brent Edwards (NBR): Opposition parties signal they will change new planning law (paywalled)
Pattrick Smellie (BusinessDesk): Industry to be consulted in RMA spatial plan reform (paywalled)
Pattrick Smellie (BusinessDesk): Resource Management Act reforms: key elements (paywalled)
Anne Gibson (Herald): Resource Management Act reform reaction: what experts think
James Perry (Te Ao – Māori News): RMA reforms to save millions but critics say still wide of the mark
Jenna Lynch (Newshub): Resource management: Planner sceptical about Government’s proposed RMA reform
Russell Palmer (RNZ): Government brings Resource Management Act replacements to Parliament
Brent Edwards (NBR): New legislation to replace RMA should be law next year (paywalled)
Bernard Hickey (Interest): New regime to replace RMA to take 10 years to bed in, cost $3.891b and create benefits of $10.039b
Piers Fuller (Stuff): The Wellington car park that’s going to be turned into 280 homes
Miriam Bell (Stuff): More pain, less gain in store for home sellers, CoreLogic says
RNZ: More houses likely to sell at a loss, Corelogic says
Susan Edmunds (Stuff): House price fall ‘biggest since REINZ records began’
Ireland Hendry-Tennent (Newshub): REINZ figures: House prices plummet 12.7% in Auckland, whopping 17% in Wellington in year
RNZ: House prices drop amid market hesitancy
RNZ: Housing affordability crisis continues to grow in Queenstown Lakes
Maria Slade (NBR): Housing projects face winter of discontent (paywalled)
Kate MacNamara (Herald): Ballooning manager class at public housing agency costs $103m per year (paywalled)

PARLIAMENT, ROY MORGAN POLL
David Farrar: Roy Morgan poll October 2022
Richard Harman (Politik): Luxon’s low point (paywalled)
Matthew Hooton (Patreon): Māori seats will decide it (paywalled)
Johnny Blades (RNZ): MPs warned of ordeals ahead amid disinformation
Audrey Young (Herald): Judge issues new decision after getting law wrong on parliamentary privilege (paywalled)
Glenn McConnell (Stuff): ‘A good day for democracy: Labour and National agree to change Māori electoral rule
1News: Māori electoral roll: Changes on way after Labour, Nats agreement
Pokere Paewai (RNZ): Electoral review does not go far enough to address inequities, Māori advocates say
Stewart Sowman-Lund (Spinoff): National MP advertising on What’s On Invers, the ‘anti-vax’ website blacklisted by RNZ
Jonah Franke-Bowell (Stuff): Slanted signs show ‘the status quo must go’ – Hamilton West by-election candidate

ECONOMY, BUSINESS, EMPLOYMENT
Susan Edmunds (Stuff): ‘Time for a tax-free threshold’: Should we give low-income earners a break?
Ireland Hendry-Tennent (Newshub): Economy: Grant Robertson says ‘tough 2023’ ahead amid warning ‘soft landing’ for economy looking less likely
Joseph Los’e (Herald): The Māori economy is booming and will be worth $100 billion by 2030
Cameron Bagrie (BusinessDesk): Why pain and hardship are on the way (paywalled)
Jonathan Mitchell (NBR): Chances of a soft economic landing get slim: Westpac (paywalled)
Dita De Boni (NBR): To the ‘Taxpayers Union’: Cry more (paywalled)
Brigitte Morten (NBR): Social Insurance Scheme could be the sleeper of 2023 (paywalled)
Ian Llewellyn (BusinessDesk): Threat of petrol price intervention is needed, says Treasury
Eric Crampton (Stuff): We all turn a little bit crazy when prices rise in a crisis
Herald Editorial: Prices surge as energy companies reap dividends (paywalled)
David Williams (Newsroom): Power discord: The battle over NZ’s biggest water take
Logan Savory (Stuff): Economist: Smelter closure impact would be ‘far less pronounced’
Damien Grant (Stuff): Bank profits aren’t the problem, the Reserve Bank is
Ben Gracewood (Spinoff): I would simply fix banking in New Zealand
Gareth Vaughan (Interest): RBNZ still mulling ‘material’ anti-money laundering breach by ANZ NZ
Ripu Bhatia (Stuff): Gender and ethnic diversity on boards improving globally, report finds
John Gerritsen (RNZ): Union reduces university staff pay demand to match inflation rate
John Gerritsen (RNZ): Teachers ‘insulted’ by govt offer of $6000 pay increase
RNZ: WINZ and Defence Force partner to place job seekers with employers

FOREIGN AFFAIRS
Paul Buchanan: On NZ foreign policy “independence.”
Thomas Manch (Stuff): Cheap limes for your Corona: Prime Minister Jacinda Ardern gets down to business in Vietnam
Claire Trevett (Herald): Mojito and Corona lovers rejoice – PM’s Vietnam trip opens door for more limes to New Zealand (paywalled)
Jo Moir (Newsroom): From elbowing into summits to Hanoi garden tours
Claire Trevett (Herald): Prime Minister Jacinda Ardern puts Agriculture Minister Damien O’Connor on stunt double duties in Vietnam
Amelia Wade (Newshub): Jacinda Ardern celebrates Xi, Biden meeting amid pageantry in Vietnam
Gyles Beckford (RNZ): PM Jacinda Ardern in Vietnam: Day of top-level meetings and ceremony
1News: Prime Minister hoping for big trade boost with Vietnam
Peata Melbourne (Te Ao – Māori News): NZ ‘puppets for the USA’ – Rawiri Waititi
Rebecca Howard (BusinessDesk): Canada insists it is meeting its dairy trade obligations (paywalled)
Ford Hart (Stuff): Will NZ’s relationship with China be driven by fear and greed?
James Halpin (Stuff): Son of Auckland woman who raised money for Russian army dodged conscription

ENVIRONMENT
Hamish Cardwell (RNZ): COP27: New Zealand blasted for ‘obstructing’ fund for climate damage
MIchael Neilson (Herald): COP27 climate change: NZ gets ‘fossil’ award at conference as new adaptation funds announced
University of Auckland’s Nga Are Whetū Centre for Climate, Biodiversity and Society: (Newsroom): NZ should lead the climate change fight, not just pay reparation
Rod Oram (Newsroom): Will this be the COP that loses the 1.5 C target?
Mike Hosking (Newstalk): As COP27 goes nowhere, the Govt is still lost in climate ideology
Thomas Coughan (Herald): National’s bonfire of climate policy leaves Auckland-shaped hole in targets – Labour
RNZ: Key trading partners beating NZ efforts in sustainability reporting
Richard Prebble (Herald): Human ingenuity needed to beat global warming (paywalled)
Christina Laalaai-Tausa (Spinoff): Climate change is a harsh reality in Sāmoa – and the world’s leaders need to face it
Stefan Dimitrof (Te Ao – Māori News): Investment in seed banks could pay off against climate change
Farah Hancock (RNZ): Scientist’s dairy factory concerns over unsafe drinking water

PRIMARY INDUSTRIES
Maddy Lloyd (1News): Waimate District returns record-high levels of nitrate in water
Rachael Kelly (Stuff): Will anyone from the Government meet with Groundswell NZ?
Dean Baigent-Mercer (Stuff): It’s time to resolve carbon forest conflict
Nikki Mandow (Newsroom): Dairy land being lost at 1 percent a year, Fonterra
Gerhard Uys (Stuff): No workers to harvest, so farmer sacrifices 300,000 heads of lettuce
Jacqueline Rowarth (Stuff): What impact will farming levies have in a world of growing food insecurity?

LOCAL GOVERNMENT, THREE WATERS
Thomas Cranmer: Five Waters and a Park
Georgina Campbell (Herald): Wellington mayor Tory Whanau will not renew Green Party membership (paywalled)
Bernard Orsman (Herald): Former Auckland Council mayoral staff lose their jobs
Erin Johnson (Stuff): Auckland mayor Wayne Brown disappointed alternative Three Waters proposal rejected

HEALTH
Rowan Quinn (RNZ): North Shore Hospital: Nurses criticise lack of privacy for patients awaiting treatment
Cécile Meier and Murray Jones (BusinessDesk): GPs and pharmacists in tug of war over minor ailments market
Victoria Young (BusinessDesk): We investigate the $30b business of health
Alexa Cook (Newshub): Man dying of cancer wins battle with ACC for palliative treatment funding
Ruwani Perera (Newshub): First phase of three-year project to reduce vape-related harm among young people launched
RNZ: Lead levels allowed in drinking water taps to be cut significantly from 2025
Will Trafford (Te Ao – Māori News): Seymour backs purchase of rehabilitation centre from developers
Ben Wheeler (The Conversation): 100 years after insulin was first used, why isn’t NZ funding the latest life-changing diabetes technology?
Melody Smith (The Conversation): New Zealand scored C+ for physical activity in children and teens – what’s driving this and what can be done?

TRANSPORT
Giles Dexter (RNZ): Government reaches compromise with National on electoral law change
RNZ: Plan to reduce speed limits on some highways will save lives, Automobile Association says
1News: Lowering the road toll: Advocates debate speed reduction proposal
1News: NZTA proposes sweeping state highway speed limit decreases
John MacDonald (Newstalk ZB): Reducing speed limits is a cop-out
Quinton Hurley (Stuff): Could rail be the future for Christchurch? Maybe not, but buses provide hope
Melanie Carroll (Stuff): By the numbers: How Air NZ brings its planes in the desert back to life
George Weeks (Spinoff): ‘Free’ car parking and roads cost drivers – in stress and wasted time

IMMIGRATION, POPULATION
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Tom Pullar-Strecker (Stuff): Migration turnaround gains momentum
John Weekes (Herald): Brain drain gone away? New stats show more people entering NZ than leaving
RNZ: What New Zealand’s population looks like as the world reaches 8 billion people

JUSTICE, CORRECTIONS, CRIME
Tara Shaskey (Herald): Home detention for Taranaki beneficiary who pocketed $50k in Covid wage subsidy fraud
George Block (Herald): Police criticised in damning watchdog report for ‘major deficiencies’ in their handling of fraud complaints
Kirsty Frame (RNZ): IPCA calls for ‘fundamental overhaul’ of fraud investigation processes
Phil Pennignton (RNZ): Fewer ram raids despite slow rollout of police security assessments
Ireland Hendry-Tennent (Newshub): Grant Robertson concedes ram raid support rollout too slow, lashes out at ‘criminals’ targeting businesses
William Hewett (Newshub): Calls for better education in prison to tackle New Zealand’s ‘high’ reoffending rates

BLACK FERNS
Abbey Wakefield (1News): Black Ferns hailed by MPs – ‘Pay them well’
Herald: PM Jacinda Ardern says Black Ferns should get equal pay and opportunities
Damien Venuto (Herald): The Front Page: How much the Black Ferns earn playing for the country
Trevor McKewen (BusinessDesk): Does NZ Rugby have the same courage as the Black Ferns? (paywalled)

COVID-19
Marc Daalder (Newsroom): Cabinet scrapped masks against health advice
Rowan Quinn (RNZ): Daily Covid-19 cases top 4000 for first time since August

OTHER
Brooke van Velden (Herald): Why we need to protect free speech
John Gerritsen (RNZ): Teachers ‘insulted’ by govt offer of $6000 pay increase
David Skipworth (Stuff): TVNZ has already spent almost $600,000 on proposed merger with RNZ
Merepeka Raukawa-Tait (Bay of Plenty Times): Foster case of ‘Moana’ and the ‘Smiths’ unlikely to set a precedent (paywalled)

Over the last three years there have been growing calls for the government to provide dental services under the health system – universal free dental care. This is because at the moment there’s an anomaly in which teeth are regarded as different from the rest of the body which means all adults need to get their treatment from the private health sector. This has led to vast inequities and a crisis in the dental health of New Zealanders.

Nearly two years ago the Labour Party responded to this need by formally adopting a policy to implement free dental visits as part of public health – you can read about this here: Political Roundup: Pulling teeth – the fight for free dental care. I emphasised the importance of Labour’s policy commitment: “This is a big deal. If the Government actually follow through on this decision, it will make a huge difference to New Zealanders’ lives. And it’s a policy whose time has come.”

But in Government little progress has been made on this commitment, and yesterday Minister of Health Chris Hipkins admitted the policy wouldn’t be implemented in Labour’s next term of government – see Dan Satherley’s Labour rules out free dental care for adults, citing ‘current economic environment’.

It’s a policy that would cost 2-3 weeks of the current wage subsidy scheme. But on Newshub’s The Nation Hipkins stated: “In the current economic climate free dental care for everybody would come at a very, very, significant price tag, and I don’t think in the current economic environment that’s a debate we’re in a position to have.”

Interestingly, National’s health spokesperson Shane Reti suggests his party might have a more progressive policy on dental health, promising a “pleasant surprise” on this issue, foreshadowing the upcoming release of his party’s health manifesto. And according to the above article, the Greens want dental health to be free. The Opportunities Party, too, also want to implement subsidised dental care.

Labour’s reneging on their dental funding policy shouldn’t be a surprise, however. Back in August Hipkins also explained why the policy hadn’t been implemented, with Newshub reporting: “Any money the Government might have used to provide free dental care to Kiwi adults has been eaten up by Covid-19 and other health issues. Health Minister Chris Hipkins said on Tuesday dental care has taken a backseat since there are other issues to focus on” – see Zac Fleming’s Funding for free adult dental care used up by Covid-19 response, mental health budget – Chris Hipkins.

This article also reports the Ministry of Health view that dental affordability issues are now causing problems: “Rates of acute admissions to hospital for dental care have also increased recently”. And Otago University professor of epidemiology Murray Thomas is quoted saying “The proportion of the population of adults who are getting regular routine dental care is actually falling”. Furthermore, “Now there’s evidence linking poor oral health to heart disease and cancer, but the Government doesn’t yet have any plans to tackle the problem.”

Last month the Ministry released its briefing to the minister on the issue, which the Government avoided making public – see Zac Fleming’s Revealed: The dental funding proposals the Government wanted to keep secret. This relates to a briefing that the then Minister of Health David Clark requested after Labour made the decision to make dental health free. According to this article, “The Government has sat on a report outlining ways to improve access to adult dental care for almost two years without taking any action.”

Fleming’s article also reports that the Ministry of Health asked Clark whether he wanted them to “undertake further work on developing options for improving access and affordability of adult oral health care”, which the Minister didn’t follow up on. Chris Hipkins, the new Minister, has now confirmed “No specific work [was] commissioned in response to that report.”

The briefing, which outlines the dire state of dental health and what might be done about it now available here: Adult Dental Care and Oral Health Issues.

Some were expecting that the Government’s wide-ranging review of the health and disability sector, delivered this year, would deal with the problems of the dental system and find a way to bring it into the public system, but dentistry wasn’t mentioned.

Public support for public provision of dental care

There is continued strong support for the Government to pump more funding into this area of health. Last week 1News reported that its Vote Compass survey showed the public was highly favourable to the proposal that “the government should cover the cost of dental care for adults with low incomes” – see Andrew MacFarlane’s Majority of Kiwis say government should fund dental care for low-income adults.

According to this, “The majority – 70 per cent of voters – said they somewhat or strongly agreed with the statement, while just 17 per cent were against it.” Those most likely to “strongly agree” were supporters of the Greens (58%) and Labour (42%).

Earlier in the year, 1News also reported a Colmar Brunton poll which showed “Sixty-four per cent of voters want the Government to prioritise free dental care for New Zealanders” – see: Almost two thirds of Kiwis want Government to prioritise free dentistry – poll.

Those polled were asked the following: “Currently, under 18-year-olds get free dentistry. Do you think the Government should prioritise making dentistry free for all New Zealanders?” The results were: Yes – 64%; No – 33%; Don’t Know – 3%.

Advocacy for government dental funding

Last month dentists took the campaign for better funding to the politicians, with the Dental Association “running a clinic on the forecourt of Parliament to highlight the need for better dental care for low-income and vulnerable New Zealanders” – see RNZ’s Dentists push advocacy of oral healthcare for low-income Kiwis.

Association president, Katie Ayers, put the case for reform: “There’s no debate that oral health is an essential component of general health, there’s no debate that we have unacceptable inequalities in access to care in oral health status, but the problem we have is just that funding is not coming through to enable us to help the people who need it the most.” The Association says millions would be saved in hospital costs if more was spent on preventing tooth decay.

However the Association does not go as far as calling for free dental care, with the president pointing out that this would cost “well in excess of $1 billion” – see Anna Whyte’s Free dental care for all ‘absolutely not possible’, NZ Dental Association says. Instead of a universal system, they call for targeted subsidies for the poor.

Some district health boards are advocating for universal provision of dental care. Last year the Waitematā District Health Board formally decided to advocate for a “comprehensive dental service for all New Zealanders” based on the public health system – see Nicholas Jones’ Time for free dental care? Queues at hospital pain clinics as Waitematā DHB backs ‘comprehensive’ dental service.

This article reports the then Health Minister David Clark admitting the “huge unmet need in dental care” and saying “We have people struggling with third world health conditions as a result of bad dental hygiene and inability to access the care and treatment they need”. He lamented that a universal system was unable to be implemented prior to the 2020 election.

Following on from this, the Otago Daily Times called the situation a “crisis” and asked in an editorial if the Government’s avoidance of reform was tenable: “will we soon get to a point where the cost of not addressing our national dental crisis is outweighed by the value of introducing universal care? For this is a crisis. It is a state of decay so bad even the dentists are recoiling in shock” – see: The tooth really hurts.

The newspaper pointed to the last comprehensive survey of oral health in New Zealand, from 2009, which showed “one in three New Zealanders was living with untreated tooth decay, and doubtless that ratio has worsened. The same survey indicated just 40% of New Zealanders regularly went to the dentist. What odds on a fresh survey revealing that number has not just dropped but plummeted? Regrettably, professional dental care is seen as a luxury for many of our citizens”.

If a full universal system is too expensive, surely other reform options are possible. This was the argument last year from Dave Armstrong, who asked: “Could the Government look at partly subsidised dental care, in the same way doctors’ visits for some are partly paid for by the state?” – see: A solution for our phobia about the high cost of dental health.

Here are Armstrong’s other main ideas: “Perhaps something the Government could look at is instigating a cheap, “no frills” level of primary adult dental care. Employing mainly hygienists and a few dentists, with emphasis on education and prevention, it could target low-income people who couldn’t afford private care.”

Finally, cartoonist Toby Morris asks “Why are teeth treated so differently to the rest of our bodies?” see: The Side Eye: Missing Teeth.