Election campaign lesson #1: don't mess with Medicare
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Labor鈥檚 2016 鈥淢ediscare鈥� has entered political memory as a campaign tactic that almost changed the game in that election. Using robocalls and text messages purporting to come from Medicare, government proposals to outsource management of back-office business became inflated into an all-out 鈥減rivatisation鈥� of Medicare.
The hyperbole cut through because of a long history of Coalition hostility to Medicare as a universal health scheme. The then Turnbull government didn鈥檛 lose the election, but it became听听to the loss of some seats.
Health has taken centre stage once again this election, with both sides trying to use 鈥淢ediscare鈥� tactics to drive fear about cuts or shortfalls in the health system.
Coalition hostility
Both the Whitlam government鈥檚 Medibank and Hawke鈥檚 Medicare faced withering hostility from Australian conservatives.
Australia became one of the only nations to introduce universal health coverage in 1975. This aimed to ensure all Australians had access to a wide range of health services at little or no cost, no matter where you lived or how much money you earned.
After three years of debate about the role of private health insurance, and indivuals鈥� responsibility to pay for their own health care, universal health care was re-established in 1984 by the Hawke Labor government, under the new name: Medicare.
In 1987, then听听to return to a user-pays system based on private health insurance. He wanted to 鈥渢ake a scalpel, without punning too much, to Medicare鈥�.
But rather than backing Howard鈥檚 plan, voters delivered a听. In 1990, the听听confessed to the press, just before resigning:
I want to say with all the frankness I can muster, the Liberal and National Parties do not have a particularly good track record in health, and you don鈥檛 need me to remind you of our last period in government.
Howard鈥檚 1996 electoral success relied on defusing the Medicare issue. He听听that 鈥淢edicare will remain totally in place under a Coalition government鈥�.
However, he retained some of his ambivalence. Howard supported Medicare鈥檚 role as a 鈥渟afety net鈥� to support people with few financial resources. But the Coalition believed those who could afford it听, through private health insurance.
The Abbott government鈥檚 2014听听report restated this call for a two-tier health system:
Higher-income earners should be required to insure for basic health services in place of Medicare.
The incoming Turnbull government rejected this advice. But the debate reinforced an image of a reluctant and half-hearted convert.
When the Coalition extended the Medicare benefit freeze, which was originally introduced by Gillard鈥檚 Labor government, the extension hurt the Coalition far more than it had Labor.
Embracing Medicare or avoiding a Mediscare?
The Coalition has been determined to avoid this trap again. The Turnbull and Morrison governments have underlined support for Medicare. The听听are punctuated with statements about 鈥済uaranteeing鈥� and 鈥渟trengthening鈥� Medicare. It also declares: 鈥淭he government鈥檚 commitment to Medicare is rock solid.鈥�
The听听was established in 2017 to emphasise this commitment. Tax dollars generated by the Medicare levy (minus the portion set aside for the National Disability Insurance Scheme), go into the fund. These are topped up with enough personal income tax receipts to meet the combined cost of the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS).
But the fund has been criticised as mere rebadging and an 鈥溾��. It offered no new funding or new policies; it simply changed the name of existing policies, and extended the definition of 鈥淢edicare鈥� from payments of medical benefits to include pharmaceuticals.
But the 鈥淢edicare guarantee鈥� wasn鈥檛 extended to guarantee adequate federal funding for public hospitals, which remains a problem.
When it comes to embracing Medicare and health funding, Labor has been called out for some of its own lapses.
In 2011 the Gillard government, during its struggles for control of spending, delayed implementation of some expensive pharmaceuticals,听听among health provider and patient groups.
Labor has had to听听that all PBS drugs approved by the nation鈥檚 expert advisory panel will be approved immediately.
Mediscare 2.0
Labor鈥檚 new attempt at scare tactics over Medicare uses well established themes. It will test how far the Coalition has been able to inoculate itself.
The attack has again focused on the out-of-pocket costs from declining bulk-billing levels, especially in cancer treatment.
Despite the Gillard government鈥檚 Medicare rebate freeze, Labor has held the high ground in this cost debate. Its cancer package focuses on extending bulk billing to minimise out-of-pocket payments.
In the field of hospital funding, Labor鈥檚 鈥淢ediscare 2.0鈥� focuses on a A$2.8 billion 鈥渃ut鈥� in funding to the states to pay for public hospitals.
In 2011, the Rudd/Gillard government pledged to share the cost of public hospital funding growth with the states with a 50-50 split to end the 鈥渂lame game鈥�. The Abbott government abandoned this policy in the 2014 budget.
The Coalition, under Turnbull, offered to return to funding 45% of the cost of public hospitals. The Labor-held states rejected this, and Shorten has now听. Labor has made traction with these attacks, though much of the detail has been lost or confused in media soundbites.
Election campaigning in health has forced the Coalition to accept how much Australians value Medicare and the principle of universal health coverage. As the common ground between Labor and the Coalition expands, we may be able to have a more rational debate over Medicare鈥檚 virtues and deficiencies. But not in the partisan heat of an election.
This article was first pubished on and written by ,听Deputy Director of the Menzies Centre for Health Policy at the University of Sydney.
