Illustration: David Rowe.
If a popularity contest was staged for Australian government programs Medicare would walk into the final.
When an Essential poll asked voters in 2011 what they thought about eight of the biggest federal government policy decisions of the modern era, Medicare received overwhelming support. Almost eight in 10 said Medicare was good or very good. Just one in 17 thought it was bad or very bad. Approval of Medicare was far higher than either floating the Australian dollar (46 per cent said good) or free trade agreements (41 per cent said good).
Even so, Joe Hockey’s first budget is set to make a landmark change to Medicare by introducing a co-payment for GP consultations.
“There is no such thing as a free visit to a doctor,” the Treasurer says.
But trends in public opinion suggests the Abbott government has set itself a tough assignment convincing voters to embrace changes to Medicare.
The public’s allegiance to Medicare is at odds with its contentious beginnings. Australia’s first universal health care scheme – the Whitlam government’s Medibank – was introduced after a protracted and bitter political battle. The law to create it was rejected repeatedly in the Senate and it required a double-dissolution election in 1974 and the first-ever joint sitting of parliament for it to pass. That scheme only operated for about a year before the Fraser Coalition government began to dismantle it triggering a general strike in1976. By 1981, Medibank had been abolished and Australia reverted to a system of voluntary private insurance, subsidised by government. The Hawke Labor government then introduced Medicare in 1984.
Despite the early divisions, Medicare gradually won favour across the political spectrum. Opinion polls for more than a decade have shown Medicare has high levels of support among both Coalition and Labor voters. When an Essential poll in 2011 asked if Medicare should be privatised 72 per cent of Coalition voters were opposed compared with 79 per cent of Labor supporters.
The danger of tinkering with Medicare was underscored in 1991 when the Hawke government introduced a co-payment for GP visits of $3.50. That was watered down to $2.50 before it even began and was abandoned months after Paul Keating replaced Bob Hawke as Prime Minister.
By the 1996 election, the Coalition had accepted Medicare and the then opposition leader John Howard promised to preserve the scheme. Earlier this year, Prime Minister Tony Abbott declared the Coalition government would be "the best friend Medicare has ever had."
Why has Medicare proved so popular? One reason is that we’ve all got a stake in it. Taxpayers contribute through the 1.5 per cent Medicate levy and taxpayers benefit when they go to the doctor. It’s my guess that many families with private health insurance feel they get much better value from Medicare than insurance.
Australians’ intuitive support for Medicare is backed up by international comparisons. We spend less on healthcare as a proportion of GDP than the OECD average and much less than the United States. But our health outcomes are good by world standards – only three nations have longer life expectancy at birth.
“People have gradually come to see their interests tied to the universal scheme,” says Macquarie University researcher Dr Shaun Wilson.
Will a co-payment make much difference?
Polling published in the Sun-Herald today suggests it would alter public behaviour. About four in 10 respondents said a $6 co-payment would make them less likely to go to the doctor.
Critics of the co-payment say this disincentive will end up adding to the overall health costs because more sick people who put off going to the doctor will require more treatment.
Supporters of the co-payment say it is affordable and necessary given the spiralling cost of health. The government's commission of audit said health care was Australia's biggest long-term budget challenge.
But Dr Wilson says there is another big issue at stake – the introduction of more user-pays policies in the health system, such as GP co-payments, could erode the very high levels of support for Medicare over time.
That would create the political space for much more far-reaching changes to the health system.
It's a big week for the Australia's much-loved universal health care system.