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Medicare ahead by a mile in popularity stakes


Matt Wade

<i>Illustration: David Rowe.</i>

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. 


  • Budget night will create more "Gillard moments" for Abbott than you can point a stick at.

    The problem for the opposition will be where to start.

    The Banker
    Date and time
    May 11, 2014, 12:32PM
    • Yes..the downhill start will be the changes to medicare....what the gooses don't seem to realise is that we do not have the same population as the US.....we are a large island with a small population....and to make medical care privatised and more expensive while heading it down the US model direction, will make our healthcare 100 times worse than the US, where the distance of travel is less to service centres to obtain health services, and where there are more private health services to serve the population, because of the larger population in the US..

      Small populated countries need to have much more gov imput into essential services than larger populated countries in my experience, because in smaller populated countries, large privately owned multi-national orgs can create monoplies, that price fix and charge huge fees...sending much of the population into poverty.

      I feel this gov is heading us for disaster.

      Date and time
      May 11, 2014, 2:38PM
    • @The Banker:
      No worries where to start. Medicare is the light on the hill for an overwhelming majority of Australians. Any adjustments to its operations will entrench Abbott's government in the unpopularity stakes and will make their re-election incredibly difficult if not impossible. Tampering with this sacred cow is without doubt reckless in the extreme. Raise the Medicare levy, increase taxation, get the mint to print more money, anything, but don't play around with this institution.

      Gosford NSW
      Date and time
      May 11, 2014, 3:24PM
  • I've never known a more corrupt organization or wasteful one.
    Where bullying and corruption reigns king.
    Staff are threatened with instant dismissal if they go the union to complain.
    Video evidence is lied about, covered up, denied, lied about.
    If people really knew what was going on they would shut it down.
    We don't need this dinosaur department.
    We could have it all electronically done.
    Yes they give refunds back but surely a much smaller department could do a much better job if the whole thing was done electronically and with smart cards.
    This department sabotages anything which looks threatening its very existence.
    Get rid of the corruption first before making outrageous claims!

    Date and time
    May 11, 2014, 1:19PM
    • Even if there were any truth to your log of unsupported allegations, what have they to do with Abbott and the Dunderheads sabotaging Medicare?

      If there were any truth to your allegations, why is it among the top 2 or 3 mecdical systems in the world; second and 3rd only to the Scandinavians who tax at about twice our level?

      Date and time
      May 11, 2014, 3:40PM
  • It'll be a pussycat budet unless you're old or sick or going
    to a state school.

    Date and time
    May 11, 2014, 1:30PM
    • Everyone likes what they might think are freebies . The reality is that Health Care has to be paid for. In the long run the Coalition look like they are willing to sacrifice false popularity for the good of the Nation long term If we don't take the corrective medicine now we will have to take a lot worse down the track.

      Beacon Hill
      Date and time
      May 11, 2014, 1:59PM
      • Not all of health care needs to be free, only the first access to the health system through GPs and emergency departments, where people are most vulnerable and unfamiliar to the system. We need to stop conflating all of Medicare costs with the payment to GPs (Medicare costs that supposedly need 9.5% Medicare Levy pays for drugs, investigations, hospitals, specialists, allied health and bureaucrats, in addition to GPs who are given about 1/20th of that). GPs and hospital EDs are not non-urgent specialists (who can charge exorbitant private fees anyways, so they don't need protection). They diagnose undifferentiated conditions, treat what they are empowered to treat, and save us exponentially higher downstream costs if patients end up with a specialist or hospital. We should be paying all doctors to become GPs rather than paying them to become specialists. It's a topsy-turvy capitalist world but we can still make a difference if we all speak out.

        Date and time
        May 11, 2014, 2:24PM
      • hi noitall - Medicare has kept health costs in Australia low, because it has determined the fee doctors charge,

        Without Medicare, doctors would charge more like dentists.

        Date and time
        May 11, 2014, 3:33PM
    • Newsflash- free stuff is popular. Bulk billed Medicare services are free at the point of delivery which is the fundamental flaw that renders the system unsustainable over time. Bulk billing is just another type of welfare that has to be paid for- bring on the copayment, then get stuck into all the other entitlement schemes.

      Date and time
      May 11, 2014, 2:11PM

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