Mark Butler
Monday, 1 February 2021

Medicare – Thirty-Seven Years Young, and So Much More We Can Do

The 1st of February 2021 marks 37 years of Medicare’s existence, and if there was ever a time to be grateful for the most fundamental part of our health system, and one of the greatest Labor reforms, Medicare, it is right now. 

Labor has fought countless attempts to cut Medicare, water it down or destroy the principles of fairness and equity in health on which it is based, and this year in particular we saw the fruits of those fights well won.

There may be arguments about whether 37 years of age is young or old, but there can be no argument about the incredible impact Medicare has now had on several generations of Australians.

37 years though is a long time in politics, and indeed a long time in health. The world we live in now and the health challenges we face are not the same as those in 1984. Those stark differences and how we support better, healthier futures for all Australians are worth some thought.  

2020 saw us think more about our health than any year in living memory.  More than ever, people realised that protecting health is an investment in a stronger economy and a better society.  The focus on health was forced on us by COVID-19, but we should ensure this focus doesn’t recede as the pandemic does. 

Australia has been relatively successful – so far – at dealing with the pandemic.  But we are less successful in dealing with more pervasive and more fatal epidemics. 

We face epidemics of chronic disease, like diabetes, dementia and mental ill-health.  We are also dealing with epidemics of the risks that drive disease, including the fact that two-thirds of us are overweight and obese.  

These epidemics should not be regarded as inevitable, untreatable, irreversible or unlinked.  Sure, dementia for example, will increase as society ages, but that doesn’t mean the extent is inevitable. 

Diabetes and dementia are both increasing solidly in Australia, but given 70% of people with type two diabetes develop dementia, should we really be surprised?  What does all this mean for health policy?

In Australia, the health debate all too often revolves around health care inputs as opposed to health outcomes.  Debates around hospital funding, for example, are important but miss the main point: unless we massively change our approach to the epidemics engulfing Australia, we could (and will have to) increase our hospital funding exponentially but not improve the health outcomes of Australians.

What are the principles that should underpin health policy in this age of epidemics?

Health in all policies. 

Governments make policy every day.  But how often do policymakers stop to think about the most important implications of their decisions – on our health and life expectancy?  Urban sprawl without jobs and services means people spend more sedentary hours commuting, with negative implications for their physical and mental health.  Increased casualisation and the untrammelled march of the gig economy produce much poorer health for the people who live from gig to gig. These are just two examples.  A health in all policies approach (as has worked in South Australia for years) will at least force policy makers to stop and think about the broader implications of their decisions, even if they are a long way from the health portfolio.

Prevention, prevention, prevention.  

Prevention seems like a no-brainer, but we do so little of it.  Prevention is important because being well beats the crap out of being sick.  Sounds simple right? Well it is, but we don’t do it.  Australia spends around 1.6% of our health budgets on prevention – one of the lowest levels in the developed world. Comparable countries like Canada, New Zealand and the United Kingdom spend 5-6%.  And it’s not just about spending.  Australia has a good track record whether it is folate in foods or the ‘Slip, Slop, Slap’ campaign. But our last major preventive health undertaking was plain packaging of tobacco, which is now more than a decade ago.  We need to do better, including on what the WHO calls the biggest health threat of the 21st Century: climate change.


Federal Health Minister Neal Blewett campaigning in 1983

Bang for buck: 

Invest in equity. When focussing on prevention, we should focus on those areas with the greatest scope for improvement and therefore returns.  That means investing more in areas and groups doing it tough.  The wealthier you are, the healthier you are. Take diabetes again.  15% of Australians are diabetic or pre-diabetic, but among hospital patients in Western Sydney the rate rises to 50%. If we are to bring about substantial improvements in health outcomes, we need to focus on those areas of poorest health – including among our First Nations peoples – to bring about the best chance of improvement. 

Make health care universal again.  

Medicare is of course one of Australia’s – and my party’s – great achievements.  It should be protected – but importantly, at nearly forty years old it also needs to be nourished. It was designed as universal health insurance, with access to care based on need rather than capacity to pay, but it is no longer truly universal. Each year 1.3 million Australians avoid or delay basic services like GP visits due to cost (not helped by the LNP Government’s Medicare rebate freeze).  Another 2 million Australians avoid necessary dental care each year because they can’t afford it.  As a result, we have over 70,000 hospital admissions each year for dental conditions that could have been prevented with earlier treatment.  Even small, incremental efforts towards more universal health care are important steps in completing the Medicare project which Bob Hawke and Neal Blewett commenced, and in improving the health of all Australians. 

Fix Primary Care. 

In Australia, our doctors and health care professionals are by and large remunerated on an episodic basis (per patient visit), not for coming up with comprehensive plans to prevent and manage chronic conditions.  Governments have been fiddling with pilot projects to fix this for decades.  While we continue to fiddle, plenty of other governments around the world have found ways to bend their health systems to facilitate more comprehensive, joined-up health care for people who need it.  We need to urgently catch up.

Australia faces a fork in the road. As we emerge from COVID we can go back to complacency in our health policy - or we can use it a chance to renovate.

If we choose the former path, health care costs will continue to grow while outcomes will continue to plateau or deteriorate. The principles outlined here must provide the framework for comprehensive health reform if we really want to say and believe that our health care system is the best in the world.

COVID-19 has brought our health system into laser-like focus in the public square. Something we can often take for granted and don’t pay too much heed to unless we’re unwell, or we can’t access the care that we need. There is no better time than now, in the shadow of the pandemic and on the 37th anniversary of Medicare to make the case for this comprehensive and much needed reform of our health system.

About Mark Butler:

Mark Butler is Federal Member for Hindmarsh and Shadow Minister for Health and Ageing. Mark was elected to Parliament in 2007 and served as Minister for Mental Health and Ageing, Minister for Social Inclusion and Minister for Housing and Homelessness in the previous Labor Government.