Health Policy in Australia- now, then, and forever?
Who would have thought in 2013 that a first term Coalition government would be seeking a second mandate after having deposed a sitting prime minister? The failings of the Rudd and Gillard years are still relatively fresh in the country’s political memory, and were frequently invoked by the government as a warning against a return to Labor. However, as with Labor before it, the Abbott and Turnbull governments could be accused of broken promises, a ‘tin ear’ for politics, leadership uncertainty, failing to set out a coherent policy narrative, and crushed expectations.
This view has been recorded in a number of chapters in the book, From Abbott to Turnbull: New Direction?, due for release in early August. The book has been produced by the Institute for Governance and Policy Analysis at the University of Canberra, the twelfth volume in a series covering each federal government since 1983. It is edited by Chris Aulich, a Visiting Professor at the Institute.
One chapter by researcher John Butcher, analyses the Coalition’s policies in health and social matters over the past three years. Butcher argues that health and social policy under Labor has emphasised the important role of government in providing a fairer and more supportive set of policies; the Abbott and Turnbull governments, by contrast, have been cast in the small government mould with health and welfare seen more as costs than investments.
The Abbott government claimed that they had inherited a ‘budget emergency’, and sought to devolve administrative and financial responsibility onto state and territory governments whose own budgets were already groaning under the weight of growing demand. Turnbull continued this trajectory with his failed proposal to invest states and territories with the authority to levy income taxes and to consider assuming full responsibility for public education.
During the election campaign, Labor accused the Coalition of proposing to privatise Medicare, an accusation which clearly resonated with the voters. In return, the government accused Labor of peddling a lie and they tried to assure Australians that they had no intention of privatising Medicare.
What is clear is that the electorate did not believe the Turnbull government’s assurances. They had been duped by a Tony Abbott comment in the days before the 2013 election where he promised voters that the Coalition was on a ‘unity ticket’ with Labor in relation to health and education (among other matters) – promises which were broken within weeks of being elected.
During the Abbott-Turnbull period, the Coalition proposed to add a co-payment for GP services, freeze rebates, reduce bulk-billing incentives, increase hospital charges for ‘walk-in patients’, and reduce the real value of grants to the states for hospitals. All these measures would have required patients to pay more for their health services. The scare campaign worked because people were already scared about the Coalition dismantling public health.
We should also not forget that increasing consumer payments is considered by most as one form of privatisation. Expecting health services to be funded more by private-user funds, accompanied by a reduction in public funding is one privatising mechanism, alongside others such as selling off government assets (like Medibank Private or Telstra) or replacing public providers with private ones (such as Detention Centre management, outsourcing employment services). All these privatisation technologies lead to us relying more on private institutions and less on government to satisfy our needs.