Retrenchment and Reform: The Politics of Medicare Under Labor, 1984–1996

The Hawke and Keating Labor governments (1983–1996) embedded the principle that basic health care was the right of every Australian. Universal equal access and simplicity of design helped to build the popularity of Medicare despite continued opposition from the Coalition and large sections of the medical profession. The lack of serious external challenges did not mean Medicare had a free ride. This article explores the challenges from within government, especially around budgetary control and growing problems of system design. The salience of Medicare to Labor’s political fortunes enabled it to survive periodic raids by the Department of Finance and the Treasury. More serious challenges appeared over the size and quality of the primary care workforce. Adapting health care to the more fundamental problems of a growing burden of chronic illness raised larger political and policy issues. A National Health Strategy review, launched by health minister Brian Howe (1990–1992), proposed reforms founded on new models of care integration and strengthening primary care, moving away from individualised fee-for-service towards preventive and population health approaches. These reform attempts fell far short of rebuilding Medicare, but the problems they identified—and barriers that blocked successful implementation—shaped health policy for several decades.