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Medicare has been a centrepiece of every modern election campaign for Labor. In an interview with The Saturday Paper, the health minister is doubling down, with a focus on Peter Dutton’s record in his role. By Karen Barlow.
Mark Butler and Labor’s Medicare campaign
On the campaign trail in the 2022 election, Anthony Albanese brandished a dollar coin prop to underscore his focus on increasing the minimum wage. In this campaign it is a Medicare card he most wants to be photographed with.
Health is a fight Labor dearly wants to pick at every election. It sees Medicare, like superannuation, as a Labor legacy – now a half-century old.
“Just remember this: when Medicare was introduced by Gough Whitlam, he had to go to a double-dissolution election,” the prime minister told reporters in Adelaide. “That’s how much they hated the idea that this little card here would be able to give the same healthcare to a billionaire that it gives to an invalid pensioner.”
The Coalition sees no benefit in scrapping over health and has largely matched Labor on its health offerings so far. These include the $8.5 billion commitment to expand bulk-billing and make 90 per cent of GP visits free by the end of the decade. Dutton pledged $9 billion. In addition, the Coalition has reiterated its intention to restore Labor cuts to the pandemic-era, Medicare-supported mental health sessions.
The Coalition has also matched the guarantee to lower medicines on the Pharmaceutical Benefits Scheme to $25, as well as supporting Labor’s $573 million investment in women’s health. However, it has not backed Labor’s $644 million expansion of its current 87 Medicare urgent-healthcare clinics by an extra 50 centres.
The Coalition has doggedly sought to neutralise Labor on health promises and fight on its own more-favoured grounds such as national security, but Labor is intent on homing in on what it sees as a perennial weak spot for the opposition. In this campaign it’s drawing on a history that is well-trodden in previous contests, and which Health Minister Mark Butler quickly reprised in an interview this week with The Saturday Paper.
“I remember John Howard called bulk-billing an absolute rort. He described Medicare as one of the Hawke government’s greatest failures. They’ve never supported Medicare. You know, to the extent they’ve allowed it to continue to exist, it’s been through gritted teeth, and they’ve sought to undermine it rather than completely abolish it, which for so long was their policy,” Butler says.
He’s now targeting Dutton’s record as health minister, particularly his role in trying to introduce an unpopular Medicare co-payment of $7 in 2014, to make the system more sustainable for “generations to come”.
“Peter Dutton wants to do anything to duck a discussion, a genuine discussion, about health because of his record,” Butler says. “He tried to do away with bulk-billing altogether. I mean, that for us, for Labor, was such a central design of Medicare. It was one that was incredibly hard fought.
“We fought doctors’ groups very hard. We fought the Coalition very hard through the ’80s into the ’90s ... So for us, bulk-billing, being able to see a GP for free, is an absolutely central design feature for Medicare. He tried to get rid of it all together. He then even tried to introduce a fee for walking into an emergency department.”
The Saturday Paper sought a Coalition interview on health policy but did not receive a response.
“Labor has made it a centrepiece of their campaign and the Liberals have tried to ensure, not entirely successfully, that there’s not a sliver of difference between them and Labor on this issue, because I think they’re very fearful of a Medicare campaign,” says Stephen Duckett, a former federal secretary of the then Department of Human Services and Department of Health.
“In fact, we’ve already seen that in some of the ads that have been around that Labor is positioning Liberals as a threat to Medicare and a significant area of difference.”
The main opposition attack is the slump in rates of bulk-billing over Labor’s term. In fact, it started when the rebate was initially frozen in 2013 by Labor as a temporary budget-saving measure, and was continued under the subsequent prime minister, Tony Abbott. Duckett says “the cost of providing services and the revenue from the rebates drifted apart”.
During the first two years of the Covid pandemic, Duckett says, bulk-billing rates were artificially inflated by Covid items. “Now about 75 per cent of all attendances are bulk-billed, when they used to be up around the 90s.”
Labor’s deployment of Medicare in a series of elections has been widely criticised as fear campaigns, however, and the tendency persists.
An authorised Labor head office attack ad in February this year showed Dutton declaring in 2014 that “Medicare is dead”. It is a tricky edit: the full sentence from the then health minister was, “Medicare is dead if we can’t make it sustainable today.”
“Health is so important,” shadow health minister Anne Ruston told the ABC last week. “We should not be scaring Australians about our healthcare system, based on lies.”
In the 2022 election, Labor also ran hard on threats to Medicare, with Labor campaign spokesman Jason Clare telling a media conference, erroneously, that “at four elections in a row, the Liberal Party has promised to scrap Medicare”.
In 2019, then Labor opposition leader Bill Shorten was similarly attached to the little green card as a prop. He launched his pitch for the election as a “referendum on the future of Medicare” – a line that’s been repeated again and again in 2025. Shorten’s campaign warned of “Morrison’s Liberal cuts” to healthcare and promised to end the rebate freeze.
Ryan Liddell, who was chief of staff to Shorten at the time, defends Labor’s repeated attacks over Medicare. “There’s always a danger in overdoing any message. But in this context, people are rightfully scared. They look at what happened before that when Dutton was health minister,” he tells The Saturday Paper.
The campaign that became known as “Mediscare” almost got Labor over the line in the contest with Malcolm Turnbull in 2016, by portraying the Coalition as intent on privatising Medicare.
Turnbull later described it as a “grotesque lie”, but Labor had the receipts.
The Department of Health was well down the path of privatising the Medicare payments system, as the government looked to digitise outdated technology and cut the size of the public service. There were also cuts to the rebates for pathology tests and scans, rising costs for medicines and significant cuts to health in the 2014 budget.
Mark Butler insists on the relevance of Dutton’s decade-old record on health as a strong indicator of his intentions as prime minister.
“He’s never said, ‘I got that wrong … really, those core principles of Medicare, I now recognise, are the right ones.’ He’s never said that. And all we’ve seen instead is the same sort of commitment he made to Australian voters in 2013 that there would be no cuts to health,” the minister says.
“Why should we believe him any more than we should have back in 2013, given what he did a few months later, particularly given how much money they have to find for their nuclear power plan, and when he said he’s going to have to make cuts, he’s just not going to tell us what the cuts are before the election, that’s what he said … very explicitly.”
Ryan Liddell says it’s a strategy that has paid off in the past. “These campaigns take flight when there’s truth to them, right? And so, there are truth points when you look at the opposition leader’s record when it comes to health.
“We saw that back in 2016 and 2019, a big fear around the Americanisation of the health system. It’s even more pertinent with Trump. So that’s why you see the PM talking about Americanisation.”
This is a fruitful angle for Labor in 2025. Less than a week into the official campaign came the announcement from United States President Donald Trump of sweeping 10 per cent tariffs on all trading partners, along with criticism of Australia’s Pharmaceutical Benefits Scheme. This is the mechanism by which the government pays prices it negotiates with US drug suppliers, in order to keep costs low for domestic consumers.
The prime minister has rejected the complaints that have arisen from the US pharmaceutical giants. “It is important to emphasise that my government will not negotiate or compromise on the Pharmaceutical Benefits Scheme. This is a part of Australian values just like Medicare and that is why we have made it very clear that this is not up for grabs.”
Peter Dutton has backed the prime minister’s defence of the PBS, while suggesting in relation to the tariffs that he would have secured a “better deal” for Australia.
The Coalition’s pledge to cut the extra 41,000 public servants hired during Labor’s term as part of its plan to cut “wasteful spending” – with a lack of modelling or detail – is now also being tied to Medicare. The Liberal leader has been pushed by journalists travelling with him on the campaign trail on whether other areas of the health budget will be cut to pay for the bipartisan position on greater investment in Medicare.
“We’re not cutting health. We’ve been very clear about that,” Dutton said.
Labor has seized, however, on the distinction between frontline and back office when Dutton was asked on Tuesday if he would repeat Tony Abbott’s 2013 election eve pledge of “no cuts to health, no cuts to education, no cut to the ABC or SBS”.
“Well, we’ve said before that we’re going to provide support and funding to the essential services,” the opposition leader told reporters on Tuesday. “We’ve guaranteed funding in relation to health, for example, in relation to education, two examples that you cite, because I want to make sure that we are spending money on frontline services, not on back-office operations, and we’ve been very clear about that.”
The back office is where Medicare claims are processed. The Australian Medical Association (AMA) says Australians rely on the public health system running smoothly behind the scenes, as do doctors.
“We would have concerns if there were cuts even to the back end of Medicare,” says AMA president Danielle McMullen.
“It may not be what people see every day when they go to see the doctor or go to the hospital, but there’s an incredible amount of work that goes into making sure that those payments flow through, that the funding is there and that Medicare is kept up-to-date.”
Butler is emphatic that the back-office staff is already “lean” and, if anything, in need of boosting.
“We’re consistently trying to improve our systems. Move to more digital health so that people are able to keep much better track of how their health record is working,” he says.
“We inherited a digital health system that was in very, very poor shape – had not really been any serious work done on it for a decade. So we still have a pretty antiquated My Health Record system that we’re in the process of modernising. It wasn’t changed from when Nicola Roxon introduced it in 2012 as a PDF format that’s not well connected to the rest of the system. So if anything, we’re asking more of those staff to catch up on a decade of, essentially, inaction on digitisation of our healthcare system.”
The Department of Government Efficiency (DOGE) cuts are also impacting global health systems via the weakening of the US Centers for Disease Control and Prevention (CDC), which has undermined disease control efforts, and will force Australia to look to other nations to extend existing collaborations.
“Could we get by without them? Probably, but it’ll be slower, and it’ll be less thorough,” Australian National University infectious diseases expert Professor Peter Collignon tells The Saturday Paper.
The health minister says Australia is still assessing the impact of the DOGE cuts and confirms that Australia has relied heavily in the past on the CDC.
Meanwhile, both parties are taking criticism for their health platforms in this election. Former paediatric neurologist Monique Ryan, who is defending her seat of Kooyong as an independent, says she is just seeing “bandaid” solutions, no commitment to including dental in Medicare and no shift to more preventive healthcare services.
“Neither of the parties is really coming up with the fact that we have to change the care model, and if we don’t do that, Medicare is going to continue to struggle in the long term,” Ryan tells The Saturday Paper.
For its part, the AMA is happy for 2025 to be a health election, and Danielle McMullen isn’t short of suggestions for further offerings. “Whoever wins this election needs to get back to the table on hospital funding and make sure that our public hospitals have the resourcing they need to provide care … urgent-care centres are not having a significant impact.
“The $8.5 billion is a huge investment in general practice and Medicare and will make affordability of general practice easier for some Australians. What it lacks is the reform to the underlying structure of Medicare,” she says.
This article was first published in the print edition of The Saturday Paper on April 5, 2025 as "Mark Butler and the golden egg".
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