Introduction by Croakey: It is common for health and medical organisations to say they want to address health inequities.
Why, then, is there so little engagement by the sector – with some notable exceptions – in ongoing debate about the stage three tax cuts and their predictably harmful impacts in exacerbating social, economic and health inequities?
Cate Carrigan writes:
The Public Health Association of Australia has launched a campaign urging the Albanese Government to abandon the stage three tax cuts, warning that they will mainly benefit people on high incomes and will undermine health equity.
The PHAA is asking high-income earners – a group which includes many medical professionals – to sign this petition saying “no thanx to tax cuts” on the grounds that “it’s the wrong time to give more money to those who don’t need it”.
The PHAA says the tax cuts, which deliver the biggest returns to those earning between $180-$200,000 annually, are inequitable and the association wants the $243 billion saved in dumping the measure to go to those most in need – for housing, income support, education and health services.
The PHAA campaign comes just two weeks out from the Federal Government’s promised “Wellbeing Budget”, and follows growing concerns about the inequitable impacts of the planned cuts at a time when many Australians are facing precarious living circumstances including food and housing insecurity, as well as the acute and long-term impacts of flooding.
A Croakey survey of health and medical organisations and sector leaders asking for their views on the tax cuts and PHAA petition suggests there has been little engagement with this critical issue for health equity, despite these tax cuts being on the political agenda since the 2018/2019 budget.
Of more than 20 health and medical organisations approached by Croakey, only a handful replied to a series of questions about whether they supported the scrapping of the tax cuts and whether they would share the PHAA’s petition with their members. The four organisations that replied declined to comment specifically on the tax measures.
The sector’s reluctance to engage with this critical policy issue comes at a time when many health organisations and leaders are arguing for increased investment in prevention, the social determinants of health, and healthcare services such as general practice and public hospitals.
Factors at play
Professor of Health Equity Sharon Friel suggested the reluctance of health organisations to comment on the tax cuts could be due to ignorance about taxation being a social determinant of health and health inequities.
Friel, the Director of the Menzies Centre for Health Governance at the Australian National University (ANU), said the failure to engage was “the challenge of a dominant biomedical model of health”.
Other factors included the conflict between personal interests and benefit versus the collective good, and a focus on professional self-serving – calls for investment in health services rather than for investment in the conditions that keep people well, such as sufficient and fair income, she said.
Echoing calls for professional groups to back ditching the tax cuts, public health social scientist Professor Fran Baum said she’d also like to see organisations urging their members to sign the petition.
“Equally important is the demand for higher payments for Centrelink allowances,” she said.
Baum, Professor of Health Equity with the Stretton Institute at the University of Adelaide, stressed that perhaps the most important thing to ensure was that there is “a health equity assessment of the overall budget” to check the impact on health equity and access to health services.
Sector responses
The Australian Medical Association (AMA) – which represents around 30 percent of the country’s 104,000 doctors – had no comment on the cuts but added that “health remains the best investment,” when it comes to government spending.
The Australasian College for Emergency Medicine (ACEM) provided this response to Croakey:
“As the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards, we are experts on matters related to emergency medicine, and on public health systems, and we confidently comment publicly on matters related to those issues. However, as a College, we don’t advise, engage or survey our members on fiscal matters, and are unable to provide a contribution for your article.”
The College and its members have a long history, however, of advocating for greater investment in important determinants of health, such as housing and poverty.
Royal Australian and NZ College of Psychiatrists (RANZCP) President Vinay Lakra told Croakey that decisions about support or opposition to the Stage 3 tax cuts were a matter of individual choice and not a decision for the organisation.
While acknowledging pressures on the federal budget, Lakra said it was up to the Government to allocate resources and that more funding was needed to meet a huge demand for mental health services.
“The Government can decide to cut spending on things like the criminal justice system and instead focus on health. Whatever amount of money they have, that’s for them to decide how they spend it,” he said.
Lakra said COVID measures such as JobKeeper payments had allowed the most vulnerable to access services and providing this kind of support was critical to improving mental health.
“I can’t say anything about tax cuts on behalf of our members, but I can confidently say that there is not enough being done for mental health and psychiatry, with many unable to afford services,” he said.
The Australian College of Nursing (ACN) told Croakey it was unable to comment on the issue due to a lack of staff.
The National Health Leadership Forum (NHLF) – a collective voice for national Aboriginal and Torres Strait Islander health and well-being organisations – sees the issues around Stage 3 tax cuts as complex, with many members personally supporting the scrapping as an equity issue but also wanting better use of current funding.
Calling for support
While the PHAA had not asked other organisations to sign the petition, CEO Adjunct Professor Terry Slevin told Croakey he hoped those who supported its intent would share it among their members.
“After all, we argue that abandoning the tax cuts would mean the Australian Government has money to invest on numerous, vital programs that benefit society, including preventive health programs and medical care, raising the rate of social supports like JobSeeker, public housing, and education.”
Slevin said more than 130 people had signed the petition since the launch of the campaign on Sunday, and it’s been shared on social media dozens of times.
While the numbers were small compared to related petitions run by the Australia Institute and petition Change.Org, Slevin said the PHAA’s was the only one aimed at people who would benefit most from the tax cuts.
The PHAA stance was “…leaning into a campaign that a lot of people across the continent support”, said Slevin.
CEO of the Grattan Institute Danielle Wood told Croakey: “It would be great to see organisations that regularly call for more government spending to weigh in on the challenge of how we pay for it.”
“Over time, more spending in one area means either we spend less elsewhere or collect more revenues to pay for it,” she said.
“The collective silence as to the benefits of collecting more tax for providing things like better health services is part of the reason we struggle to have a sensible debate about the costs and benefits of increases taxes in this country,” she said.
Wood believes the stage three cuts are not affordable in the current fiscal circumstances.
“I would like to see them modified or bundled with more significant reforms – better targeting of super tax concessions, winding back negative gearing and reducing the CGT discount – to reduce their fiscal cost,” she said.
• Croakey welcomes further comments from health and medical organisations and leaders on the stage three tax cuts and health.
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Watch the video below from Greg Jericho about “quite possibly the worst tax cuts devised by any government”.
Editor’s Note: This story was updated on October 13 to amend comments attributed to ACEM.
See Croakey’s coverage of the Federal Budget to be handed down this month
