Is there a better way to debate health policy during federal election campaigns? It’s an obvious question in the wake of the Health Policy Debate this week.
Jason Staines writes:
Much was left unsaid at the National Press Club of Australia on Wednesday, when Health and Aged Care Minister Mark Butler and Shadow Minister Senator Anne Ruston met for the Health Policy Debate. The usual suspects got an airing — bulk billing, Medicare funding, workforce shortages, and the cost of GP visits.
However, key health issues were notably absent from the conversation: First Nations peoples’ health, climate-linked health impacts, violence against women, cultural safety in healthcare, and prevention and public health matters, including the future of pandemic preparedness infrastructure.
While these issues sit at the heart of the health system’s long-term challenges and efforts to address health inequities, the debate’s focus rarely broadened beyond electoral battlegrounds such as Medicare and general practice.
This narrow scope was in contrast to calls from prominent health experts for a wider, more ambitious reform agenda.
Ahead of the debate, health economist Professor Stephen Duckett argued that while boosting bulk billing is welcome, it does little to address systemic issues such as workforce shortages, chronic disease, and fragmentation of care.
“Critically, neither party has announced anything to improve access to other medical specialists. The gap continues to grow between what specialists charge and what Medicare will cover. This means some patients are delaying or avoiding necessary care altogether,” he wrote.
Health policy analyst and Croakey columnist Dr Lesley Russell likewise urged parties to move beyond slogans and tackle the realities faced by Australians living with chronic and complex conditions.
Speaking to MS Australia, she said the current level of debate was about quick fixes: “They’re really Band-Aids in a way. They’re substitutes for the really hard work of reform and restructure that needs to be done.
“And we see it because politicians want to be able to say, ‘here is what I’ve done for health’.
“And it’s much easier to present someone with an urgent care clinic, which may well be needed, and which I must say for the most part, despite what the AMAs and the RACGP says, this is an extremely popular gift to the public.” A much harder sell was “to say, here is a program that’s going to keep you healthy, and you won’t get a disease”.
Familiar terrain
Ruston opened the debate with a direct attack on Labor’s record, framing Medicare as under threat not from the Coalition, but from mismanagement.
“Australians know because it’s never been harder or more expensive to see a doctor that it is right now in this country,” she said. “By almost every metric, Labor has failed Australians on healthcare.”
She claimed that bulk billing had dropped by 11 percent since Labor came to office, citing national health accounts and specific drops in the minister’s own electorate.
“Across the country, Australians have seen 40 million fewer bulk-billed visits to their GP last year alone. And while bulk billing is dropping, out-of-pocket costs are skyrocketing,” she said.
Ruston promised that “the Coalition rules out any cuts to Medicare”.
“We will keep open all urgent care clinics,” she said. “Under us, medicines will be cheaper. We will rule out any cuts to hospital funding”.
Butler countered that these were the same kinds of promises made before Opposition Leader Peter Dutton’s 2014 health budget.
“When Peter Dutton was health minister, he looked Australians in the eye and promised that there would be no cuts to health,” Butler said.
“And then in his first budget, he cut $50 billion from public hospitals … and when he couldn’t get all of that through the parliament, Peter Dutton started the Coalition’s six-year long freeze on the Medicare rebate.”
However, many of Dutton’s 2014 cuts were not mentioned by Butler.
As Croakey has noted, among the key measures abolished were the Australian National Preventive Health Agency (ANPHA) and Health Workforce Australia (HWA). Funding for Indigenous health programs, including through the National Aboriginal and Torres Strait Islander Health Plan, was also significantly reduced.
While not all of the 2014 budget’s proposed cuts were implemented, its wide-ranging impacts are still felt today.
Butler defended Labor’s Urgent Care Clinic rollout, claiming the Government had already delivered 87 of a promised 50 clinics, with 50 more on the way. He rejected the Coalition’s bulk billing figures, citing support from the Royal Australia College of GPs and saying the numbers were “misleading and highly skewed”.
Workforce was another central issue, with both candidates naming it the biggest crisis facing the system.
Ruston focused on GPs: “We have a crisis in workforce. It’s the biggest crisis, I think, that is facing healthcare at the moment, because without the workforce to be able to deliver the outcomes in healthcare, we cannot possibly deliver them.”
Butler spoke about growing the workforce pipeline, fast-tracking international medical graduates, and giving greater flexibility to state and territory systems.
“We are rebuilding Medicare, not just with new money, but with new models of care,” he said.
While the debate largely overlooked the role of nurses and allied health professionals, it’s worth noting that the Albanese Government is considering recommendations from a Scope of Practice Review aimed at enabling health professionals to work to the full extent of their training, and to develop more flexible, team-based models of care.
While both Butler and Ruston acknowledged the scale of the workforce challenges, stakeholders later criticised the debate’s narrow frame: little attention was paid to the important health workforces who are not doctors, or to structural reform beyond GP access and Medicare billing models.
Deafening silence
In a debate that covered topics from Medicare to mental health, the conspicuous absence of any discussion on Aboriginal and Torres Strait Islander peoples’ health was striking.
This silence was particularly notable given the persistent health disparities faced by First Nations communities and concerns about the fallout from the rejection of the Voice to Parliament referendum. A list compiled by Croakey identified more than 220 health and medical organisations that supported a ‘Yes’ vote because of its significance for health.
The silence was also notable because of widespread concern in the health sector about the implications of an LNP Government for Aboriginal and Torres Strait Islander peoples’ health and the future for the Closing the Gap National Agreement and investment in the community-controlled sector.
Questions that Croakey contributors suggested should be put to the LNP on health policy, include:
- Will a Coalition Government support continuation of the national Closing the Gap Agreement in a partnership model with the Coalition of the Peaks?
- What will be a Coalition Government’s commitments to Aboriginal Community Controlled Health Organisation (ACCHO) funding and supports?
- Will a Coalition Government invest in the implementation of the National Anti-Racism Framework from the Australian Human Rights Commission, launched in 2024?
- Does the Coalition have plans to invest in the establishment of the Bureau of Indigenous Data, as recommended on the Review of the National Agreement on Closing the Gap Study Report released by the Productivity Commissions in January 2024?
- Will a Coalition Government continue with the Department of Health and Aged Care committees: First Nations Health Governance Group and the First Nations Aged Care Governance Group?
- Will a Coalition Government engage with and continue providing secretariat funding for the National Indigenous Health Leadership Alliance (formally NHLF)?
- Will a Coalition Government continue work to implement recommendations from the National Review of First Nations Health Care in Prisons?
It was also notable that while Butler began his remarks with an Acknowledgement of Country, Shadow Minister Anne Ruston did not. No further mention of Indigenous health was made by either speaker.
Glaring omission
Despite being one of the most pressing public health challenges of our time, climate change, its health impacts and the need to decarbonise healthcare systems were entirely absent from the debate.
This omission came just a week after a CroakeyLIVE webinar featuring leading health professionals and advocates calling for stronger political leadership on climate and health.
Dr Kate Wylie, a GP and Executive Director of Doctors for the Environment Australia, told the webinar: “We know that climate change is impacting health right now. This is not about the future. This is about heatwaves, food insecurity, trauma – all things doctors are dealing with.”
She also noted that in a lot of electorates it was clear that candidates “had never thought about climate and health before” and lacked understanding on the issue.
Following the NPC debate, Australia’s major medical colleges – representing over 112,000 doctors – today issued a joint statement, warning that “delaying climate action will cost lives, hip-pockets and the public purse”.
“As doctors, we know an emergency when we see one. Climate change is a public health emergency and a major threat to our nation’s health system,” the statement said. “Failure to reduce emissions and climate-proof health services will lead the system to a breaking point.”
The statement highlights how climate impacts such as heatwaves, floods, and bushfires are already driving up demand for emergency care, mental health services, and chronic disease management. Without urgent adaptation, “Australians will find it even harder to get the medical care they need”.
College presidents reinforced the message: “Climate change is a public health emergency which particularly impacts priority populations, including older people, children and First Nations people,” said Professor Jennifer Martin from the Royal Australasian College of Physicians.
“The next government needs to continue climate-proofing our health system and take strong action on emissions reduction across all sectors.”
Dr Rod Martin from the Australian College of Rural and Remote Medicine added that the effects were “especially felt by rural and remote communities”, while Dr Stephen Gourley from the Australasian College for Emergency Medicine called for health systems to rapidly “decarbonise … especially by reducing unnecessary tests”.
The National Health and Climate Strategy, launched by the Albanese Government in 2023, outlines ambitions to build climate-resilient health systems, but critics say its implementation lacks funding and detail.
As reported by Croakey: “Serious concerns have been raised previously about the strategy’s capacity to achieve its stated objectives, due to a lack of detail and commitment on implementation and funding.”
The joint statement calls on the next government to continue implementation and avoid any winding back of emissions targets, warning that to do so would “endanger lives in Australia and beyond”.
The Coalition has not committed to supporting the National Health and Climate Strategy, and seems unlikely to do so, given its long history of not supporting such a strategy or engaging with climate health concerns.
In this context, the total absence of climate and health from a national health debate feels less like an oversight and more like a political and media blind spot — one that the health sector is urgently trying to correct.
Left on the sidelines
Despite being the largest and most geographically distributed part of Australia’s health workforce, nurses were barely mentioned in the debate — a fact not lost on those in the profession.
The Australian College of Nursing expressed its frustration in a social media post, noting that “nurses were mentioned only once” despite ongoing conversations about primary care reform and workforce shortages.
In response, Professor Jane Mills, Pro Vice Chancellor Health Innovation (Regional) and Dean, La Trobe Rural Health School at La Trobe University, said: “The debate was indeed disappointing with little to no recognition of nurses’ role in providing outstanding primary care in urgent care clinics. GPs are not the only answer to health care delivery.”
Nor did the allied health, pharmacy and public health workforces rate a mention, despite their significant roles in health reform agendas.
Another striking omissions was the absence of any mention of violence against women – an issue that had made its way into the election campaign in the lead-up to the debate.
Just days earlier, Opposition Leader Peter Dutton had unveiled the Coalition’s $750 million “Operation Safer Communities” initiative.
When asked at the time whether the package included specific measures targeting domestic and family violence, Mr Dutton called such violence an “abomination” and promised the Coalition would have “more to say”, but offered no detail.
That detail arrived the day after the debate, with the announcement of a $90 million package pledging to create a national offender register for domestic violence perpetrators. The proposal would allow law enforcement agencies across Australia to share information about offenders, while also funding additional support services for victims, including counselling and emergency accommodation.
The timing of the announcement, however, underscores the critique that gender-based violence remains under-prioritised in mainstream health and political forums.
The issue did not surface in the health debate at all, despite its implications for women’s health and intersections with reproductive and mental health, housing and income insecurity, and frontline healthcare.
For many observers, the absence was not just disappointing but emblematic. As recent Croakey coverage and sector commentary have noted, sustained, integrated action on violence against women requires far more than retrofitted law-and-order responses.
It demands prevention, system reform, and genuine cross-portfolio leadership.
Centre for Disease Control
In 2022, Labor promised to establish a Centre for Disease Control if elected. The Coalition then did not support this measure, despite years of advocacy from some health and medical organisations and leaders.
An interim CDC is now operating within the Department of Health and Aged Care, and is planned to launch in January 2026 pending the passage of legislation.
According to its website, the agency’s roles include ensuring we are better prepared for the next pandemic through early detection and analysis of health threats, modernising Australia’s national disease surveillance and data systems as a frontline defence against communicable infections, rolling out a national wastewater surveillance program to detect emerging diseases, such as avian influenza, and strengthening Australia’s preparedness levels to respond to future health challenge.
While Butler has previously positioned the CDC as a critical reform, he made no reference to it in yesterday’s high-profile exchange.
The absence was particularly notable given ongoing concerns about pandemic preparedness, the growing impacts of misinformation and disinformation, and issues such as long COVID.
The Coalition’s position on Australian Centre for Disease Control appears muddled.
Asked about the CDC this week, Coalition campaign spokesperson James Paterson told media: “If that’s what the experts are recommending that we need to have, then that’s what we will have.”
However, Ruston had previously advised the Public Health Association of Australia that the case has not been made, and her comments during the debate did not add clarity.
At the very least, these conflicting statements suggest critical public health concerns are not high on internal discussion agendas for the LNP.
Time for change
If elections are a test of political vision, this debate offered a cautious, transactional view of health – focused more on media talking points (who can forget the ‘gotcha question’ for the Prime Minister during this week’s Leaders Debate about whether he would stake his Prime Ministership on bulk billing rates) than the wide-ranging challenges to our health and healthcare.
The conversation was dominated by immediate pressures: GP costs, bulk billing, access to mental healthcare, but missed the opportunity to engage with long-term structural reform, equity gaps, climate resilience, and public health concerns such as tobacco control, alcohol harms, gambling regulation and so on.
As one observer noted afterward, what politicians choose not to talk about can be just as revealing as what they do. In this debate, the silences were loud.
The media, too, often reinforce the narrow framing of election debates, defaulting to coverage of zingers and set pieces while leaving broader health policy questions unasked.
As the Leaders Debates have also highlighted, it is past time to move away from these binary debates. A more inclusive format — one that includes the Greens and independents — would reflect the reality of Australia’s political representation, and encourage richer, more nuanced discussions about our health and future health system.
The electorate deserves a health debate that reflects the complexity of the forces shaping our health, the system and the diversity of views within it — not just a standoff between two scripted party lines.
See Croakey’s archive of articles on the federal election and health
