Introduction by Croakey: As Australia faces the prospect of a Dutton Government, it is important for the health sector and the media to hold the Coalition to account on its health policies, as well as the wider policies affecting health.
What can we learn from history?
Charles Maskell-Knight, who was a senior public servant in the Commonwealth Department of Health for over 25 years, has some advice for the Opposition Leader and colleagues if the Coalition wants to head off a Mediscare campaign.
Charles Maskell-Knight writes:
For the last two and a half years the Federal Opposition under Peter Dutton’s leadership has avoided virtually any concrete policy commitments in the health area.
What happened when the Coalition won Government in 2013, when Dutton became Health Minister?
When the Liberal National Party under Tony Abbott won government at the 2013 election, Dutton had been shadow health minister for over five years. He had not been an active shadow minister – months would go by without a media release, far less a policy statement.
The health policies the Coalition took to the 2013 election were largely promises to undo Labor decisions or maintain the status quo.
It undertook to reverse means testing for the private health insurance rebate and restore the chronic disease dental scheme as soon as it “responsibly” could. It also undertook to maintain the activity-based funding system for public hospitals set out in the National Health Reform Agreement.
On a positive note, it promised to ensure that the listings of medicines recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) was not deferred for budgetary reasons, boost funding for dementia research, extend the bowel cancer screening program, expand the headspace youth mental health program, and increase funding for general practices providing training places.
And just before the election, Tony Abbott promised “no cuts to health” in an interview with SBS.
An unforgettable budget
The reality included in the 2014 Budget was very different.
Budget Paper 4 showed total savings from the health portfolio over four years amounted to a little over $6 billion, after netting off the cost of a small number of new spending items. Savings in the Treasury portfolio in health-related payments to the states amounted to almost $2.4 billion over four years.
The biggest single savings item was the proposal for mandatory co-payments for GP, pathology and diagnostic imaging services under Medicare, estimated to save $1.2 billion in a full year.
The Government also proposed to allow the states to charge for hospital emergency department services, to ensure patients did not attempt to avoid the copayment by attending a hospital rather than a GP.
Far from accepting activity-based funding for public hospitals, the Government decided to revert to block funding with indexation based on population growth and inflation, saving a whopping $55 billion over a decade.
Rather than abolishing means testing for the private health insurance premium rebate, the Government decided to freeze the income thresholds, saving about $1 billion over four years.
While medicines were listed on the PBS after a PBAC recommendation, the Government proposed to increase PBS copayments and safety net thresholds, saving $300 million in the first full year.
The Government abolished the Australian National Preventive Health Agency, saving $100 million, and terminated payments to the states for preventive health, saving another $370 million.
It abolished Health Workforce Australia and General Practice Education and Training Ltd and moved their functions to the Department of Health, saving $280 million along the way. (While GP training has survived, a decade later health workforce planning and reporting is virtually non-existent.)
Despite Prime Minister Abbott’s self-appointment as Minister for Indigenous Affairs, $125 million was saved from Indigenous health programs as part of a “rationalisation” of Indigenous programs.
It is little wonder that Dutton was voted the worst health minister in 35 years by 46 percent of respondents to a poll carried out by Australian Doctor.
Expecting an encore?
The current Liberal Party website page on health has a section devoted to Dutton’s record as health minister, setting out achievements including increasing hospital funding by 16 percent; increasing overall health funding by 5.5 percent; and establishing Australia’s $20 billion Medical Research Future Fund.
This encomium ignores the fact that hospital funding increased due to the agreement reached by Prime Minister Gillard in 2011 – an agreement which Abbott and Dutton proposed to tear up.
Total health spending increased despite the Minister, not because of the Minister; after adjusting for inflation and population growth, real per person spending increased by only about 0.7 percent, barely enough to cover population ageing.
And the MRFF was established using the savings from slashing other health programs – after Abbott had promised not to cut them.
In recent days Mark Butler has been reminding people of Dutton’s record as health minister.
In response shadow health minister Anne Ruston told Sky News that has the Government “are actually flat out lying about the record of the Coalition Government because they’re trying to cover up for the fact that they have absolutely failed in the two and a half years that they’ve been in government”.
I think the lady protests too much.
If the Coalition want to head off a Mediscare campaign, Dutton needs to acknowledge the Coalition attacks on the health system from a decade ago and make it clear that they will not be repeated.
He should give an explicit commitment to maintaining public hospital funding, Medicare bulk billing, and PBS copayment arrangements, as well as continuing to fund the myriad other programs that keep the health system working.
Unless this happens, Labor is perfectly justified in pointing to the 2014 Budget and suggesting an encore performance is coming if the Coalition wins government.
• This article was first published by Pearls & Irritations, and has been edited for Croakey style.
Author details
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20.
He is a member of Croakey Health Media and author of The Zap column. Follow on X/Twitter at @CharlesAndrewMK, and on Bluesky at: @charlesmk.bsky.social.
Follow Croakey’s coverage of the 2025 election and health
