WeRise · Policy platform
Universal Healthcare
Key findings
- $38.9 billionAustralians paid $38.9 billion directly out of pocket for health goods and services in 2022–23, on top of taxes, Medicare levies and insurance premiums. Source: Australian Institute of Health and Welfare · Health Expenditure Australia 2022–23 · 2024
- 1 in 616.1% of Australians who needed dental care in 2024–25 delayed or did not use it because of cost. Source: Australian Bureau of Statistics · Patient Experiences, 2024–25 · 2025
- 7.7%Nearly 1 in 13 people who needed a GP in 2024–25 delayed or went without care because it cost too much. Source: Australian Bureau of Statistics · Patient Experiences, 2024–25 · 2025
- $252.5 billionAustralia already spent $252.5 billion on health in 2022–23 – 9.9% of GDP – yet essential care still depends too often on a person’s capacity to pay. Source: Australian Institute of Health and Welfare · Health Expenditure Australia 2022–23 · 2024
Part 01
The Case for Change
Why Universal Healthcare matters
Medicare Must Mean Care
Australia’s health system covers people on paper, but too often charges them at the point they need help.
Australia does not need to invent universal healthcare from scratch. It needs to finish the work Medicare began. The country already pools risk through taxation, the Medicare levy, public hospitals, the Pharmaceutical Benefits Scheme and state health services. Yet a person who is sick can still be asked to make an impossible calculation: pay a gap fee, defer a prescription, wait months for a specialist, travel hundreds of kilometres, or go without dental treatment entirely.
In 2022–23, Australia spent $252.5 billion on health goods and services – equivalent to $9,597 per person and 9.9% of GDP.1 Governments funded approximately 70.8% of that total, but individuals still paid $38.9 billion out of pocket.1 This is the essential contradiction: Australia spends at the scale of a developed universal health system while leaving a large and uneven share of costs to households.
Cost barriers are not abstract. In 2024–25, 7.7% of people who needed a GP delayed or did not see one because of cost. The same survey found that 8.6% delayed or did not see a medical specialist because of cost, 7.5% delayed or did not obtain prescribed medication because of cost, and 16.1% delayed or did not use dental care because of cost.2 These figures measure people who have already identified that they need care. They do not capture those who never seek help, cannot obtain an appointment, lack transport, do not trust the system, or do not know which service to approach.
The cost of inaction is also carried by hospitals, employers, families and carers. Hospital care absorbed $107.1 billion in 2022–23 – 42% of total national health expenditure.3 Not all hospital spending is preventable, and no responsible policy should pretend otherwise. But when general practice, mental healthcare, dental treatment and medicines are inaccessible, avoidable deterioration becomes more likely and public hospitals become the system’s default safety net.
Australia has already shown that public policy can improve access. The Commonwealth’s $7.9 billion investment in expanded bulk-billing incentives is intended to make bulk billing available to every Medicare-eligible person and support practices that bulk bill all GP non-referred attendance services.4 This should be treated as a foundation, not the finish line. A modern universal system must guarantee free primary care at point of use, transparent and capped specialist gaps, affordable medicines, public dental coverage, sustained mental health support and allied health access linked to clinical need.
The alternative is not a cheaper system. It is a system that bills people later: through emergency departments, avoidable illness, lost earnings, debt, pain and disability. Healthcare is a public good and a condition of equal citizenship. Medicare should work when a person is healthy enough to seek prevention, sick enough to need treatment, and poor enough that a bill would otherwise decide the outcome.
Part 02
Evidence and Experience
Universal Healthcare: what other countries show
Universal Care Is Designed, Not Declared
Taiwan · Germany · France · England’s National Health Service
International systems show that universal coverage is not one model. Taiwan uses compulsory single-payer national health insurance; Germany and France use social health insurance funded by payroll-linked contributions and public subsidies; England’s NHS is tax-funded and provides most care free at the point of use. Their differences matter. No country offers a perfect template, and each confronts workforce shortages, waiting times, pharmaceutical costs and ageing populations.
But together they demonstrate that governments can pool health risk more comprehensively than Australia does, set clearer public entitlements, regulate provider payment, and reduce reliance on direct household payment. The relevant lesson for Australia is not institutional imitation. It is that universal care requires a defined benefit package, durable pooled financing, cost protection and active workforce planning – not simply nominal insurance coverage.
Taiwan · National Health Insurance introduced 1995; current annual reporting 2024–25
Compulsory single-payer National Health Insurance, financed through premiums, public funding and co-payments, with the National Health Insurance Administration acting as purchaser and regulator. Near-universal population coverage through a single national insurance program.
- National Health Insurance has operated as Taiwan’s national universal insurance program since 1995.
- The National Health Insurance Administration publishes a dedicated 2024–25 annual report.
- The system centralises purchasing and claims administration in one national insurer rather than relying on multiple competing health funds.
- Taiwan’s national statistical yearbook reports dedicated National Health Insurance revenue and expenditure accounts in New Taiwan dollars.
Taiwan demonstrates the value of a single national purchaser with strong capacity to set prices, manage claims, monitor utilisation and negotiate with providers. Australia need not abolish federalism or nationalise every provider to learn from this model; it can expand Medicare’s purchasing role and simplify patient entitlements.
Germany · Mandatory health insurance since January 2009; 2024 financing settings
Statutory health insurance contribution rate of 14.6% of gross income plus an average 1.7% supplementary contribution in 2024, split equally between employers and employees. Approximately 89% of the population covered by statutory health insurance and approximately 11% by substitutive private health insurance.
- Health insurance has been mandatory in Germany since January 2009.
- Statutory health insurance covered around 89% of the population, with about 11% using substitutive private insurance.
- The fixed statutory contribution rate was 14.6% of gross income in 2024.
- The average supplementary contribution was 1.7% in 2024.
- Employer and employee each pay half of the standard and supplementary contributions.
Germany shows that a universal system can retain independent, mostly non-government providers while financing care through broad compulsory risk pooling. Its main caution is equally important: multiple funds and parallel private coverage can increase administrative complexity and preserve inequities if benefit design and payment regulation are weak.
France · Universal statutory health insurance framework; 2024 expenditure data
Statutory health insurance provides universal coverage for people residing or working in France for at least three months; supplementary insurance and public assistance reduce remaining co-payments. Universal coverage for qualifying residents and workers.
- France’s statutory health insurance covers all people residing or working in France for at least three months.
- In 2020, statutory health insurance funded about 80% of health consumption expenditure.
- Household out-of-pocket expenditure was €20.0 billion in 2024, or 7.8% of consumption of healthcare and medical goods.
- Per-capita household out-of-pocket expenditure was €292 in 2024.
- Current health expenditure in the international accounting framework reached €333 billion, or 11.4% of GDP, in 2024.
France demonstrates that universal insurance can coexist with private and non-profit providers while maintaining a much stronger public financing role. It also warns Australia not to mistake universal formal coverage for full financial protection: supplementary coverage and residual charges can still create complexity and inequity.
England, United Kingdom · National Health Service, current 2024–25 settings
Tax-funded National Health Service providing most medical and hospital care free at the point of use; specified prescription and dental charges apply in England with broad exemptions. National tax-funded system serving England’s resident population.
- In 2024–25, the NHS prescription charge in England was £9.90 per item for people not exempt from charges.
- Around 95% of prescription items were dispensed without charge because patients were exempt or held a pre-payment certificate.
- A three-month prescription pre-payment certificate cost £32.05 in 2024–25.
- An annual prescription pre-payment certificate cost £114.50 in 2024–25.
- Standard NHS dental charges in 2024–25 were £26.80, £73.50 and £319.10 across three treatment bands.
England illustrates the clarity and equity advantages of tax-funded care free at point of use, while also showing that exclusions and user charges remain politically consequential. Australia should learn from both sides: design a broad national entitlement, but avoid leaving dental and medicine costs as enduring fault lines.
Part 03
Costs and Trade-offs
The cost of Universal Healthcare
The Cost Is Already Being Paid
The choice is not between spending and not spending – it is between fair public financing and fragmented household bills.
Universal Healthcare has a real fiscal cost. Extending public coverage to primary care, dental care, mental health, allied health and specialist gaps would require substantial new Commonwealth and state expenditure, workforce investment, provider-payment reform and transition funding. It would be misleading to claim a precise net cost before a defined benefits package, eligibility rules, workforce plan, tax design and staged timetable are modelled by Treasury, the Parliamentary Budget Office and independent health economists.
But the starting point matters. Australia already spent $252.5 billion on health in 2022–23, including $38.9 billion in direct household out-of-pocket expenditure. The policy question is therefore partly distributive: how much essential healthcare should be paid collectively according to capacity to contribute, rather than individually at the moment of illness? A transfer of essential costs from households to public funding raises the budget line but can reduce financial hardship and improve access; it is not automatically a net new resource cost.
There are also credible offsets, but they must be treated cautiously. The Productivity Commission estimated that priority mental-health reforms could cost up to $2.4 billion annually, generate up to $1.2 billion in annual savings and produce up to $18 billion annually in improved health and quality-of-life value. These estimates apply to a specific reform package, not to Universal Healthcare as a whole. They demonstrate why costings must distinguish gross program cost, household savings, avoided downstream expenditure and wider economic benefits. A full WeRise costing should be commissioned before policy launch.
| Item | Amount | Note |
|---|---|---|
| Current national health expenditure, 2022–23 | -$252.5 billion | Existing annual health spending across public and non-government sources; not the cost of the proposed policy. |
| Current household out-of-pocket health spending, 2022–23 | +$38.9 billion | Potential pool of household expenditure partly displaced by stronger public coverage; not all is essential or transferable. |
| Commonwealth bulk-billing expansion, 2025–26 to 2028–29 | -$7.9 billion | Existing committed investment in expanded bulk-billing incentives and fully bulk-billing practice support; a foundation for, not the complete cost of, universal primary care. |
| Additional Commonwealth public-hospital funding, 2026–27 to 2030–31 | -$25 billion | Existing National Cabinet funding commitment; relevant baseline rather than a Universal Healthcare cost. |
| Productivity Commission priority mental-health reform savings | up to $1.2 billion per year | Modelled savings from the Commission’s identified priority mental-health reforms; not a universal-healthcare saving estimate. |
| Productivity Commission priority mental-health reform quality-of-life gain | up to $18 billion per year | Modelled annual value of improved health and quality of life; not a cash budget saving. |
| National preventive-health investment target by 2030 | 5% of total health expenditure | Existing national strategy target; a directional benchmark rather than a funded cost estimate. |
| Net cost estimate | Not yet responsibly estimable | Requires a specified benefits package, workforce plan, delivery timetable, revenue design and independent dynamic costing. |
The strongest objections to Universal Healthcare
The strongest objection is fiscal: comprehensive universal coverage could be expensive, and public funding may displace private spending without reducing total healthcare use.
This is a serious concern. Extending dental, mental health, allied health, specialist and primary-care coverage would require large recurrent expenditure and may increase demand when unmet needs are revealed. The evidence-based response is not to promise that reform pays for itself. It is to define benefits carefully, phase implementation, commission transparent costing, identify fair revenue sources and distinguish genuine resource costs from a transfer of costs currently borne by sick households. Australia’s existing $252.5 billion annual health expenditure indicates fiscal scale, not fiscal ease.1
A second objection is capacity.
If care becomes cheaper, more people will seek it; workforce shortages may lengthen queues, particularly in general practice, dentistry, mental health and regional services. This risk is real. A universal entitlement without workforce planning can become a nominal entitlement. Reform must therefore fund training places, supervision, rural incentives, Aboriginal Community Controlled Health Organisations, multidisciplinary teams, digital infrastructure and capital investment alongside patient subsidies. Sequencing is crucial: expand supply and priority access while progressively widening the benefit package.
A third objection is that bulk billing or price caps could undermine provider viability and autonomy.
General practices and clinicians face rent, wages, insurance, technology and administrative costs. If governments set rebates too low or impose excessive compliance requirements, providers may reduce services, raise fees elsewhere or leave underserved areas. The response is blended payment reform rather than blunt price control: transparent base payments, rural and complexity loadings, practice infrastructure funding, quality safeguards and negotiated fee schedules. Providers should be partners in a universal public system, not merely contractors expected to absorb policy risk.
A fourth objection is that public systems can produce waiting lists and rationing.
This is true: every system rations healthcare somehow, including through budgets, workforce limits, clinical triage, queues and private fees. Australia already rations care through waiting times and ability to pay. The question is not whether rationing exists; it is whether it is explicit, clinically governed and equitable. Universal Healthcare should publish waiting-time standards, invest in capacity, use clinical urgency rather than wealth, and allow regulated supplementary private options only where they do not erode public workforce capacity or create preferential access to publicly funded services.
A fifth objection is institutional complexity.
Federal-state financing, private provider contracting and existing insurance arrangements make reform difficult. This is correct. Universal Healthcare should therefore be structured as a decade-long National Health Compact, governed through National Cabinet, legislated access standards, independent performance reporting and staged benefit expansion. The policy should not overclaim international evidence: Taiwan, Germany, France and England each face their own access, cost and workforce problems. Their lesson is not perfection; it is that clearer public guarantees and stronger pooled financing are feasible when backed by durable institutions.
Part 04
The Australian Design
How Universal Healthcare would work in Australia
Complete Medicare in Stages
A national guarantee of essential care, delivered locally through public, community-controlled and private providers.
Universal Healthcare should be implemented as a staged expansion of Medicare, not as a disruptive overnight replacement of every existing institution. The objective is straightforward: establish a practical national entitlement to clinically necessary care without financial hardship, while retaining a mixed provider system and respecting state responsibilities for public hospitals and community services.
Stage One: universal free primary care. The Commonwealth should convert the current bulk-billing expansion into a binding national guarantee: no out-of-pocket fee for standard GP consultations, nurse-led primary care and essential care coordination for Medicare-eligible patients. The existing $7.9 billion four-year bulk-billing package provides an operational starting point, including incentives for practices that bulk bill all GP non-referred attendances.4 Funding should move progressively from fee-for-service alone toward blended payments: a base payment for enrolled patients, loading for rurality and disadvantage, and outcome payments for continuity, prevention and chronic-disease management.
Stage Two: affordable pathways beyond the GP. Medicare should establish transparent maximum patient contributions for specialist consultations and clinically necessary diagnostics, alongside a strengthened safety net that operates automatically rather than requiring patients to accumulate bills. PBS co-payments should remain low and be further protected for people with chronic conditions, low incomes and high medicine use. The 2024–25 evidence that 7.5% of people delayed or did not get prescribed medication because of cost supports treating affordability as a core access standard, not a residual welfare issue.2
Stage Three: universal public dental care. Australia should build a national dental scheme through public clinics, Aboriginal Community Controlled Health Organisations, contracted private dentists and mobile rural services. It should begin with children, concession-card holders, First Nations communities, people with disability, older people and those on public waiting lists, then expand toward universal adult coverage. The case is strong: 16.1% of people delayed or did not use dental care because of cost in 2024–25.2
Stage Four: integrated mental health, allied health and prevention. Medicare-funded mental health and allied health must be linked to locally commissioned multidisciplinary services, not restricted to a small number of subsidised visits with open-ended gap fees. This requires Commonwealth-state regional planning, with Primary Health Networks, state health services and Aboriginal Community Controlled Health Organisations jointly responsible for local access.
The Commonwealth should fund national entitlements and Medicare payment reform; states and territories should remain central to public hospitals, public dental delivery, community mental health and workforce infrastructure. National Cabinet should agree measurable access standards, shared data and multi-year funding. The Commonwealth’s commitment of $219.6 billion for public hospitals from 2026–27 to 2030–31 creates a significant platform, but hospital agreements should include stronger links to community care and prevention.6 A realistic rollout is five to ten years, with annual public reporting on bulk billing, waiting times, gap fees, service use and inequities by income, location, disability, age and First Nations status.
Part 05
People and Transition
Who Universal Healthcare affects
Who Pays When Care Is Not Universal?
The gaps fall hardest on people with the least room in their household budgets and the greatest need for ongoing care.
The absence of fully universal healthcare harms anyone who needs care at the wrong time financially, but the burden is not evenly shared. People with low incomes, chronic illness, disability, insecure work, caring responsibilities, rural and remote residence, and limited access to transport face compounding barriers. So do people whose health needs sit outside Medicare’s strongest protections: dental patients, people needing regular psychology or allied health care, people requiring specialist assessment, and people managing multiple medicines.
In 2024–25, 7.7% of people who needed a GP delayed or did not see one because of cost. The proportion was 8.6% for medical specialists, 7.5% for prescription medicines and 16.1% for dental professionals.2 These figures identify direct affordability barriers. They do not include people who used a service but incurred debt, sacrificed other essentials, relied on charity, or accepted long waits because private care was unaffordable.
Case study
A single parent in Logan develops persistent pelvic pain. Her local GP is affordable only when she can secure a bulk-billed appointment; the available specialist charges a gap that competes with rent, food and school costs. She postpones the referral and uses over-the-counter pain relief. Universal Healthcare would not guarantee an instant specialist appointment, but it would guarantee a free primary-care assessment, transparent and capped specialist costs, and a publicly funded pathway based on clinical urgency rather than her credit limit.
Case study
A retired worker in regional Queensland has diabetes, deteriorating teeth and anxiety after bereavement. His public dental wait is long, the nearest private dentist requires an upfront payment, and transport into town is difficult. He skips appointments until pain becomes acute. A universal model would combine local primary care, subsidised medicines, public dental access and coordinated transport or outreach services, reducing the chance that preventable problems escalate.
Young adults also require particular attention. Analysis using Australian patient-experience data found women aged 25–34 reported especially high cost barriers: 11.3% delayed or did not see a GP due to cost and 20.3% delayed or did not see a specialist due to cost.7 While this evidence is from 2022–23 and should be refreshed against new ABS microdata, it illustrates why universal policy cannot rely solely on concession-card targeting. People may be employed, uninsured, renting and above income-support thresholds while still unable to absorb repeated health bills.
Those most likely to oppose reform include some insurers concerned about reduced market scope, providers concerned about rebate adequacy and administrative control, and fiscal conservatives concerned about public expenditure and taxation. Their concerns deserve serious engagement. The response is not to deny costs, but to negotiate fair provider payment, preserve clinical independence, phase reform responsibly and make public spending accountable for access and outcomes.
Part 06
Related policies
Universal Healthcare sits within a wider set of WeRise policies.
- Foundations of Dignity: more WeRise policies in this pillar
- WeRise: all 29 policies across seven pillars
Notes
Sources and Supporting Documents
- Australian Institute of Health and Welfare. Health Expenditure Australia 2022–23. AIHW. 2024. www.aihw.gov.au
- Australian Bureau of Statistics. Patient Experiences, 2024–25 Financial Year. ABS. 2025. www.abs.gov.au
- Australian Institute of Health and Welfare. Hospitals at a Glance. AIHW. 2024. www.aihw.gov.au
- Australian Government Department of Health, Disability and Ageing. Budget 2025–26: Strengthening Medicare – More Bulk Billing. Australian Government. 2025. www.health.gov.au
- Productivity Commission. Mental Health, Inquiry Report. Australian Government. 2020. www.pc.gov.au
- Australian Government. Record Funding for Public Hospitals and Disability Reform. Prime Minister of Australia. 2026. www.pm.gov.au
- Australian Government Department of Health. National Preventive Health Strategy 2021–2030. Australian Government. 2021. www.health.gov.au
- Australian Institute of Health and Welfare. Oral Health and Dental Care in Australia: Costs Datatables. AIHW. 2024. www.aihw.gov.au
- National Health Funding Body. National Health Reform Agreement. Australian Government. 2026. www.publichospitalfunding.gov.au
- National Health Insurance Administration, Ministry of Health and Welfare. National Health Insurance Annual Report 2024–2025. Government of Taiwan. 2025. www.nhi.gov.tw
- DREES. Health Expenditure in France: Overview. Government of France. 2025. drees.solidarites-sante.gouv.fr
- NHS England. NHS England Annual Report and Accounts 2024 to 2025. Government of the United Kingdom. 2025. assets.publishing.service.gov.uk
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