Healthcare & Welfare

How the nation heals the sick, cares for the vulnerable, and promotes personal responsibility-pairing compassion with agency, subsidiarity, and bodily integrity consistent with Foundational Values.

sections

Pathway mix

4 1

4 legislation · 1 agreement

Government levels

Federal ×5 State ×4 Intergovernmental ×3

Dependencies

2 requires 0 enables

evidence rows

oldest 2026-04-19

Key Takeaways

Replace universal third-party coverage with mandatory or tax-advantaged HSAs, true catastrophic insurance, and a narrow safety net for the genuinely indigent while phasing Medicare for working-age adults.
Attack long waits and rationing by liberalising scope of practice, speeding drug and device access via mutual recognition, and stripping certificate of need barriers so private capacity can expand.
Break centralised federal control over health delivery through block-grant funding, slashed admin overhead, mandated price transparency, and competitive provider models that reward outcomes over compliance.
Reduce regulatory capture and defensive medicine through faster approvals, strong medical choice and right-to-try protections, and actuarially fair incentives tied to prevention and wellness.

Current Australia

New Australia

🏥 Medicare & Universal Public Insurance

Medicare and the PBS anchor universal coverage with heavy public and regulated-private involvement, while per capita spend and NDIS costs have outpaced expectations-see AIHW health expenditure reporting for national aggregates. - as at 2026-04, confirm latest fiscal tables in Budget papers.

Medicare (Health Insurance Act 1973): Universal coverage with bulk-billing incentives shaping how care is accessed and paid for.
Private health insurance: Heavily regulated and subsidized, sitting alongside the public system rather than as a thin add-on.
Pharmaceutical Benefits Scheme (PBS) and public hospitals: Dominate how medicines and inpatient care are financed and delivered.
Spending trajectory: Per capita spending has grown faster than GDP for decades.
NDIS: Costs have exploded beyond projections, adding to total health-adjacent spending pressure-see Welfare & Social Security for NDIS reform detail.

🛡️ Health Savings Accounts (HSAs) & Catastrophic Insurance

Personal accounts and catastrophic cover replace routine third-party payment for most working-age people, with transparency, tax advantages, and a residual safety net for the indigent.

Health Savings Accounts (HSAs): Mandatory or tax-advantaged accounts for routine and predictable care.
Catastrophic insurance: Dedicated true catastrophic cover for serious illness.
Medicare transition: Phased out for working-age adults, replaced by a safety net for the genuinely indigent.
Price transparency: Mandated so patients and purchasers can compare value.
Tax treatment: Deductions for all out-of-pocket medical expenses.

Why this is better

Third-party payer systems (public and regulated private): They destroy price signals, fuelling overconsumption and cost explosion.
HSAs: Restore skin-in-the-game, encourage preventive care, and reward shopping for value.
International evidence: Singapore, Switzerland, and US HSA experiments point to dramatically lower costs with maintained or superior outcomes.

In context

Peer

Health spend % GDP: AU / OECD avg / US / Singapore ~10.5 / ~9.3 / ~17 / ~5

AU sits slightly above the OECD average. Singapore's mixed-model HSA-plus-catastrophic system achieves comparable life-expectancy outcomes at roughly half AU's share of GDP.

Source reviewed 2026-04-19
Over time

AU per-capita health spend ~A$4,900 (2004) → ~A$9,600 (2023)

Real per-capita spend has roughly doubled in 20 years. AIHW attributes the bulk to higher unit prices and administrative cost, not improved access or outcomes.

Source reviewed 2026-04-19
Precedent

Singapore's 3M system

Medisave (mandatory HSA), MediShield Life (catastrophic insurance), and Medifund (safety net). Combined with heavy provider competition and published prices, Singapore delivers top-decile outcomes on roughly half the share of GDP that AU spends.

reviewed 2026-04-19

Implementation

📜 Legislation

Levels 🏛️ Federal 🏢 State 🤝 Intergovernmental

Affects

Health Insurance Act 1973 (Cth)
National Health Act 1953 (Cth) (PBS)
Private Health Insurance Act 2007 (Cth)

Federal: Health Savings Accounts and catastrophic insurance require new primary legislation or major amendment to the Health Insurance Act 1973; phasing out Medicare for working-age adults would be a staged legislative reform with a residual safety-net floor retained for the indigent. State: state health systems and public hospital funding arrangements renegotiated to reflect the shift from universal Medicare to a market-based model with government backstop. Intergovernmental: the National Health Reform Agreement renegotiated to redirect hospital funding from activity-based to outcome-linked block grants consistent with the new insurance framework.

⏳ Long Wait Times & Rationing

Elective surgery and specialist access lag badly-especially in the regions-while tight rules on training, foreign credentials, and scope worsen shortages; COVID exposed how brittle centralised delivery is for non-COVID care.

Elective surgery waitlists (public hospitals): Often 12-18 months or more for many procedures.
Specialist access: Poor in regional areas relative to need.
Workforce and regulation: Shortages worsened by heavy regulation of medical training, foreign qualifications, and scope of practice.
COVID-era lesson: Centralised systems proved fragile; lockdowns disrupted non-COVID care as well as pandemic response.

📉 Massive Deregulation of Providers

Expand who can deliver what care, align approvals with leading overseas regulators, and remove facility-expansion gatekeeping so supply can meet demand.

Scope of practice: Liberalisation for nurse practitioners, pharmacists, and telemedicine so more qualified providers can serve patients directly.
Drugs and devices: Faster approval aligned with leading regulators via mutual recognition (e.g. FDA, EMA).
Facility and market rules: Elimination of facility licensing and health-service planning restrictions that block new capacity.
Private hospitals and clinics: Free to expand without bureaucratic approval for routine growth.

Why this is better

Barriers to entry and practice: They stifle supply and innovation in how care is organised.
Workforce paradox: Australia imports many doctors while domestic training stays bottlenecked by rules and caps.
Deregulation payoff: More supply, lower costs, and room for new models such as direct primary care and ambulatory surgery centers.
Competition: Rewards quality and efficiency instead of protecting incumbents.

Implementation

📜 Legislation

Levels 🏛️ Federal 🏢 State 🤝 Intergovernmental

Affects

Health Practitioner Regulation National Law Act 2009 (scope of practice)
Therapeutic Goods Act 1989 (Cth) (drug and device approval)
State and territory health facility licensing legislation

Scope-of-practice liberalisation requires amendment to the Health Practitioner Regulation National Law via the Health Ministers' Meeting; faster drug approvals via mutual recognition can be legislated by amending the Therapeutic Goods Act 1989; removal of facility licensing and planning restrictions requires state legislative action.

📈 Centralization & Cost Explosion

Federal funding and national bodies tighten central control as admin and compliance costs rise, with little price transparency for patients at the point of care.

Federal control: Growing leverage through funding agreements and national bodies (e.g. Australian Commission on Safety and Quality in Health Care).
Administrative burden: Overhead and compliance costs trending up across the system.
Transparency gap: Little price transparency for patients at the point of care, making informed consumer choice almost impossible.
Welfare interfaces: Disability and aged-care funding streams interact with the health system; see Welfare & Social Security for NDIS and aged-care reform detail.

🏗️ Decentralised Delivery & Price Transparency

Replace top-down federal micro-management with outcome-linked block grants to states, radically simplified reporting, mandated price transparency, and competitive provider models.

Block-grant funding: Replace prescriptive federal funding agreements with outcome-linked block grants to states, giving hospitals and health networks operational autonomy while holding them accountable for results.
Admin simplification: Slash compliance and reporting layers; consolidate overlapping federal and state quality bodies into a single lean accreditation framework.
Price transparency: Mandate that every provider publish standardised pricing for common procedures and consultations so patients and insurers can compare value before committing.
Competitive provider models: Fund follows the patient-public and private hospitals compete on equal terms for elective and outpatient work, rewarding quality and efficiency over bed counts.

Why this is better

Centralised funding concentrates decision-making far from patients and clinicians, inflating admin overhead while adding little clinical value.
Price opacity is a root cause of cost escalation; transparency restores consumer pressure and lets HSAs (Section 1) function as intended.
Outcome-linked grants align incentives: states and providers that deliver better health results keep more funding flexibility, while underperformers face accountability.

Implementation

🤝 Agreement

Levels 🏛️ Federal 🏢 State 🤝 Intergovernmental

Affects

Health Insurance Act 1973 (Cth) (funding and billing)
National Health Reform Agreement (federal-state funding)
Australian Commission on Safety and Quality in Health Care Act 2006 (Cth)

Outcome-linked block grants require renegotiation of the National Health Reform Agreement and possible amendment to the Health Insurance Act 1973; admin simplification by consolidating quality bodies requires amendment to the ACSQHC Act 2006; price transparency can be mandated by new primary legislation or regulation under existing health Acts.

🏛️ Regulatory Capture & Innovation Barriers

The TGA and rules on private insurance blunt competition and delay access versus peers; weak price signals and a defensive litigation climate inflate low-value care.

TGA: Approval processes can be slower than peer countries (e.g. US FDA).
Private insurance rules: Community rating and guaranteed issue-style constraints distort markets and limit risk-appropriate pricing.
Competition and prices: Limited use of price signals or head-to-head competition between providers at the consumer level.
Defensive medicine: Medical indemnity and the litigation environment encourage defensive practice patterns and extra services.

🔬 Innovation & Personal Responsibility

Constitutional and policy moves that protect medical choice, accelerate access to innovation, tax-favour prevention, and let fair underwriting reflect lifestyle where actuarially justified.

Medical choice: Constitutional protection for medical choice and bodily autonomy.
Right to try: A strong right to try pathway for experimental treatments outside the slowest approval tracks where appropriate.
Prevention and wellness: Tax incentives for wellness, fitness, and preventive health spending or behaviours.
Personal responsibility in pricing: Insurance pricing may reflect lifestyle choices where actuarially fair, so incentives line up with long-run health behaviour. Actuarial differentiation is limited to behaviours substantially within the individual's control (e.g. smoking, chronic voluntary substance misuse) and must not be extended to penalise genetic conditions, disabilities, or illnesses arising from circumstances of disadvantage outside the person's control-consistent with the equal-dignity commitment in Foundational Values.
Conscience protection for clinicians and institutions: The same Foundational Values commitment to non-establishment and freedom of conscience that protects citizens from being compelled into religious activity protects clinicians, nurses, pharmacists, and health institutions from being compelled to participate in services that conflict with their sincerely held religious or moral convictions (e.g. abortion, euthanasia, gender-related interventions for minors). Conscientious objectors must refer patients to providers who will perform the lawful service so that no patient is denied access; objectors may not be coerced into personal participation, and faith-based or values-aligned hospitals, practices, and aged-care providers retain the right to define the scope of services they offer in line with their mission. This is a non-establishment rule running in both directions: the state does not impose a confessional medical orthodoxy, and it does not impose a secular orthodoxy on clinicians whose conscience binds them otherwise.

Why this is better

Centralised control: Tends to suppress innovation and individual agency in treatment decisions and care models.
Patient and provider empowerment: Freedom paired with responsibility improves outcomes through competition, technology, and personal investment in health.
Incentive alignment: Shifts the system toward prevention and value instead of sheer volume of services.
Two sides of one liberty: Patient bodily autonomy and clinician/institutional conscience are two faces of the same individual sovereignty defended in Foundational Values. Compulsory participation in contested procedures is the same kind of state overreach as denial of patient access; protecting both, plus a referral duty, is what an ordered-liberty health system looks like.

Implementation

📜 Legislation

Levels 🏛️ Federal

Affects

Therapeutic Goods Act 1989 (Cth)
Private Health Insurance Act 2007 (Cth)
Commonwealth of Australia Constitution Act 1900 (medical choice and bodily autonomy)

Right-to-try pathways and faster approvals by amendment to the Therapeutic Goods Act 1989; insurance pricing reform by amendment to the Private Health Insurance Act 2007. Constitutional protection for medical choice and bodily autonomy is an optional add-on - enacted if later pursued as a chapter within the entrenched Bill of Rights (see Individual Rights › Entrenched Bill of Rights), which provides the broader rights framework that would ground medical autonomy as a constitutional guarantee rather than a statutory privilege - but the core statutory package stands on its own.

Requires Individual Rights › 📜 Entrenched Bill of Rights

🚬 World-High Tobacco Excise & the Black-Market Crisis

A pack of 25 cigarettes retails near A$50 (excise ~A$1.40/cigarette plus ongoing 5%/yr indexation since 2023, on top of the 12.5%/yr 2010-2020 stack); Treasury excise revenue has collapsed from a $16.3B 2019-20 peak to a $7.4B 2025-26 forecast as consumers shift to a fast-growing illicit market that funds organised crime and is now driving tobacconist arsons in Victoria and NSW; recreational nicotine vapes are prescription-only since 2024, ceding the cessation market to the same black market.

Excise stack: Twice-yearly AWOTE indexation; 12.5%/yr increases 2010-2020; 5%/yr further indexation since 2023; per-cigarette excise ~A$1.40 by 2025.
Revenue collapse: Treasury collected $16.3B at the 2019-20 peak; 2025-26 is forecast at $7.4B; the four-year forecast has been written down by $22.3B in MYEFO Dec 2025-the policy has rolled off the Laffer curve.
Illicit-market explosion: ATO tax-gap work estimates ~18% of all tobacco sold was illicit by 2022-23 (1,656 tonnes, $2.7B in evaded duty); industry-funded seizure trackers and Border Force data point materially higher in 2025.
Arson and organised crime: Hundreds of tobacconist firebombings in Vic and NSW since 2023 are organised-crime turf war over the illicit market; police have explicitly linked the violence to the price differential the excise stack creates.
Vapes pushed to the black market: The 2024 Therapeutic Goods (Vaping Reforms) regime forced recreational nicotine vapes prescription-only; the black market simply absorbed the demand, and pharmacy access has been minimal in practice.
Smoking decline not faster than peers: AU adult daily smoking is ~10% and falling, but the rate of decline is not faster than NZ, UK, or Sweden-each of which have lower excise and legal regulated nicotine harm-reduction (vapes, snus). The marginal harm-reduction per dollar of further excise has clearly fallen.
Regressivity unaddressed: Smoking concentrates in lower-income deciles; the excise stack functions as a near-flat tax on the addicted poor, and is now also funding the gangs whose street-level operations target the same suburbs.

🚭 Cap Excise, Restore Harm Reduction

Cap and progressively roll back tobacco excise to the harm-reduction-effective level under a published annual IFO review; legalise pharmacy-grade adult nicotine vapes and snus with labelling, age-gating, and a ban on flavour marketing aimed at minors; treat illicit trade as serious-and-organised crime, not as a customs failure; and keep truthful labelling, ad bans, and no-sale-to-minors rules in place.

Cap and roll back excise: Freeze further indexation immediately; the IFO publishes an annual harm/Laffer review against published outcome metrics (smoking prevalence, illicit-market share, NZ/UK/Sweden comparators), and recommends the rate to Parliament; the rate is capped at the level beyond which marginal harm-reduction is dominated by black-market substitution. Revenue need is not a defence-this is the public-reason test from Foundational Values applied honestly.
Legal regulated adult vapes and snus: Pharmacy-grade adult nicotine vaping products and Swedish-style snus are sold under a regulated retail framework: age-gating (21+), plain packaging, no flavour marketing aimed at minors, advertising rules consistent with tobacco. Treats vaping as the cessation tool the international evidence shows it is, not as contraband.
Illicit trade as organised crime: The Border Force / AFP / state-police effort against illicit tobacco is reframed as a serious-and-organised-crime taskforce, with proceeds-of-crime, freezing orders, and sentencing aligned with the Justice & Law Enforcement framework. The arson wave is treated as the organised-crime violence it is, not as a tax-collection problem.
Truthful labelling and ad bans stay: Plain packaging, graphic health warnings, advertising bans, and the no-sale-to-minors rule are all continued-the public-reason case for them is unambiguous.
Excise to consolidated revenue, not earmarked: The remaining excise flows to consolidated revenue rather than being earmarked to a "tobacco-funded" health program-the IFO review is the discipline, not a circular cross-subsidy.
Coordinate with state licensing: State tobacco-retailer licensing regimes are tightened in parallel-licensed retailers face genuine compliance audits, repeat illicit-stock breaches end licences, and unlicensed sale carries serious-and-organised-crime exposure where evidence supports it.

Why this is better

The policy has rolled off the Laffer curve: A revenue line that has fallen from $16.3B to a $7.4B forecast in five years, while the illicit-market share approached or passed a quarter of consumption and tobacconists are being firebombed, is not a working public-health instrument-it is a working organised-crime subsidy.
Public reason about harm: NZ, UK, and Sweden all reduce smoking faster or comparably while permitting legal regulated nicotine vapes / snus and applying lower excise. The international evidence on harm-reduction substitution is unambiguous; refusing it is not a defensible public-reason position once the data is on the table.
Equal dignity, not flat-tax-the-poor: Smoking concentrates in the lowest-income deciles; the current excise stack is regressive and falls hardest on the people least able to absorb it. The Foundational Values equal-dignity test asks whether a policy treats persons as ends or as fiscal means; an excise that addicts the poor to a price they cannot afford and then pushes them to gang-supplied product fails that test.
Treat the violence as crime, not as policy: Tobacconist arsons are violent organised crime, not "an enforcement gap." Resourcing them as such-and reducing the price differential that creates the black-market premium-is the only response consistent with the rule-of-law commitments elsewhere in this manifesto.
Bodily autonomy, bounded not abandoned: Adults are entitled to make adult choices about legal products under a public-reason regime; the state may discourage harmful choices by truthful information, age limits, and proportionate excise, but cannot organise its fiscal base on continuing the addiction it claims to be discouraging.

In context

Peer

Adult daily smoking vs excise: AU / NZ / UK / Sweden ~10% / ~6.8% / ~12% / ~5%

Sweden has the lowest smoking rate in the EU on much lower excise plus legal snus; NZ has lower excise plus legal vapes and a faster decline since 2018; UK has lower excise plus the world's most permissive regulated vape regime. AU's much higher excise has not produced a faster decline than these peers, and its prescription-only vape regime has handed the cessation market to the black market.

Source reviewed 2026-04-26
Over time

Tobacco excise revenue: 2019-20 → 2025-26 ~A$16.3B → ~A$7.4B

Treasury's MYEFO Dec 2025 wrote the four-year tobacco-excise forecast down by $22.3B versus the 2023 budget projection. The policy has now rolled off the Laffer curve: excise is increasing the illicit market faster than it is reducing smoking, and Treasury has revised forecasts down at every successive update.

Source reviewed 2026-04-26
Reframe

Excise per pack of 25 ~A$35 / pack of 25

At ~A$1.40/cigarette excise, a pack of 25 carries roughly A$35 in excise alone-a flat tax that falls disproportionately on the lowest-income deciles, where smoking is concentrated. The same product on the illicit market sells in the A$15-25 range; the price gap is the organised-crime margin and the engine of the arson wave.

reviewed 2026-04-26
If nothing changes

If 2010-2020 excise stack had stopped at the harm-reduction-effective rate

Australia's smoking-rate decline through the 2010s tracked NZ and the UK closely; the marginal contribution of further excise increases past ~$0.50/cigarette is hard to identify in the cross-country data, while the illicit-market share is unambiguously price-driven. A policy that had capped excise around the late-2010s level and admitted regulated vapes alongside it would plausibly sit at a similar smoking-rate today, with materially lower illicit-market share and no street-level arson wave.

reviewed 2026-04-26

Implementation

📜 Legislation

Levels 🏛️ Federal 🏢 State

Affects

Excise Tariff Act 1921 (Cth)
Customs Act 1901 (Cth)
Therapeutic Goods Act 1989 (Cth)
Tobacco Plain Packaging Act 2011 (Cth)
Public Health (Tobacco and Other Products) Act 2023 (Cth)
Charter of Budget Honesty Act 1998 (Cth) (IFO harm-reduction review)
State tobacco licensing Acts (e.g. Tobacco Act 1987 (Vic); Public Health (Tobacco) Act 2008 (NSW))

Federal: cap and roll back excise by amendment to the Excise Tariff Act 1921, with the IFO harm-reduction review function added by amendment to the Charter of Budget Honesty Act 1998; legalise pharmacy-grade adult nicotine vapes and snus by amendment to the Therapeutic Goods Act 1989 and the Public Health (Tobacco and Other Products) Act 2023; reframe enforcement as serious-and-organised-crime through Border Force / AFP funding allocations and the framework in Justice & Law Enforcement. State: tighten retailer-licensing compliance by amendment to existing state tobacco-licensing Acts; align unlicensed-sale offences with the federal organised-crime framework. The constitutional anchor is the public-reason test in Foundational Values' anti-immiseration revenue rule; the instrument changes here are legislative.

Requires Foundational Values › 📊 Public Reason in Sin Taxes & Vice Markets

Sources

Health Insurance Act 1973 (Cth) - Federal Register search · accessed 2026-04-12
AIHW - Australia's health / health expenditure · accessed 2026-04-12
Department of Health and Aged Care - Medicare overview · accessed 2026-04-12