'The best friend Medicare ever had'? Policy narratives and changes in Coalition health policy.

ABSTRACT

As Leader of the Opposition in 1987, the current Prime Minister of Australia John Howard, stated unequivocally that he would dismantle Medicare at his first opportunity. By April 2000, the Health Minister in a Howard-led government proudly proclaimed to the Australian Parliament the Coalition was 'the best friend Medicare ever had'. Such a shift in ideology and policy position appears remarkable, overturning more than 60 years of conservative opposition to a universal, publicly funded, health care system. This paper traces the shift from the lead-up to the 1996 election until 2000, interrogating official policy texts to map how the Coalition reconfigured its own policy narrative about the Australian health care system. This paper argues that in order to understand contemporary reforms to the health care system, we must consider the way in which those reforms provide solutions to discursively, rather than objectively constructed, policy problems.

KEY WORDS

health policy; Medicare; private health insurance; social policy; sociology

Introduction

Throughout his tenure as Australian Leader of the Opposition in the 1980s, John Howard was unequivocal about his dislike for Medicare and firm in his commitment to dismantle it. His view resonated with the strong position historically held by the Liberal Party and its commitment to a voluntary insurance system. In the 1996 election campaign Howard, this time as leader and Prime-ministerial aspirant, announced a change of mind: the universal publicly funded health care system Medicare would be retained by a Coalition government. The Coalition has essentially kept its promise. Medicare and bulk billing still exist, and there has been no explicit limit on access to Medicare services. (1) However, between 1996 and 2000 substantial reforms, designed to promote private health insurance membership, were introduced. These reforms were justified to the electorate through a new policy narrative which broke with the traditional political division over health financing. Beginning from the position that in order to understand contemporary reforms to the health care system we must consider the way in which those reforms provide solutions to discursively, rather than objectively, constructed policy problems, this paper traces the shift, interrogating official policy texts produced between the 1996 election campaign and 2000, in order to map the Coalition's reconfiguration of their own policy narrative about the Australian health care system.

Drawing on the work of Schon (1979), Bacchi 1999) and Bessant (2002a, 2002b) this article focuses on the official rhetoric employed by the Howard government in reforming health policy. In the process, it maps the construction of narratives justifying and presenting particular policy developments. With regard to the politically charged policy arena of Medicare, such an approach draws attention to the underlying and often unspoken goals of such reform. Often policy analysis explores the technical changes--and their potential ramifications--in policy delivery, or the philosophical shifts driving policy change. These two levels of analysis are of central importance to the understanding of social policy. However, understanding the implementation of policy change, particularly in a politically charged area, also requires examination of the way in which such changes are publicly represented through policy texts. It is through such representations that policy actors articulate, and through such articulation create, the need for change. This article concentrates on exploring the creation of a new policy narrative about the organisation and operation of the Australian health care system. In particular, it examines the way in which this new narrative has promoted the view that the Australian health care system was in disrepair and required significant modification in order to be transformed into a successful health care system.