Medicare’s founding promise is failing millions as jurisdictional division leaves patients stuck on waiting lists and priced out of specialist care. A shared federal–state hospital system is the missing reform.

With the introduction of Medibank in July 1975, the Whitlam Government made a core and solemn promise to all Australians: no-one would be denied essential, timely medical care due to the cost involved. As the data now show, for millions of people, that promise is dying, if not already dead.

On 13 November 13, ABC journalist Stephanie Dalzell reported on the unconscionable waiting times for specialist consultation at public hospital outpatient clinics. Nothing had improved since her 2023 analysis of the same data and none of the causes addressed. The mother of a deaf toddler being told that an appointment at a paediatric ENT clinic would be three critical years away exemplified millions of human stories of unrelieved suffering and avoidable death by people unable to afford the high and rising out-of-pocket costs of private specialist referral. All too often, specialist care delayed is care denied.

Inequity of access to specialist consultation is part of a trifecta of critical dysfunction along with Emergency Department (ED) exit block with ambulance ‘ramping’ and waiting times for elective surgery.

At the heart of these large and growing holes in the Medicare safety net is a jurisdictional divide, with the states taking responsibility for in-hospital patients whilst the commonwealth funds all out-of-hospital care. It is a divide that ensures a system that is no longer fit for purpose, not least because it encourages cost and blame shifting.

The........

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