Healthcare is one of the strategic issues that is paid attention to by the state and government. Moreover, after the world was hit by Covid-19 pandemic around 2019–2022. This issue is massively positioned as a priority for any kind of policy maker, whether they are working as state actors or non-state actors. However, long before this humanitarian disaster occurred, health issues have always been a vital agenda, starting from the local or subnational, national, and even international levels.
The reason behind the importance of health issues also touch on how health acts as a pivot for the sustainability of other sectors. If a country does not have a good healthcare system, it is very likely that the people, who should be the human resources, labour, or workforce, will not be able to carry out productive activities (Rastegar, 2004). People will face difficulty fulfilling their daily living needs. As a result, various development plans in the socio-economic sector have been disrupted. This is more or less an illustration of the urgency of why health requires special attention for every country, including Australia.
Australia itself is known as one of the greatest countries in handling healthcare systems among others. Regarding the Commonwealth Fund Mirror Report that is written by Eric C. Schneider, Arnac Shah, Michelle M. Doty, Roosa Tikkanen, Katherine Fields, and Reginald D. Williams II (2021) and OECD Health Data (2022), Australia placed as the first healthcare system performance ranking. If to be compared within overall countries, Australia holds third position behind Norway and Netherland (Liotta, 2021). Those accomplishments resulted from Australia’s healthcare that operates under a shared public-private model underpinned by the Medicare system, the national single-payer funding model (Dixit & Sambasivan, 2018). Other than that, the government also takes the healthcare sector seriously which is depicted from its government expenditure. Referring to the Australian Government document titled Budget Strategy and Outlook, health is ranked as the third biggest budgeting in 2023-2024 after social security and welfare plus all other expenses.
Nevertheless, health is not just what it is. Same like others, healthcare issues must be analysed from other perspectives, such as economy and politics that could determine the quality of Australian democracy itself. It must prevail over all the hidden and abstract formulations behind that veil. This paper will have a critical thinking towards the “helicopter view” from it, including the budgeting and political parties’ role. Directly or indirectly, the game of tug-of-war for power in the form of budget-setting authority through campaign promises of political party programs based on the ownership of contesting ideologies shows a quality election process which leads to the level of democracy quality itself.
Australia has two big political parties, the Liberal Party (LP) and Australian Labor Party (ALP). Both of them are having slightly contrasting differences, LP is considered as centre-right believer and ALP represented as centre-left (Toby, 2013). The Liberal Party trusts in a slim government with lower taxes, less money spending for health and other services for the good of society, and also simplifies things as possible as they could for helping big and small business. On the other hand, the Labor Party believes in higher taxes to fund a larger public sector for providing any kind of basic levels, such as health, education, and others for everyone.
During the last election campaign phase, the Coalition (consisting of Australia Liberal and National Party) and Australia Labor Party had fierceful debates on healthcare policy evaluation. Anthony Albanese, the Labor leader, stated that the Labor Party will always be better on handling health than the Coalition as their opponent because Liberal Party is not on the same page with Labor Party in carrying three strategic agendas, including ensuring an accessible and a responsive dental care, an equal cost for specialist treatment, and reasonable price to pay for seeing a doctor (Karp & Butler, 2022). The Labor believes that any kind of cut could extremely destroy Medicare program sustainability. Much contrast from Liberal party propagates on how they relatively uphold the “quality over quantity” catchphrase. Other than that, the Labor party is always known from year-to-year as a health fighter activist. They give an explanation about how the Coalition is even outgrowing the real growth of healthcare costs, loosing up public hospital funding deals with the states, and drowning in rent-seeking phenomenon which inflict bill shock and exorbitant patient out-of-pockets (Ducket, 2022).
The Coalition and Labor Party have dissimilar on formulating the Pharmaceutical Benefits Scheme (PBS). The Coalition promised to reduce the cost of medicine on the PBS by 29% which equals $10, meaning the maximum cost will be $32.50 (Martin, 2022). On the other hand, the Labor party offered a further surpassing numbers than the Coalition, who is promising to lower the cost of medicines by $12.50 which means a maximum cost of $30 (Daniel, 2022). Outside of the expenditure composition, both of them take a different lane to receive and absorb funds. The Labor said that they will be fitting neatly every single aspect of the healthcare program into the national macro-management. The Labor party fought for expanding public sources where Australian people are not penny-extorted each time they do a medical checkup and anything else. On the contrary, Liberal party endeavoured privatising goods and services, including in the healthcare sector. They prioritised on how people could hold money so they have a capacity to purchase Medicare.
The Labor Party even promised a huge funding up till $970m in Medicare and general practice (GP) ahead of the final week of election (Murphy, 2022). The Australian Medical Association welcomed the Labor Party’s idea to implement a “strong down payment” in boosting primary healthcare, including a $750m “Strengthening Medicare” fund to roll out from 2023-23 and a $220m grants program for upgrades in local GP practices. The Labor Party also pledged an extra $2.5 billion over four years to improve regulation and mandate 24/7 registered nurses by July 2024. Very much different with the Coalition or especially the Liberal Party which is pretty silent on addressing some major problems in health workforce shortages (Calder, et al., 2022).
How is the realisation of substantive democracy influenced by contestation of public policy programmatic budget plans based on the ideological spectrum of political parties in the 2022 Australian election?
Theoretical and Concept Framework
Due to that topic, this writing will be matched with the substantive democracy theory that was studied by Lawrence R. Jacobs and Robert Y. Shapiro (1994) in their academic journal entitled Studying Substantive Democracy. In this academic journal, substantive democracy studies are understood as a process of democratisation that is deeply rooted from a cultural perspective, not only limited to the existence of formal institutional pillars. This main premise is supported by several vital factors. First, there is in-depth research, both in qualitative and quantitative form, regarding the public policy designs offered by political parties to the public during the campaign period. Second, continuing from the first point, this means that the public policies offered and produced are guaranteed to be based on similar ideological ties or priority issues with supporters or voters or constituents of the political party. These two factors will later lead the country’s political landscape to a participatory, responsive, accommodating, and transparent democracy. In this way, democracy is truly born from a process of dynamic interaction between elite and non-elite actors in order to form relevant public policies.
Other than that, this writing is also trying to refine the theory explanation by adding two concepts. First one,a concept introduced by Alisha C. Holland and Ben Ross Schneider (2017) in their academic journal entitled Easy and Hard Redistribution—by the time, “easy” is changing to a “soft” word. Soft redistribution is defined as a social policy practice that consumes a relatively small share of the budget so that it does not have the potential to threaten the flow of resources reserved for diversion to other programs. In contrast, the hard redistribution involves relatively more intensive policies. This type requires a great deal of responsibility from the state to manage benefits and carry out bureaucratic reform. It can be said that the huge difference between them is relying on spending, in this context it is concentrated on fiscal government spending. Easy redistribution is when the government decides to cut the budget, whereas hard redistribution is when the ruling government is determined to pour out the budget as much as possible. Its consequences lead to “how” the government treated economic and finance policy.
The easy one must be opening many privatisation so the government would not have to tiredly take care of everything. In this way, the easy redistribution type rather chooses a policy where each individual owns the money than all-handled by the state and government. On the other hand, hard redistribution is giving in all out the money for detail reaching out to serve people. This argument builds over the same second concept of proposition that was conveyed by Helmut Herwarts and Bernd Theilen (2017) in their academic journal entitled Ideology and Redistribution through Public Spending. They found that left-wing parties advocate more income redistribution than right-wing parties. It is proven from the research finding, left-wing parties are accumulating higher public spending that could benefit low-income people than right-wing leaning to support budget reductions in the public sector.
Somehow this Australian political landscape reflected the essence of a democracy, so-called substantive democracy. This is depicted from how Australian political parties and the people themselves are having less quantitative minded when talking about a political issue, such as popularity, electability, or wealth—is more considering the similarity of the party’s ideas. The power exercised to elevate the shape of ideas, notions, and programs which pioneer a strategic and concrete solution, especially in terms of the health sector in this context, starting from talking about PBS, nurses’ welfare, until the massive healthcare reformation program.
Deliberately sharpening Australian people to justify their candidacy choice on more measurable data, through history and calculated data. This is what is called as realisation of rational voters generating. Australian parties are giving guidance to hinder and press the voters typical that using the emotional and transactional process. To conclude, Australian political activities have successfully fulfilled the two factors that were introduced by Jacobs and Shapiro back then where political parties have done the in-depth research and a parallel political parties’ ideology spectrum with their program offers.
These two different poles portray how ideology battle is still living in their democracy through practical evidence, and that is budgeting. The Liberal Party or Coalition has been proven to spend less (soft-redistribution) on everything related to health programs compared to the labour party (hard-redistribution). Due to that, the labour party is much more offering reasonable and affordable healthcare programs as in categorised as one of a public sector.
Lastly, to narrow down the whole discussion, those rivalrous budgeting policies in Australia implicitly yet explicitly describe the practicality of power exercising in Australia. This issue is replicating the political power, specifically suiting the ideology or belief dimension which sourced from material form (ex. money). It indicates that substantial democracy really is alive in Australian politics, from how technocratic resolvement on the health sector that the party already designed is straightly linked back to their origin of ideology spectrum. Indeed, it is very likely to align between the programmatic concept and the political party’s identification (Party ID’s) way of thinking.
The Australian general election contest in 2022 illustrates the political life of a substantive democratic spirit. This is proven by two things, including the availability and ability of political parties to reach the community to capture measurable aspirations (based on facts or data) and the existence of program offers from political parties that are in line with their ideological spectrum. The concrete form of this explanation lies in the differences between political party strategies in promising to manage budgets in the healthcare sector. The liberal party prioritises the implementation of soft-redistribution, while the labour party implements hard-redistribution in carrying out improvements in the healthcare sector. Meaning that the liberal party is quite less in expanding the budget than the labour party on healthcare sector or issues.
In order to maintain the conducive-living of substantive democracy in Australia, it is important for the government in office to have the ability to balance political campaign promises, including in the healthcare sector context, while still opening up space to accommodate for other alternative policies from the opposition. The intention of attitudes and behaviour like this is that it can drive Australian political maturity in a more promising direction. On the one hand, the winning political party can still fulfil its programs, issues, budget, and other healthcare political campaign promises to its constituents without needing to abandon its party’s ideological identity. However, on the other hand, the winning political party also behaved rationally in dealing with the existing situation and conditions, even though it had to accept suggestions and criticism from the opposition party, if it was judged that this would be the best unified statesmanlike solution.