The changes the Abbott government is proposing to Australia's healthcare system are the biggest since Medicare was introduced more than 30 years ago. Indeed, they are the biggest step away from Medicare in more than three decades.

A bit over a week ago the government's Commission of Audit released a report that is a blueprint for what Australia's healthcare system could look like under the Abbott government.

It is no exaggeration to say that the changes recommended would render Medicare only a residual system for very poor Australians, not the universal healthcare system that all Australians rely upon today.

Labor's principle is that we all contribute to Medicare. Australian taxpayers pay a Medicare levy and high income earners pay a Medicare levy surcharge. It’s a principle Labor has always believed in. Whereas Tony Abbott's view is that his government should not pay, individuals should - through taxes on GP and emergency department visits, through higher private health insurance premiums, and through increased out of pocket costs.

The blueprint the government is using is one for a less fair Australia based on ideology, not sensible policy that is informed by experts.

Last week Bill Shorten and I met with senior leaders from across the health sector, including representatives of doctors, nurses, pharmacies, hospitals and the public health sector. Their message was clear: the Commission's report does not reflect the sector's views, their submissions were not listened to and the recommendations will not improve Australians' health or improve the health system. That is why Tony Abbott should not be allowed to use its recommendations to get away with wholesale changes to the system.

Take for example the justification by the Commission's Chairman Mr Tony Shepherd that Australians visit their doctor on average 11 times per year, and that in his view, 'I just don't think we're that crook'.

First of all, it's not up to businessmen to decide how crook we are. Doctors do that. But more worryingly it shows that the government's determination to introduce a tax on doctor visits and its claims of ‘over servicing’ are based on a complete nonsense. The figure being relied upon to justify 'over servicing' is plain wrong. In fact the latest data demonstrates that Australia is bang on the OECD average at 6.5 doctor consultations per capita in one year.

So when Labor says the government's intention to introduce a tax on doctor visits will spell the end of Medicare, it’s because it will be the first step in a concerted campaign to pursue the blueprint recommended by the Commission of Audit.

The strategy so far has been Conservative policy making 101. That is to create a sense of crisis and immediacy to justify significant changes. Changes based on ideology rather than fact. It’s been the case across policy areas, with the government trying to create an overall sense of a budget emergency to justify its broken promises, and a compact the Australian public never signed up to prior to the last election.

The question about sustainability and paying for healthcare is really a question of who pays. Healthcare is not a discretionary commodity. You cannot plan for when you or your family will get sick. But that is exactly what Tony Abbott is asking every Australian to do through his plan to introduce new taxes and increase out of pocket costs in health.

So the debate about sustainability is really a false one. The true question is a question of who pays. Labor's principle is that we all contribute to Medicare. Australian taxpayers pay a Medicare levy and high income earners pay a Medicare levy surcharge. It’s a principle Labor has always believed in. Whereas Tony Abbott's view is that his government should not pay, individuals should - through taxes on GP and emergency department visits, through higher private health insurance premiums, and through increased out of pocket costs. These are all things that the government's Commission of Audit has recommended, and they are all things that are consistent with the government's arguments about 'unsustainable' health costs. It’s conservative policy making 101, but we haven’t had a conservative leader in 40 years who has been willing to go as far as Tony Abbott proposes to.

The debate is false too because Australians get very good value out of Medicare, our universal healthcare system. We have a better life expectancy than similar countries and we spend less. Our average health spending is less than the OECD average and our life expectancy is 7th in the OECD.

These are not changes the government proposed before the election, and they are not changes the government has a mandate to pursue.

Catherine King is the Shadow Minister for Health.