The unhappy few of Americans who still think national health insurance is a good idea might learn something from Australia’s experience with a national system—not so much about how to design a workable system, but about the political struggles that must occur before one finally emerges. Australia had the rudiments of a welfare state well before the United States, and its first comprehensive proposal for national health insurance dates from 1938, but the final battle over a program really began in 1972 when a Labor government took power.

Australia has two major political parties: Labor, which is similar to the British Labor Party, and the Liberal Party, which is similar to the British Tories, and which works in coalition with several minor parties. In 1972, Gough Whitlam’s Labor government proposed a national health care system, dubbed Medibank, to provide free public hospital care and to defray the cost of other medical services. Australians could still supplement Medibank with private insurance that would allow them to stay in private hospitals and be cared for by the physician of their choice. Medibank was roughly similar to America’s Medicare system, but applied to all ages.

Australia elects its prime ministers on a parliamentary vote, but it is a federation like the United States, and it elects state governments and a second national chamber, a senate, in which each state has an equal vote regardless of its population. Labor controlled the lower House, which is based on population, but Liberals controlled the Senate and were able to block implementation of Medibank. Finally, in August 1974, after a third standoff between the House and Senate, the two bodies were forced by Australia’s Constitution to create a joint legislature. It passed the Medibank bill. But that wasn’t the end of the controversy.

As Pamela Behan recounts in Solving the Health Care Problem, the powerful Australian Medical Association responded to Medibank by encouraging doctors to jack up their rates, creating a widening gap between what Medibank’s reimbursement and the doctors’ fees. Liberals, who controlled four of the six states, refused to cooperate with the new legislation. And while the joint body had approved spending on Medibank, it was not permitted by the Constitution to decide on its funding. So instead of coming out of an additional percentage of the income tax, funding came out of general revenue, widening deficits and creating a fiscal crisis at a time when unemployment was rising in Australia. Voters, concerned about the economy, voted out the Labor government in 1975 and installed a new Liberal government under Malcolm Fraser.

What happened next should send chills up the spine of Obamacare supporters. The Fraser government gradually undermined Medibank by amending it. It passed a tax to pay for the system, but allowed citizens who purchased private insurance not to pay the tax. It reduced payments to the public system. Finally, in April 1981, it repealed the Medibank legislation, ending the program. Two years later, however, with the economy again in recession, Labor under Bob Hawke won a resounding victory in the House and Senate. Labor also controlled four of the six state governments. One of Labor’s campaign promises was to restore the national health insurance system.