Talk of changes to Medicare as part of the Budget make this the perfect time for Labor to argue for a radical overhaul of our healthcare system, writes Joff Lelliott.

Earlier this year the Federal Health Minister, Peter Dutton, called for "a national conversation" about the future of health care in Australia.

Endless talk of the system's financial sustainability from the Coalition benches means health spending is firmly in the Government's sights as part the Treasurer's supposed fight against "the age of entitlement".

Medicare co-payments have been floated as a possible part of the upcoming federal budget.

Australia has long suffered from lacklustre performance in health. There is a high level of public dissatisfaction with the current system.

This presents Labor with a golden opportunity to look beyond the nips and tucks of reforming the system and go for major reconstructive surgery.

The evidence suggests Labor should go on the offensive and argue for a radical overhaul to improve Australia's healthcare performance through a single, socialised, universal system. But so far progressives have been on the back foot, only defending the current system, and Medicare in particular.

As a percentage of GDP, Australia spends slightly under the OECD average on health care (about 9 per cent compared with an average of 9.3 per cent). But the public gets poor value for money out of Australia's complex, hybrid system.

In 2010 the US think tank, the Commonwealth Fund, conducted research into the health systems of 12 developed countries. On almost all measures Australia was one of the worst performers, especially for those relating to costs as a barrier to health care. These included confidence in being able to afford health care if sick, not going to a GP when needed and not filling prescriptions because of the cost.

A large amount of Australian expenditure is on a pay-as-you-go basis. The Consumers Health Forum of Australia pointed out in March, out-of-pocket expenses make up 17 per cent of Australian healthcare expenditure, far higher than for most OECD nations.

Increased co-payments for doctor visits are a lazy answer, simply limiting access rather than making the system more efficient; yet increasing and extending them seems to be at the centre of Federal Government thinking.

By contrast, socialised single-provider systems can give quality health care, free at the point of use and provide good value for money because of their scale. Physicians for a National Health Program, which advocates a universal, comprehensive single-payer system in the US, argues that socialised systems like Britain and the Nordic countries "tend to have low costs per capita, because the government, as the sole player, controls what doctors can do and what they can charge".

Don't believe the naysayers on Britain's National Health Service; it is a good example of a world-class but cost-effective system.

After 18 years of Thatcher and Major governments the public belief was that the NHS was on the critical list. The subsequent Blair and Brown Labour governments of 1997-2010 embarked on a massive reform programme and increased expenditure from 6.6 per cent of GDP in 1997 to 9.6 percent in 2010.

The results of Labour's investment were impressive. According to the opposition health spokesman, Jamie Reed, the investment resulted in all-time low waiting times and the highest patient satisfaction ratings ever recorded. In 2007 Labour even gave Britons a legal right to begin any non-urgent treatment within a maximum of 18 weeks. This all comes without co-payments, insurance claims, fees, gaps or out-of-pocket expenses.

International research backs up the idea of a high-performing NHS. Among the many areas of the Commonwealth Fund research where Britain performed well, it ranked highest for public confidence in receiving the most effective treatment if sick, highest for confidence in being able to afford treatment if sick, lowest for out-of-pocket expenses, lowest for serious problems paying medical bills and lowest for cost-related access problems.

This is all achieved with British health spending per head being only about the middle of the pack for developed countries.

Recent research from the Grattan Institute states Australians pay up to 14 times as much for some drugs as those in the UK.

Research published in the Journal of the Royal Society of Medicine in 2011 ranked Britain's NHS as the second most cost-effective health system in the developed world, saving more lives per pound spent than any country except Ireland.

In fact, many countries are emulating the NHS in part or in full, as discussed in a recent article from The Economist - hardly a cheerleader for the left.

In the final section of the US Commonwealth Fund research discussed above, interviewees were asked whether their country's health system should have "only minor changes", "fundamental changes" or be "rebuilt completely".

Britain had the highest proportion wanting "only minor changes" (62 per cent) while Australia had the lowest (24 per cent). Conversely Australia had the highest combined score for "fundamental changes" and "rebuild completely" (75 per cent) while Britain had the lowest score by a large margin (37 per cent).

Fully 20 per cent of Australians want the system completely rebuilt compared with just 3 per cent of Britons.

Health care in Australia is expensive and the system is unpopular. Given the public's embrace of the NDIS, it is easy to imagine massive support for a political party that is brave enough to develop a detailed, workable policy for socialising Australian health to deliver a cost-effective, efficient and accessible system for the public. As the founders and defenders of Medicare, it would be a logical next step for the ALP.

Dr Joff Lelliott is a board member of the think tank The Australian Fabians. View his full profile here.