As the federal election campaign unfolds, two key questions emerge: how will alternative health care policies of the two major political parties influence voter choice, and how will health care change once the political victors take charge of the Treasury?

There is actually no paucity of political and professional opinion as to how health care in Australia should change. The looming election merely triggers a crescendo in the chants of the Greek chorus of health care experts — “we need to change this” or “we must do that” — all part of an incessant stream of advice, mostly devoid of any evidence base, calling for reform of our health care system. Presently, our system is characterised by “fragmented roles, responsibilities and regulatory arrangements . . . inadequate co-ordination between governments, planners, educators and service providers . . . inflexible regulatory practices . . . perverse funding and payments incentives . . . and entrenched custom and practice”.1

Furthermore, the system is beset with such problems as:

• reduced opportunities for Australians to access health care when and where they need it;

• downstream effects of a chronic shortage of doctors, nurses and other health professionals and the system’s chronic reliance on overseas imports;

• a diminished focus on prevention and primary care;

• insufficient financial support and a wastage of resources inherent in the current federal–state funding structure;

• lack of political resolve to undertake reform; and

• the abysmally poor health status of Indigenous Australians.

In short, the system is diminishing in its capacity to deliver universal access to equitable and quality care. It is ripe for reform.

Some experts advise that there should be structural change rather than continual incremental changes to tackle the major problems,2,3 and observe:

Missing from all this rhetoric is a clear, prioritised account of the precise challenges facing our health system. Also missing are detailed enunciations of the health policies and plans of the major political parties contesting the election.

To demystify the confusion and rhetoric, in this issue of the Journal we have canvassed the views of a group of seasoned and respected health experts who outline their perspectives on the current challenges facing Australia’s health care system (→ Challenges in health and health care for Australia), along with the electioneering health policies of the Liberal Party (→ Good health systems, getting better), the Labor Party (→ Taking leadership — tackling Australia's health challenges), and the Australian Medical Association (→ A mandate to strengthen the health system).

Some of our readers may well ask why the MJA is straying into politics. In embarking on this initiative, the Journal is simply returning to a longstanding tradition of the MJA and following the lead of the Journal of the American Medical Association which, during the 2004 United States presidential election, boldly published responses to the question “How would you ensure access to health care for the citizens of the United States?” by presidential hopefuls George W Bush and John Kerry.4,5

But there is a more fundamental reason. In contemplating our apparent foray into politics, we turned to Julian Tudor Hart (the Welsh general practitioner who described “inverse care law” — that the availability of health care varies inversely with the need for it), who recently decried New Labour’s introduction of private providers to serve the United Kingdom’s National Health Service in his book The political economy of health care.6,7 Among other claims, he contends that if political parties are incapable of confronting the challenges of modern health care, then doctors need to become a politicised profession.8

Have we reached that point in Australia? We might know better when the outcome of this federal election is known, whether the newly elected government will have the political will to pursue reform and will step out from the comforting shadow of the blame game.