Government spending on Medicare safety net benefits in Australia has exploded, reaching $871.4 million in 2024 — more than double the $339 million spent in 2010. The rise mainly comes from the extended safety net, introduced in 2004 under Tony Abbott, which helps cover out-of-pocket fees for specialist doctors. These are the costs patients pay beyond Medicare rebates when doctors charge more than the standard rates. Once a patient spends $2,615.50 out-of-pocket in a year, Medicare covers up to 80% of further expenses. Spending on this extended net surged from $324.9 million in 2010 to $850.4 million in 2024, nearly tripling. Peter Breadon of the Grattan Institute called the increase “explosive” and blamed rising specialist fees outpacing inflation and care costs. He said the subsidy mostly benefits fee-charging specialists and wealthier patients who see them repeatedly, creating “greater inequities in Australia’s healthcare financing.” The government is reviewing the safety nets and recently expanded caps on extended benefits to rein in fee inflation. A department spokesperson confirmed a working group and consultations are ongoing to explore reforms. Former chief medical officer Brendan Murphy noted the extended safety net has been inflationary and led to high specialist fees, making private care unaffordable and crowding public hospitals. “This, sadly, is a failure of one of the original aims of Medicare,” he said. Murphy also criticized the large income gap between general practitioners and other specialists, calling it “unjustifiable.” While some suggest redirecting safety net savings to increase specialist rebates, he believes more funding should target primary care instead. He urged specialists to consider the effect of their fees on patients and suggested a modest income trade-off. Addressing workforce shortages, better public care access, and controlling fees are key to solving the issue, said Breadon. The sharp climb in costs and specialist fees highlights urgent challenges in Australia’s health system as policymakers seek solutions.