The establishment of Medicare revolutionised health care in Australia, with a focus on providing universal access to the health care people need, when they need it. Four decades have passed and much has changed; in both the health conditions that people manage and in the way care can be delivered. Australian health policies must keep pace with change to deliver health system reform that builds on the strengths of the existing system and preserves the principles that Medicare was founded on- equity, efficiency, simplicity and universality.