Since the advent of Medicare in 1984 there has not been much attention paid in the public policy arena to the issue of what consumers pay directly for health care. This may be partly due to the success of Medicare and the Pharmaceutical Benefits Scheme. This chapter examines the issues for consumer organisations in the area of direct out-of-pocket payments for health care. First, data on total spending on direct payments are presented, followed by an analysis of the success of Medicare in keeping costs low for consumers. Three main strategies have been used by two of Australia’s leading consumer organisations, to mount a critique of the direct payment system. These include a critique of existing arrangements, the definition of needs at the margin and an attempt to redefine core or central health needs. The chapter draws principally on the framework developed by critical theorist, Nancy Fraser, analysing the politics of needs interpretation.