Quebec Government's Health Care Bill -- Radical Rupture with the Past

A Modern Quebec Can and Must Guarantee the Right to Health Care

The principle of public health is based on the fact that the society has attained such a level that its future prosperity depends on expanding public services. The enormous development of the productive forces in Quebec and Canada and the technological revolution driving this in all spheres of life should be reflected in a corresponding growth in the capacity to meet the needs of the population, including micro-surgeries and the latest prostheses.

However, the opposite is true. The refusal to meet the needs in health care causes increasingly serious problems. Instead of taking on the social responsibility, governments are taken over by private interests and take anti-social decisions for private gain. This is the case with the "health reform" of the Legault government in Quebec. Bill 15, An Act to make the health and social services system more effective, tabled by Quebec Health Minister Christian Dubé on March 29, shows that the government is not capable of solving the problems of a modern Quebec. It also shows that the government will use any means to silence those who claim their rights and to dismiss all those who are the crucial factor in providing solutions -- the workers who provide the existing services and know first hand what is required.

The bill puts in place a structure that further centralizes decision-making, frees the government from accountability and debilitates health care workers' defence organizations. It also shows its obsession with "coordinating" what are called "user complaints." It proposes the creation of a "national user committee" and a "national complaints commissioner" with a responsibility to "harmonize the practices of user committees and make recommendations." It is to manage "Quebeckers' dissatisfaction with their health care system," which it finds "unacceptable." 

The government uses the expression "top guns" to describe its intention to seek out the best private sector administrators to carry out this reform. In this way, Minister Dubé tries to give the impression that this time privatization of the management of health care is going to work. This is a way of admitting that the last four decades of reforms, which have turned the people's health care into an opportunity to make profits at the expense of national standards, and especially at the expense of the people's needs, have not gone well and now require "top guns" -- a U.S. expression which refers to the top fighter pilots in the U.S. air force.

The criminal irresponsibility of the private management of centres for our seniors was exposed during the pandemic and amply documented by the Kamel Commission which submitted its report in May 2022. The construction of Montreal's major university hospitals was so rife with corruption and inordinate private enrichment that half a dozen "top guns" from SNC-Lavalin ended up behind bars.

Governments taken over by private interests are not guided by the aim of providing the right to health care with guarantees. They are guided by the neo-liberal mantra that to develop society, all the nation's resources must be put at the disposal of the same narrow private interests in command. Motivated by the pursuit of private profit, these private interests create projects that serve themselves and, as a secondary consideration, could have "societal benefits." In other words, the rights of the people are left to chance and made subject to limits, while the demands of the rich are given a guarantee and no limit is placed on them. This is achieved through deregulation, the abandonment of national standards, and an all-out assault on rights.

There is much confusion about what privatization of health care means. The government says that using private intervention does not mean that users will be required to pay or that there will be a two-tier system. This is then used to say that there is no problem and everyone should just be happy they have "access to free health care" whether publicly or privately managed and operated.

This is disinformation. First of all, it is not true that there is not a two-tier system. Anyone who has had to use the health care system in recent years knows that, despite the denials of successive ministers of health, the situations are many where people can have faster access to services in exchange for payments or paid subscriptions. Furthermore, as a researcher from the University of Sherbrooke explained in a recent article in Le Devoir, "federal transfers to Quebec have been reduced because of the tacit acceptance [by the Quebec government] of paid access to private diagnostic services (magnetic resonance imaging, for example), in the absence of sufficient coverage of these services within the public system." There is also an increasing number of "medically necessary" services that can now be obtained from non-physicians, outside the public system, at the patient's expense.

Second, the principles of universality and accessibility are being undermined by the handing over of the management of the health care system and decision-making power to private interests. This means that needs are met on the basis of what can be privately profitable for someone. Minister Dubé says the goal of this new bill is to make the system "more humane," but this reform, which continues the reforms of the past four decades, turns humans and their needs into things and opportunities for profit.

The claims that human beings are entitled to make on society are the real engine of development in any modern society. A modern Quebec begins with the recognition of the right to health care as a right that belongs to everyone by virtue of their being human and that governments have a duty to guarantee. Guaranteeing this right means that people have recourse if the government does not fulfill its obligation. So long as the right to health care remains a policy objective, governments continue to privatize health care and we must step up support for the health care workers and professionals whose demands for increased pay and suitable working conditions are in the public interest.

This article was published in
Number 28 - May 25, 2023

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