Previous Restructuring of Quebec's Health Care System

– Pierre Soublière –

The Quebec government introduced a new health care bill which further concentrates decision-making and implementation of health care services in narrow private hands. Bill 15 is part and parcel of the ongoing take over of the state by private interests. It steps up the anti-social offensive which denies the very notion of a modern society that is accountable to its members and guarantees their rights as human beings and as members of society.

What Years of Restructuring Have Given Rise To

It is useful to put Quebec's Bill 15 in context by recalling efforts by previous Quebec governments to restructure the state to serve narrow private interests. The measures to dismantle the social welfare state and not invest adequately in social programs began to take shape in the early 1980s under René Lévesque's Parti Québécois where the need for reform had become obvious. The issue was what kind of reform should be pursued? Should the reform strengthen the public sector and provide the rights of the people with guarantees or should the need for reform be used to dismantle the public system.

The Liberal government of Robert Bourassa then took over in 1985. It produced, among other things, three reports -- the Fortier, Gobeil and Scowen Reports -- all of which advocated governmental reorganizing by means of privatization, deregulation, dismantling of agencies and outsourcing. The authors of these reports claimed that government, through its state-owned enterprises, intervened in the commercial and industrial realms at the expense of and in competition with the private sector. They upheld that the time had come to re-examine public enterprises and to privatize those services whose mandate could allegedly be taken up more efficiently by the private sector.

In terms of deregulation, the aim was to eliminate all government intervention in the functioning and operations of private enterprises. It was also recommended that small and medium-sized hospitals, as well as state-owned enterprises, be privatized. These reports were based on the premise that state-owned enterprises were inefficient, that the public sector, by nature, was in contradiction with the private sector, and that the space taken up in the economy by the public sector should be made available to the private sector.

The Lucien Bouchard PQ government continued the trend of dismantling the public sector in the name of "zero deficits." Its Public Administration Act among other things, involved downsizing through attrition and its impact continues to be felt today in terms of elimination of staff, loss of expertise and work overload. Bouchard launched his privatization schemes in Lac Saint-Jean, the heart of the Quebec nation, thus also driving a nail into the heart of what had come to be known as Quebec Solidarity. Since then, neither the PQ nor the Bloc have been able to salvage their claim to represent Quebec interests and its has been up to the people of Quebec to fight for the right to health care, education and social services in the face of the brutal anti-social offensive which subsequent governments have pursued. Today the government of the Coalition Avénir Québec (CAQ) continues to privatize health care and use the public treasury to favour private interests. While the Public Administration Act claimed to promote "a new management framework for the public service and improved services for citizens," the CAQ government claims that the aim of Santé Québec is to favour access to health and social services.

Announced in the wake of their 2003 victory at the polls but not mentioned in their electoral platform, the aim of the Jean Charest Liberals' "restructuring" included revising state structures and government programs as well as reorganizing the health system. It favoured calling on experts from the private sector as opposed to public deliberation, dialogue, or negotiation with those involved.

The Liberals' state restructuring later became a "modernization plan." Very much in tune with the CAQ government today, its restructuring was based on the premise that there should be a divide between operational activities and the development of public policies, and a reinforcement of performance management through a contractualization of the relations between administrative units. This new structure of internal governance implied a focus on ministerial powers over policies and orientation.

The declared mission of Santé Québec is to offer health and social services through public institutions as well as to coordinate and support private institutions and "other service providers." The Health Minister is entrusted with functions regarding the priorities, objectives and orientations as well as "certain powers relating to the supervision of the health and social services system."

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

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