Quebec wants the private sector to be able to “increase the offer” in health

He has been a close collaborator of François Legault since the early 2000s and most often works in the shadows: he gave his last major interview to the Homework in 2011. As the second anniversary of the pandemic approaches, the Prime Minister’s chief of staff, Martin Koskinen, has agreed to revisit the great moments of this crisis, the consequences of which still haunt him.


” Deaths. That people have died in difficult conditions, ”he replies without hesitation, before pausing. Martin Koskinen sits in his office in the Honoré-Mercier building, adjacent to the large wooden doors that lead to the prime minister’s quarters on Quebec City’s Parliament Hill. In the spring of 2020, it was he and the head of government who made the most pressing decisions. The most unusual and difficult ones, too.

“Deaths” is his answer when The duty asks him what still troubles him, two years after he put “Quebec on hold”. “Impotence,” he adds.

At the end of the fifth wave, the government of François Legault is preparing a “refoundation plan” for the health network. “There is so much cynicism that we will have to have quick results,” predicts Mr. Koskinen. The objective is now to assign each Quebecer to a Family Medicine Group, and no longer to an absolute doctor.

“You must not be dogmatic,” warns the chief of staff. He evokes the “turning point” that was the vaccination campaign. “We can do things differently,” he insists.

“The private sector will never be at the center of the service offer, but if it can increase the offer, he continues before interrupting himself. Personally, I think that it is absolutely necessary to keep the universality of the network. […] The challenge of our health network is accessibility above all. So how do we make the health care system more accessible for our needs with the health insurance card? ” he asks.

Exception powers

In mid-March, the government must also table a bill to ensure the transition after the end of the state of emergency, renewed 101 times since the start of the pandemic in 2020. These successive extensions should no longer happen, acknowledges Mr. Koskinen in response to criticism of the extensive use of this exceptional remedy.

“Unfortunately, it is a measure that can be perceived as extreme to solve problems that can be solved otherwise, so we have to find an accommodation,” he suggests. With the bill that it must table in mid-March, the government hopes to be able to turn its back on the state of health emergency for good, he adds.

“Learning to live with the virus is not [vivre] under the state of health emergency”, summarizes the right arm of the Prime Minister. He recognizes in the same breath that the state of emergency has allowed the government to take advantage of exceptional powers, but he adds: “I do not believe that these powers have been abused. »

The “break” of December 31

At 48, he says he is “a moderate by nature”. In the media, he has been described as “close to François Legault” since 2002, 3 years after their meeting at the 1999 Quebec and Youth Summit. Mr. Koskinen was then part of Force Jeunesse; Mr. Legault was Minister of Education. “You’re coming with me,” said the chosen one, according to what he says in his book Heading for a winning Quebec. “It’s still there,” he also wrote.

Propelled to the top of the state, then at the controls of a “plane that was built in full flight”, the close collaborators have always worked with two variables to face the COVID-19, explains Mr. Koskinen. On the one hand, the desire to “save the health network in order to be able to provide urgent care to the population”. On the other, the concern to preserve “popular support” for health measures.

On December 31, a beep sent to cell phones reminded of the entry into force of the second pandemic curfew. The main adviser to the Prime Minister knew that a “break” had just been provoked.

“Me, I felt that at that moment, something happened. There, people said, “Enough is enough.” “says Mr. Koskinen. He sided “in the camp of the hawks”. ” [Je voulais] to be tougher with the non-vaccinated, because I felt that we were losing the support of the vaccinated”, he underlines. Upon returning from the holidays, Mr. Legault therefore announced his intention to impose a health contribution on those who were not vaccinated. To “keep membership” of the immune “silent majority”.

But the idea of ​​a pecuniary penalty finally “polarized” opinions, including those of deputies and government ministers. Mr. Koskinen was – and says he remains – “very well able” to defend the legitimacy of this contribution. He would even have liked the second curfew to affect only the unvaccinated, “who have made an individual choice not to be vaccinated, despite [le fait] that the vaccine is accessible and free”.

Except that the second option “was not applicable”, he mentions, while the first turned out to be too controversial. “We had to step back [sur la contribution santé]it was a question of cohesion and unity”, he believes today.

Arruda left by mutual agreement

Accustomed to FinancialTimes and New York Times, Martin Koskinen often relies on the international press review – “essential” – to see the tremors of the pandemic coming. He remains stunned by the flaws in Ottawa’s lookout system. “We had zero information from the federal government [au début de 2020]. It’s not normal that we were left to ourselves, ”he says.

He says he is “very critical” of federal public health. On the other hand, he finds the treatment reserved for the former national director of public health, Horacio Arruda, “unfair”. “He left by mutual agreement” after three days of reflection and discussion, he assures us.

“We saw that in the public space, people were saying: can we separate public health from politics? Make separate press briefings with the Dr Arruda, it would have been more difficult. So that allowed us, on the arrival of the [directeur national de santé publique par intérim, Luc] Boileau, to say: look, there are going to be separate press briefings, ”explains Mr. Koskinen.

He claims to have “never” doubted the skills of Dr Arruda, to whom he is “emotionally attached, because he is one of our brothers in arms”, lost in combat. “He devoted himself body and soul, seven days a week,” he recalls. However, he admits that the verbosity of the public health expert may have been a source of “annoyance” for him.

“Can this get on our nerves? he asks about the —“colorful“—personality of the Dr Arruda. “Five percent of the time, maybe. I would have liked it to be concise and precise, but at the same time, it felt good to have some color. »

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