For the 10 million or so Canadians who have found some help in telemedicine services offered by their employers, such as Dialogue or Telus Health, the respite could be short-lived. The federal government is insisting that the provinces assume the entire bill for all virtual care that would normally have been covered if it had been provided in person. However, this literal interpretation of the law places a sword of Damocles over these services, which have become essential allies for some.
Quebec does not appreciate this umpteenth incursion into its jurisdictions at all. Its impatience is not unfounded. As guardian of the Canada Health Act, the federal government—especially under Justin Trudeau—is excellent at handing out dunce’s caps and giving lessons, but singularly lacks drive when it comes to contributing to sustainable solutions to its funding. Wrapped in its virtue, it also has the habit of bringing out the stick every time it brandishes a carrot. This attitude is counterproductive.
Earlier this year, it took months of difficult negotiations for Quebec and Ottawa to finally reach an agreement of $900 million per year, valid for ten years. Wrested without conditions, this victory had the appearance of a bitter defeat for the Legault government, which wanted to obtain $6 billion per year to finance its health services.
However, a letter from Canadian Deputy Minister of Health Stephen Lucas sent earlier this year to his provincial counterparts and obtained Monday by The Press suggests that those millions could be cut if patients had to pay out of pocket for virtual care. Provinces, some insurers, employers and the Business Council of Canada fear that by doing so, Ottawa is signing the death warrant for virtual care in the workplace.
The Trudeau government, whose slowness to decide on certain issues is becoming legendary, had promised to clarify its position in June, which it still has not done. Propelled by the pandemic, telemedicine has made giant strides in recent years, opening up a whole range of basic interventions that range from sore throats to mental health problems. These services help to disengage the front line and 811, and their providers work rather well with those in the public network when it comes to passing the torch (or rather the patient) in the event of more complex or critical care required.
It is true that the current formula for the development of telemedicine, fragmented and without defined political and technological parameters, has major flaws that the federal government is right to highlight. In a report published last year, the Institute for Socioeconomic Research and Information warned against the rapid growth of private virtual care providers, judging it likely, in the long term, to threaten equity in access to care and fuel a deterioration of public services.
These fears did not shake the Quebec Minister of Health. At the time, Christian Dubé defended the growing number of companies, including public organizations such as Hydro-Québec and Investissement Québec, using it, judging that it was access to care — still problematic for thousands of Quebecers — that urgently needed to be prioritized.
Less attached to the letter than to the spirit of the law, Minister Dubé had opened the door to the establishment of a similar public service so that everyone could, one day, benefit from the advantages of virtual care. In the meantime, cohabitation with these services deemed “complementary” appears to the minister to be a lesser evil.
Few Quebecers are likely to hold it against him. Access to care is also their priority. As attached as they are to their public network, they are not naive. They see the breaches that have multiplied. They know that the illusion of the public is too often maintained by billing the private sector for an increasing number of treatments. However, advocating a hard line on the telemedicine issue, as the federal government is threatening to do, is reminiscent of the adage: when genius points at the moon, the idiot looks at the finger.
This hard line, if drawn hastily and without solid alternatives, will have negative effects on the accessibility of care. At the wheel of a risky overhaul of our health system, Minister Dubé does not have the luxury of clinging so peremptorily to such principles. His challenge is to provide the expected care, in a timely manner, at reasonable costs for the Quebec Treasury, despite all the flaws of the flagship he inherited.
Maintaining universality of services does not necessarily mean blindly passing on all the bills to governments. It is first and foremost about ensuring that everyone is equal in the face of the injustice of illness. And with all due respect to Ottawa, the means to achieve this ideal belong only to Quebec.