The irony was that the mercantile adventures of Stéphane Le Bouyonnec resurfaced last week while Christian Dubé adopted his reform of the health system.
Destiny binds the two. In August 2018, Le Bouyonnec was president of the CAQ and candidate in La Prairie. He ended up resigning because of his involvement in Finabanx. He was a shareholder and director of this company which offered loans at rates of up to 90%. It was legal because the company operated in Ontario. In Quebec, this rate exceeds the permitted limit.
Christian Dubé had agreed to replace him in the middle of the campaign. It was a boost to François Legault after leaving the ship at the start of his mandate in 2014 to join the Caisse de dépôt et placement du Québec.
We know the rest. At the start of the pandemic, Mr. Dubé was named Minister of Health. After hesitating, he ran for office again. He is in his second term as Minister of Health and is now experiencing his moment of truth.
A gag order is never a great episode of parliamentarianism. The government short-circuits the debates and provokes a vote.
Few people were surprised, however. With its 1,180 articles, this bill was the fourth most voluminous since the 1980s. And it was the one that was studied the longest – no less than 238 hours in parliamentary committee.
According to Mr. Dubé, there were only a few days left to complete the study. He was prepared to extend the session, provided there was a guarantee of being able to vote before December 15. The PQ and solidarity activists refused.
Mr. Dubé will not pay the price of the gag order. We will quickly forget how the reform was adopted. The important thing is the result. And if she fails, we won’t forgive her.
The minister creates Santé Québec. This agency will have a board of directors which will give direction to the network.
The agency centralizes planning. Mr. Dubé believes that it will be accompanied by decentralization in the choice of means to achieve these objectives. This remains to be seen, and there are many skeptics.
The hardest part is yet to come, and the gag doesn’t help build confidence. Until the last minute, Mr. Dubé tabled amendments. There were hundreds in total. He sometimes struggled to explain them. For example, he did not know why Santé Québec could unilaterally withdraw the bilingual status of certain establishments – this power ended up being removed. He also did not foresee that Santé Québec would have to include health professionals among its administrators.
Around 80 feature articles remained to be studied. They focused in particular on the pre-hospital aspect, such as paramedics and ambulance drivers. Outside of Greater Montreal, deadlines vary, as does the organization of services.
We were also unable to examine the penalties for specialist doctors who refuse to see patients deemed a priority. And “Social Services” was not included in the agency name.
But these are details when compared to the other outstanding questions.
For now, the reform only exists on paper. Mr. Dubé will set up his transition committee at the start of winter. He will then need to appoint the CEO and other members of the board of directors, and specify their mandate. After he said he was looking for top guns from the private sector, the health sector will monitor whether the person at the head of the agency has minimal knowledge of the network.
The minister will also have to come to an agreement with the unions. He passed legislation to phase out employment agencies. However, Quebec must currently negotiate with the unions the recognition of the seniority of nurses and other professionals in these agencies. How can we encourage them to return to the public without demotivating those who never left?
With specialist doctors, Mr. Dubé will have to specify how he will require each specialist doctor to see a minimum of serious cases instead of favoring quicker, paid consultations.
There are also union accreditations. Santé Québec will become the sole employer. The number of unions and collective agreements will be greatly reduced. This aspect has not been included in the bill or in current negotiations with the public sector.
And finally, there is the cultural change that the reform is supposed to enable. This is the most important and intangible part. It will take time.
Mr. Dubé is still one of the most popular figures in government, an achievement for a Minister of Health. No one expects him to seek another term. Faced with rumors of a hasty departure, he was however firm: he stayed to finish the job.
François Legault hopes that, by 2026, the first advances in reform will be felt. Until then, we will mainly see the obstacles.
In the chamber, Mr. Dubé will have to endure the barrage of effective opposition deputies Vincent Marissal and André Fortin, who are hot on his heels on the problems that remain on the ground – I will come back to this in a future column.
Between now and the end of the mandate, Mr. Dubé risks finding the time to be long. But not as many as the patients who are still waiting for care.
And Stéphane Le Bouyonnec? According to the latest news, this top gun of the private sector is still deputy minister.