The Minister of Health, Christian Dubé, has not yet presented his “refoundation plan”, but we already know that the debate will mainly focus on the role of the private sector in the delivery of health services.
It has been discussed for more than half a century and the establishment of the Régie de l’assurance maladie. Even if the Bourassa government had imposed the principle of a public and universal system on physicians, the private sector was never completely evacuated and today it accounts for almost a quarter of health expenditure.
Despite the periodic temptation to entrust it with a greater role, the public sector monopoly has never been officially challenged, even if the private sector was allowed to gradually expand its activities. Public opinion was unwilling to this breach in the welfare state.
The Legault government is the first to propose so openly to make the private sector an important partner in the system. Québec solidaire shouted “resignation”. It is true that there is an admission of impotence here, but the government doubtless believes that the population has also resigned.
After the shock caused by the pandemic, which has exposed the shortcomings of the system like never before, we are dusting off the reports that have followed one another over the decades and whose recommendations have always remained a dead letter. After so many dashed hopes and broken promises, how not to lose faith?
Over the next few months, the government will swear hand on heart, no doubt sincerely, to have no intention of instituting “two-tier medicine”, where those who can afford it seek faster treatment in institutions private, while the others hang around on waiting lists that never stop growing.
Whether public or private, all you have to do is present your health insurance card. At first glance, it seems so simple that you wonder why you waited so long. Except it’s not that simple.
Before health insurance, medical specialists used to set their fees according to the income of their patients. They would have liked the future public system to apply only to the less fortunate, but the Bourassa government stuck to the recommendation of the Castonguay-Nepveu commission.
The education system has taken another direction, which is sobering. The private school was not only maintained, but encouraged by heavy subsidies. Although it wants to be a complement to public school, it has instead become a competitor which, by dint of draining its best elements, makes it less and less attractive. Wanting to relieve the public health system by calling on the private sector also risks having perverse effects.
Once the door is wide open, we risk going down a slippery slope, which will make it very difficult to control the expansion of the private sector. Without seeing a dark plot hatched by neoliberal forces to deliberately undermine the foundations of the public system, there is a good chance that the private sector will develop quite naturally due to the explosion of costs and the aging of the population.
From the moment it has the necessary facilities, which can be used at all times, how can it be prohibited from offering services billed directly to patients in addition to those it must provide under the public plan? Therefore, it will become increasingly difficult to curb the sale of private insurance. The slope will become even more slippery.
There are already private clinics where it is possible to receive services covered by health insurance. You will be told, however, that the wait time is two months for an ultrasound, while it can be done within two days at a cost of $700. And when there is an emergency, we are ready to pay… If we can.
In a context of shortage, how to prevent the movement of staff from the public to the private sector? Who could blame a nurse for preferring to work in a clinic where the working conditions are more pleasant and the hours more regular?
Of course, the worst is never certain. There are places where the public and the private coexist harmoniously in the interest of the population. In Denmark, for example, all citizens are guaranteed treatment within one month.
If they cannot be treated in a public institution, they can be treated in a private institution, or even in another country, at public expense. Yet 98% of Danes prefer to wait a little longer – 60 days on average – for public treatment. We believe we are dreaming!