The Dubé reform is based on an idea: the problem with Quebec’s health system is not that it is a mammoth. This is because each leg of the pachyderm moves in its own direction. Or don’t move at all.
In other words, the system is not sick of its bureaucracy, but of its private preserves. Unions. Medical. Institutional. All these organizational rigidities, all these corporatist tensions mean that the system is not effective. That we don’t get the care we pay for.
The aim of the operation, if we can use this term, is to break down barriers. And so far, no one has convinced me that the project is in the wrong direction. In fact, the more I hear Christian Dubé, the more he convinces me.
But yes, like you, I cannot shake off a core of cynicism in the face of these big reforms which parade before us every 10 years like allegorical floats. We saw others.
It’s not every day that six former prime ministers take up pen together either. In fact, it never happens.
Are they right to want to preserve what they call “the soul” of Quebec’s cutting-edge hospitals? Yes of course.
Are they right to believe that Christian Dubé’s immense reform threatens the very existence of the Cardiology Institute, Sainte-Justine, the CHUM, the MUHC, etc.?
I am not convinced.
You would have to be completely crazy to question institutions as prestigious as the Montreal Heart Institute. And after the epic debates and the billions invested in the major university hospitals, do we really think that a Quebec government will want to bring them to the level of funding of the Jean-Talon hospital?
Basically, the approach of the ex-PMs is not aimed at opposing “bill 15”, as this historic reform is called. Lucien Bouchard even said on Wednesday at Paul Arcand that he agreed with the concept of “Santé Québec”, which will become the sole employer in the field.
But we should avoid “wall to wall”, and preserve exceptions to protect what works well in the system, say the six. Each of these institutions has its own ecosystem of research, teaching, innovation and high-level care. Immersing them in the great sea of Santé Québec will kill the model, we are told.
Minister Christian Dubé calmly responded to these fears. Everything that constitutes the essence of these institutions is specifically preserved in the law, including philanthropy intended specifically for a hospital unit. In other words, if Mr. This is what is valuable in this model: the complete integration of research and care. Innovations are quickly tested, taught, and disseminated.
What changes, and is disturbing, is the disappearance of the legal entity of each establishment. And the power of boards of directors.
“In Quebec, the councils are perceived as an official opposition,” told me a doctor involved in the search for one of these high medical places, but who is not at all alarmist. “No government will want to deprive itself of these centers or the philanthropy associated with them. »
Understand that no one in the industry dares to speak publicly: it’s too politically delicate. The ex-PMs speak on behalf of the leaders of these centers of excellence, and the major donors who help them survive. Those who support the reform are just as anonymous, for fear of being ostracized in their own circles. I have the impression that there is as much politics in medicine as in the National Assembly.
Not that these boards of directors are populated by people hungry for money: they are volunteers and as one member told me: “Apart from the time spent and the trouble it gives to convince donors, it gives nothing personally. »
It is also true that these centers arouse a lot of jealousy in the ministry and in a network that is at the end of its resources. A bit as if these settings were protected politically, legally and financially from the storms that hit everywhere else. As if everyone was a little sheltered from accountability.
Reform shifts the place of power. These institutions will have their direction. Their cutting-edge specialties. Their connection to the university and philanthropy. But will no longer be outside the system and will be a little more encouraged to collaborate – the pandemic has revealed a lot of this resistance in the system.
Ex-PMs fear that in the future, a government will dilute them. This would indeed be a serious mistake. If this were to be the case, there would be reason to step up. But that is neither the government’s stated intention nor what is written in this bill.