As soon as the question of the privatization of health care in Quebec is raised, the government hastens to reassure worried minds by affirming loud and clear that regardless of the mode of delivery of health services, it will always be possible to receive them. free of charge by presenting the Régie de l’assurance maladie du Québec card.
For a long time, this has been an exaggeration. Because it is estimated that around 70% of health services are covered by this public and universal insurance. Thus, dental, psychological, orthopedic and rehabilitation services, for example, are rarely free, except for those injured at work or on the road and the lucky ones who are protected by group insurance at work. As a result, the privatization debate today essentially concerns services offered in hospitals and medical practices.
Let’s not forget that in Quebec, as elsewhere in Canada, physicians, independent contractors, lead the game and actually determine what services are required. Over time, this has led the regime to treat any service other than that offered in the doctor’s office or by the hospital like a trickle. And yet, the framework law that is about to be analyzed in Bill 15 proposed by Minister Dubé is indeed called the Act respecting health services and social services (LSSSS).
Thus, in view of the increase in the supply of private health and social services, the role of the State must be understood differently. First, the state is accelerating the conclusion of contracts with the private sector. But it also alters the rules of the game by making the citizen, whom we like to describe as a client, a direct or indirect (if insured) potential consumer of private health services. Needless to say, insurance companies revel in it.
Several studies show that this new competition between the public and the private sector creates a deleterious effect of siphoning off from the public to the private sector: human resources, infrastructures, etc. An analogy with the world of post-secondary education – highly privatized – is essential here.
The dilapidation of the public health network, increasingly unloved despite all claims to the contrary, sacrifices the right of every person to health, even to the best attainable state of health. This fundamental right – affirmed in parts here and there in several Quebec legislations – implies that the movement to privatize health care be examined and curbed in the name of the requirement to fight against discrimination and to promote the interdependence of all rights. of the person.
A two-speed society is taking shape on the near horizon: that of households who will be able to benefit from care and services by paying or having insurance paid, or even by mobilizing deductions or tax credits.
Several professionals – physicians and non-physicians – are rushing into this new market of private services, starting with specialized nurse practitioners (SNPs). This Americanization of Quebec society is not consciously chosen by the citizens. The others, and there are many of them at a time of precarious work and the uncertainties of migratory trajectories, will content themselves with basic care for which they will not have to pay. Has anyone bothered to assess the discriminatory impact of this segmentation?
Vulnerable populations are in great need of public health, which can be defined as the sum of society’s organized efforts to keep people healthy and avoid injury, illness and premature death. The Health Plan and Bill 15 obviously do not abolish public health. But very clever would be the one capable of evaluating what will remain, starting with the CLSCs.
Then comes the issue of the interdependence of all human rights. Quebec households are poorly housed, poorly fed due to food price inflation, poorly supported in their psychosocial needs and mistreated at work and through work.
Isolating, as government discourse does today, the issue of access to attending physicians and surgery from other public health issues – as if the answer to these problems lay in a GMF – constitutes an affront to the citizen intelligence.
In this respect, the work of the parliamentary committee examining Bill 15 creating Health Quebec is off to a bad start and misaligned. To tell the truth, this bill does not enshrine the partial privatization of health and social services in Quebec. It will facilitate support without being the heart of the problem.
Many other initiatives are more decisive and pave the way for economic players. The right to health, while it does not prohibit recourse to the private sector or to insurers, nevertheless requires a holistic vision of health intended in particular for the well-being of the most vulnerable populations in all dimensions of their arduous daily life.
It is therefore urgent and essential to re-establish the terms of the debate on the right to health in Quebec. To this end, should we open a site, create a – another – commission of inquiry? It is to be discussed democratically and not in the technocratic corridors of the future Health Agency.
To read on June 19: Privatization in health: major changes in all discretion