A few days ago, we learned that Ottawa will reduce part of the health transfers to the provinces and territories that allow a parallel public-private system. Let’s be clear: we recognize the urgent needs of our network, and a decrease in its funding is not good news. Nevertheless, we share the observation: making patients pay for essential services contravenes the Canada Health Act (CHA), and it must remain the beacon and safeguard of health policy orientations.
Coming into force in 1984, the LCS guarantees the principle of equity in access to health care throughout the country. To be eligible for health transfers, provinces and territories must respect its main principles. They remind us that we are all equal in the face of illness, and that everyone should have access to the necessary care, within a reasonable timeframe, regardless of their socio-economic status or geographic location.
Quebec, under both sovereigntist and federalist governments, was built on principles of equity and social justice similar to those defended in the CHA. We have been — and still are — a proud and wealthy nation of our strong social safety net. The protection of the public health system must not be instrumentalized in the name of provincial autonomy.
The announced cut targets diagnostic imaging services. As a result of the withdrawal of certain types of imaging in an extra-hospital context, and the authorization of mixed private-public practice for radiologists, two-tier imaging has become the norm in Quebec. Médecins québécois pour le régime public (MQRP) has demonstrated in the past that Quebec has the longest waiting lists for MRIs to the public, while having the most material resources, indicating that the two-tier system costs more expensive and, above all, that it weakens the public, contrary to what the partisans of private industry claim.
This is the risk that awaits us for other medical services, if a change of direction is not quickly made in the privatizing direction in which recent governments have embarked. The federal ministry also warns that other cuts could follow, for example if Quebec does not backtrack on private telemedicine. Indeed, taking advantage of a recent decree from the Coalition avenir Québec (CAQ) amending the Health Insurance Act — a decree adopted on the sly and without public debate — the private virtual care industry is quickly carving out a very lucrative place in Quebec.
Here is an example of a situation endorsed by provincial policies and against which the federal government would like to take action. A person with knee pain pays out of pocket for a consultation in a private telemedicine service which they access the same day; the doctor prescribes an MRI (magnetic resonance imaging) that she will do in a private radiology clinic, reimbursed by her private group insurance, which she pays at great expense through her employer. Everything is completed in less than a week, and the public care that she could then require will thus be accelerated. Let’s say she’s lucky; nevertheless, she will have paid twice, since she is already financing her care through her taxes.
A second, not having the same privileges, presents worrying symptoms for cancer. The delays to consult on the front line are long, those to then obtain a scan at the hospital more, in spite of the priority which it was seen allotting. These months of delays delay his treatment and the possible care for the cancer he will be diagnosed with. She waits her turn, always longer, at the door of a network whose capacities are dwindling, since its employees desert, in whole or in part, for the private sector.
This shocking duality is something doctors on the front lines witness every day. MQRP argues that it is the responsibility of governments to ensure that all citizens are cared for by a system that treats them fairly and in a timely manner. The CAQ government is striving, without tangible evidence or conclusive data, to position private enterprise as an innovative and necessary health solution.
This, however, has proven its limits, here and elsewhere: siphoning of personnel from the public network, preventing it from functioning; additional costs incurred by the State and the population to finance sometimes indecent profit margins; mismatch between the overall needs of the population and private business decisions; loss of citizen and democratic participation… For these reasons, privatization is rather one of the causes of the dysfunction of the public and universal health care system, now seriously jeopardizing its mission in Quebec.
The deep inequities running through the two-tier system in the United States provide us with a concrete example. It is necessary to increase the public funding of our network, and we call on the federal government to take this into account, while remaining firm in respecting the CHA. We invite the Quebec government to make the necessary changes without delay to preserve the universal mission and the principles of equity of our health care system.
In the next two years, the amount cut off from the federal transfer could be returned to Quebecers, who paid for it through their taxes: to do this, the Government of Quebec must stop allowing them to pay twice for care that are necessary. We are also asking the CAQ government to quickly and significantly improve the working conditions of the staff of the public network, and to give them autonomy, time and flexibility to be able to provide good care within it.
In order for the public network to honor its mission, the State must become the best health employer, nothing less. Given the state of play, this should be an urgent political priority. Will the orchestrated weakening of the public health system continue its perilous trajectory? The Quebecers of today and tomorrow have everything to lose if the dismantling of one of their main social achievements continues.