We learned last week that the government plans to entrust the management positions of the new Health Quebec agency to “ top guns of the private sector”. It is therefore business leaders, recommended to the Minister of Health by other business leaders, who will be at the head of this new central body intended to oversee the public health system. The government’s intentions have the merit of being very clear: what must be called the Santé Québec inc. will have the mission of realizing the vision of the health system supported by the business community (which is also, incidentally, that of the government).
In some respects, the current situation is reminiscent of a forgotten episode in the history of the Quebec health care system. During the 1980s, in the midst of a neoliberal turn, the government of Robert Bourassa entrusted a working committee with the task of evaluating all government organizations, including the health network. Chaired by Paul Gobeil, former CEO of Provigo, this committee was made up of 80% businessmen (and no women). For this reason, its detractors dubbed it the “Provigo Committee” at the time. Among the recommendations of his report, published in 1986, were the privatization of hospitals and the abolition of CLSCs.
Due to the popular opposition they aroused, these recommendations could not be implemented immediately, but several of them were implemented in the decades that followed or are in the process of being implemented by the current government. It should be noted that the businessmen at the head of the Provigo Committee only had the power of recommendation. For Santé Québec inc., he is offered the direction of what will become the most powerful decision-making place within the network, and we even plan to pay the employees handsomely to occupy this new position of power.
But can the private sector really save the public network, as the government claims? A simple look at the role it has played in its evolution in the past is enough to strongly doubt it.
From the outset, the business community was fiercely opposed to the creation of the public system, as clearly shown by the briefs submitted to the Castonguay-Nepveu Commission by the Quebec Chamber of Commerce, the Canadian Manufacturers Association, the pharmaceutical industry and private insurance. Despite this resistance, the adoption of public and universal health insurance and the creation of a public network of health establishments had become essential in the early 1970s.
Historical responsibility
Since then, business and employers’ associations have worked tirelessly to erode this major achievement of the labor and popular movements. For anyone wishing to take advantage of the business opportunities offered by the health care market, the measures put in place to promote universal access to care were obstacles that needed to be removed. It is largely under insistent pressure from the business community that successive governments have, in recent decades, subjected the network to chronic underfunding and a series of neoliberal reforms with catastrophic cumulative consequences.
Health care merchants and their political allies therefore bear an undeniable historical responsibility for the deterioration of public health services. And they now have a fair chance of presenting the private sector at the source of the problem as being the solution.
Under these conditions, that the government chooses to call on the Chamber of Commerce of Montreal and companies such as IBM, Google, Énergir, Pharmaprix and KPMG to the rescue of the public system is disturbing, but not surprising, especially when one considers the current composition of the Council of Ministers. Indeed, you should know that more than a third (36%) of its members, including the Minister of Health, Christian Dubé, are businessmen or women. In the general population of Quebec, entrepreneurs account for only 2.3%.
As explained elsewhere, there is no need to resort to conspiracy theories to explain the ability of business to influence governments. But the least we can say is that with the Coalition avenir Québec in power, the economic elite is well represented at the head of the state.