In many matters, I try to avoid dogmatism, which only addresses the convinced. However, I show myself to be intractable on two issues: the defense of French Quebec and that of the public health system.
These are questions of life and death; for a nation, in the first case, and for individuals, in the second. These are, also, questions of elementary justice: a people has the right to live in their language and everyone, rich or poor, has the right to be adequately cared for when they are ill. In these matters, therefore, I do not negotiate; I fight.
On the health battlefield, I have no shortage of opportunities to engage in combat. The failures of the system are obvious every day: overcrowded emergency rooms, difficulties in accessing primary care and a place in a CHSLD at the end of life, waiting lists, labor shortages, delusional bureaucratization, and I pass.
Inevitably, faced with such an observation, there always arise good, eager souls who come to tell us that the only necessary solution is to make more room for private healthcare in order to unclog the system. The private sector, assert these interested saviors, would cost less, would be more efficient, would help to reduce waiting lists in the public sector and would improve the quality of care for the benefit of all. Let’s try, they say, this new approach.
In Health Inc. (Écosociété, 2024, 168 pages), political scientist Anne Plourde, researcher at the Institute for Socio-Economic Research and Information (IRIS), pulverizes with passion and rigor, with supporting studies, the claims of supporters, particularly the CAQ, greater privatization of the Quebec health system.
Private healthcare, she first notes, is not a new idea, but a “very old model”, partly abandoned in the 1970s due to its failure to treat the population. This model continues, with the same inefficiency, monopolizing 25.8% of total health spending in Quebec.
The private sector still reigns in non-medical care – dental and eye care, psychology, physiotherapy, accommodation, home care – and is even carving out a place in medicine. In 2021, each Quebec household spent $2,897 on average on private health services. So what ? Tell that to the 36% of Canadians in the poorest quintile of the population who have had to give up going to the dentist because it costs too much.
Private healthcare does not reduce the overall bill. The American system, for example, “is the most expensive in the world” and yet it ranks among the bottom of rich countries in terms of efficiency. The explosion in its costs is explained by the high administrative costs of private insurance, by advertising expenses and by the profits returned to shareholders, all inseparable elements of the private model.
We might say that these criticisms are aimed at the private-private model and that the model favored in Quebec, which combines public financing and private provision, escapes these excesses. Plourde refutes this objection. Publicly funded surgeries performed in private clinics cost more than those performed in hospitals.
Furthermore, they do not help reduce waiting lists since they do not add new services, but only move them from the public to the private sector, thus stealing manpower from hospitals. Worse still, the quality of care provided by the private sector is of lower quality and is accompanied by an increase in the avoidable mortality rate, as studies carried out in Italy and England have shown.
We often imagine that the famous family medicine groups (GMF) are fully dependent on the public, and their dysfunction makes us believe in the latter’s ineffectiveness. However, Plourde explains that this model is also based on private provision – doctors are independent entrepreneurs – with public funding and that it fails to fulfill its promises. Some GMFs even subcontract their evening and weekend service hours to hospital emergency services!
GMFs had to promote access to a doctor and relieve emergency room congestion by offering extended opening hours. The result was a failure, despite heavy public funding.
In health, Plourde concludes, the private sector is not the solution, but the problem. It is therefore urgent instead to deprivatize health services by repatriating the workforce to the public and making doctors employees of the network. It will be expensive, you think. Yes and no. Each household will now give to the public network the almost $3,000 it pays annually to the private sector. It will be more efficient and more equitable.