Robert Libman: Quebec health reform too critical to ram through

The government must learn to listen to all stakeholders instead of rushing ahead with a bureaucratic, one-size-fits-all approach.

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Two more people died in an overcrowded emergency waiting room last week, this time at the Anna-Laberge Hospital in Châteauguay. 

It’s no secret our public health care system is in urgent need of reform. In yet another poll this week showing François Legault and his Coalition Avenir Québec in free fall, the inability to improve the health care system and education was cited as the No. 1 reason for dissatisfaction toward his government. 

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Successive Quebec governments have tried various ways to reform or improve the system, including the Parti Québécois in the early 2000s with Legault briefly as health minister. Several former ministers were doctors; some were social workers, educators or administrators. They all had ideas about how to restructure the network or address specific problems, sometimes with radical changes. But we’re still in dire straits.

If money was unlimited, many problems would likely be solved. But it isn’t. So the challenge is to get the most out of what we have, as effectively as possible. But how?

It’s now the turn of Christian Dubé, the current health minister, to try to figure that out. As a chartered accountant with a diverse business background, his proposed approach is unsurprisingly along the lines of a business model. In March he presented Bill 15, which he boldly warned would “shake the health system to its foundations.”

The bill creates a new Crown corporation — Santé Québec — to take full operational control of the health care network. The Health Ministry would focus on establishing general orientations. Dubé affirms the reform would “make the system more efficient and provide Quebecers with the health care to which they are entitled, improving access to services and offer a patient experience that meets what Quebecers deserve.”

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That’s bold and lofty rhetoric. But verbiage doesn’t mean it will happen, as we’ve seen over and again. Running certain government services like a business to maximize economies of scale or through an arm’s-length Crown corporation can be an interesting approach when profit is king. But the health care system is far more interactive and intricate on a human level than, for example, Hydro-Québec.

Under a massive new entity, run by unaccountable bureaucrats in an office somewhere, end users on the ground easily become invisible. In many communities, particularly in Montreal, where institutions might have more diverse characteristics and users, the one-size-fits-all model won’t work. 

Millions will be spent to install Santé Québec’s management. We know what invariably happens when Quebec creates new bureaucracies. Bloat infiltrates the system and we end up paying far too many people who have nothing to do with front-line health care services. As most professionals and even six former premiers have warned, the merger of institutions under Santé Québec risks delivering the opposite of efficient service.

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If this government hopes to slow its downward spiral, it must show it is capable of listening. Given his poll numbers, the only good news for Legault is that a general election is still three years away. One need only look at how the PQ was languishing 12 months ago to understand how fortunes can change by 2026.

Second mandates are difficult for governments everywhere now. Focusing on improving health care could be a catalyst for a reversal. But to be given the benefit of the doubt, it must be done right — with buy-in and collaboration of all stakeholders. This includes putting priority on resolving contract negotiations with workers in the field over adding a multitude of 9-to-5 pencil pushers. 

The government’s offer to extend the National Assembly session by a few days to better study Bill 15 falls woefully short if it wants a reform that is not destined to fail and that, ultimately, will prevent more deaths in waiting rooms.

Robert Libman is an architect and planning consultant who has served as Equality Party leader and MNA, as mayor of Côte-St-Luc and as a member of the Montreal executive committee. He was a Conservative candidate in the 2015 federal election. X @robertlibman

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