One thing the current Quebec election campaign has in common with most other provincial contests is the importance of health care. Here, as elsewhere, the fate of the system remains a potent and salient electoral issue.
In Quebec, doctors have a strong role in partisan politics. Jean Rochon, a public-health specialist, was a key player in the reform of Quebec’s health-care system in the 1990s as the Parti Québécois minister of health and social services. Neurosurgeon Philippe Couillard steered the health file during the controversial Chaoulli Supreme Court ruling in 2005. Before he left politics, many saw him as a potential successor to Jean Charest.
Now, a new player has been added to the mix: radiologist Gaétan Barrette, running for the upstart Coalition Avenir Québec. For a party that promised a raft of “star” candidates, Dr. Barrette’s nomination, along with former anti-corruption leader Jacques Duchesneau, gives the CAQ impressive public recognition.
Dr. Barrette is already a well-known figure. As head of the Fédération des médecins spécialistes du Québec, he is the spokesperson for close to 9,000 specialist physicians. The group has a long political history: It led the strike to protest medical insurance in 1970, and has had repeated conflicts with government over fees and extra-billing ever since.
Dr. Barrette’s high profile, and the fact his leader François Legault is a former PQ minister of health, does not make the CAQ’s position on health care any more lucid. His raison d’être for entering the electoral fray – so that Quebeckers can “get their money’s worth” from the health-care system – is a laudable one. But the doctor’s prescriptions are remarkably, almost painfully, simple. Problems with access to family physicians? Assign a doctor to every Quebecker. Imbalance of distribution between family medicine and specialists? Pay the family docs just as much.
There is no question that a big part of Quebec’s health care woes stems from organizational problems. Dr. Barrette's description of “bureaucratic hell” is probably apt in some areas of the system, and a more rational distribution of diagnostic testing would help. But importing a roster system without tackling reimbursement (in Britain, for example, this is based on capitation rather than fee-for-service payment) is not the best solution. Nor would his proposals conform to the spirit of freedom of choice for patients and professional autonomy for physicians that underlie the health-care system. Moreover, raising fees for GPs to specialist levels would hardly do much to control costs in the system, unless Dr. Barrette really does intend to advocate reducing specialist incomes.
The more troubling aspect of the CAQ’s health platform is its populist undertone, which is characteristic of the party’s campaign rhetoric. In addition to these impractical solutions for health care, the CAQ is promising to reduce taxes for the middle class – a whopping $1.8-billion worth – through abolishing school boards, health agencies and massive cuts to Hydro-Québec. And to top it all off, adopting a “9-to-5” school schedule, which would create even more organizational chaos.
The CAQ is gaining resonance as a third party advocating change and fighting corruption. But if issues such as health care are as central in the voters’ minds as polls seem to show, Quebeckers would be well advised to take a second look at the new party’s far-from-compelling proposals.