Barack Obama's health-care victory was greeted in Quebec with banner headlines and genuine pleasure. At long last, this bill signals the end of the terrible injustice that left millions of Americans without health insurance. On the dour Canadian political scene, the U.S. President has, to a certain extent, been adopted as a folk hero.
His ascent to the presidency, with its potent mixture of emotion and symbolism, has been more passionately followed in Quebec than any recent federal or provincial election. People rejoice at good news coming out of the White House, while feeling disappointed when Mr. Obama doesn't seem able to deliver what he promised, especially on international issues.
As La Presse columnist Vincent Marissal noted, "This President had a real 'collective project,' something that hasn't been seen in Canada since the 1988 free-trade deal. … Is there a Canadian politician who would put his head on the block like Obama did, to push for a project that's more important for him than his re-election?"
Still, some had an entirely different perspective, based on legitimate national self-interest. Hours after the Democrats squeezed the health-care bill through the House of Representatives, I received an e-mail from a physician. "For us," he said, "this reform will be a tragedy: Where will the United States look for the doctors and nurses needed to take care of the 32 million Americans who will now enter the health-care system?"
Obviously, American hospitals won't be recruiting their health professionals in Liberia or Iraq. Canada is the ideal pool. It's next door. Its doctors and nurses are trained to the same standards. Moreover, many Canadian specialists did their postdoctoral studies in the United States. Moving there might be tempting: The salaries are higher, the taxes lower, and many hospitals are equipped with state-of-the-art technology.
For the Americans, it will be easier and much cheaper to recruit Canadian health professionals than to increase the number of students in their own medical and nursing faculties. It takes 12 years to train a top-notch medical specialist, and highly educated and experienced nurses are hard to find. France looks for them in Spain, the Swiss recruit them in Quebec and, in the Philippines and the Caribbean, young women know that the key to a work visa for the country of their choice is to become a nurse.
Of course, the possibility of a brain drain in the health sector concerns the whole of Canada. But Quebec is especially vulnerable because its doctors and nurses are particularly exasperated with their working conditions. Quebec's medical specialists are paid less than in most other provinces and, because of reduced budgets and the lack of specialized nurses, their time in the operating room is so limited that some of them are afraid of losing their skills. A number of them have already left for Toronto or Western Canada. Nurses are overworked and abandon hospital work for private agencies, where the salaries are higher and the work schedule more flexible.
Montreal's old hospitals are in a sorry state, with their overcrowded emergency rooms and their facilities in dire need of renovation. Construction of the two state-of-the-art university hospitals that were initially supposed to open this year hasn't started yet. Because of the many delays arising from political squabbling and managerial incompetence, nobody knows when the new Centre hospitalier de l'Université de Montréal (CHUM) and the new McGill University Health Centre will open their doors.
Asked when the future CHUM would open, a young doctor, attached to one of CHUM's decrepit hospitals dating from the middle of the 19th century, said she's not sure she'll see it in her lifetime. She's 35. And she was only half-joking. The morale of the best doctors and nurses is sinking. If things don't change, it wouldn't take much incentive to persuade many of them to move south.
Lysiane Gagnon