When a commission report comes
out these days — any kind of commission, but especially
those dealing with healthcare — the actual content
appears far less interesting than the political motives
behind it. The Charest government in Quebec knew in
advance what it would get from the working group on
healthcare financing headed by Claude Castonguay (see
page 22): more private involvement, increased revenue
sources and devolution of power away from the provincial
government.
The net result is akin to holding
an election on healthcare issues, without actually having
to put your party's lead at risk. What can we get away
with, and what will cause irreparable damage to our
popularity? The consensus model cleverly forced the
opposition parties to state their objections clearly,
while the governing party was able to pick and choose
which recommendations to support after the dust had
settled. Judging from Health Minister Philippe Couillard's
dismissal of so many of the report's recommendations,
there was a lot of dust — especially on the issues
of private sector expansion and increased expense to
the population through either higher sales taxes or
some form of user fee.
Dr Couillard was less categorical
about the recommendation of most direct concern to doctors:
their ability to work in both public and private healthcare
provision. And this is the one recommendation where
the cost effect is described as fairly neutral in the
report.
Both Dr Couillard and Mr Castonguay
have clearly got the message from doctors that they're
tired of the restrictions on the way they practise.
To head off an MD mutiny — and thus keep the health
system alive — Quebec's government must figure
out the best way to peaceably liberate them. —
Susan Usher, Health Policy Editor
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