The Quebec health care system is collapsing. In response to this crisis, the CAQ government has just proposed a reform to the healthcare system. Its solution? To pay businessmen to run a new agency that will manage health care like a private company. This reform will not solve anything and will only make the current problems worse. The system needs massive reinvestment and significant improvement in working conditions to stop the hemorrhaging of staff. This reform will not solve anything and will only make the current problems worse
The ‘top guns’ of the private sector
The proposed reform, spearheaded by the Minister of Health and Social Services, Christian Dubé, takes the form of a mega-bill—Bill 15. Its stated aim is to make the healthcare system “more efficient”. Reading between the lines of the thousand or so articles contained in the bill, a few provisions suggest the real intention behind the reform. Bill 15 will create Santé Québec, a new government corporation—like Hydro-Québec and the SAQ—with a board of directors and a CEO. François Legault has even described the new agency as “Hydro-Santé”. These existing public corporations are run like private companies, generating profits and crushing the unions that work there, so this does not bode well.
Also very telling: Minister Dubé has said that he wants to recruit “top guns” from the private sector to run the new agency. He has just met with some 50 executives from major corporations including IBM Canada, Google Canada, Energir, Accenture, Pharmaprix, and KPMG to get their recommended candidates. He even says he is prepared to “break out of the current compensation framework” of the Department of Health—a nice euphemism which really means that these capitalists turned bureaucrats will be paid even more handsomely, at taxpayers’ expense, than senior public servants. This is not surprising coming from a government in which one-third of the ministers are businessmen and women, including Dubé.
It is hypocritical for Dubé to talk about the need to “go outside the current pay scheme” to attract the best entrepreneurs for this proposed corporation. Why not apply the same logic to nurses and health care workers in general? Wouldn’t that keep “top gun” nurses too, instead of seeing them leave the profession by the thousands? This government of bosses obviously never applies this logic to workers, for whom only wage increases below inflation, mandatory overtime, and ever more suffering are on offer.
The government presents the reform—managing our public services like private companies— as a “cultural shift”. We can already foresee what will follow this shift in culture. If Quebec’s health-care system is managed by businessmen who only think about money, they will have free rein to help their private sector friends profit by continuing to privatize health care, to the detriment of accessibility and quality of care.
A more ‘flexible’ workforce
This umpteenth restructuring will not be much different from the previous ones; it will be a simple displacement of bureaucrats, which will not change anything in terms of services offered and will not make anything better for patients. Yet the Legault government is trying to portray Bill 15 in a positive light to better sell it. Its selling points, though, do not stand up to scrutiny.
One of the important changes concerns the issue of seniority. With the creation of Santé Québec, integrated health and social services centres (CISSS) and integrated university health and social services centres (CIUSSS) will be abolished. Day-to-day management will be handed over to Santé Québec, with the Ministère de la Santé remaining responsible for general guidelines. With the abolition of the CISSS and CIUSSS, Santé Québec will become the sole employer. This will unify seniority at the provincial level and allow employees to move to another region and have their seniority recognized, which was not possible before.
But what appears to be a “sweet treat” for workers is actually a poisonous one. Without the constraint of localized seniority, the government will be able to move staff at will from one region to another, creating a “mobile staff bank”. Legault says that “we need to look for more flexibility, for example in scheduling”. His goal is to turn health care workers into mere pawns that he can move around the province at will.
His support for the management of the CIUSSS de la Mauricie-Centre du Québec and their recent attacks on nurses’ schedules suggests that this kind of measure could easily be exported to other regions as well. This would be even easier under a single employer, like Santé Québec.
Moreover, as the president of the Fédération interprofessionnelle de la santé (FIQ) pointed out, this will not solve the shortage of health care professionals or reduce their mandatory overtime. She also mentions that this change in seniority could push employees to leave their region for another one, resulting in a short-term disruption of services.
In addition, by abolishing local structures and merging them under a single employer, the Dubé reform will reduce union certifications from 136 to 4. Legault explains, “There are currently local negotiations that can be blocked by local unions. We don’t want that to be possible anymore.” The government is not even hiding its intention to reduce the power of local unions in order to better attack the working conditions of employees.
In a rare bright spot within Bill 15, the government has promised to stop using private employment agencies by 2026. These private companies have become a real blight on the public system. They siphon off employees from the public system by offering them better wages and salaries, and then “rent” them out to the public system, taking a cut in the process. The public system ends up paying more in the end, while allowing capitalist parasites to enrich themselves on the backs of taxpayers. If the government keeps its promise to abolish them, we’ll say, “Good riddance!”
Whatever happens, Bill 15 will not solve the problems that created these agencies in the first place. They are a byproduct of poor working conditions in the public sector, a “relief valve” for nurses’ disgust. Nurses exhausted by the miserable conditions in the public sector are leaving for private agencies. Abolishing these agencies without improving conditions in the public sector will only encourage nurses to leave the profession altogether or to go work elsewhere.
What is striking about Dubé’s bill is how such a sweeping reform offers so few solutions to the real problems in the health care system. With more than 800,000 people waiting to see a medical specialist (a 64 per cent increase since September 2020), an average wait of 14 months, and 161,000 people waiting for surgery, the fundamental problem is not so much the management of the health system as it is the lack of resources. After years of cuts and attacks on health care workers, a regime change will not solve the problem. Yet Bill 15 does not increase health-care funding and offers only crumbs to workers to improve their working conditions. One has to wonder how a multi-million-dollar scheme to hire businessmen, at taxpayers’ expense, will retain health care workers and avoid the total collapse of the health care system.
The next step in a long process
Turning health care over to the corporate sector is another step in the long process of privatization that began decades ago. The bourgeoisie never truly accepted that workers had won a public health care system through the workers’ struggles of the 1960s and 1970s. In the 1980s, the ruling class hastened to take back the concessions made to workers by mandating the various Liberal and PQ governments to carry out massive cuts in the health care system and gradually privatize it.
In the late 1990s, Lucien Bouchard implemented the “Zero Deficit”, an austerity program that included massive cuts to the health care system, the closure of several hospitals, and the early retirement of almost 4,000 nurses. This led to a labour shortage and an explosion of wait lists. In the 2000s, Jean Charest continued the slow privatization of the health care system by allowing the private sector to cover supplementary care,promoting the outsourcing of hospitals towards private companies, and introducing a regressive health tax of $200 per person regardless of income.
A further step was taken with Gaétan Barrette’s reform in 2015 under the Liberal government of Philippe Couillard. Under the pretexts of efficiency and optimization, he thoroughly restructured the health system, giving pieces of it to the private sector, and cut hundreds of millions of dollars from hospital budgets. It is a near consensus in Quebec that the Barrette reform has been a monumental failure, causing bottlenecks and deterioration of access to care, longer waiting lists, no greater access to a family doctor, increases in mandatory overtime, etc.
Much to Dubé’s chagrin, Barrette is not hiding his joy over the CAQ’s reform: “What is being done now is expressly the continuation of what I started [… It’s a] change of culture that I initiated and was continued by Christian Dubé, and I congratulate him on it…” Barrette also claimed that the PLQ and Philippe Couillard would have prevented him at the time from creating a similar agency, even though doing so was his dream. If the Dubé reform is indeed a continuation of the Barrette reform, as all signs indicate, we have everything to fear.
The 2015 Barrette reform centralized health care management in a huge machine, a real bureaucratic monster, where employees have no control. Power was concentrated in the hands of managers who are almost never in the field and are difficult to reach. This big machine is very slow and incapable of reacting to daily situations, as information takes time to get to the top of the bureaucracy before coming back down to the workers—not to mention that the decisions made at the top are often disconnected from the reality on the ground. The Dubé reform will not solve the problems caused by bureaucratization, but will simply perpetuate them.
One would have to be very naive not to see that the CAQ’s reform is part of the same process of progressive privatization of the health care system that Quebec’s bourgeoisie has been engaged in since the 1980s. Successive governments have made massive cuts to the public health care system to make it inefficient and ineffective, in order to better sell the idea that the private sector is more efficient. They have cut jobs and forced staff to work overtime in difficult conditions for stagnant wages, leading to mass departures. As services were affected, governments justified transferring them to the private sector to ensure supply. Bill 15 is a further step in this direction.
Health care under capitalism
With the dismal state of the health care system, just about everyone agrees that things need to change. This is reflected by a recent poll showing that 40 per cent of Quebecers think private care would improve the health care system, while 38 per cent disagree. This should not be surprising. The public system is indeed in tatters, and many people feel that things can’t be worse with private care. The CAQ will no doubt exploit this sentiment to demonize anyone who opposes Bill 15.
But this collapse is the result of sabotage by successive governments at the behest of the bosses. The capitalist system is in crisis everywhere, and the crisis is forcing governments to implement austerity and to cut public services, under pressure from the big banks and corporations that seek only to maximize their profits. In the absence of a clear explanation that connects the crisis in health care with the crisis in the capitalist system, the idea that privatization can be a solution may gain popularity by default. The whole history of the destruction of the welfare state, in Quebec as elsewhere, shows that turning services over to the private sector leads to a deterioration of those services, as well as to a higher bill for the working class.
The response from the unions, however, has been disappointing. Union leaders do not seem alarmed by the Dubé reform, expressing only mild irritation that seniority will be unified across Quebec, which could lead to departures from their local union base. This is far from the correct approach. Of course they should not demand that nurses be confined to their workplaces, but they should still mobilize their base against Santé Québec through mass action, denouncing it for what it is: a step closer to privatization. The current negotiations of the common front offer the possibility of adding the withdrawal of this reform to the existing demands, and of going on strike if necessary. If they wait until Bill 15 is implemented before they react, it will probably be too late.
In any case, so long as the labour movement does not have the perspective of fighting the capitalist system, our health care system will waste away. The only way to prevent the destruction of our health care system is to put it under the democratic control of the real specialists in the field: the health care workers. Only then will it be possible to massively fund the health care system and offer universal coverage, while also abolishing mandatory overtime and improving working conditions, thereby solving the staff shortage. But neither the bosses nor their representatives in the CAQ will hand control of society over to the workers. Workers must organize to remove them from power.