Système de santé et élections : des principes fondamentaux en péril

On March 29th, the CAQ tabled its proposition for healthcare reform, the “Plan pour mettre en œuvre les changements nécessaires en santé,’’ to be referred to here as the Plan Dubé. The Minister of Health and Social Services, Christian Dubé, has stated that its focus is on “relevance, efficiency and the creation of value, in keeping with principles that are dear to me and to our society: universality, accessibility, equity and quality of care [translation].” These principles drive us, and guide our own work and activism. They must serve as a beacon for all health policy decisions, large or small. Our collective humanity is at stake.

The announced reorganization is inconsistent with these fundamental principles. Halfway through the election campaign, they do not appear to be guiding the CAQ’s orientation to health reform.

Universality, accessibility, equity and quality? We’ll see…

Among its shortcomings, it should be noted that there is no provision to guarantee universal coverage for adult migrants with precarious status. While last year’s adoption of Bill 83 granted healthcare access to migrant children, what about their parents, who are at risk without access to care? What about when those children turn 18? The regularization of all precarious migrants would solve the problem of universal access to health care. Prime Minister Trudeau having instructed his Minister of Immigration to create a program giving permanent resident status to undocumented persons, the Quebec government should endorse and promote this initiative by facilitating the granting of permanent residence to all precarious migrants.

The CAQ’s stubborn denial of the reality of systemic racism does not preclude its existence in Quebec. The Plan Dubé and the CAQ’s electoral commitments fail to mention any of the recommendations put forward by the Atikamekw Nation to end the injustices experienced by Indigenous people in our healthcare system. It is in Quebec where Joyce Echaquan died, a victim of systemic racism, and the silence on behalf of the CAQ is an extension of that violence. Acknowledging and implementing Joyce’s Principles should be self-evident in any healthcare and social service reforms.

Although the Plan Dubé recognizes the importance of “reducing social inequalities that affect health [translation],” it does not propose any concrete measures to do so. How and when will marginalized populations, including 2SLGBTQ+ communities, racialized communities, unhoused and incarcerated people receive dignified and adequate care? When will people with disabilities finally get the dignified home care they require?

Privatization vs. the principles we cherish

Future generations will pay the price of the dismantling of the public healthcare system, having begun under previous governments, with the CAQ proposing to weaken it further. Our public system no longer reflects the ideal of the “Quiet Revolution”; it is a victim of two decades of neoliberal management, chronic underfunding, centralization, and senseless bureaucratic reforms. It suffers from a lack of respect and disregard for its workers, who bring all their devotion and competence to their jobs.

The CAQ’s announcements of increased privatization will have disastrous consequences for universality, equity, accessibility and the quality of healthcare in Quebec. Based on its own experience with overspending, the government knows that replacing public- with private-sector personnel is not economically sound, nor is it socially acceptable. A look south of the border makes this clear. The population deserves a 100% public system, and this requires solving labour shortages, especially of nurses, by investing in the public system first and foremost, and not the private sector.

A long way from the democratization of healthcare

Despite the fact that section 2 of the LSSSS guarantees peoples’ participation in their own physical and mental health, there is no proposal to work with marginalized communities to make healthcare truly accessible. The contemptuous way the Plan Dubé treats community organizations speaks volumes, regarding them as government resources, even though they are autonomous. As well as offering an alternative response to peoples’ needs, these organizations allow citizens to take part in the decisions that affect their health. Democratization should be at the heart of all healthcare decisions and reforms, particularly by ensuring the autonomy of community groups and granting decision making to communities and healthcare workers, as was the case in the early days of CLSCs.

A plan within a plan

In addition to inconsistencies between what the CAQ envisions for its next mandate and the values represented in the Plan Dubé, other campaign announcements will also affect the right to health. From tax cuts, to the refusal to accommodate more than 50,000 immigrants, the CAQ’s commitments will negatively impact Quebec society in general, and the funding of public services in particular. Rather than ending the dismantling of our public healthcare and social services, a CAQ government will largely contribute to it, in defiance of what we have long chosen as a society.

Arnold Aberman MD, The Caring for Social Justice Collective

Kat Stein, Health Services Director, Head & Hands