Quebec's Tommy Douglas calls for change

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National Post, Thursday, February 21, 2008

As the father of Quebec's health care system, Claude Castonguay was so closely identified with it that for years the health card was known as the "Castonguette."

His moral authority is unique, which is why the Charest government appointed him as head of a task force to recommend changes to the province's public health care system. What Premier Jean Charest and his Health Minister, Philippe Couillard, evidently didn't count on is that Castonguay also has a well-earned reputation for being his own man.

And how. In his sweeping report to the government on Tuesday, not only did Castonguay say the system is broken and needs fixing; he announced that it's broken beyond repair.

Among other things, Castonguay recommended a $25 user fee for every visit to a doctor (exempting seniors, children and low-income families). He proposed a 1% increase to the 7.5% Quebec Sales Tax (QST), which is imposed on top of the 5% federal GST, with proceeds to go to a health stabilization fund.

He called for doctors to be allowed to practise privately as well as in the public sector, and for doctors to be allowed to use hospital facilities after hours. He called for some hospitals to be run by the private sector.

He even suggested an end to free meals in hospitals. Well, if you have to pay for a sandwich from Air Canada, why wouldn't you pay for a bad meal in a hospital?

Oh, and private health insurance should be expanded.

It didn't take long for Couillard to nix the idea of a QST increase and paying extra for visits to the doctor, above and beyond the cost on the Castonguette, now known as the carte du soleil. Couillard, himself a brain surgeon who was executive director of a major hospital at the age of 28, quickly rejected these recommendations, saying they would be seen "by the middle class as an additional tax burden."

As a politician with leadership ambitions, Couillard is not about to commit political suicide. Neither is Jean Charest, who is currently bouncing and his government quickly affirmed its support of the CHA.

But Castonguay's fundamental point is that the escalating costs of public health care -- which at 6% a year are growing twice as fast as Quebec's GDP-- simply aren't sustainable.

He also makes a lot of common sense recommendations: Why shouldn't some hospitals be run by the private sector? It's only the unions that are stopping them. Why shouldn't doctors be allowed to practise privately outside their hours in the public system? Why shouldn't there be more private insurance?

A two-tier system? It already exists in practice in Quebec. If you want a knee transplant, you can schedule it at your convenience at a private clinic in the Montreal suburb of Laval. If you can't get an appointment at a local health care clinic, you can walk into the Westmount Medical Centre on the mall at Westmount Square.

If you have a detached retina, you can see my opthamologist, the renowned eye surgeon John Chen, at his semi-private clinic in Montreal. But he performs his surgeries inside the public system at the McGill University Health Centre.

If you need to see a family doctor, though, good luck. There's a big shortage of doctors in Quebec that won't be alleviated by allowing doctors to work their own hours outside the system. But it's a start.

Oh, and if you need to see a gynecologist, you'd better be pregnant. Otherwise, the waiting time can be up to six months.

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