A prescription for healthcare

As the new Couillard administration prepares its agendas, let’s put some pressure on to make sure it gets healthcare reforms right. Health Minister Barrette knows the score. He knows what needs to be done. We must press that the government to have the political will to do it.

As the super hospitals come close to opening, we must be honest as a society and realize that they cannot succeed. The plans were based on the thesis – a correct one - that most people can now be treated on an out-patient basis if enough equipment – enough as to quality and quantity – is obtained. People would do better.

But what has happened in the years since the plans for the hospitals, is that the monetary cupboard is bare. There is no money for the state-of-the-art equipment envisioned in the original initiatives to compensate for the cuts in beds by a third. And the lack of funds is not simply due to the alleged corruption in the construction of the hospitals. That is a pittance compared to the groaning and overriding problem that saps the strength out of  our budgets. Our groaning leviathan of bureaucracy is the crippling factor.

Quebec is the only political jurisdiction in the western world where over 50% of the people paid in the healthcare system are bureaucrats who have nothing to do with the delivery of medical care or the operation of hospitals. They make the lives of medical professionals miserable with their tables and restrictions and grey-card protocols. Even France’s system – upon which so much in Quebec seems to be modeled – has a bureaucracy making up only 36% of the healthcare workforce.

No government, regardless of party, has ever had the courage to make the needed cuts for one simply reason. Fear of taking on the unions who represent the bureaucrats. Well, as we face the prospect of hundreds – if not thousands – of needless deaths as the super hospitals come on stream, the state will have to make a vital moral decision: stay silent for votes, or cut the bureaucrats and free up the money needed for the equipment to handle out-patient care. Much of the next decade of all our lives, and the legacy of a government, will rest on this decision.

There are other problems too that could be solved by freeing up the bureaucratic dollars, particularly funding the smaller hospitals we still have and giving them their needed compliment of medical staff. We wouldn’t send children to be educated as far as we send the sick to be healed. Some 80 percent of our medical institutions are concentrated in a very small area in the centre of Montreal. It is vital to keep local hospitals robust. Lachine, LaSalle and Lakeshore not only serve important community needs but are excellent medical settings. As much as people do better as out-patients, they also do better in smaller institutions. The closing of hospitals like the Reddy Memorial and the Queen Elizabeth have been demonstrable, disastrous mistakes. Instead of super-hospitals, we should have used existing, empty infrastructure to build at least a half-dozen local medical facilities across Montreal island. Institutions of human scale that treat patients as whole individuals and not just cogs in an overburdened machine. 

Doctors need to be treated better as well. They need to have the fullest opportunities for professional fulfillment. The PQ’s forced retirement of so many doctors in the late 1990s  was a blow from which we have still not recovered. The requirement that medical graduates serve several years in rural areas chases many out. And the salary caps are sending too many out of the province ass well.

We need to give our doctors incentives and make maximum use of them through an understaffed system. Ontario has a central referral registry that allows hospitals to share specialists when they are short. Quebec needs to implement that system. As much as we want to protect the public healthcare system we must realize that we need satisfied healthcare professionals to stay and make it happen. It is time to consider the French system where some 20 percent of the time doctors give to the state system, they can use for private work in their own clinics or private practices. We also need to loosen requirements for admission for healthcare professionals from western countries. 

This past year alone, some 25 percent of Montreal’s medical school grads – Quebec grads - announced they would be leaving the province. And the stats don’t change much whether they are English or French. Canada as a whole needs 2,500 new medical graduates just to keep up with existing demands. We’re only graduating 2,200. Yet one stark figure stands out in relief. In Quebec there are more non-frontline personnel in our healthcare system than doctors or nurses. It is a bureaucracy gone mad that merely perpetuates political power and does nothing to relieve suffering. And we’re paying for it. When you look into the problems, the solutions jump out at you. It merely takes the political will to do it. And the courage to admit past mistakes and talk straight to the people.