Here's my hypothesis on why Jean Charest ordered a report on health-care financing only to have his health minister shoot it down like an enemy plane.
The report was ordered in June 2007. Charest's minority government was facing Mario Dumont, who had just become leader of the official opposition and was seen as the premier-in-waiting. The media were full of musings on voters shifting to the right.
This created what I called the "adéquisation"of Quebec politics, with Charest cozying up to Action démocratique policies. So it was no surprise when the premier called on Claude Castonguay, an advocate of user fees and private health-care services and insurance. He was a shoo-in to produce an ADQ-clone report. Predictably enough, Dumont just called the report the best thing since sliced bread.

But things have changed since 2007. The ADQ is in trouble and Charest is in better shape. This pro-business report was too hot to handle. Health Minister Philippe Couillard was thus sent out to sound like he was shredding it. But did he really?
The fact is that private health care has been on the rise in Quebec for a decade and nobody's stopping it. The Parti Québécois created the conditions for it when it weakened public health-care with its zero-deficit policy. Since 2003, the Liberal government has turned a blind eye to the growing number of privately paid-for services and tests.
Result: Quebec is now the province with the highest rate of private health-care spending, at 30 per cent. The Gazette's Aaron Derfel also reported that while the public sector is short 800 family doctors and 650 specialists, the number of doctors who have gone private has tripled in the past 10 years. Meanwhile, Ontario stopped allowing doctors to opt out of medicare in 2004.
Who hasn't been told by a doctor to get a test done in a privately run clinic where you pay out of pocket or through private insurance? Some family doctors ask first-time patients for a battery of tests to be done privately for $500 to $1,000 before they'll even see them.
Yesterday's Globe and Mail reported that Quebec, in violation of the Canada Health Act, refuses to give Ottawa its data on extra-billing or user fees. Ottawa has turned its own blind eye by refusing to penalize the province for this. Like the three monkeys, nobody sees, hears or says anything. It is no wonder private care flourishes in Quebec.
In fact, the three major parties either advocate more private care or ignore it, while professing support for the public system. Pauline Marois's own silence on the Castonguay report said it all.
Even Couillard couldn't fake it that well. He said he wanted a "dialogue" on a user fee based on revenues and use of services, he was open to privately run hospitals and allowing doctors to move between the private and public sectors under certain conditions. His Bill 33 could also extend private-insurance coverage to a number of surgeries through a simple change of regulation.
He also said a final no to the only equitable way to finance public health better: increase the sales tax. This government cut income taxes by $900 million and now gives up $1.5-$2.5 billion a year if it took back one or two of the GST points that Ottawa vacated. But isn't money what is needed to train, hire and give better conditions to more doctors and nurses, and to get better technology, more home and long-term care?
By saying no to the tax revenue that would strengthen public health care, it means the private sector will be called upon more and more. Keeping the public system starved of cash also scares the public into wanting more private services. It's called agenda setting.
The private sector is persevering. It knows that profit-based medicine will continue to grow here as governments and political parties fail to protect public health care and voters are told the public system can't do the job without even more private services.
Future generations will pay a very dear price for that.
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