So, Dr. Couillard, if not this, then what?

Commission Castonguay

Doctors, they say, bury their mistakes, and this week Dr. Philippe Couillard, Quebec's health minister, was hard at work with his shovel, getting rid of some wide-ranging proposals about health-care financing. The government's mistake, it seems, was to ask hard questions while unwilling to face the inevitable hard answers.
To be sure, not all the proposals in the report on paying for health care, delivered by a study group headed by former health minister Claude Castonguay, deserve approval. Castonguay exceeded his mandate (which was about financing) in some proposals, tried to finesse the realities of the Canada Health Act in others, gave no quarter to the demands of political prudence in others, and endorsed the obvious in still others.
Still, Castonguay's report, for all its imperfections, has at least the redeeming virtue of confronting the problem. But Couillard accepted only one of the proposed real changes, and that acceptance was so hedged about with conditions as to be meaningless: We'll let MDs work in both the public and private sectors, Couillard said, only after there are enough doctors, only if it means no problems on the public side, etc. etc. As with Lucien Bouchard's "winning conditions" for a referendum, this is a road map for inaction.

In a short-term way, that's easier than upsetting the hornet's nest of interest groups who think "private" is a dirty word. But it ignores the reality of a rapidly-growing private-clinic sector, and amounts to hiding from the problem.
Couillard did, also, promise to look at some common-sense proposals about how hospital budgets are set, about the role of regional health boards, and about best practices in hospitals.
But to Castonguay's main financing proposals, the meat of the report, Couillard just said no.
If he had waited long enough to be polite, even, the other political parties might have been canvassed in hopes of some kind of consensus. But Couillard didn't wait.
That's his right; he's the minister, after all. But now he, other ministers, and Premier Jean Charest are going to have to solve this problem some other way.
There's an elephant in the room, and it's eating everything. In 1980-81, Castonguay's report reminds us, the health portfolio consumed 30.6 per cent of all government program spending. This year, 2007-08, the figure is 44.3 per cent. And the growth of health's share of program spending is speeding up. This fiscal year Quebec will spend $10.1 billion more on all programs than it did in 2002-03; of that increase fully $6 billion goes to health.
On and on the monster rampages, devouring everything in its path: Between now and 2018, government figures say, health-care costs will rise by 5.9 per cent per year, well above even the optimistic estimate of 3.9-per-cent general economic growth (and government revenue growth.) Our prescription-medicine insurance plan's costs will grow even faster, at 11 per cent per year. And total payments to doctors - we need more MDs, remember? - will jump by 7.5 per cent a year. The monster wants more.
In truth our health-care system is not a monster. We're getting a lot for our money: Quebecers, and all Canadians, live longer, more active, more fulfilling lives than ever before because of the numerous advances in medicine, diagnostics and pharmacology.
But nobody doubts that our system is inefficient. There is, as Castonguay says, real incoherence in what's covered by medicare, and what's not, for example. And nobody denies that it costs a fortune. And why, he asked again yesterday when he met our editorial board, is there no system for evaluating hospitals' performance?
Relentlessly, costs keep climbing. Where will this all end? The gap between 5.9 per cent health cost growth and 3.9 per cent GDP growth demands an extra $2.8 billion by 2012-13, rising to an additional bill of $7 billion a year by 2018. Nor will the problem end then: Older people use more health care, and our population is aging rapidly.

Some claim those government estimates are suspect. But the rapid growth of health spending until today, and our demographics, point in only one direction: Costs will keep growing more rapidly than the economy as a whole.
Something has simply got to give. The diagnosis is clear, the prognosis alarming. If Castonguay's pills and potions are not acceptable to Couillard and Charest, then they need to reach into their black bag and pull out their own plausible, sensible course of treatment. Quebecers are waiting, and worrying.
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