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The myth of a 'Canadian' health system
NATIONAL POST
November 3, 2006
by Antonia Maioni
One of the most pressing challenges for Quebec in the 21st century is health care. Though the issue has become a lightning rod for
intergovernmental tensions in Canada, the debate over health reform in Quebec is foremost a debate about the relationship between
Quebec's state and society.
Before he arrived in Ottawa, Pierre Trudeau held up the social-democratic impetus that led to universal health care as an
example of why Quebecers should be open to the Canadian left.
Quebec was the last province to introduce hospital insurance (1961). It was also one of the last to introduce medical insurance,
in 1971, under the federal cost-sharing program. But this time the delay was for different reasons. Health care was considered part of a
larger tableau of social reform in Quebec, from education to culture and labour training. The 1971 health and social services law put in
place a distinctive health care system that included "global medicine" as part of an integrated system of services. Arguably, it was the
most "public" health care system in Canada.
The sentiment of a Canadian health care system, or of a link to Canadian identity through it, was never a rousing force in Quebec.
The Canada Health Act of 1984 was contested by successive Quebec governments because it was a unilateral imposition of central norms.
Attempts to co-ordinate national strategies or to ascribe "Canadian values" to health care reform (as with the Romanow Commission) have been
resisted in Quebec.
The term "fiscal imbalance" originated in Quebec, in part as a way of labelling the problems of federal transfers to the province, most notably
in health-care spending. In 2000, the Quebec government commissioned a study of the fiscal relationship between Quebec and Ottawa. In Quebec,
the imbalance issue was not primarily about equalization, but rather about the transfers of cash and tax points that Quebec needed to fund and
develop its social programs.
Last year's Supreme Court decision in Chaoulli vs. Quebec is an example of this dynamic. The case reminded Canadians of two basic points.
First, health care is a provincial jurisdiction and the discourse about the "Canadian health care system" is misleading: The Chaoulli case was
fought in Quebec courts over Quebec's health care laws, and the court's judgment was focused on remedies within provincial competencies. Second,
a national institution -- the Supreme Court -- can have an important voice in shaping its reform trajectory, though the court referred to Quebec's
Charter of Rights and Freedoms rather than the Canadian Charter.
In Quebec, the decision -- invalidating the ban on private insurance in Quebec's health care legislation -- became a lightning rod for those on
both sides of a wider societal debate about the role of the private sector in health care.
Health policy in Quebec can be characterized by Robert Bourassa's idea of "a Quebec that is master of its choices." The key point is that
Quebec is choosing the direction of health-care reform based on societal choices and economic realities, rather than having change imposed
from Ottawa or elsewhere.
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