Quebec Health Minister urges talks on limits of public health care

A frank public discussion about the limits of publicly funded medicare and the restrictions placed on private health care is long overdue, Quebec’s Health Minister says.

“Should the Canada Health Act remain as is?” Gaétan Barrette said in an address to the Canadian Medical Association’s 150th annual meeting and general council. “That’s where the challenge lies.”

Dr. Barrette criticized Ottawa for its “contradictory messages,” saying the federal government limits its financial contribution to health care while at the same time punishing provinces that seek other sources of financing, such as user fees.

“If we can have a viable health system and fund everything publicly, I’m all for it,” Dr. Barrette said. “But can we really afford that, universality for everything?”

Speaking to reporters after his talk, the Quebec Health Minister stressed repeatedly that he was not calling for the Canada Health Act to be reopened, nor is he advocating more private health care, but simply citing that as an example of the uncomfortable discussions that need to take place.

“I’m not taking a position, I’m asking a question. I’m saying we need to have broad societal debate on this important issue,” Dr. Barrette said.

In recent years, Quebec introduced user fees for some “medically necessary” services, but then reversed the decision after the federal government threatened to claw back the monies raised.

At the same time, Ottawa allowed Saskatchewan to proceed with a plan to allow private sales of diagnostic scans.

Asked if this was hypocritical, Dr. Barrette smiled and said, “I didn’t use that word but it does seem contradictory.”

On Monday, federal Health Minister Jane Philpott lauded the fact that health-funding agreements had now been signed with all provinces, and Ottawa was investing an additional $11-billion in home care and mental health. (Until then, Manitoba was the lone holdout.)

But Dr. Barrette said the federal transfers were clearly inadequate and they were take-it-or-leave it offers, not negotiated deals.

“The funding was imposed and it actually reduces the federal government’s contributions. It was a hostage-taking, but the provinces couldn’t leave money on the table,” he said.

The Quebec Health Minister also got his digs in on the controversial issue of federal tax reforms on professional incorporation, an issue that has rankled physicians.

“You are irritated by federal tax changes and that’s understandable,” Dr. Barrette said.

He added, however, that as health spending continues to climb, governments will have to make more tough choices like this one.

“They realize they need to find money, and they are taking it from your pockets.”

The Canadian Medical Association represents 85,000 physicians, residents and medical students. Its annual general council is often referred to as the Parliament of Canadian medicine.

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