Imagine: PQ fighting for Canadian symbol
Forget the predictable war of words on health care in the coming federal campaign. The eye of the medicare storm is about to move to Quebec. Within weeks, maybe days, a government white paper that charts a substantially different course for the province’s health- care system is expected to be brought down in the National Assembly. If the plan is adopted, a private stream will be allowed to operate in tandem with the public system.
Last spring, the Supreme Court of Canada ruled that Quebecers should be allowed to buy insurance to purchase privately delivered, essential medical services. The proposed response of the Quebec government involves the kind of change to the medicare mix that no active politician outside Quebec and possibly Alberta would dare promote for fear of being run out of office.
But, then, anywhere else in Canada the debate would also pit the sacred cow of medicare against that of the Charter of Rights and Freedoms.
In Quebec, medicare does not have the iconic standing it enjoys in the rest of the country. Quebecers do cherish the notion of a public healthcare system, but as an essential service, not a symbol of nationhood.
Outside Quebec, any discussion of medicare immediately raises the spectre of two- tier medicine, along the lines of the American system. But in Quebec, the model that is more likely to come to minds is the two- track public/ private system of European countries such as France. The same dichotomy was at play during the debate on the Iraq war. Quebecers who get their information in a language other than English are often more exposed to European approaches than most other Canadians.
Quebecers also tend to be more concerned with preserving the margin in which their provincial government can manoeuvre. For linguistic and cultural reasons, they have a vested interest in not letting the provincial government be reduced to a mega-hospital board by spiralling health-care costs.
For most francophone Quebecers — including federalists — the national government sits in Quebec city while the federal one operates on Parliament Hill. The two are not one and the same. On the other hand, there is no Quebec taboo on overriding Charter rights. In many quarters outside Quebec, the mere mention of the notwithstanding clause is a cardinal sin against Charter orthodoxy. But in Quebec, the Parti Québécois has no qualms about advocating a recourse to the clause to shelter medicare from the Supreme Court ruling.
In the last election, more than 60 per cent of Quebecers voted for parties that are ideologically to the right of the PQ. One- third of those voters opted for the Action démocratique, a party whose platform included moving to a two- tier healthcare system. There is a receptive audience to a different medicare mix in Quebec. The Charest government may be unpopular, but Health Minister Philippe Couillard has emerged as the most credible member of his cabinet. His name tops the list of potential replacements for the embattled premier.
On the other side of the debate, the PQ is committed to fighting tooth and nail to preserve the medicare status quo. In one of his first interviews as leader this week, André Boisclair restated his commitment to a resolutely public system.
In the next Quebec election, the PQ will have to watch its left flank for fear of losing votes to a fledging new party.
Boisclair is already suspected by progressive elements of his own mercurial party of being too conservative. He has an interest in shoring up his credentials by defending medicare.
Given those conflicting trends, the outcome of the upcoming Quebec discussion is hardly a foregone conclusion. But it is ironic that the PQ may be all that stands between Quebec and medicare as Canada now knows it. Chantal Hébert’s national affairs column appears Monday, Wednesday and Friday. chebert@thestar.ca.