The newspaper yesterday published a punchy text by Dr. Yves Lamontagne. Formerly president of the College of Physicians, author of a few hard-hitting books on health and society, the author brings a refreshing look at the Dubé reform.
Doc Lamontagne starts from a few simple observations to describe the evils that plague our health system. First, the scale of the bureaucracy. The comparison with Sweden strikes the imagination. Quebec has almost three times as many non-care workers as Sweden, despite a slightly lower population.
The finding is not new, but over the years and the accumulation of problems, we end up forgetting it.
A heavy bureaucracy and often far from the field, moreover. Since the Barrette reform, there was no longer the presence of a management in each establishment. A blunder hard noted during the pandemic, and which will be corrected.
However, it would be a mistake to conclude that there is a lack of administrative staff in the network. Poor distribution, lack of accountability, OK. But international comparisons show that our system is expensive, particularly because of the cost of its bureaucracy.
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Loss of innovation
Dr. Lamontagne highlights another problem related to bureaucratic red tape: the loss of innovation. By definition, innovating means getting out of the norm. However, bureaucracy consists of the most uniform possible imposition of binding standards. Heavy bureaucracy enforces its standards with an even tighter straightjacket.
Without innovation, no SME might prosper, grow and stand out.
Bureaucracy also stifles initiative. Combined with rigid collective agreements, it tends to penalize efficiency. The model employee does not innovate or surpass himself. It stays in frame and does what is required, period. No more, no less, no better.
The most disturbing part of Yves Lamontagne’s shock text is his analysis of the forces involved. “David versus Goliath”.
Power struggles
Minister Dubé small once morest colossal forces of inertia. Despite a majority and stable government.
The considerable experience of veteran Lamontagne leads him to a certain pessimism.
Can certain trade union organizations or the Federation of Medical Specialists sabotage the success of any reform in the defense of their corporate interests? I hope not.
What scares me the most when analyzing these power struggles in major public services is the user’s weak position. In the capitalist economy, the customer has a certain power. In the case of a restaurant, store, or cell phone provider, the dissatisfied customer can take their dollars elsewhere next time. If everyone leaves the negligent trader, he will quickly be taken out of the picture.
Faced with a state monopoly that offers an essential public service, the citizen has a very weak balance of power. The great showdowns are being played out above our heads.
Elected officials from all parties need to keep this in mind and stand on the side of the patient when working on reform.
