Is 50% of Quebec spending is directed towards healthcare? It's true, if you turn a blind eye to just how that number was calculated. Were we to be a bit more nuanced and honest regarding "healthcare costs", we would come to a figure between 33% and 34%. We would realize that compared to the size of Quebec's whole economy, Quebeckers' healthcare spending increases at a rhythm which is far from unsustainable. In the end, we would realize that the increased spending is not necessarily what we make it to be.
IRIS published a study last week which brings attention to nuances that should be taken into account when we consider the future of healthcare and social services in Québec.
Last week, both the government and the opposition starting singing to their usual tune. The PQ spokesperson on healthcare, Diane Lamarre, insisted for instance that it now eats up "half of Quebec's budget". If she had chosen to make a more exact statement, she would have said that "the envelope granted to the Healthcare and Social Services portfolio makes up close to 50% of Quebec's government program spending".
That isn't the same statement, and it's a conscious choice.
Firstly, if we were to remove "social services" spending from the equation, we would be subtracting 12% of the total.
If we were then to take all the budgetary spending to evaluate the size of healthcare spending (therefore if we also included debt service), healthcare spending's share would shrink to 38% of Quebec's budget.
If we were to continue and consider spending by the Healthcare and Social Services Department (MSSS) in comparison with the whole of Quebec government operations, the total would drop below 30%!
Hence, just like for national debt, there are many different ways to come up with a number… and many ways to manipulate the information along the way.
It makes more sense to compare healthcare spending to the size of the economy (GDP). Surprise, surprise! Government spending is relatively stable: 8.7% of the GDP in 2009, slightly over the 7.4% historical average since 1981.
And if we were to take only spending dubbed "hospitals and doctors" —i.e. that for which the state acts as a single payer, making that portion of spending easier to control—, it has slightly decreased over 35 years compared to the GDP, down from 5.1% to 4.8%.
The pupil and his master
When he passed Bill 10 in mid-February, Minister Barrette knocked the wind out of the healthcare system which —it's worth remembering—was a cornerstone of the Quiet Revolution.
Philippe Couillard started undermining the system in 2003 when he himself was Minister of Healthcare and Social Services. The pupil has now surpassed the master. Barrette completed the dirty work with the little regard he has been known for others' opinions. And with a gag order to top it all.
In short, we could say that the centralized healthcare system which the population inherits after these mega-mergers reflects Gaétan Barrette's bulldozing tactics in implementing these transformations: simply anti-democratic.
The Minister tells us the reform will bring savings, but nobody believes him. And rightfully so. Hyper-centralization which removes socio-sanitary administration further away from populations creates all the necessary conditions for waste ensuing from the inadequate understanding of actual needs as well as poor allocation of resources which brings about the dangers of regional disparities.
In contrast with what we often hear, the government of Quebec just might have broken what so far made it possible to maintain a certain control over healthcare costs.
This article was written by Guillaume Hébert, a researcher with IRIS—a Montreal-based progressive think tank.