Behind the health care promises

>> Liberal star candidate wants more market forces in the health system

by DOMINIQUE RITTER

Promises, promises.

Election campaigns are full of them, but no one really believes them. Politicians, once elected to power, simply move ahead with whatever agenda they please.

Now Jean Charest's Liberals have pledged to do better by Quebec health care. Among their promises: suspend hospital closings, mergers and conversions; ensure 24-hour access to medical care; and inject $2.1 billion in new health spending.

But which of its promises should we take at face value? If you want to know what a Charest government would really do to health care, look at what its candidates stand for--particularly those likely to be included in Jean Charest's cabinet. And a good place to start is with star candidate Monique Jérôme-Forget.

When asked what role she might hope to play in provincial government, Jérôme-Forget replies that, for the moment, all her energy is being focused on getting herself elected. But parachuted into the Liberal safehouse of Marguerite-Bourgeoys (LaSalle), she is a National Assembly shoo-in. If her boss becomes this province's next premier, there is little question that she will find herself a cabinet minister--and her domain will likely be health care.

Princess of policy

Jérôme-Forget's cv reads like a Guinness world record for brainy overachievement. Over the last 25 years, she has sat on almost 20 different boards, including the Medical Council of Canada and Canada Life Assurance Company. She holds a PhD in psychology and has served as vice-rector of finance for Concordia University. She writes monthly columns for the Financial Post and Journal Les Affaires. But what Jérôme-Forget seems to do most is influence health policy.

For four years she was chair and CEO of the Worker's Compensation Board, managing an annual budget of nearly $2 billion and, in the early 1980s, she served as assistant deputy minister at Health and Welfare Canada. For the last seven years, Jérôme-Forget has served as president of the Institute for Research on Public Policy (IRPP), an independent thinktank. This September, she and her husband, Claude E. Forget, co-authored an IRPP proposal entitled Who Is the Master? A Blueprint for Canadian Health Care Reform, which some see as a partial privatization of the health system.

Bargain health care

The IRPP blueprint outlines a more cost-effective health-care system in which every individual would have an "annual medical budget" determined by their age and state of health. Medical budgets would be managed by "Targeted Medical Agencies" (TMAs)--clinics of 25 to 30 general practitioners--which would be responsible for providing basic care for their 10,000 to 15,000 patients. The TMAs would have full control over their patients' annual medical budgets and would be charged with finding and purchasing any extra treatments their wards may require.

By IRPP calculations, waiting lists would be reduced, patients would be treated more quickly and budgets would be slashed, all while maintaining universal accessibility to health care. But the plan would have hospitals and specialists vying for a cut of your annual medical budget, and would force them to compete much as businesses compete in an open market economy. The idea is that competition would force health-care providers to tighten their belts and focus on offering cheaper services. Your GP would become your entry point into the health-care system and your broker in search of the best deal. At the end of the year, any money left over from your "annual medical budget" goes right into your doctor's pocket as a bonus.

In an interview with the Mirror, Jérôme-Forget tried to draw a line between her work at the IRPP and her new role as politician. "There is no real link," she said. "You cannot associate a long-term proposal with the Liberals' commitment to do something tomorrow." But that line is blurred at best--especially after a reading of the Liberal party's health-care platform. Among its promises, the Quebec Liberal Party has undertaken to "give doctors the essential mandate of being the entry point to health care, either in their offices or, preferably, in medical clinics organized for that purpose" and "review the financing of establishments to introduce performance and quality incentives to better use resources."

Jérôme-Forget admits that the September 1 release of the IRPP health-care "blueprint" was timed to coincide with the provincial election (before she was asked to join the Charest team). But although the IRPP and the Liberal party may see eye-to-eye on health care, not everyone is in agreement with the "blueprint."

"The type of system they are proposing would have health care as a commodity rather than a public good," said Colleen Fuller, author of a book on health-care economics, Caring for Profit. "Their system is not going to protect universal accessibility. It undermines one of the main strengths of our system, which is public management."

Jérôme-Forget insists that nothing about the IRPP proposal spells privatization. But then again, that's just another promise.