Paging Dr. Layton

In his wilder dreams, the relentlessly optimistic Jack Layton may have envisaged taking political ownership of Quebec, but I'm still reeling from it. Happily, though. All the Bloc Québécois cared about was sovereignty. The NDP actually cares about ordinary people's quality of life.

The sanctity of equal-access health care is a particular NDP passion. Delivery of health care is a provincial responsibility, but Jack will now be able to exercise great moral suasion on that file here. No other province needs it more.

In Quebec, after 50 years of allegedly equal-access Medicare, Quebec is short more than 1,200 family doctors, and the situation is worsening.

A full 27% of Quebec's population does not have access to a GP. The only similarly disgraceful statistic is the sub-Arctic population at 29%. None of the other provinces comes close: The percentage of people lacking access in Alberta is 16%, in Nova Scotia 5%, in British Columbia 11% and in Ontario 8%. Toronto's lack of access is also 8% against Montreal's shocking 33%, the worst access stat in Canada.

How does Ontario keep provincial and urban access so high? In an interview, Dr. Mark Roper, chair of the department of general medicine for the Health and Social Service Agency of Montreal, ticked off the reasons for me: Even though Ontario's population is bigger, Quebec has twice as many bureaucrats per capita; Ontario offers more hardship pay to rural doctors than Quebec does; Ontario imports 20% more doctors than it graduates (Quebec is a net exporter of doctors); and Ontario doesn't require doctors to get a regional permit to practice, as Quebec does. Anyone practicing in Montreal without a permit may only bill 70% of what a doctor with a permit can -forever. Quebec limits the annual number of these regional permits to 9% fewer than that year's graduating cohort.

The shortfall of doctors in Quebec began in the 1990s when, in a paroxysm of budget-slashing, Quebec offered doctors enticing early retirement programs and created a bureaucratic labyrinth for young doctors. Each region is granted individual permit allocations, the government allots maximum numbers per region, doctors must get local permission to practice and and must execute certain "prioritized tasks," such as taking on vulnerable patients.

By maintaining strict controls over family doctor recruitment, Quebec saves half a billion dollars a year. The human cost for that savings is two million Quebecers with no family doctor. And so, a third of pregnant Montreal women don't see a doctor in their first trimester, when the need is greatest; thousands of people are unaware that they have diabetes, high blood pressure and mounting bad cholesterol; hospital emergency rooms are clogged with low-level issues a GP should deal with; and, since a full-time GP makes 2,000 diagnoses a year, mortality from all causes is up by 6% and will ensure heavy costs down the road. But these delayed costs are not on politicians' radar screen; their horizon is the next election.

One problem is that statistics (such as those above) are, as Dr. Roper puts it, "ripe for obfuscation," because few investigative journalists are trained as special-ists in health issues, or are wellinformed on data deconstruction. And because there is virtually no pressure from the media, many politicians are not particularly motivated to privilege patients' needs over cost-cutting. The result is that, in Dr. Roper's words, "Quebec is at a third-world level of access to health-care delivery."

Best of luck to you, Jack Layton. Quebec's sclerotic political arteries have been stiffening for years. I'd say you're the plaque-draining medicine the doctor ordered. If I could find one.