Lewis: Quebec’s health reform D-Day turned out to be Dieppe. What happened?

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The best laid schemes o’ mice an’ men / Gang aft agley
— Robbie Burns

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True that — there are few slam dunks in life and almost none in public policy. In any grand enterprise, be it building a subway or drafting a quarterback, uncertainty looms and stuff happens. But when the best-laid schemes turn out to be neither best-laid nor even coherent schemes, failure has barely to fire a shot to win the day. Exhibit One: Super Bowl 2015. Give the damn ball to Marshawn Lynch! (Look it up.)

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Exhibit Two: Quebec’s sweeping health care law, enacted on Oct. 25, 2025, a declaration of war on an unsustainable status quo. It held family doctors collectively responsible for enrolling 1.5 million unattached patients within a year. Territorial managers could assign new patients to underwhelmed practices. Fee-for-service payment would largely disappear. There would be fines for unmet targets.

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Less than three months later, it’s all over. The 1.5 million target is now 500,000, and no fines for missing it. Physician clinics will not be conscripted to serve orphaned patients deposited on their doorsteps. Fee-for-service will continue to be the source of about half of family physicians’ incomes.

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And there is a 14 per cent pay increase. The battle had barely been joined when the government ponied up reparations. Health Minister Christian Dubé resigned in protest at the government’s swift capitulation.

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And this week, Premier Francois Legault quit. What might we learn from the revolution that wasn’t?

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First, do not go over-confident into a battle with doctors. Organized medicine is battle-hardened and successful, and when attacked, it can mobilize loyal troops. It is adept at portraying physicians as over-worked hostages in a system victimized by government parsimony. People like their doctors; they rarely have a cherished public servant.

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Second, the government assumed that a noble cause — finding a doctor for orphaned patients surely qualifies — confers a warrant to pursue it by any means necessary. The government misread the room, if it read it at all. Soon after the law was passed, thousands of doctors rallied in opposition in Quebec City and Montreal. A public opinion poll found that 47 per cent of Quebecers opposed the law and 27 per cent supported it. Seventy-three per cent feared doctors would leave the province, and they were right — hundreds applied for licenses in Ontario.

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Third, the political context matters. The Quebec government was massively behind in the polls. On the one hand, this created a pretext for taking a big swing at an intractable problem because there was no political capital left to lose. On the other, it could easily be labeled desperate opportunism, a cynical attempt to create a wedge issue with a populist patina. Such strategies are always long shots, especially when the public has tired of the incumbents and lost faith in their competence.