Quebec's experiment in public-private partnerships is on the verge of being scrapped. Three years after the Charest government decided Montreal's two new teaching hospitals would be built in a public-private partnership, the province is seriously considering taking over the multi-billion-dollar projects.
This is a dramatic shift in government thinking. Right up to the time she left politics this spring, then finance minister Monique Jérôme-Forget remained an enthusiastic and vocal cheerleader for PPPs. Her departure seems to have removed the last bulwark against abandonment of the idea. Barely five months later, Health Minister Yves Bolduc is talking about new economic contexts and how PPPs might no longer be the best option.
And indeed they might not be. But what killed the PPP process, for the hospitals and for other government projects as well, is not any inherent flaw in them as much as ceaseless opposition from unions and others with a stake in the old way of doing things. Those closest to the public payroll are always wary of the private sector, and quite content for taxpayers to pay higher costs.
The PPP advantage is that a government need not pay out large amounts for capital projects. Instead a private company builds and owns a hospital, or highway, and undertakes to maintain it for, say, 30 years. Government pays an annual lease fee. The disadvantage is that total government outlay over the period might be higher, to allow the private partner a profit. But more-efficient private management can sometimes narrow that total-cost gap.
It should be clear that a PPP might, or might not, be the right solution for a given project. Still, it is certainly not axiomatic that a PPP is guaranteed to be worse than the traditional route. Yet in Quebec over the past three years, PPPs have become mired in ideological disputes. Any augmented private role anywhere in health care, even with single payer maintained, seems to inflame unions and their political allies, so that PPPs have been depicted in some quarters as sinister madness.
It appears that the current capital-market situation - Bolduc's "new context" - made it harder for the consortiums interested in these hospital projects to borrow money, so that costs and delays multiplied. But whatever happened, the challenge for the government now is painfully obvious: Get on with the job.
A whole generation of students is growing up waiting for the city's two medical schools to have new teaching hospitals. Several generations of Montrealers are waiting for the modern efficient care such hospitals could provide. Medical students enter, pass through, and leave our med schools with all the while the same weary promises - a new hospital soon - ringing in their ears.
It's past time for the government to quit fooling around with studies, for the university-hospital groupings to settle their internal squabbles, and for actual construction of hospitals to begin.