He is widely recognized as the founder of Quebec's health insurance scheme. He also participated to Quebec's public pension plan, the law regulating professions, and Quebec's pharmacare scheme. He was minister of Health, family and welfare for a single mandate (ending in 1973), prefering to be a behind-the-scenes government advisor. He also led La Laurentienne, a large insurance company.
The health insurance scheme is now 50 years old. It is generally perceived as universal and free but it excludes immigrants, temporary foreign workers, most care when you are a tourist abroad, tourists here, chronic care, ambulance services, most psychologists and physiotherapy, oxygen, most dental care, reports to third parties like insurance companies, recently available equipment like retina tomography, soft lenses for cataracts, fiberglass casts for broken arms (instead of plaster casts). There is also a growing tendency for doctors to leave the medicare system and bill patients directly like the Lacroix clinics.
I am not arguing that our governments should pay all forms of medical care. It needs to prioritize, fighting tuberculosis first, then providing vaccines to travelers to exotic destinations, then contagious diseases, then wounds and injuries which will get infected or worse if not treated. To limit expenses, the system first limited billing for visits from the doctor. The patient is expected to go to the doctor (or hospital for critical care) Now it is difficult to find a GP so emergency rooms are overcrowded and wait times of 24 hours for non-urgent care are common. Costs were rising fast so campaigns like a switch to ambulatory care (le virage ambulatoire), the need for a referance from a generalist to see a specialist, administrative bundling of hospitals, re-arrangement of which hospital does what were instituted. Mr. Castonguay has been a witness of these transformations and he criticized the opposition to any change as an attack on "sacred cows". Limits to services can be put by expecting the patient to loose say 20 pounds before a procedure like an operation is performed. Why are vasectomies covered? Can we exclude from coverage heart disease, or obstructive pulmonary disease or even cancer? Mr. Castonguay's answer when he was in old age was "we have to find a new source of financing". That means a new form of taxation!
Before he was elected, Francois Legault suggested the construction of "homes for the aged" which would be less hospital-like. The Covid-19 events surprised the governments and demonstrated to Legault that before providing new buildings, he has got to staff existing resources adequately. The pandemic has strained resources in the health system, delaying operations, for example.
Mr. Castonguay was an actuary. In january 1966, the Régie des rentes came into being. At first it had almost no disbursement and millions of providers. The system had lots of reserves. But now, with an aging population, interests rates near 0, Covid uncertainty, government directives that CDPQ fund public transit which has no hope of being profitable, are we headed for the need to cut down annuities? Or an increase in salary deductions?
