Who Killed the Queen?: The Story of a Community Hospital and How to fix Public Health Care.

K.V. Nagarajan is a professor in the Department of Economics at
Laurentian University.

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With a provocative title, the book promises to deliver a murder mystery about the closure of a community hospital in Montreal. It claims to “shatter myths and establish some shocking historical connections.” If one is looking for a riveting potboiler, this is not the book. What one finds here is a sprawling, dramatic treatise on Canada’s health care issues in which hospital closures of the 1990s also play a role. While describing the story of the small community hospital, the author takes off on so many tangents that it is hard to see the point of so many details. After plodding through the myriad historical stories, the plot becomes clear: a small community hospital, such as the century-old Queen Elizabeth Hospital which was shut down in 1995, is better in serving the patients’ needs than large super-hospitals. The author argues that such hospitals are innovative, flexible, resilient, focused on patient care, and fun places to work. The extensive archives of the Queen Elizabeth Hospital buttress her case.

            The plot thickens as the author goes digging into the background of the hospital closures in the mid-1990s. Hospitals were being closed in Alberta, Saskatchewan, Ontario, and other places. At that time, it appeared to be just local decisions in order to rationalize and consolidate the system. The author takes on the role of a sleuth and traces the imperative to a secret document delivered by the International Monetary Fund (IMF) to Canada and the pressure exerted by the bond rater Standard and Poor’s on the government of Lucien Bouchard. She argues that in the 1980s, large international financial organizations encouraged Canada and its provinces to borrow and spend on public programs. In the 1990s, when the ability to service the debt became questionable, the same institutions applied pressure to cut spending and pay back their loans. The infamous 1995 Liberal budget of Paul Martin, according to the author, was written by the IMF. Although there is no direct proof for this assertion, she quotes Paul Martin’s 2004 confession to the effect that if health care spending was not cut, Canada’s bond rating would have gone down. Meanwhile, what happened to all the money that was saved by shutting down the hospitals? That mystery remains unsolved.

            The story does not end there. The author goes on to comment on the recent efforts to bring in more privatization in Quebec and other provinces. She is totally opposed to such initiatives. The book takes a brief tour of other health care systems and comes to the conclusion that the single-payer Canadian model is cost-effective and equitable. It does not mean that there is no room for improvement. The author discusses many of its shortcoming and ways to overcome them.

            This book has many nuggets, but it is so all-encompassing that one has to dig to find them. The search is worthwhile.