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At the Club Saint-James in Montréal last month, the debate over Quebec’s struggling healthcare system resurfaced with force as the Montreal Economic Institute, the Canadian Constitution Foundation and SecondStreet.org hosted the second edition of “Putting Patients First.”

The guest of honour, Dr. Jacques Chaoulli—whose 2005 Supreme Court case upended fundamental assumptions about Quebec’s health model—did not mince words.

Twenty years later, Chaoulli says the situation has worsened. “Patients … continue to suffer. And even die,” he warned, adding that governments have “refused to act” even after the Supreme Court ruling. He attributes this to political dependence on “the lobbies,” especially powerful medical and union organizations.

Chaoulli singled out unions and professional associations as major barriers to reform. “These unions are huge financial powers,” he said. “They have never attacked the Canadian financial system because it benefits them. But when it threatens their own pocket, they go to the barricades.”

According to him, these groups have leveraged their influence to monopolize control over the healthcare system, diverting public funds toward their own interests rather than patient care.

Chaoulli has consistently criticized the system’s structure: “The governments ration care and blame doctors… The lobbies, the medical corporations, these are the elements blocking the system.” He argues that empowering citizens directly could create meaningful reform: “The only solution I see is to give power back to the people through popular referendums… Politicians won’t act due to lobby dependencies.”

Chaoulli concludes, reflecting on law and democracy: “If people had the power to enact laws, they wouldn’t need to protest… It’s about restoring decision-making to citizens, not bureaucrats or lobbyists.”