Claude Castonguay unveils a report on Quebec's health system on Feb. 19, 2008, in Quebec City.JACQUES BOISSINOT/The Canadian Press
Claude Castonguay, who played a key role in establishing Quebec’s medicare, its network of community clinics and its pension plan, has died. He was 91.
Although he served as provincial cabinet minister for only three years during the first government of Liberal premier Robert Bourassa, he became so closely associated with the creation of Quebec’s medical-insurance plan that the device used to imprint a patient’s health card on the billing form became known as a “castonguette.”
Mr. Castonguay, who had announced last month that his declining health had forced him to end his column in the newspaper La Presse, died early Saturday, surrounded by his family, his brother-in-law, Gaspard Fauteux, said.
“His legacy is immense and he helped set the foundations of our social-security network. Thank you, Mr. Castonguay,” provincial Liberal Leader Dominique Anglade said on Twitter.
“Quebec lost one of its great visionaries,” Premier François Legault said.
Mr. Castonguay was health minister from 1970 to 1973, but had been a key adviser in the 1960s under Liberal premier Jean Lesage, when the province embarked on a wide range of reforms and began to claim more powers and autonomy from Ottawa.
He was also a prominent entrepreneur, co-founder of an actuarial firm and later chief executive of the Quebec financial conglomerate Laurentian Group during the 1980s.
“A man of few gestures and fewer words, he seems to be perpetually brooding, appraising people and situations from under furrowed, grey-haired brows,” said a 1985 Globe and Mail profile of Mr. Castonguay, describing his cerebral, methodical style of leadership.
His commitment to the Canadian federation came with a strong streak of Quebec nationalism.
He was blamed in Ottawa as the man who convinced Mr. Bourassa to reject the constitutional proposals in the 1971 Victoria Charter, a decision later seen as a missed opportunity to settle the country’s national-unity issue. Mr. Castonguay said his opinion mirrored the views of the provincial cabinet and legislature.
He was born in Quebec City on May 8, 1929, the son of Jeanne Gauvin and Émile Castonguay, an administrator.
In the 1950s, Mr. Castonguay studied actuarial science at the University of Manitoba, then taught it at Laval University while working as an actuary for an insurance company. He co-founded an actuarial consultancy, Castonguay, Lemay et Associés, lauded as one of Quebec’s first francophone agencies in that field. It later became Sobeco and is now part of the Morneau Shepell human-resources firm.
Mr. Castonguay’s skills as a number cruncher led him to work for the government of Mr. Lesage, the reformist Liberal premier whose election in 1960 marked the beginning of Quebec’s Quiet Revolution.
Mr. Castonguay was interested in issues relating to social insurance. He contacted the premier to offer his help and was added to a committee that helped the province set up its own pension plan, he recalled in a 2007 history video for the Quebec Legislature.
Next, he was appointed to head a commission to assess the health care system. It recommended the implementation of a universal health-insurance plan.
At the time, a third of Quebec’s population did not have health insurance of any kind. There was a hospital insurance plan, but medications and care outside of hospitals weren’t covered.
“Our health care system did not exist as a system. You had doctors in private practice, hospitals set up by religious congregations … but there was no connection between all of that. It was clear that health insurance had to be a priority,” Mr. Castonguay said in the history video.
After Mr. Lesage lost power in 1966, Mr. Castonguay remained as government adviser and chaired a royal commission on health and social services set up by the Union nationale government of premier Daniel Johnson.
During the commission’s proceedings, a frequent caller was the Opposition critic for health, a rising star for the provincial Liberals, Mr. Bourassa.
By 1970, Mr. Bourassa, who had become party leader, urged Mr. Castonguay to become a candidate for the Liberals, arguing it would be the best way to see the health care reforms he was advocating become reality.
Then, Mr. Lesage said he was retiring and hoped to see Mr. Castonguay represent his riding of Louis-Hébert in Quebec City. “Between Bourassa and him, it would have been hard to say no,” Mr. Castonguay recalled.
But he warned that he was inclined to stay in office for only one term. His wife, Marie Fauteux, was the daughter of Gaspard Fauteux Sr., a former Speaker of the House of Commons, and was concerned about the demands of political life.
Mr. Castonguay was a star candidate in the April, 1970, election won by Mr. Bourassa. Appointed to the health portfolio, he tabled legislation to implement his medicare scheme in the fall.
“It was the end of an era of unfettered medicine, when doctors were kings and masters,” Mr. Castonguay said in the video history.
The new system was introduced during an extraordinarily tense time. Thousands of medical specialists went on strike to protest the health-insurance plan and the government threatened them with hefty fines and jail time in a back-to-work law.
At the same time, the terrorist Front de libération du Québec had kidnapped British diplomat James Richard Cross and then-labour minister Pierre Laporte. Mr. Castonguay had to temporarily assume Mr. Laporte’s labour portfolio.
The universal plan came into effect Nov. 1, 1970.
The following year, Mr. Castonguay introduced a network of community health centres, widely known by the French abbreviation CLSC, that are still a key part of the province’s health and social services.
Along with some fellow cabinet ministers such as Jean-Paul L’Allier and Jean Cournoyer, Mr. Castonguay was part of a nationalist wing of the Quebec Liberals. He believed Quebec’s cultural and linguistic situation needed to be protected by a special status within the federation.
In 1971, Prime Minister Pierre Trudeau offered what became known as the Victoria Charter, a set of constitutional changes that included a key gain for Quebec: a right of veto on future amendments.
However, Mr. Castonguay had reservations about other parts of the proposal. He urged Mr. Bourassa to push for provincial primacy on matters dealing with income security and social spending.
After Quebec withdrew its support following the first ministers conference in Victoria, Mr. Castonguay was blamed as the man who got Mr. Bourassa to scuttle the deal.
In his video interview, Mr. Castonguay acknowledged he “was seen as the spokesman of the backlash faction,” but said Quebec’s decision was supported by the provincial cabinet and legislature.
The following year, after objecting to the federal budget, Mr. Castonguay threatened to resign because he felt the Bourassa government wasn’t forceful enough in its dealings with Ottawa. He relented, however, because the province was in the midst of major labour strife caused by the jailing of three union leaders.
He didn’t seek a second mandate when an election was called in 1973.
He was a staunch supporter of prime minister Brian Mulroney’s proposed Meech Lake constitutional accord. Mr. Mulroney appointed him to the Senate in the fall of 1990. In the stormy months after Meech’s failure, Mr. Castonguay became co-chair with Conservative MP Dorothy Dobbie of a special parliamentary committee looking at other constitutional proposals. However, he resigned, citing exhaustion, after a month of chaotic public hearings, and was replaced by senator Gérald Beaudoin.
Mr. Castonguay also resigned from the Senate at the end of 1992, after the failure of the Charlottetown constitutional accord.
He leaves his wife, Marie; their children, Monique, Joanne and Philippe; and five grandchildren.