ISSN 1847-2397 godište II broj 1 2009. | volume II number 1 2009

Sabina Stan: The Discourse on the “Crisis of the Health Care System”suvremene TEME, (2009.) God. 2, Br. 1CONTEMPORARY issues, (2009) Vol. 2, No. 1side effect to achieve health care reform in theUnited States” and inevitably spilled over intoCanadian media and health services academicand policy literature.But why, for all matters, did the crisis discourseonly enter the Quebec health care arenaonly at the end of the nineties, and why it hastaken this particular form? Of course, the turbulentchanges effected during 90s led the Canadianhealth care system to “an apparent stateof crisis” marked by contradictory measures,services slashing and disorganising restructurings(Lewis et al., 2001: 926). Still, reading theappearance of chaos as a “crisis of the healthcare system” was not the only reading available.Elements of the chaos could still have been readas separate ones, and not necessarily as takingpart in a more total, encompassing crisis of thesystem.For example, one event with importantchaotic consequences for the system, “hospitalclosings” (“fermeture d’hôpitaux”), saw its medianotoriety reach a peak in 1995, 47 but faded awaybefore the take off of the crisis discourse in 1998.By comparison, the more visual events of “emergencyroom crises” (“crises des urgences”) hada media evolution that closely preceded the crisisdiscourse (as it took off in 1998 and reachedits peak in 1999 48 ). It seems that, as media coverageof emergency room crises intensified, it fuelleda more encompassing systemic discourseon the crisis. How did it happen, and why did thecrisis have to be systemic?The particular meaning of the crisisdiscourse stems from larger ideological transformations(i.e. the turn from Keynesianism toneo-liberalism), but also from the conjectural internalstruggles of the social field in which theyare produced (Chalaby, 1996: 691, 694), namelyin this case the francophone journalistic field. InCanada and Quebec, the end of the nineties sawinternal competition inside the field mount in intensity,as francophone and Anglophone mediaalike went through a process of renewed concentration.49 Moreover, the continuous trend of47 The 1995 peak registered more than 160 mentionsof the phenomenon in the three dailies considered here.48 In 1999 there was a peak of 60 articles mentioning“the emergency room crisis” (“la crise des urgences”).49 The dailies analysed here were subject to earlierprocesses of concentration. While Le Devoir always remainedan independent journal, La Presse was bought byQuebec media mogul Paul Desmarais in 1967, and Le Soleilwas purchased by the Hollinger group of Conrad Black in1987 (Gingras, 1999:115, 118). But at the end of the 90s,Canadian media underwent a series of important mergersand buy-outs, leading to "one of the world's highest degreesthe diminishing importance of the written pressvis-à-vis other media (television and internet) putfurther pressure on editors and journalists insidethe written media field.The media’s propensity to offer a moreschematic and dramatic presentation of issueswas compounded with an appearance of chaosin the health care sector, a strengthening of rightwing positions in the Canadian media (Hackettand Gruneau, 2000: 204) and intensified internalcompetition in the journalistic field, to producediscussion of on an encompassing, systemic crisis.By claiming expertise on the health care domain(through powerful statements on the systemiccrisis affecting it), media executives andjournalists not only gave voice to marketisinginterests, but also enhanced their own positionsand established a new symbolic territory (“thehealth care system”) inside a shrinking journalisticfield.Of course, media discourses are not onlythe domain of journalists and editorial boards.One, they are overlapping with and are participatingin larger discourses, such as those developedby governments, experts, or other media.Two, media discourses are not produced solelyby the media, as discourse producers are alwaysmultiple (Chalaby, 1996: 695). In fact, mostof the articles analysed here include (cited orauthored) utterances not only of journalists, butalso of other social actors, such as politicians,officials, experts, representatives or membersof different professional and labour groupings.Journalists are part of a bigger chorus of voices,as they “give form to concerns and problems ofother social worlds, in particular the political andthe administrative ones” (Pierru, 2004: 2).Therefore, we can say that the discourseon the crisis of the health care system in Quebecis produced by a variety of actors and forces: theglobal neo-liberal ideology of welfare state bashing,essays by health care policy makers on advancingmore radical reforms of the health caresector, the intensification of struggles inside thefrancophone journalistic field, as well as contestationsby actors inside the health care field triggeredby health care reforms.of press concentration" (Fleras, 2003: 110). Even if this concentrationaffected less the written Quebec francophonemedia, it certainly affected the manner in which Quebec journalistsperceived their field.centar za politološka istraživanjathe political science research centrewww.cpi.hr28