​Adapting to social change (1960-1972)

 

 

The unionization of SSQ's employees marked a new chapter in the company's history, and the rest of Quebec society was poised on the cusp of change as well. In Quebec and in many other parts of the world, the slow process of transforming socio-economic relations had received the political establishment's official approval. Henceforth, the twin forces of urbanization and industrialization would bring a whole new dimension to Quebec society.

Secularization, nationalization and progress

Before 1960, Quebecers' living and working conditions, often shaped by Catholic charitable organizations and unions, left much to be desired. Little by little, though, progressive elements gained a foothold inside the Catholic unions in their quest to uphold workers' rights. The spirit of the times was resolutely secular—so much so that the union movement, fearful of being hindered by its hidebound traditions, eventually turned its back on its Catholic roots so workers, if they so desired, could unite regardless of their religious beliefs.

After years of looking inward to maintain its distinctiveness, Quebec now opened up to the modern world. As a result, nationalistic sentiment and political ideals, though still evident, became tinted by the hues of a new philosophy centred on the notion of progress. And progress hinged on the state, or so it seemed. Whether they were involved in the federal system, now influenced by "French power", or part of an increasingly activist provincial government, the new generation of Quebec politicians and civil servants saw the solution to all problems as lying in the growth of the state apparatus.

It is fair to say that the 1960s played out in Quebec as if the pressure on a tightly coiled spring had at long last been released.

A raft of new social policies and programs was adopted as the state apparatus went through a genuine growth crisis and a new class of power-hungry technocrats emerged. Insofar as SSQ was already active in the area of social services, these transformations inevitably had an effect on its development. As noted previously, SSQ saw little benefit in the advent of governmentrun healthcare.

In 1956, the federal government made grants available to provinces willing to set up hospital treatment programs; in the intervening years, most of them had already done so. In Quebec, the first 100 days of Paul Sauvé's administration were dominated by the winds of reform. Staying the course, his immediate successor, Antonio Barrette, immediately focused on hospitalization insurance. At stake was a central issue: the delicate matter of challenging the exercise of powers long deemed off limits, including those of religious communities, medical professionals and hospital nurses. A provincial commission of enquiry on hospitalization insurance was established in 1960. Two insurance company leaders—L'Industrielle's Gérard Favreau and SSQ's Jacques de la Chevrotière—were among the members serving in a personal capacity.

They were joined by the vice-president of Northern Electric, H.M. Sparks; FTQ president Roger Provost; two doctors (Jean-Baptiste Jobin and Gérald La Salle); and the director of Montreal's Conseil des œuvres, Abbé Riendeau.1 Each of the principal stakeholder groups was thus represented. At the risk of simplifying their positions somewhat, it is fair to say that all these stakeholders envisaged or at least anticipated state intervention in the healthcare field.

The state's role: a matter of controversy

Various organizations representing the broadest segments of the population (FTQ, CSN, UCC, CCQ, etc.),2 and unionized workers in particular, viewed the state as responsible for the social and physical well-being of its citizens. They thus regarded hospitalization insurance as "a first step towards health insurance".3

In contrast, the medical profession,4 in agreement with the insurance companies, business owners and religious communities, refused to recognize that the state was responsible for controlling and coordinating the response to citizens' health-related needs. While acknowledging the necessity of state intervention, these groups advocated a "middle-ground" approach, in which the state would take action on behalf of the poor, while private enterprise would take care of the rest. This approach was based on the traditional concept of public assistance, i.e., assigning an exclusively secondary role to the state while leaving the existing levers of power (medical professionals, religious communities, etc.) with some room for manoeuvre.

For its part, the Quebec division of the Canadian Medical Association proposed a more "contemporary" version of the hospitalization insurance plan.5 In its view, it was time to uphold the principle of social security and to leave notions of public assistance behind: insurance should cover public hospital expenses in all cases. The private sector's role was to cover the cost of a private or semi-private room. Meanwhile, the medical profession would remain autonomous since the provision of medical care, broadly speaking, was not regarded as a hospital-related service.

Although it accepted the principle of social security, thus vindicating the unions' position, this new formula considerably restricted the scope of social security coverage. The medical profession's powers, for example, were not called into question. Moreover, a portion of the market (private or semi-private hospital rooms) was set aside for the insurance companies.

In keeping with these overall goals, Quebec's Hospitalization Insurance Act6 retained the core elements of the formula, while also meeting federal requirements for the hospitalization insurance program.7

Adapting to change/or not

Only nine months after the commission of enquiry was established, the Hospitalization Insurance Act came into effect in Quebec. The legislators' swift action caught most of the insurance companies off guard: premium revenues for Blue Cross and Metropolitan Life fell by 32% and 20% respectively. Only SSQ emerged unscathed: its premium revenues actually rose by 6%. The general manager at this time, Jacques de la Chevrotière, described the turn of events as a "withstandable shockwave". In actual fact, a large number of hospitalization insurance policies had been converted to cover the cost of private or semi-private rooms, rather than "basic services", as in the past. The general manager offered these thoughts:

The recruitment of many new policyholder groups and the sale of enhanced benefits, not only in medical and surgical services, but also in group life and disability insurance, have offset lost hospitalization insurance revenues and have even boosted the company's total revenues by a quarter of a million dollars compared with the previous year.8

Nevertheless, the Hospitalization Insurance Act was only the first step on the road to reforming the healthcare system. In 1961, the Royal Commission on Health Services (also known as the Hall Commission) was tasked with reporting on "the existing facilities and the future need for health services for the people of Canada and the resources to provide such services". In view of the fact that a federal commission was looking into a matter of provincial jurisdiction, Quebec Premier Jean Lesage was quick to deem the process blatantly unconstitutional.9 Despite this harsh judgment, SSQ, wasting no opportunity to bring its influence to bear on social and political issues, decided to submit a brief to the Hall Commission.10

New brief, same principles

In SSQ's submission to the Hall Commission, the principles underlying its 1954 brief on constitutional matters remained unchanged. The state, in keeping with SSQ's thinking and hopes for the future, would retain an auxiliary role and would only intervene in exceptional cases. This time around, however, the company laid out a "wish list" for a provincially run health insurance plan. Administered by a mutualist-style provincial health insurance agency, the plan would offer universal risk coverage; participation would be mandatory. Premiums would constitute the funding base, either deducted directly from workers' pay or covered by the state in the case of the poor or the unemployed. The provincial government would also be assigned an oversight role via a health insurance board. Doctors would keep their autonomy and would be paid on a fee-for-service basis with no maximum fee cap.

Blending the old with the new, the new proposal was in keeping with SSQ's policy positions and dynamics since its founding. Viewed as "cutting edge" in medical terms, the company's philosophy emphasized prevention and regarded hospitalization as a last resort in the fight against disease (it bears repeating that the company's position in this regard was clear from the outset).

Since 1944 and even more clearly this time around, SSQ had attempted to diagnose and resolve the issues of healthcare distribution and accessibility. But at a time when Quebec was acquiring the trappings of a modern state and poised to assume responsibility for social services, SSQ was proposing solutions that harked back to a bygone age, at least in part. The era of doling out public assistance was over; that of providing social services had begun. SSQ, however, was torn between pursuing its interests as a mutual insurance company and upholding its progressive traditions as a cooperative. In the end, the compromise it devised was more reflective of its business interests than its reformist roots.

In part, SSQ's choice was shaped by the burden of its traditions. Since 1944, doctors fully dedicated to the company's cause had been the standard-bearers of social medicine. Drawing on the teachings of the papal encyclicals, they feared government-run healthcare more than anything. In their view, a concerted effort was the only thing required to resolve social problems. The state's intrusive power, initially in the areas of hospital funding and administration and potentially affecting the medical profession itself, was the focus of their opposition. And since its members were primarily "liberal professionals", SSQ's board had every reason to stand behind the medical establishment in support.11

Taking a painful stand

However, its tradition of social activism did prompt SSQ to support a universal health insurance plan (admittedly less comprehensive) despite the potential threat to its operations. Since it specialized in health insurance, SSQ could not remain on the sidelines as a "neutral observer". But it recognized its own biases and limitations with remarkable candour:

As a general rule, private health insurance plans cannot guarantee absolute protection; they do not cover all forms of medical care and do not fully cover those forms that they do insure.12

A new administrative style

SSQ's administrative structure also kept pace with the changing times. The company continued to pursue the goals (e.g., streamlining and service) originally set by Jacques de la Chevrotière in 1950, while the principles of performance and efficiency enhanced the administrative structure. These changes proved beneficial as the company's growth meant that responsibilities needed to be defined more clearly. In 1961, for example, the company had a workforce of 120 employees, 18 of whom worked in the Montreal office.13 Detailed job descriptions were thus essential.

A good organizational chart is both static and dynamic. It should set out the scope and limits of each individual's responsibilities, along with the lines of authority. The dynamic component, which is so essential to the life of the company, is to be found in those who run it and who shape its development by making adjustments designed to reflect changing socio-economic realities.14

The watchwords were streamlining, dynamism and realism, in keeping with two key goals: sales and service. Driven by management's line of thinking, these principles helped to propel SSQ into a new era.

In 1959, the position of administrative services manager was created. This role was assigned to Léopold Marquis, who had served as personnel director since 1958. His job was to define, structure and coordinate the various corporate functions. The company had three main divisions (actuarial, sales and administration).15 The administrative component had seven subdivisions: personnel, contributions, benefits, policy issuance, office equipment, administrative accounting and insurance accounting. The sales function, in addition to the secretariat created in 1958, had two separate subdivisions: research/training and information/advertising. The company had two offices in Quebec City and Montreal.

In line with the goal of shoring up SSQ's structures, an investment committee was created in 1970 to administer the company's portfolio (the overworked executive committee was unable to take on the task of managing the funds earmarked for the pension plans16 set up in 1966). Two board members and two members of the internal administrative team served on this new committee, which was tasked with mapping out an investment policy.

Meanwhile, the company was growing at such a pace that its democratic control structures were brought into play with greater frequency and in various ways. In 1966, the number of board members was increased from 12 to 15.

New services and programs

As the administrative structures were being modified, new services also came into being. In several regions of Quebec, the principles set out in SSQ's brief to the Royal Commission on Health Services (also known as the Hall Commission) led to close cooperation between insured groups, participating doctors and SSQ—the very first time that such cooperation had taken place in Quebec.

It was entirely unprecedented to see medical practitioners discussing matters with workers, explaining the social problems facing their profession and trying to grasp the problems of their patients. The closeness of their ties, which no one would have thought possible, is perhaps the most striking thing about this experiment.17

The experiment in question concerned healthcare facilities in Sorel, Kenogami, Jonquière and Alma. SSQ's new plan, known as the MSP (medical services plan), offered comprehensive coverage for medical and surgical services. Under this new plan, doctors accepted as final payment the fees set by SSQ for each medical service they provided.18 Some saw this as an opportunity to offer comprehensive coverage without government intervention. Despite these hopes and efforts, the plan's complexity hampered its expansion and jeopardized its survival at the local level. The task of convincing doctors in a given region (general practitioners as well as specialists) and resolving special cases that had to be treated outside the region soon proved overwhelming. All in all, it was an interesting initiative—a worthy experiment, but one with "no future".19

Learning much from its forays into the health insurance field and anticipating an imminent state intervention, SSQ began to diversify its range of operations in the 1960s. In 1963, long-term disability insurance was introduced, under which insured members unable to work due to illness or accident received financial compensation until age 65, in effect replacing the income lost due to their disability. In that same year, SSQ also began offering a health insurance plan (the "catastrophe" plan) based on a much broader definition of health care.

Quebec's provincial health insurance plan and the Pharmaxo experiment

As Quebec's provincial health plan began to take shape, SSQ launched three new types of coverage: dental care, optometry care and chiropractic care. In the latter two cases, this innovative move was striking insofar as institutional recognition was given to controversial fields of endeavour: chiropractic and optometry. As it happens, there were spirited debates among board members in this regard. Dr. Matteau and Dr. Pelletier20took a dim view of this initiative, which was nonetheless approved by a majority of the board. In that same year, SSQ launched its revolutionary drug insurance plan (known as Pharmaxo), under which insured members' prescription drug expenses were paid directly to pharmacists.21

Pharmaxo was based on American "paid prescription plans" and on SSQ's medical services plan (MSP), which had been tested in various regions of Quebec. Pharmaxo was completely different from anything else on the prescription drug insurance market. In exchange for a 50¢ co-payment by the insured for each medication prescribed, SSQ pledged to settle the account directly with the pharmacist by paying the cost price plus a professional fee agreed on with the Quebec association of owner pharmacists (AQPP). Highly advantageous for consumers, this coverage was a big hit and enabled SSQ to maintain its sales volume despite the risk that the provincial health insurance plan (RAMQ) might peel away "most of the groups required to convert their insurance policies on November 1, 1970, that choose to take out this new coverage."22 In other words, money was no longer a barrier to obtaining needed prescription drugs. The coverage, however, cost much more than expected, primarily because the related calculations were based on a different type of market (the province of Quebec had its own public plan). The problem was that no one had anticipated that the demand for medications would rise so much as a result of government-run health insurance. This reality was compounded by significant increases in drug prices in 1970 and 1971.23

A costly experiment

The premiums collected were clearly not enough to cover payments for the medications consumed. In fact, the benefits paid out under Pharmaxo worked out to 170% of the premiums collected.24

SSQ's financial position in 1970, although hardly rosy, could still be described as sound. In that same year, the company posted a record-breaking $21 million in total revenues. Health insurance revenues did not plummet quite as dramatically with SSQ as they did with its main competitor, Blue Cross. The creation of SSQ's new drug insurance plan enabled it to offset much of the decline in its health insurance business and helped maintain its total revenues.

In 1971, however, the situation grew critical. "As at August 31, 1971, it appears that the accumulated operating deficit since January is nearly $1,300,000."25 The main reason was the underestimation of Pharmaxo's costs. Other factors also came into play, such as the decline of the health insurance sector and employee pay raises. The combination of these factors had a negative impact on the company's profitability.

The company, however, had reserve funds available to absorb its first deficit:

Needless to say, SSQ is taking significant steps to rectify the situation: laying off staff and cutting certain administrative expenses, as well as increasing contribution rates for ‘deficit' groups.26

Unfortunately, an operating deficit was also posted the following year. This time around, SSQ could not tap into its reserves (the Superintendent of Insurance prohibited member equity from falling below 5% of the company's commitments to insured members). The company's back was to the wall: it had to find another way of tackling its operating deficit.

In June 1972, SSQ approached the Union régionale des Caisses populaires Desjardins for the Quebec City district with a plan to sell the property it owned on Laurier Boulevard, together with its option to purchase the SSQ building.27 The parties quickly came to an agreement: the price of the land was set at $450,000, while SSQ's stake in Les Immeubles d'Argenson was valued at $550,000. The company, however, retained an option to repurchase the SSQ building. Thanks to the charitable assistance of various other cooperative institutions, the company now had enough funds on hand to overcome its temporary difficulties.

SSQ gradually began charging contributions based on the actual coverage costs. Despite some difficulties, this attractive formula encouraged several groups to entrust SSQ with their insurance policies and to take out coverage for other non-disease-related risks. As a result, the company was able to develop new types of coverage and to make up for the diminished role of its health insurance division.

Pharmaxo was still available, although its high cost had a major impact on its popularity; today, it is regarded as a luxury product. Even so, SSQ's strategy of filling in the gaps associated with government services continued to pay off. Complementary forms of health insurance, particularly those covering prescription drugs, remained in high demand among insured groups.

Labour relations in the face of state intervention and the advent of new technologies

Meanwhile, SSQ launched its very own technological revolution. Back in 1958, it had automated some of its administrative processes. In 1964, it acquired a computer for electronic data processing purposes. Beginning in 1966, it undertook a series of IT system modifications aimed at benefiting from the latest technological advances. The underlying goals were to make information more accessible to employees while providing better service to insured members.28

 

Times have changed since the introduction of the first computer.

The company's workforce dropped from 349 to 269 employees between 1969 and 1972 as the provincial health insurance plan was rolled out and as work methods were reviewed and the costs of the Pharmaxo experiment were calculated. Some laid-off employees were able to find positions with RAMQ that were in line with their previous work with SSQ.

This wave of technological change, combined with insecurity brought on by the launch of the provincial health insurance plan, raised concerns among SSQ's employees, leading them to demand job security and various guarantees.

Well aware of the co-management principle advocated by the unions (some of which were SSQ clients), the employees sought "a voice within the company". They also noted that SSQ's own members had already been given such a role. The union demanded job security and pay raises of 40% to 50% over a 12-month period.

Hard-fought agreements

This plethora of demands cast a shadow over the company's prospects. SSQ was simultaneously dealing with the impact of forced changes to its business plan and a "double deficit" caused by Pharmaxo's difficulties and the loss of health insurance risks now covered by RAMQ.

A strike was inevitable. Launched on September 7, 1971, it lasted for a week. The company agreed to the job security demands but rejected the idea of comanagement. It also agreed to increase pay rates by approximately 40% over a three-year period. An agreement was signed in which employee fears were clearly stated despite the union's gains:

Management must give notice of three to four months if any technological changes are required that will affect workers.

These fears re-emerged at the end of the year, when SSQ laid off some 20 employees. Tensions were mounting. To address the situation, a special committee was set up with an equal number of company and union representatives. According to SSQ, the exchanges of views facilitated by the committee were designed to "foster mutual comprehension and to clear up a number of misunderstandings due to a lack of information".29This committee was dissolved only in a short time before negotiations began leading to the signing of a new collective agreement in 1974.

Nevertheless, relations between SSQ and its employees were never intolerable; there was regular contact between management and employees, for example, to inform them of new developments. SSQ's stance towards its employees was the same as its attitude towards members and clients: it remained focused on communication and dialogue.

Diversifying revenue sources

The diversification of the company's operations during this period required various changes to its founding charter. Under the act adopted by Quebec's legislature in 1964, SSQ was granted additional powers, including authorization to move into the areas of individual life insurance and pension plans.30 As regards pension plans, for which Quebec had recently established guidelines, SSQ took action in 1966:

As part of its normal evolution, any organization eager to maintain its cutting-edge position in the area of social security must be present in a sector for which the federal and provincial governments have set out relevant guidelines in recent legislation.31

Close consideration was also given to the idea of adding individual life insurance to SSQ's range of services.32

By diversifying its operations, SSQ was less dependent on health and accident insurance premiums and thus had an easier time grappling with government initiatives. The following table confirms the progress made in this regard; it also shows how SSQ caught up to Blue Cross over the course of a decade.

Health insurance premiums as a percentage of total premiums, SSQ and Blue Cross (1960-1973)

(in thousands of dollars)

  Health/accident insurance premiums as a % of total premiums SSQ's premiums as a % of BC's
  Blue Cross SSQ BC SSQ total
1960 23,583 3,753 93.2 83.7 15.9
1961 15,940 3,953 90.5 83.8 24.8
1962 16,949 4,480 89.9 82.6 26.4
1963 17,758 5,234 90.3 80.3 29.5
1964 19,904 5,921 90.5 73.7 29.7
1965 22,495 7,131 90.8 73.3 31.7
1966 23,291 8,659 90.5 73.4 37.2
1967 25,963 10,349 89.8 73.5 39.9
1968 25,946 12,270 88.9 71.8 47.3
1969 28,253 13,980 88.8 71.2 49.5
1970 27,976 14,522 88.0 68.8 51.9
1971 11,855 11,152 79.1 61.6 94.1
1972 13,178 12,726 79.4 62.7 96.6
1973 14,340 14,980 79.7 64.1 103.8

Sources: Report of the Superintendent of Insurance and SSQ's annual reports

Two successive shockwaves (in 1961 and 1970) had sent Blue Cross's health insurance premium revenues plummeting, though they had no comparable effect on SSQ, which offered new services in this area. Showing a lack of foresight, Blue Cross lost its dominant position in 1973 when it was hit hard by government intervention in the healthcare field. In addition, after 1962, SSQ's health insurance premiums accounted for a smaller proportion of total premiums, dropping from 83.8% in 1961 to 68.8% in 1970 and 61.6% in 1971.

Growing prestige

Thanks to service diversification and resulting growth, SSQ became affiliated with a major Canadian medical services organization. Headed by members of the medical profession, the Trans-Canada Medical Plan (TCMP) was created and developed primarily in Ontario and the Western provinces; it quickly became a major stakeholder in health insurance discussions with the federal government. In addition, because it was opposed to government control of healthcare and sought to establish Canada-wide plans, the TCMP ostensibly had to represent all provinces. Hence the urgent need to enlist an organization that could legitimately speak on Quebecers' behalf. Its first choice was Blue Cross. Subsequently, SSQ's innovations, particularly its medical services plan and doctors' key roles within the company, prompted the TCMP to invite the company to represent Quebec alongside Blue Cross.

After joining forces with the TCMP, SSQ was positioned to negotiate contracts with national employers such as Air Canada and Bell Canada, which insured their employees through provincial-level companies grouped under the TCMP umbrella. Moreover, despite its focus on autonomy in its sales arguments, SSQ was willing to enter into dialogue with the federal government; in its view, the TCMP's proposed solution was the right one. There was now room to greatly expand its healthcare offer and to entrust the insurance program to non-profit organizations that made up this private national network.

All in all, however, this affiliation brought only modest benefits, although it did indicate SSQ's desire—and that of its competitors—to prevent massive state intervention in the healthcare field by whatever means, including by developing alternative solutions.

Les Services de Santé du Québec becomes La Mutuelle SSQ

In an era of government expansion, a corporate name like "Les Services de Santé du Québec" was certainly confusing; the public was not quite sure whether SSQ was a government agency. A new name, "La Mutuelle SSQ" [SSQ mutual insurance company], 33 was adopted in 1963 to avoid any potential misunderstandings. In making this change at a time when tension between the government and the social services sector was mounting, SSQ positioned itself as a private company bound and determined to operate in the social services sector.

 

Paul-H. Plamondon
Chairman of the Board
(June 1971-March 1977)

Fiscal problems

Meanwhile, SSQ faced a new problem that was also linked to the growing role of the state, albeit indirectly. Regarded since 1956 as a "mutual benefit association", SSQ only paid income tax on its investment income. In 1966, a 2% tax on premiums came into effect for mutual benefit associations that offered accident and health insurance.34 SSQ was thus affected by the new legislation. In order to prevent a sudden overwhelming shock for these companies, the law only applied when a member's policy was renewed; this fortunate provision meant that the rates for SSQ's annual policies could be adjusted prior to renewal time.

SSQ paid this tax faithfully until the board found out that another insurer had managed to dodge it. If policies did not stipulate a precise timeframe for the rates in effect, the very notion of renewal became meaningless. In the case of a company whose monthly premiums were adjusted as the insurer saw fit, there was never an actual renewal, strictly speaking. As a result, the premiums acquired a "forever after" status while the insurer was exempted from paying the tax.

SSQ denounced this injustice. In a brief submitted to the provincial government, the company protested the discriminatory nature of the 2% premium tax: not only did it penalize forward-thinking citizens, i.e., people who generally attempted to resolve problems without state assistance, but it also ignored the fact that healthcare was of primary importance. If healthcare was among the most basic human needs, healthcare expenses should reduce the taxes people owed, not increase them.35 SSQ thus called on the government to reverse its decision. The government, however, turned a deaf ear to these protests. The company then decided to "take the offensive by ceasing to remit the premium tax in order to induce the government to reverse its stand definitively".36 It took three years to resolve this conflict.

When the government finally changed its policy, SSQ was not penalized for having refused to pay the 2% tax since 1970. The company, however, agreed to pay the tax in the future. But SSQ had won an important battle: from now on, all mutual benefit associations would be equal in the eyes of the law.

Main financial statement items (1960-1973)

(in thousands of dollars)

  Premium revenues Total revenues Surplus (deficit) Total assets Investments Liabilities Member equity
1960 4,522 4,543 46 1,033 845 781 251
1961 4,770 4,794 32 1,424 1,127 1,191 233
1962 5,446 5,496 76 1,995 1,642 1,691 304
1963 6,536 6,602 (75) 2,118 1,658 1,540 496
1964 8,088 8,149 99 2,754 1,733 1,688 564
1965 9,760 9,834 163 3,532 2,201 2,110 966
1966 11,852 11,964 481 4,737 3,271 2,802 1,163
1967 14,182 14,362 438 6,350 4,644 3,431 1,725
1968 17,147 17,419 181 7,626 6,147 4,687 2,044
1969 19,753 20,184 6 8,486 6,662 5,700 1,860
1970 21,120 21,612 208 10,415 7,204 7,116 2,068
1971 18,113 18,799 (995) 8,247 6,241 6,556 1,070
1972 20,291 21,018 (971) 9,562 6,666 7,955 943
1973 23,472 23,969 325 11,746 8,417 9,940 1,268

Continued growth

These conflicts should not obscure the fact that SSQ underwent remarkable growth from 1960 to 1973, as the above table shows clearly. The increase in the company's investments reflected the size of the reserves required for its new services. These conflicts also serve to chart SSQ's progress in diversifying its operations in response to state intervention in the health insurance sector.

The company's business thus continued to expand. Seeking greater efficiency, the board decided to acquire a new computer37 in the hope of speeding up claims processing and day-to-day administrative procedures. It was also around this time in 1964 that the company began preparations to relocate its headquarters in order to ensure continued growth. After conducting an in-depth study, the company acquired a 200,000 sq. ft. property along Boulevard Laurier in Sainte-Foy for $364,000,38 opting to make five annual interest-free payments of $72,000.39 That way, the company remained in compliance with section 75 of Bill 142, which limited the size of annual acquisitions to $100,000.

 

The claims department, circa 1967

In subsequent years, the construction project for the new headquarters took shape after the company carried out various profitability studies and analyzed the terms and conditions. It came to the conclusion that it was preferable to entrust the project to an independent corporation: as previously noted, Bill 142 did not allow for annual acquisitions in excess of $100,000.40

A contract, including a purchase option under which SSQ could become the owner of the building and the land beginning in 1978, was then signed by the corporation in question and the company.41 However, the project's feasibility remained conditional: profitability would only be achieved if Quebec's pension board (Régie des rentes) signed a 10-year lease with the building owner at a price of $4.25 per sq. ft.42

It was against that backdrop that the company known as Les Immeubles d'Argenson came into being. It had eight shareholders/bondholders: La Laurentienne, Les Artisans, Les Coopérants, Desjardins Life Insurance, SSQ, La Solidarité, La Sauvegarde and the Société d'assurance des Caisses populaires. Three other organizations purchased bonds and debentures: Caisse de dépôt et de placement du Québec, Alliance and Fiducie du Québec.43

This project coincided with an upswing in construction in the Quebec City region, including major projects such as Complexe G, the Grand Théâtre, Pierre Laporte Bridge, etc. Many observers will (correctly) attribute this flurry of activity to the influence of the government apparatus, which was also expanding at a rapid pace. In any event, SSQ's project certainly benefited from demand for new space by government agencies. For example, in November 1967, Quebec's Régie des rentes signed a 10-year lease with Les Immeubles d'Argenson.44 Under this agreement, the Régie undertook to occupy at least 50,000 sq. ft. Around the same time, Caisse de dépôt, Commission de police du Québec [provincial police board] and Université du Québec all made similar commitments.

Gaining acceptance

In the eyes of the public, the construction boom in Quebec City and the surrounding areas epitomized the captivating ideals of modernism, progress and prosperity. It is easy to understand why local residents were so enthralled by SSQ's building project. In fact, there appears to have been very little opposition to the transformation of what used to be a residential district into an area dominated by public buildings. The City of Sainte-Foy held a referendum in which "nearly two-thirds of the registered property owners cast ballots and gave their approval in about the same proportion".45 SSQ had provided local residents with information on its proposal in the form of an illustrated brochure, 46 which set out the benefits of the project as a significant contributor to local tax coffers and a potential source of employment. The company pledged to combat any problems (e.g., noise, loss of sunlight, increased traffic) via a series of technical measures, including the creation of a generous buffer zone between the adjacent residential areas and the building and the construction of an access road via "little" Boulevard Laurier. In addition, air vents would be installed on the rooftop along with equipment to verify air quality, while non-opening windows would be used throughout the building. Selected by SSQ, the architectural firm of La Roche, Ritchot, Déry and Robitaille designed a 12-storey concrete tower, in keeping with the company's prosperous image. Praise was delivered in these terms:

 

SSQ founded the company Les Immeubles d'Argenson inc. in 1968 to build its headquarters. It had eight shareholders, including SSQ.

The use of concrete is a nod to the company's foundations, placing it among the most durable of institutions.47

Work on the project began in late April 1968.48 Due to a dispute with the owner of the building on Rue Dorchester, where the company had been headquartered for nearly 10 years, SSQ found itself "homeless" sooner than anticipated and had to temporarily lease space from the Congrégation des Frères des Écoles chrétiennes49 on Chemin Sainte-Foy. The company finally moved into its new headquarters on Boulevard Laurier one year later, in May 1969. The actual construction costs exceeded the initial estimate of $3,385,000 by only $50,000.50

From October 17-25, 1969, festivities were held marking the inauguration of the building, in conjunction with SSQ's 25th anniversary. All steps were taken to celebrate an event described as a "sign of hope", including a press conference, a speech by the Quebec premier (actually delivered by his deputy, Armand Maltais) and a series of dinners, receptions and visits.

The strength of SSQ's newly unveiled concrete building reflects management's desire to do whatever it takes to build on the company's momentum as it enters a new phase in its history.51

Meanwhile, the company benefited from a wave of public support that extended to all social security-related initiatives. This stood in stark contrast to the previous chapter in its history, when it had to fight to promote the principles of healthcare distribution and accessibility. Clearly, the turmoil of the 1960s had left Quebecers infinitely more favourable to social security schemes. People also realized that, since the 1920s, most of the industrialized nations had resolved the same problems by expanding their governmental apparatus. Canada and in particular Quebec were simply taking part in a "structural evolution". Even though reformers had looked elsewhere for solutions to the difficult social situation faced by so many, virtually all observers now agreed that the state had many things in its favour.

It is evident that if SSQ had limited itself to providing health insurance, it would have gone out of business. But by striving to fill in the gaps associated with government-run social services, the company had much to gain from recent developments.

True to form, SSQ again exemplified the values of realism and dynamism. Fully aware that the numerous health insurance debates were driving and shaping the demand for its services, SSQ was also planning ahead. In 1967, there was no more room for doubt: sooner or later, the state would definitely be entering the health insurance field, SSQ's main operating sector. Without any further ado, the company set aside its dream of working cooperatively alongside the government. As was the case when hospitalization insurance was brought in, it was now a question of working in the same direction as lawmakers, even if that meant having to smoothly and skilfully come up with private plans designed to fill in the gaps of the public system. Thanks to its clear-sightedness and its imagination, SSQ was never caught off guard.

Next chapter : SSQ: group insurance specialist (1973-1982)

  1. Outil, Henri, "Nomination des membres de la Commission d'enquête sur l'assurance-hospitalisation" (Le Soleil, March 19, 1960). 
  2. FTQ, CSN, UCC, CCQ, Fédération des unions de familles, Montreal francophone chapter of the Canadian Association of Social Workers, Mémoire sur l'assurance-hospitalisation [Brief on hospitalization insurance](Quebec City, November 4, 1960, 48 pp.). 
  3. Idem, p. 3. 
  4. Brief on hospitalization insurance submitted by the Association des bureaux médicaux des hôpitaux de la province de Québec (July 1960, 122 pp.). 
  5. Blouin, Nicole, "Mémoire au provincial sur les principales recommandations de la profession médicale" (Canadian Medical Association, Quebec division)" (L'Action catholique, May 9, 1960). 
  6. Quebec Ministry of Health (MSQ). Le Service d'assurance-hospitalisation du Québec: Renseignements généraux [Hospitalization insurance services in Quebec: general information](Quebec City, undated). 
  7. Cl. FTQ, CSN et al., op. cit., pp. 23 and 24. 
  8. General manager's report (SSQ Annual Report, 1961). 
  9. Royal Commission on Health Services (Ottawa, 1965, vol. II, 371 pp.). 
  10. In 1954, SSQ submitted a brief to the Royal Commission on Constitutional Problems. 
  11. Doctors, lawyers and notaries accounted for 58% of the board members in the early 1960s. 
  12. Press release on SSQ's brief submitted to the Hall Commission (April 9, 1962, p. 2). 
  13. General manager's report (SSQ Annual Report, 1961, p. 3). 
  14. Marquis, Léopold. "Pourquoi des cadres, pourquoi ces lignes?" (Échanges, April 1965, p. 4). 
  15. Organizational chart and description of officers' functions, 1964, 37 pp. 
  16. Executive committee minutes (December 22, 1969, p. 369). 
  17. Dutrisac, Claire. "Dans quatre villes du Québec : expérience unique dans le champ de l'assurance-groupe où médecins et ouvriers se donnent la main " [Four cities in Quebec: a unique experiment in the group insurance field, in which doctors and workers are working together] (La Presse, Tuesday, November 19, 1962). 
  18. Board minutes (December 13, 1962, p. 340). 
  19. Interview with J. de la Chevrotière, p. 48. 
  20. Interview with Dr. J.-E. Pelletier, pp. 110- 114, June 17, 1980. 
  21. Dutrisac, Claire. "Entretien avec les associations de pharmaciens : La Mutuelle SSQ crée un "mini-régime" d'assurance-médicaments" (La Presse, May 7, 1970, p. 4). 
  22. Board minutes (March 25, 1971, p. 403). 
  23. J. de la Chevrotière (Pharmaxo, December 2, 1971). 
  24. Memorandum from Mercure to J. de la Chevrotière, October 6, 1971.
  25. Executive committee minutes (September 28, 1971, pp. 410-411). 
  26. SSQ Annual Report (1971, p. 2). 
  27. Board minutes (June 20, 1972, pp. 618- 619). 
  28. Le développement SSQ (information document presented at the annual general meeting, 1982).
  29. Board minutes (September 29, 1972, p. 623). 
  30. An Act respecting Les Services de santé du Québec (private member's bill 142, adopted on July 15, 1964, Legislative Assembly, 1964, 3 pp.).
  31. De Bellefeuille, Denis and Cantin, Hervé, "Plans de retraite" (Échanges, November 1966, p. 15). 
  32. Board minutes (October 3, 1967, p. 425). 
  33. General manager's report (SSQ Annual Report, 1963, p. 5). 
  34. "Dans un mémoire remis au gouvernement : La Mutuelle SSQ s'en prend à la taxe de 2 % sur les primes d'assurance-maladie" [In a brief submitted to the government, SSQ criticizes the 2% tax on health insurance premiums] (L'Action, May 17, 1967, p. 21). 
  35. "Dans le but de révoquer l'imposition d'une taxe sur les primes d'assurance : La mutuelle SSQ fait pression auprès du Gouvernement" [In an attempt to revoke the imposition of a tax on insurance premiums, SSQ lobbies the government] (Le Nouvelliste, Trois-Rivières, May 17, 1967, p. 32).
  36. Executive committee minutes (April 30, 1970, p. 381). 
  37. Executive committee minutes (August 13, 1965, p. 233). 
  38. Board minutes (April 23, 1964, p. 372). 
  39. Idem, p. 372. 
  40. Executive committee minutes (April 13, 1966, p. 250). 
  41. Executive committee minutes (November 14, 1966, p. 264). 
  42. Executive committee minutes (April 13, 1966, p. 250). 
  43. Board minutes (December 12, 1967, p. 428). 
  44. Executive committee minutes (November 21, 1967, p. 305). 
  45. Executive committee minutes (September 19, 1967, p. 295). 
  46. Referendum concerning a proposed building on Laurier Boulevard in Sainte-Foy (August 1967). 
  47. Marquis, Léopold. "L'inauguration : une pierre… deux coups" [Inauguration: killing two birds with one stone] (Échanges, 1970, no. 2, p. 39). 
  48. Board minutes (June 6, 1968, p. 440). 
  49. Executive committee minutes (February 8, 1968, p. 311-312). 
  50. Board minutes (June 5, 1969, p. 555). 
  51. Léopold Marquis, op. cit., p. 39.