Michael Kary reviews Dr. Danielle Martin’s latest book
Better Now: Six Big Ideas to Improve Health Care for all Canadians, is authored by Dr. Danielle Martin, this year’s keynote speaker at the BCCPA Annual Conference. Register as a delegate and you will receive a signed copy. Books available while supplies last.
Dr. Martin’s Ideas Make for Compelling Look at Canadian Health Care
Review by Michael Kary, BCCPA Director of Policy and Research
One of the first books I finished reading this year, just released in January, is Better Now: Six Big Ideas to Improve Health Care for All Canadians by Dr. Danielle Martin, a Family Physician in Toronto and the Vice President of Medical Affairs and Health System Solutions at Women’s College Hospital.
Since becoming a family physician, Dr. Martin has been a strong advocate for Canada’s single-payer public health system including speaking regularly on CBC’s the National, as well as defending its main tenets in front of the United States Congress following an invite from Vermont Senator Bernie Sanders. In 2015, Dr. Martin was also named Canada’s eighth most powerful doctor by The Medical Post, and in 2013 was one of The Toronto Star’s top “13 People to Watch.”
In her book, Dr. Martin outlines six main ideas to improve the Canadian health care system, including:
- Ensuring every Canadian has regular access to a family doctor or other primary care provider;
- Bringing prescription drug coverage under Medicare;
- Reducing unnecessary tests and interventions in the health system;
- Reorganizing health care delivery particularly through centralized systems to reduce wait times and improve quality;
- Implementing a basic income guarantee to alleviate poverty; and
- Scaling up successful local innovations to a national level.
While the ideas in Dr. Martin’s book, including the strengthening of primary care, the development of a National Pharmacare Program and fostering innovation, are not new and have been articulated in various reports and articles, they are nevertheless important ones that merit further consideration going forward to improve and strengthen Medicare. The book also recognizes that these six areas are only a few ideas for reform and not necessarily the only solutions to fixing what ails the Canadian health care system.
One of the most interesting aspects of the book is how Dr. Martin interweaves some of the stories from her patients into the highlighting why action on the six areas is critical. As outlined by Globe and Mail health reporter and columnist, Andre Picard, “Martin’s proposals are intriguing because they do what few others have – place as much emphasis on improving care for the individual patient as on reforming the larger health system.”[i] This, for example, is seen from the portrayal of Abida, a complex care patient, who could benefit like many others from a strong primary care system to Ahmed who is unable to afford the costs of necessary prescription drugs and ends up like many in the emergency department. Likewise, along with patients, Dr. Martin discusses the personal story of her grandfather Jacques who could have benefited from a public Medicare system but which did not exist when he arrived in Canada from Egypt in the early 1950s.
Arguably one of the most provocative ideas in the book is contained within the fifth section which makes the case for the development of a guaranteed annual income for all citizens. Here Dr. Martin recounts the story of Leslie, a single mom who struggles with poor health outcomes, due in large part to the poverty and lack of adequate social housing that she endures. Dr. Martin emphasizes the importance of socio-economic factors or social determinants in one’s health, such as access to an appropriate level of income or adequate housing, noting that although health care currently takes up nearly half of provincial budgets and is ranked as a top priority among Canadians, the health care system itself only determines about 25 percent of the health of populations, while social and economic factors account for about half.
To deal with this issue, Dr. Martin advocates for a guaranteed minimum annual income for all Canadians to not only reduce poverty but also improve health outcomes among the general population. As outlined in the book this would be like what already exists for Canadian seniors through programs such as Old Age Security (OAS) or the Guaranteed Annual Income Supplement. While the costs of such an initiative would be substantive it may, however, save significant health care costs over the long term, while also improving outcomes.
One potential area, however, that could merit further discussion in the book is how to ensure the changes or fixes proposed could be made. As outlined by Picard “if there is a shortcoming in Better Now, it is that there is too little discussion of how to do it.”[ii] While a valid concern, Dr. Martin nevertheless provides some discussion on this as part of idea number six namely to scale up successful local innovations to a national level. As an example, Dr. Martin highlights initiatives such as the establishment of Canadian Blood Services or the development of surgical safety checklists as best practices.
Overall, I highly recommend this book to anyone who would like to gain a better understanding of Canada’s health system; along with focusing on the six key areas it also provides a good high-level overview of some of the main challenges facing the health system – from the limited access and affordability of necessary prescription drugs, to the tendency for many patients to undertake unnecessary and expensive drugs, tests and other treatments. Likewise, even for those familiar with the system, it is a very good read and summary of Canada’s Medicare system.
I also look forward to hearing Dr. Danielle Martin at the BC Care Providers Association (BCCPA) 40th Annual Conference in Whistler, where she will be providing the opening keynote address and participating in the opening plenary discussion. Joined onstage by Dr. Jennifer Baumbusch, an Assistant Professor at the School of Nursing at UBC and Dr. Samir Sinha, Director of geriatrics at Mount Sinai and the UHN hospitals, and Provincial Lead of Ontario’s Seniors Strategy, Dr. Martin will articulate her vision for the future of seniors and continuing care, as well as offer strategies to ensure excellence in end-of-life care.
Be sure to register for the BCCPA Conference to hear this thought-provoking address and for an opportunity to obtain a signed copy of Better Now: Six Big Ideas to Improve Health Care for all Canadians. To order your own copy, visit Chapters-Indigo.ca.
[i] Dr. Danielle Martin’s Better Now, reviewed: An intriguing proposal for improving health care. Andre Picard. Globe and Mail. January 27, 2017. Accessed at: http://www.theglobeandmail.com/arts/books-and-media/book-reviews/danielle-martin-better-now-review/article33791912/.