By Dr. Danielle Martin. Allen Lane, 298 pp, hardcover
Dr. Danielle Martin is a familiar face to approximately a million Canadians who watch The National with Peter Mansbridge.
As a member of the show’s Checkup Panel, the Toronto-based general practitioner and hospital administrator regularly prescribes sensible and bite-size health-policy solutions on topics ranging from elder care to chronic diseases.
In Better Now: Six Big Ideas to Improve Health Care for All Canadians, Martin delivers a full-meal deal. In an imaginative and far-reaching look at the Canadian health-care system, she integrates her personal experiences with patients and her family history with compelling research to make a passionate and convincing case that medicare can be improved immeasurably.
It’s even better than Dr. Michael Rachlis and Carol Kushner’s landmark 1994 book, Strong Medicine: How to Save Canada’s Health Care System, because it’s so damn readable. Martin’s anecdotal stories connect to the heart, while the science connects to the brain.
So what are Martin’s big ideas?
First off, she dispenses with what she refers to as the “health-care zombies”. These are rotten ideas—like user fees, a parallel private system for paying doctors, and private financing—that won’t enhance public health or save money.
Instead, she advocates for every Canadian to have regular access to a family doctor.
In this section, Martin makes excellent suggestions for improving general practitioners’ communication with the acute-care system to ensure that when their patients are released from hospital, these doctors are immediately informed about their health status.
“There is no magic to an MD degree that makes the doctor the only person suitable for providing high-quality primary care,” she writes. “Other providers play important roles in disease prevention, health promotion, and the treatment of illness.”
She also includes an important section on prescription drugs, noting that under certain circumstances, they’re overprescribed. In other instances, she shows how low-income people are deprived of life-saving and life-extending medications because of an inability to pay.
Martin’s solution, which draws heavily on UBC health economist Steve Morgan’s research, is to create a national drug plan. That’s because if governments bought in bulk, they would sharply drive down prices charged by pharmaceutical companies, thereby saving Canadians massive sums of money and increasing public access.
There’s another section on the plethora of unnecessary diagnostic tests, some of which have negative repercussions on health. While it’s very informative, it’s not quite as comprehensive as UVic professor Alan Cassels’s Seeking Sickness: Medical Screening and the Misguided Hunt for Disease.
One of Martin’s most daring ideas is to implement a basic-income guarantee, something long advocated by former Conservative senator Hugh Segal. She makes a strong case that this would reduce hospital utilization and save money because poverty is demonstrably linked to shorter lifespans and poorer health outcomes.
Deep into the book, Martin quotes Saskatoon-based health-policy consultant Steven Lewis declaring that there “are lots of sensible books with self-declared big ideas about how to fix the system, and none of them has any influence”. Martin’s response was to include a section on how to effect change by scaling up local innovations to be replicated nationwide. That’s another of her big ideas.
She made the point in Washington, D.C., that Canada’s single-payer system is not the cause of any of the health-care system’s shortcomings.
Senator Bernie Sanders posted her testimony on YouTube, where it has since attracted almost 1.5 million page views.
From the enthusiastic reactions to the video and ensuing media attention, she concluded that many Canadians are “wildly proud” of their health-care system. And with Better Now, Martin may be well on her way to becoming its greatest defender.