The good guys of Canadian healthcare are writing in full force. Dr. Danielle Martin’s engaging new book, Better Now, is one of several recent releases from leading Canadian intellectuals, including: André Picard, Matters of Life and Death: Public Health Issues in Canada; Andrew Bresnahan, Upstream Medicine: Doctors for a Healthier Canada; and John Lavis, Ontario’s Health System: Key Insights for Engaged Citizens, Professionals and Policymakers. All of these authors support public healthcare and want to fix its trouble spots. But probably the only one among them who went viral on the topic is Martin, who garnered international recognition as “the expert who taught a smug US senator about Canadian healthcare” during televised hearings on American healthcare in 2014.
Martin embodies the best of a new generation of family physicians, not only continuing to practise obstetrics within primary care but also holding a senior administrative position at Women’s College Hospital in Toronto. In her own words, her book “brings together the perspective of the front line—individual patients and healthcare providers—and the perspective of system thinkers.” Written in a conversational style and buttressed by excellent research and citations, Better Now examines six bold ideas to improve public health care. These ideas are: Strengthen primary care relationships; implement universal pharmacare; choose patient tests and treatments wisely; reorganize healthcare to reduce wait times; introduce a basic income; and scale up promising interventions. Before presenting these ideas, she summarizes the context of public healthcare in Canada, clarifying what our public payer system is and isn’t amid so many private payees. The most powerful contextualizing section in the book is Martin’s attack on “zombies”—bad ideas to reform healthcare that are widely repeated and simply will not die.
As a public-health physician, I was particularly intrigued by the bold idea of ensuring relationship-based primary care for every Canadian. Primary care has been the mantra of healthcare reform for 30 years and the topic of repeated provincial announcements. Yet for all the talk there has been little action. Martin explores what it would really take for all Canadians to establish a long-lasting, trusting, caring and resource-responsible relationship with a primary caregiver. Her attempt is laudatory but perhaps too idealistic, and Martin treads surprisingly lightly on walk-in clinics, despite their existence being the total antithesis of this idea.
Better Now’s discussion of the need for a basic income—also known as a guaranteed annual income—is a welcome addition to the other, more healthcare system-focused ideas. As Martin notes, poverty is at the core of much ill health, including higher rates of heart disease, depression, diabetes and other illnesses. A basic income is an essential prescription for health and healing. The fact that healthcare, including physician remunerative demands, consumes so many public dollars is part of the dilemma that Martin acknowledges in rebalancing our health and social safety nets.
Overall, Better Now is an articulate account by a committed physician outlining what we can do to preserve, protect and improve our important yet imperfect Canadian healthcare system. Aided by the inclusion of Martin’s own family story, along with the numerous highly readable patient accounts woven throughout the book, readers who engage with Martin’s analysis should also be better able to value our system.
—Dr. Lynn McIntyre is a public-health physician and professor emerita of Community Health Sciences at University of Calgary.