Dr. Martin became known from her medicare advocacy work through Canadian Doctors for Medicare, and a particularly effective sound-bite during testimony to US congressional hearings. This book, aimed squarely at a mainstream public audience, continues in that same vein, mounting a staunch defence of the principles behind Medicare, but not shying away from its problems, charting six "big ideas" to move it forward.
The early chapters provide a solid foundation for understanding how Medicare works today, and if there was ever a law that you need to know what you're talking about before arguing about something, should be required reading by every Canadian. Coupled with a pre-emptive strike against the recurring simplistic "quick fix" ideas, they set the stage for the necessary but unlikely "adult discussion" we should be having but aren't.
The first five big ideas — relationship-centred primary care, national pharmacare, strong evidence-based treatment practices, better organization of resources, and guaranteed basic income — are presented in an accessible manner, tied to patient stories, with solid explanations of how they would improve the health system. Given the audience and limited space, the tone is necessarily inspirational rather than prescriptive.
The last big idea focuses on what is needed to change the system, to actually have these or any of the other ideas that have been suggested over the years actually happen in Canada. It is again high-level and general, not so much an actual blueprint for a way forward, but an explanation for the public about the extremely difficult obstacles that are encountered when there is any attempt made to change healthcare in Canada.
So much more could be said here, and I'm sure earlier drafts contained a lot more about feckless administrators and bureaucrats, promoted beyond their skill level and doing everything they can to not be noticed, to particular groups of physicians and allied health professionals who have been screwed over so many times they've given up caring about the system as a whole and just want to hold onto what they have got, to the morale problems, the perverse non-accountability exercises. Yes, perhaps just a taste of these is best.
This book provides a path for the public to go beyond the sound-bites that are all most Canadians see from Dr. Martin and others. From that point of view, the book accomplishes this. Her point of view, which touches on clinical and administrative, far enough along in her career to have had some worthwhile and credible experiences and yet early enough so as not yet to be completely jaded, comes across well in the optimistic but not idealistic tone.
At times, the limitations of her perspective do shine through. Though there are a few token examples drawn from other provinces, her perspective is solidly Ontario-based. As an obviously gifted and emotive family physician, who's undoubtedly encountered a range of poor-to-excellent specialists, a reliance on primary care looks ideal. As a counter-point, my wife is a specialist (psychiatry), who's encountered her share of poor-to-excellent family docs, and the thought of relying on many of them to be the center of anyone's care is a disaster waiting to happen. Similar other thoughts crossed my mind given she's practiced in more provinces (Ontario, Alberta and BC) and different settings (non-profit and for-profit hospitals, both community and tertiary, community clinics, and private practice). There's a lot of variability out there, which is of course what makes the whole change process so challenging.
She wryly quotes one health policy consultant who says "there have been lots of sensible books with self-declared big ideas about how to fix the system, and none of them has any influence." Despite the significant writing on the difficulty of health care change, if this book were meant as a standalone, I think the quote would still apply. But when seen as a backgrounder, only a part of a broader campaign of awareness and advocacy, and a means to engage the public in a positive, national conversation by Dr. Martin and many other health professionals in Canada, I think this book works. There's so much inertia preventing change, so those who hope to make progress will need all the help they can get.
- Hardcover: 304 pages
- Publisher: Allen Lane; 1 edition (Jan. 10 2017)
- Language: English
- ISBN-10: 0735232598
- ISBN-13: 978-0735232594
- Product Dimensions: 15.8 x 2.8 x 23.5 cm
- Shipping Weight: 481 g
- Customer Reviews: 26 customer ratings
- Amazon Bestsellers Rank: #22,239 in Books (See Top 100 in Books)