Patients at Risk: Exposing Canada’s Health-care Crisis
Susan D. Martinuk
Frontier Centre for Public Policy, 2021
Reviewed by Johny Van Aerde, MD, PhD
Canadians should no longer accept the current state of their health care system. Open a window and shout, “I am mad as hell, and I am not going to take it anymore!”1 That is what Susan Martinuk suggests in Patients at Risk: Exposing Canada’s Health-care Crisis. The outcomes of our health system are about the worst of all Organisation for Economic Co-operation and Development (OECD) countries, while the cost is the same or more (except for the United States, which is the worst in cost and outcomes). When Dr. Jane Philpot was federal minister of health, she summarized the situation well: “It’s a myth that Canada has the best health care system in the world.”2
Using painful and sometimes lethal stories, sharing plenty of data, and recounting the history of Canada’s health care since the Second World War, Martinuk describes how Tommy Douglas’ dream turned into an outdated, bureaucratic, government-controlled nightmare. The dream was that patients would have access to universal health care, but the recurring nightmare has them stuck in wait lists, while health care workers, including physicians, are trapped in a regulatory dungeon without a chance of escape.
Sixty years ago, it started well as Douglas introduced a system to provide acute relief for a farmer with a broken leg or for a child with pneumonia. However, his system was not designed to deal with the tsunami of baby boomers with multiple chronic ailments, the explosion of expensive technology that analyzes us down to molecules, or the ever-increasing greed of the pharmaceutical industry perpetuating the illusion of needing more and more slightly different pills, even if the evidence for benefits is limited to non-existent.
The Canadian health care system was created when the common good and socialism prevailed. If we accept that it is a moral duty to have health care as a common good, then don’t we also have the moral obligation to provide healing and medical care to those in need? There is limited evidence that the Canada Health Act (CHA) protects that common good and some of the five principles might even be damaging to the act:
Accessibility was meant to guarantee access to health care but has deteriorated to access to wait lists. Only life-threatening conditions receive timely care, most of the time.
Universality does not apply to some groups with preferred access, including professional teams and athletes, workers compensation boards, personnel of the army and the RCMP, members of Parliament, federal civil servants, judges, and inmates at federal prisons.
Portability: Although this principle should imply that the same health services are available to all Canadians across Canada, much variability exists between provinces.
Comprehensive applies to little else than in-hospital services and most services provided in physicians’ offices.
Public administration might be detrimental to the CHA itself, as bureaucracy is the biggest barrier to the innovation and creative change needed in our health system.
Although top-down bureaucratic control of government-rationed medicare might make Canadians feel powerless to change the system, Martinuk’s last two chapters show possibilities. In “How to make health care better,” some suggestions for further exploration include proactive patient advocates, patient education, minimizing bureaucracy, investing in health care personnel and physicians, building networks for data and information sharing, while adding technology and artificial intelligence.
In the last chapter, “Where do we go from here?”, Martinuk advocates abandoning the polarization that proponents of both medicare and private health care create, which stokes fear in Canadians and prevents real dialogue. We need a long-term plan for health care, we need to separate politics from health care, and (re)create a real system rather than the fragmented hodge-podge of silos we have now. We deserve a commitment from all levels of government to stop bickering and work together, to act with all stakeholders to create a health system that is truly universal and accessible. Neither the public nor a private system can accomplish those principles. In many European countries, hybrid systems that combine the public health system with additional, controlled, and competing private insurance have been successful. Unfortunately, the top-down government control of our health system and fear that the right thing might cost votes prevent us from exploring a hybrid model.
Martinuk finishes by sharing what each of us can offer in the moment: kindness and finding small actions to make things simpler, better, and more pleasant for each other. That is the most important form of healing we can always offer. What has been tried for the last 60 years no longer works, and it behooves us to look at alternatives, based on data, outside the traditional way of thinking. By looking both inside and outside the health care box, this book helps Canadians with urgently needed redesign and improvement to our health system.
1.Chayefsky P. “Network” (movie). Beverly Hills, Calif.: Metro-Goldwyn-Mayer; 1976.
2.Remarks by Dr. Jane Philpot at the Canadian Medical Association’s annual general meeting, 23 Aug. 2016. Ottawa: Health Canada; 2016 Available: https://tinyurl.com/4hsutbrz
Johny Van Aerde, MD, PhD, FRCPC, is past executive medical director of the Canadian Society of Physician Leaders and founding editor of the Canadian Journal of Physician Leadership.