Better Now: Six Big Ideas to Improve Health Care for All Canadians

by Danielle Martin

Longlisted for British Columbia's National Award for Canadian Non-Fiction 2018

Dr. Danielle Martin sees the challenges in our health care system every day. As a family doctor and a hospital vice president, she observes how those deficiencies adversely affect patients. And as a health policy expert, she knows how to close those gaps. A passionate believer in the value of fairness that underpins the Canadian health care system, Dr. Martin is on a mission to improve medicare. In Better Now, she shows how bold fixes are both achievable and affordable. Her patients' stories and her own family's experiences illustrate the evidence she presents about what works best to improve health care for all.

Better Now outlines "Six Big Ideas" to bolster Canada's health care system. Each one is centred on a typical Canadian patient, making it clear how close to home these issues strike.

- Ensure every Canadian has regular access to a family doctor or other primary care provider
- Bring prescription drugs under medicare
- Reduce unnecessary tests and interventions
- Reorganize health care delivery to reduce wait times and improve quality
- Implement a basic income guarantee to alleviate poverty, which is a major threat to health
- Scale up successful local innovations to a national level

Passionate, accessible, and authoritative, Dr. Martin is a fervent supporter of the best of medicare and a persuasive critic of what needs fixing.

Genres: Nonfiction, Medicine, Canada, Politics, Health, Health Care, Science

298 pages, Hardcover

First published January 10, 2017

Reviews

[Allie · Rating 5 out of 5]

The combination of research, policy and patient anecdotes made for an incredible read. I admire Dr. Martin’s honesty and vulnerability in Better Now. A must read for all those working in health care (and even those who aren’t)!

[Alexis Jeynes · Rating 4 out of 5]

This was an assigned reading for one of my nursing courses this semester. Written in 2017, it describes and details 6 big ideas that should be implemented to improve our healthcare system. Some that stood out to me were including essential prescription meds into Medicares coverage (regardless of age), providing relationship based care, reducing the amount of unnecessary testing, and of course, providing some structural framework to help out those of low income access better and more nutritious food, better care, medications, etc. Even though this was an assigned reading, I found it really did ring true, and blatantly points out the flaws within our medical system. I can only hope that one day Canada will implement at least a few of these…

[Cynthia · Rating 5 out of 5]

This is a re-read. I first read this book in 2020 while I was applying for medical school and it was my first glimpse into what would grow into a passion for family medicine.

It’s illuminating to re-read this book 5 years later, as I’m in the middle of preparing for my family medicine residency interviews. I wanted a refresher on the Canadian healthcare system and structure, and was admittedly struggling with an answer to “What are the challenges in our healthcare system and how can we address them”. After going through medical school and reflecting on what I’ve seen and learned, it’s been a joy to circle back to this book which leaves me feeling so hopeful to enter the profession of family medicine, despite its challenges. I’m excited to do right by my future patients and for my community.

Excellent read! Would highly recommend to every medical student in Canada.

[Catherine · Rating 4 out of 5]

My neck and shoulders hurt, and my eyes are dry. After nearly 4 years of university, I've still failed to stick by my one goal/tip for each year: DO THE READINGS ON TIME. (Seriously. You'll just regret it the week before finals, like I always do.)
My foolishness aside, I actually found that this book was really interesting. Dr. Martin highlights aspects of the Canadian healthcare system that I never considered before, and it made me realize how many illnesses and conditions could be avoided, if we had a better functioning system embedded in the grassroots level in place. This book presents ideas and solutions that will prevent people and especially sick patients ("frequent flyers) from being in the hospital in the first place. As someone who is interested in public health, I genuinely enjoyed reading about the upstream approach to healthcare, and how we can invest more in prevention and promotion, in order to reduce patient acuity.

[Chad Kohalyk · Rating 4 out of 5]

A very accessible book for people like me who do not work in the sector. I learned a lot about how (ideally) the system of patient-centric care we have should work, and she convinced me to be a believer in our public medical system.

The Six Big Ideas did include some acute solutions, but some of the others (eg. mincome) were so broad as to be unachievable. Like Piketty's Global Wealth Tax, sometimes offering up (politically) impossible solutions is just what people need to realize how intractable a problem is.

In one chapter Dr Martin makes supplications to the holy "innovation" of Silicon Valley, smacking of the solutionist thinking that I think has already fallen out of favour in other social projects. But it seemed more of an afterthought — an attempt to be current, or "innovative"? — and did not cast a pall over the other solutions, which seemed much more progressive.

[Sarah Sawaya · Rating 5 out of 5]

This might just be my new favourite book!! I am inspired by Dr. Martin’s courage in describing the 6 big ideas to improve healthcare for Canadians. I highly recommend this book to anyone in healthcare or to those interested in improve our system! Definitely a book I will be referring back to in the future.

[Jordan Tallis · Rating 5 out of 5]

This was an assigned reading for a class that I never did LOL I finally read it and found that it explained the Canadian healthcare system in a very simple way and outlined some great ways to improve the system and patient’s lives :-) I would totally recommend this to ppl interested in learning more about healthcare 💌

[Tia · Rating 3 out of 5]

pray for me that I pass this exam

[Kbeckermann · Rating 5 out of 5]

For many reasons I loved this book. First, Martin gives concrete actions that everybody can start to work on, whether a patient, a provider, a funder, a policy maker or a business. Second, she names things beyond the health care system that are needed to improve health care. Third, Martin calls a 'spade a spade' and doesn't shy away from being explicit about what all the actors in the system (including consumers) do that contribute to the mediocre results we get. Finally, she writes in an engaging style, that is simply fun to read. I know what I'd like to see happen with many of these ideas but for my part, as a patient, I can start with my relationship with my primary care provider.

[Anna Marie · Rating 4 out of 5]

We all do a great job of pointing out the downfalls of "the system." It's easy to see flaws, but harder to visualize solutions. Dr. Martin not only points out the flaws of the Canadian Healthcare System, but also proposes practical ways to overcome them. What I like most is the simplicity of Dr. Martin's proposals. Dr. Martin's 6 big ideas are not overly complicated or complex, they just make sense. While reading, I found myself asking "why haven't we done this already?" I recommend this for both healthcare providers and patients alike. There's much we can learn from Dr. Martin's ideas, and a brighter future to look forward to, if they are implemented.

[Lindsay Elizabeth · Rating 5 out of 5]

Insightful, engaging, and highly informative. Dr. Martin's book is a must-read for anyone interested in better understanding our health care system and how we can improve it for everyone.

[Matt · Rating 5 out of 5]

"We know what to do in our local communities, clinics, and hospitals. The real obstacle in Canadian health care is that we haven't figured out how to do it for everyone, everywhere, all the time... If we can't effectively spread and scale our success, we can't deliver on the promise of medicare."

Better Now bridges an important gap between the theory and implementation of strategies for improving the Canadian healthcare system. While many of these ideas for improving healthcare are well established and familiar, the localized Canadian context has certainly been missing, and Martin filled this gap nicely. Martin's background in policy is evident, as her assessment of the Canadian healthcare system often touched on institutional factors like bureaupathologies, state scope and capacity of the federal vs. provincial governments, and the economic ramifications of jobs, physician payment models, and these Big Ideas. Overall a great read and highly recommended for anyone working in healthcare.

[Ietrio · Rating 1 out of 5]

Martin knows. After all the publisher put a Dr. on the cover so you would know Martin brings messages from the true gods of political administrations. And the gambit is right. If something happens and someone puts these ideas in practice the technique is already well tested: it does not work because Satan and the Russians have employed the evil big pharma corporations to hurt the perfect bureaucratic plan.

[Anna · Rating 3 out of 5]

it's kinda funny how i ended up reading about medicine and healthcare at an arts university; but here we are!

good read, and really clear, consice writing, just a topic i wasn't super invested in, personally

[aforestofbooks · Rating 4 out of 5]

This was actually a pretty well-written and thought-provoking read. Martin mentions a lot of things that are super relevant right now especially with COVID. I just wish there was a way to get everyone on the same page and make these changes

[Edwin White Chacon · Rating 5 out of 5]

Highly recommend. Gives great overview of how the Canadian health care system works and how it can be better.

[Jenna (Falling Letters) · Rating 4 out of 5]

Review originally posted 17 January 2017 at Falling Letters. I received a complimentary copy from the publisher via NetGalley in exchange for my honest review.

A few days ago, I came across an expose by the CBC’s The Fifth Estate on “The High Cost of Pharmaceuticals: Canada’s Big Drug Problem”. A lot of what that investigation discussed sounded familiar. I had just read all about it in this book, Better Now. I had originally decided to read this book because I thought it would a good supplement to the books I had read last year – books by life and death professionals (ex. family doctor, crematorium technician) about their work and how to improve their field through anecdotal stories about their patients and their own personal lives (is that specific enough? haha). As described above, Better Now, written by a family doctor who believes ‘in the value of fairness that underpins the Canadian health care system’, presents the following ‘Six Big Ideas’ to improve the system:

1) Ensure relationship-based primary health care for every Canadian
2) Bring prescription drugs under Medicare
3) Reduce unnecessary tests and interventions
4) Reorganize health care delivery to reduce wait times and improve quality
5) Implement a basic income guarantee
6) Scale up successful solutions across the country.

This book turned out to be even more personally relevant than I expected. I am currently searching for a new family doctor, as I found my old one unsatisfactory. I couldn’t pinpoint exactly why, but after reading about these ideas and some of the issues with our system, I see my relationship with my previous doctor reflected in them. Idea #5 surprised me in a good way. I appreciated how Dr. Martin considers the bigger picture and explores social factors, especially in ideas #5 and #6. Her proposals are indeed ‘big ideas’. She acknowledges the potential difficulties in implementing them, but also presents them as actionable realities. She strikes an appropriate balance between support for the current healthcare system and addressing its shortcomings, which can be improved upon. One area she doesn’t explicitly address is the education of medical professionals, which is an area I imagine could use some changes.

Better Now is written in an accessible style, with straightforward prose. These are complex ideas, but there isn’t too much technical jargon or infodump – just enough so the reader can understand the ideas being presented. This is a short book and therefore largely a starting point. If one concept intrigues you, Martin provides many resources for further reading at the end of the book.

The Bottom Line:Is it too trite of me to say ‘I recommend this book to any Canadian’? I could say, ‘I recommend this book to any Canadian with a stake in our healthcare system’ – well, isn’t that the same thing? But seriously, if you have any interest or care for your healthcare, check out this book.

[R.J. Gilmour · Rating 5 out of 5]

Martin's book is a manifesto for improving Canada's national healthcare program, with six ideas she realized while working as a GP in downtown Toronto. It is an important book for anyone interested in healthcare, including doctors, patients and administrators.

"Health care systems are structurally fairly simple. As my grandfather, Jacques, knew all to well, someone has to pay for the care. That's called health care financing. And someone has to give the care to patients. That's called delivery. If you understand who's paying for the service and who's delivering it, you can begin to understand the health care model being discussed." 16

"The complexity and overhead involved in multi-payer financing systems explains why American private insurance companies spend an estimated 18 percent of the premiums they bring in on billing and insurance-related administration. By contrast, Canada's elegantly simple single-payer system spends less than 2 percent on insurance overheard for the public plans found in each province and territory." 19

"But aside from public health departments, we have almost no public delivery in Canada. In fact, we have a highly private health care delivery system. That hasn't changed much since the pre-medicare days."19

"The delivery of health care service is constitutionally under provincial jurisdiction. Our provinces and territories have primary responsibility for managing most of our health care systems. The federal government doesn't delivery health care services to most Canadians, but it does provide money to support health care in every province and territory...The big tool that the federal government has used to shape how the provinces deliver care is the Canada Health Act, which was unanimously passed into law in 1984. In order to receive federal funding for health care, provinces have to adhere to principles of the CHA, including not allowing doctors or hospitals to charge patients extra for services covered by medicare." 23-24

"The real challenge of an aging population isn't the increasing number of aging baby boomers, but the increasing number of tests and treatments we administer to them without improving their health." 35

"That's the Big Idea in this section: relation-based primary care for every Canadian. This means that every individual should have a relationship with a primary care doctor or nurse practitioner. It also means that every primary care group should have good relationships with the rest of the health care system, and with the community in which all are embedded." 55

"One of the most important things we do in primary care is what Dr.Heath has called "patrolling the border" between illness and disease. Disease is what we learn about in medical-school textbooks: a somewhat arbitrary set of definitions that have developed over time based on pattern recognition...Illness, on the other hand, is an individual human being's experience of being unwell." 61

"Canada is only developed country with universal health coverage that does not include prescription drugs." 90

"Today, only about 60 percent of Canadians are covered by private drug insurance." 94

"We could learn a lot from New Zealand. In 1993, the New Zealand government introduced the Pharmaceutical Management Agency, more commonly known as PHARMAC, in response to significant increases in medication prices...Between 2013 and 2014, tendering-the practice of competitively procuring each drug from the most competitive manufacturer-led to savings of over $50 million." 110

"In most parts of our health care system, we don't need more money, more doctors, or fancy machines. What we need is to better organize the resources we have." 151

"There are alternatives to hospitals and the ED. Michael Decter, the former deputy health-minister I quoted earlier, has referred to the "six components of the out-of-hospital universe": primary health care, home care, the community pharmacy, community-based paramedicine or ambulance care, palliative care, and rehabilitation." 167

"The SCOPE project instead wraps services around the primary care provider, helping family doctor take better care of complex patients in the community, close to home." 170

"The notion of partnering more deeply with patients is surfacing all over the health care system. Barbara Balik, a health care leader in the U.K., has nicely summarized this by noting that countries have been slowly evolving from providing care "to patients" to providing it "for patients to providing it "with patients." 175

"In Canada we often speak proudly of our social safety net, but the reality is that many of our "poverty reduction programs" are an exercise in scarcity and humiliation." 193

"Life on social assistance is a labyrinth of case worker, forms, claims, denials, and self-justification. This system feels designed to limit access as much as possible, not to ensure that all those who need support actually get it....Segal sums it up nicely. "Our present system does not fight poverty. It institutionalizes it." 194

"First, social assistance in Canada tends to provide a level support well below the poverty line. Second, because it would work through the tax system, the Basic Income Guarantee would eliminate complex eligibility and exemption criteria, making it quite administratively simple. The only criterion for eligibility would be a person's level of income...What makes the Basic Income Guarantee attractive is that it would eliminate the need for the kinds of income support programs that invade people's lives and limit their choice. Many existing programs, such as social assistance in Canada or food stamp programs in the United States, are based on a highly paternalistic approach to social welfare." 195-196

"Like medicare, a Basic Income Guarantee is a form of insurance against hard times, a policy that is both simple and fair. The same principles that led us to establish universal health insurance underpin it: administrative simplicity, rise pooling, reliability, dignity for the recipients, and the belief that access to some basic things should be automatic-a right of citizenship rather than an act of charity." 208

[Ania · Rating 5 out of 5]

Recommended read for anyone who works in healthcare. Inspirational and hopeful that our healthcare system can change and improve.

[Alishia Reeves · Rating 3 out of 5]

Layed out the basics. Interesting read if you are being introduced to the ideas. A bit repetative and drawn out.

[Suzanne F. · Rating 5 out of 5]

This book is a critical read for anyone interested in the Canadian health care system. It provides several key ideas which - though not exhaustive - can be used to improve health care in Canada, if political courage and professionalism is adopted by all members of the medical profession.

The most important idea in the book though comes at the end: how can members of the medical profession make change, especially on a large, nation-wide scale, occur? The inevitable answer comes from being more courageously political in engagement, especially in professional associations, hospital committees and administrations, and also in grassroots organizations and political offices. As Steven Lewis, a health policy consultant noted to Dr. Martin regarding her book: "The book that needs to be written (if any needs to be written) is a careful, sophisticated political analysis of how change occurs and where there may be opportunities to get done what everyone says needs to get done."

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As Dr. Brian Day's current legal challenge to Medicare is pending at the BC Supreme Court - Dr. Martin takes the time out to address why public-private system won't work in Canada and why adopting either the "American" model or even, as so many people love to point out, the "European" model - namely Europeans pay a lot more taxes, have a broader scope of social services, and have better integrated systems of community care. These issues are covered in some of the earlier chapters of the book which also provide salient information on how the Canadian healthcare system is funded and delivered.

[dani · Rating 3 out of 5]

i had to read this book for school, but after coming across this article about a woman in Saskatchewan, i genuinely believe this country is in shambles. this is not a first-world country as it claims to be. mismanagement and poor handling of resources by the government are sending this country into turmoil. what will happen to all of us?

here is an excerpt from the article:

“Every day I get up and I'm sick to my stomach and I throw up and I throw up,” Van Alstine said.
She visited the provincial legislature on Tuesday to plead for help getting surgery to remove her remaining parathyroid gland.
Currently, there is no Saskatchewan surgeon able to perform the operation.
Van Alstine said she must be referred out of province, but she can’t obtain a referral without first being seen by an endocrinologist — and none of them are accepting new patients.
Van Alstine said the pain has become so unbearable that she has applied for, and been approved for, MAID on Jan. 7.

how is it possible that a person’s last resort is to apply for euthanasia rather than receive a surgery that should be a simple, straightforward fix? how did we get to a place where patients are being pushed toward death instead of being given the care they need to heal?

[Peipei · Rating 4 out of 5]

I felt a bit confused or lost about my opinions on the Canadian healthcare system, and this book really educated me and opened my eyes to the importance of public health and the impact one should aim to have when working in healthcare. Many ideas are for policy makers and those higher up, but as someone who wants to be in the healthcare field, I think there are many many valuable tips and lessons for that group of people as well. This was tremendously helpful in helping me prepare for policy questions in my medical school interviews this cycle- I dare say that this is the best preparation that I did since the policy type questions are hands down the most intimidating kind to me. I thought this book would be very dry and read purely for the sake of interview prep, but I enjoyed it thoroughly, there were sections that I couldn't put down, and I loved that it surprised me in that way. Don't get me wrong, a lot of this is very matter of fact and hard facts being relayed in an eloquent manner, but I enjoyed it a lot, particularly since the author is great at tying in her own experiences in the form of her patients when she gets to each idea

[Lailita 💕 Nesbitt · Rating 5 out of 5]

An excellent collection of relevant perspectives of the patient , the determinants of health , the influence of policies, and the role of all health care providers. For any one in health care this book should be read , and for those out of health care it will give a true perspective of how our Canadian health care system works .

The writing about nurses and NPs was greatly appreciated. Dr Martin understands that doctors are not the only professionals capable of providing primary prevention that is effective to manage the care or Canadians . Dr Martin also emphasizes on the critical importance of the 1984 Health Act and how our publicly funded Health Care system is a key part of our Canadian culture and identity. Fighting to improve and keep our publicly funded health care system is pivotal in keeping our economy strong and progressing the lives of all Canadians . As a practicing nurse, I am so happy I read this book.

[Kelly Greenwood · Rating 4 out of 5]

Many of the ideas presented in this 2017 book makes sense. It seems even more obvious in 2023 that change must be made. Let's hope government and key stakeholders will commit to making change, even if the change is not as fast as the system needs. Using existing resources more efficiently will help all Canadians.

This book presented complex topics in an easy to read and understand manner. While it is my first book on the topic, at least for quite some time, it was a good introduction to a complex topic.

1. Importance of primary care relationships.
2. National pharmacare.
3. Slow medicine (not everything needs aggressive or urgent attention).
4. Do more with less.
5. Basic Income for Basic Health.
6. Change through pilot projects and the development of system solutions, collection and use of data, and incentives.

[Numberbox · Rating 3 out of 5]

I love how Dr. Martin admits to asking Steven Lewis to review a chapter of her book and he replied (paraphrasing), absolutely not- the last thing this world needs us another book about great ideas that will save the healthcare system. What we need to do to fix the healthcare system is to start implementing, widespread uptake, of these simple, excellent ideas. I love that he said that (so true!) and I love that she wrote about it (go, Danielle!) So the chapter on driving the uptake of innovation across the system is a great short dabble into an important field.
I also love that each section of the book, or big idea, ins anchored in a real patient's story.

[Ann · Rating 5 out of 5]

Discussion in layman's language of the present state of our healthcare system and suggestions of ways to improve areas that are not functioning well. These areas are easily seen but the fix may be difficult to attain. The concept of understanding the importance of learning from and sharing failure is commendable but our systems are some entrenched in the idea that failure is shameful and unacceptable, that it will take many brave individuals to achieve the goal.
Well worth the read for patients, care givers, medical professionals and politicians!!!

[Marilena · Rating 5 out of 5]

anyone who is Canadian and accesses healthcare (all of us!) should read this. I’d rate it actually 4.7 (round up to 5 for the sake of the stars), because there’s a big financial focus sometimes on healthcare, which is definitely important especially from a public policy POV, but for the general public perhaps it’s important to also have some data on what various equity-deserving groups face when navigating healthcare. It’s mentioned, but I think a specific focus on how healthcare may continue to perpetuate systemic discrimination could be really useful.

[Amy · Rating 4 out of 5]

A well written book on how to make some changes to the current health care system. It is written in a format that those without any health care background can relate to and understand.

The ideas are well thought out and presented. The arguments are clear and provide real life examples to expand the idea.

The author highlights six ideas she believes can make a difference, but recognises there are more that could be investigated and that implementation would not be easy.

[Kathy · Rating 4 out of 5]

Anyone working in, interest by, or affected by the Canadian healthcare system should read this book!

Dr. Martin obviously cares a lot about this subject and she often speaks publicly about it.

These 6 recommendations are important, and I hope that we as Canadians will be able to work together to improve a healthcare system that deserves to be strengthened and celebrated.