Book review: Patients at risk: Exposing Canada’s health-care crisis

Patients at risk: Exposing Canada’s health-care crisis By Susan D. Martinuk. Winnipeg: Frontier Centre for Public Policy, 2021. ISBN: 978-1-7776577-4-1. Paperback, 264 pages.

Susan Martinuk is a Vancouver-based journalist and research fellow in health care for the Frontier Centre for Public Policy, an independent Winnipeg-based think tank. This book, published by the Frontier Centre in 2021, begins with the stories of five patients who endured prolonged suffering and poor outcomes while waiting for specialized medical care, and lays blame squarely at the feet of a “‘system’ that has lost sight of its raison d’etre and now functions more to constrain medical care than provide it.”

The author argues that the tenets of Canadian medicare enshrined in the Canada Health Act in 1984 (public administration, comprehensiveness, universality, portability, and accessibility) represent tragic myths when viewed from the patient’s perspective. She touches on the history of publicly funded health care in Canada, then reviews two legal challenges to medicare, beginning with the successful Chaoulli v. Quebec decision (Supreme Court of Canada, 2005). She then proceeds to an in-depth analysis of the ongoing case of Cambie Surgeries Corporation v. BC, initially unsuccessful in the BC Supreme Court in 2020, currently awaiting a decision by the BC Court of Appeal, and expected by all players to be ultimately decided by the Supreme Court of Canada. Martinuk is uncompromising in her support for Cambie surgeon Dr Brian Day and condemns what she sees as the misguided role played by the government of BC, the defendant in this ongoing litigation; hence the title of Chapter 20: “The BC Government v. Common Sense.”

Martinuk’s two final chapters, “How to Make Health Care Better” and “Where Do We Go from Here,” detail in broad strokes her prescription for reform, which involves acknowledging medicare’s failings; abandoning rigid ideology; and separating politics from health, care, and planning for the long term, including the establishment of a Canadian hybrid public/private system embraced by other countries with better-ranked health care systems.

Patients at Risk is eloquently written, moves along quickly, and is carefully referenced by an experienced journalist who presents a compelling argument for a major refit in Canadian medicare. The patient anecdotes are especially poignant, and while necessarily subjective, they continually remind the reader that health care exists to serve patients, and that a system that places ideology ahead of patient care is destined for failure.

Martinuk’s book is a concise and worthwhile read. It will elicit applause from readers frustrated by their experience with Canadian medicare and eager for change, and condemnation from those who fear that any venture into hybrid public/private care will lead to the extinction of a system that represents the very cornerstone of the Canadian identity.
—David Esler, MD, CCFP(EM)

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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Dr Esler has practised emergency medicine in and around Vancouver for 34 years. He is also a clinical associate professor of emergency medicine at the University of British Columbia and a member of the BCMJ Editorial Board.