Book review: When Politics Comes Before Patients: Why and How Canadian Medicare Is Failing

When Politics Comes Before Patients: Why and How Canadian Medicare Is Failing By Shawn Whatley, MD. Optimum Publishing International, 2020. ISBN: 978-0-88890-311-2.

This book, written by former Ontario Medical Association president Dr Shawn Whatley, is the second in what will be a trilogy of books focusing on different but overlapping aspects of Canada’s health care system.

The book is extremely well written, and Dr Whatley’s analysis is backed up by many carefully referenced sources. He demonstrates how political concerns and priorities have trumped patient priorities in Canada. When it comes to diagnosing the systemic problems that plague our health system, he pulls no punches.

In clear, simple language, he explains how Canada’s system evolved, and describes the premises, promises, and broken promises. Politicians have repeatedly propagated myths about our system, and Dr Whatley exposes those myths.

Our flawed funding system, including that which disincentivizes hospital authorities when it comes to prioritizing and treating patients, is well explained. Canada stands alone among all developed countries in funding hospitals based on global budgets. Uniquely, our hospitals are penalized financially for every patient treated.

Dr Whatley analyzes the role of political action in creating Canada’s shortage of doctors. This was a purposeful policy based on the premise that reducing the numbers of doctors would lower health costs by reducing the number of patients being treated.

Similarly, the lack of incentives to treat patients has resulted in Canadian politicians overseeing and implementing policies that have led to reluctance to innovate and embrace new technologies that benefit patient care. Our current ranking of 26th in the number of hospital beds on a per capita basis is yet another outcome of ineffective political control.

As Dr Whatley explains, perhaps the biggest myth surrounding our health system is that it is envied by other countries. Not a single country on Earth has ever considered embracing any of its features.

The book reveals that politicians have neglected their responsibility to the public. Yet those same politicians have no difficulty in gaining timely access to excellent care for themselves and their friends. They have the power to manipulate and influence the system when it suits them. This book should be a wake-up call for them and for the public that elects them. Every potential patient (that means everyone) and every politician should read it.

Dr Whatley describes the role of Tommy Douglas in introducing medicare to Canada some 60 years ago. I doubt that any politician of that era would have envisioned that the system they implemented then would be subjected to historical stagnation and inertia by their successors. Evolution requires that we continually adapt to change. There have been many changes in medicine, and in patients’ needs and demands, yet politicians have not acted. Perhaps the most startling fact is that, as a result of political neglect, our government’s own data reveal that in Canada, low-income groups suffer from the worst health access and the worst outcomes.

As one encounters the shenanigans described in this book, which epitomize governments’ handling of our health system, the reader can come to only one conclusion: the phrase “politically correct” is a classic oxymoron as it pertains to medicare in Canada.

If politicians can assimilate the material in this book, perhaps Dr Whatley’s final book in the trilogy will be titled, When Patients Come Before Politics.
—Brian Day, MB
Vancouver