Cross-border checkup: Dr. Danielle Martin defends Canada's single-payer system

Health-care advocate alumna takes fight to Washington

By Adela Talbot
Western (University) News, London, Ont., April 24, 2014

Danielle Martin sure can stand her ground.

Last month, the 2003 Schulich School of Medicine & Dentistry graduate spoke as part of an international panel presenting to the U.S. Senate’s Subcommittee on Primary Health and Aging. Invited alongside health-care professionals from Taiwan, France and Denmark to present a defense of a single-payer health-care system, Martin did just that.

And when conversation veered toward an attack of Canada’s health-care system, and its long wait times for certain procedures, Martin delivered a defense that has garnered much applause from fellow Canadians and national media.

“On average, how many Canadian patients on a waiting list die each year? Do you know?” asked U.S. Sen. Richard Burr, R-N.C., in Washington, D.C., last month.

“I don’t, sir, but I know there are 45,000 in America who die waiting because they don’t have insurance at all,” replied Martin, a family physician and vice-president of medical affairs and health systems solutions at Women’s College Hospital in Toronto.

And that’s just one snippet of her Senate exchange with the anti-Obamacare Republican.

After completing her undergraduate degree at McGill University, Martin first worked in health-care policy and politics. She applied to Schulich for medical school and arrived at Western in 1999. Having done her residency in family medicine in Toronto, she stayed put. She took on a Master’s of Public Policy at the University of Toronto and has since enjoyed a professional life as a doctor who gets things done – with and without her white coat.

“My area of interest has always been health-care systems and how can we construct health-care systems to best serve the needs of the population; that’s what drew me to medical school in the first place,” Martin said.

In 2006, along with colleagues across the country, she helped establish Canadian Doctors for Medicare, a national physician organization that does advocacy work around evidence relating to equity and access to health-care services.

“Unlike many other medical leaders who sort of start from a clinical interest and move into policy issues later in their careers, I started out with a policy interest and then developed a love of family medicine during my medical training at Western,” Martin continued.

“But my interest has really been in health-care systems, and my primary concern, until recently, has been around the preservation and enhancement of publically funded health care in Canada – trying to make sure that we construct an insurance model that makes sure that access to health care is based on need, rather than ability to pay.”

The Senate hearing had more elements of political theatre than a substantive policy discussion.

Martin was invited to testify by the committee chairman, U.S. Sen. Bernie Sanders, an independent Vermont senator and self-described socialist who has advocated for the United States to adopt a single-payer system like in Canada.

Burr, however, is no fan of the single-payer system.

According to the Center for Responsive Politics, health professionals, insurance companies and pharmaceuticals/health products companies ranked second, third and fifth, respectively, among his top donors. Combined, these industries, which led the fight against Obamacare, have given the senator more than a million dollars toward his campaign. Elected in 2004, and then again in 2010, Burr ranked second among 100 senators in receiving donations from health insurers and topped the list of those receiving money from pharmaceuticals/health products companies.

But in response to Burr, and other critics of single-payer health-care systems, Martin has a message: There is no evidence to support a claim that the structure of the system is to blame for lengthy wait times.

“On the international panel that day, there was a representative from Taiwan, which is a true single-payer system that has no wait times at all. The U.K. model, which is a two-tier health-care model, has struggled a lot with wait times. There’s no causality there,” she explained.

At the same time, Canada can be better, Martin continued. But saying that is not a critique of the Canadian Medicare system.

“The Canadian system’s not perfect, but what we need to be doing is protecting the public insurance plan and doing everything we can to fix the delivery system so that it will meet people’s needs better into the future. We call that ‘better Medicare’ – building a better version of the public health-care system that we have,” she explained.

“Supporting Medicare doesn’t mean making excuses for areas in which the system is underperforming. Supporting it means remaining committed to the values and principles that underpin it, and working very hard, every day, to do all we can to make it better for patients.”

Addressing long patient wait times – which largely affect non-urgent cases, Martin noted – includes considering options like a central intake assessment in which there is a single common queue that would ensure patients are seen by the next available specialist or surgeon. Another option is primary-care reform that would connect patients with a hub of health-care specialists that includes doctors, nurse practitioners and pharmacists working together, ensuring patients have same day or next-day access to primary care.

“Obviously, nobody wants to see patients waiting too long for care. The question is, how do you go about fixing the problem? Those of us who are working in the system are looking at trying to make better utilization of the resources that we have. There’s lots of good work being done in the country,” she explained, noting she was thrilled to see so much support of her defense in the U.S. Senate.

“An explicit articulation of our values is important. The reaction I’ve had has been overwhelming and I think that speaks to the profound values of Medicare Canadians hold, and that’s terrific and heartening,” Martin said.

Pharmacare is the next big challenge she sees coming for Canada’s health-care system.

“It really is an accident of history that we’ve ended up with publicly funded health-care system that provides us insurance for doctor and hospital care not for their medially essential medications,” she said.

“We really need to do everything we can to advocate as physicians for our patients to get access to the medically necessary pharmaceuticals they require. They are not optional; in many cases, they are life saving medications and it ends up costing the system more when we have people being admitted and readmitted to the hospital because their chronic illnesses aren’t controlled because they can’t afford their medicine.”

While she has encountered some political courtship as a result of her advocacy, it’s a career Martin won’t be pursuing.

“I feel really lucky to be able to be in a job where I have this opportunity to both do patient care and think about these big picture issues. I can’t really imagine anything better at this stage of my career,” she said.