FirbyTwo hours into a drive through this eastern U.S. state, my American co-passenger finally asked me about the Great Canadian Myth of universal healthcare. Did I really think it was better, he asked.

It still surprises me that Americans are bamboozled by the anti-medicare propaganda so prevalent in their country. So I told him flat out that – warts and all – I would never trade the healthcare system Canada has for the dysfunctional and inequitable mess in the U.S.

Defending Canadian healthcare against such a poor system, however, should not be construed as an argument for the status quo in our system. As critics rightly note, Canada’s system has significant problems, including long delays in elective surgery, frustrating waits for tests, seemingly soaring costs and institutionalized inefficiencies. If it’s to survive intact to serve the next generation of Canadians, our healthcare system needs fundamental improvements.

Objective performance measures provide a high-level view of the problem. In 2013, Canadians spent nearly 11 percent of the national gross domestic product on healthcare. That puts us in the top quarter of Organization for Economic Co-operation and Development (OECD) countries for spending. Yet our health outcomes didn’t match the amount of spending.

Dr. Danielle Martin, founder of Canadian Doctors for Medicare, has written a book that lays out simple and common-sense ideas to address the biggest sore points in our system. It’s called Better Now: Six Big Ideas to Improve Health Care for All Canadians. Martin, you may recall, gained instant fame a couple of years ago defending Canada’s healthcare system to U.S. senators. Now you can barely turn on a TV without seeing her doling out advice.

I love some of Martin’s ideas. There’s an impressive body of evidence, for example, that a universal pharmacare program would save Canadians billions of dollars a year. Martin also recommends changes that would reduce the number of unnecessary tests that can lead to costly, counterproductive medical procedures. A U.S. survey in 2014, for example, found that 70 percent of doctors believe the average physician orders at least one unnecessary test or treatment every week partly as protection against potential lawsuits. In this regard, Canada is not much different.

Her prescription for a renewed approach to end-of-life treatment is also refreshing. We should spend less money on heroics that extend a dying person’s misery and more on making sure they depart this world with some dignity and comfort. And, yes, avoiding those very expensive treatments that may buy a few days or weeks will also save a lot of money.

As Martin points out, there’s no shortage of system insiders providing insight into how to improve healthcare. And yet the most meaningful changes, it seems, are the toughest to make. Some are systemic. In my home province of Alberta, for example, citizens still carry around paper health cards that bear the technology of a bygone era.

Martin says innovations have failed to gain traction in Canada because of “spread and scale.” When a systemic change is proven to make things better, our healthcare leaders don’t not have the tools to ensure the idea spreads across the country and scales up. Hence, electronic health records – a proven time-saver (and an effective means to reduce abuses, such as physician-shopping for prescriptions) – are not yet universal. That has to change.

To reduce wait times, Martin suggests a new form of queueing, in which patients line up for the next available specialist, rather than holding out for one particular doctor.

What Martin fiercely resists is the misguided notion that a two-tiered system will take the pressure off public healthcare. Where, she asks, are the doctors, nurses and other healthcare professionals going to find time to deliver services privately? By reducing the amount of time they devote to public services, of course. “Imagine the cost and time required to … build the private tier in a way that wouldn’t drain the resources from the public tier.” It’s naive to think it’s even possible.

Martin said a colleague told her that when New Zealand moved to two-tiered healthcare, doctors quickly figured out how to lengthen waiting times in the public system to drive more patients into the private system.

Ultimately, though, meaningful improvements depend on the courage of leaders to drive change and engage in disruptive thinking. Achieving better health outcomes, providing faster service and doing so affordably requires both healthcare leaders and the health consumer to be willing to let go of must-haves.

It will take political courage. And it will take a public open to a fresh approach.

We have a system worth building on. Nurturing it to its full potential is in our hands.

Veteran political commentator Doug Firby is president of Troy Media Digital Solutions and publisher of Troy Media.

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