While the 2022 federal budget proposed funding for national dental care, the plan, as currently understood, lacks universality, would disrupt existing public and private dental care and threatens single-tier health care.
According to a recent article in the Harm Reduction Journal, thousands of Canadians needlessly suffer from largely preventable oral conditions, mostly tooth decay and gum disease. This so-called silent epidemic is a threat to general health because heart disease, stroke, type 2 diabetes and other chronic illnesses are linked to poor oral health.
There are also reported links between oral health and self-esteem, diet and mental health. With its ability to reduce chronic illness and improve mental health, why is basic dental care not already insured under Canada’s health-care system? Clearly, dental care is part of health care.
Countless emergency room visits each year involve patients experiencing pain linked to poor oral health. For this reason alone, the Canadian Association of Emergency Physicians supports the expansion of publicly insured dental care.
During the 2021 election campaign, the Canadian Dental Association suggested Parliament undertake a detailed study on how to address oral health in Canada. It reminded politicians that the best way to quickly improve oral health was to invest in the existing patchwork of federal, provincial and territorial dental-care plans.
In March, the minority Liberal government reached a confidence agreement with the New Democratic Party, which, in exchange for political support, it agreed to implement national dental-care and pharmacare plans. The 2022 federal budget included $5.3 billion over five years for dental care and the Liberals have committed to passing the legislative framework for national pharmacare in 2023.
The dental-care plan is an NDP brainchild from its last election platform. While full details are yet to be released, the original NDP model looks like a standard dental-care plan covering preventative and restorative services. Only uninsured households earning less than $90,000 per year would be entitled to benefits. Surprisingly, there are no adjustments in recognition of household size or geographic location. Large families living in expensive cities will struggle to afford dental care, even with more than $90,000 in income.
The plan is to be phased in before the confidence agreement expires in 2025. Beginning in 2022, children under age 12 will become eligible for benefits. So the government has less than six months to design and launch a completely new dental program, but it has yet to answer the most basic question — what form will the new program take?
In 2020, the parliamentary budget officer reported on the proposed federal dental-care plan. It estimated only 6.5 million people would benefit from the plan because of its stringent participation thresholds. It also stated costs could be higher than estimated and underscores how complicated the government’s task is in establishing a dedicated dental plan from scratch.
The report noted a lack of universality creates an incentive for premium-paying families to opt out of existing dental insurance plans. Likewise, provinces, territories and employers that fund existing dental care plans could potentially discontinue their plans and refer patients to the federal dental-care plan.
In a matter of months, the vast network of public and private dental care plans across Canada could be disrupted as patients are shuffled from one plan to another. And since the plan’s details have yet to be fully disclosed, this has urgent ramifications for governments, insurers, unions, plan sponsors and plan members.
A two-tiered oral health system
Abandoning universality could create a two-tiered oral health system — those who qualify for the dental plan and those who don’t — which will inevitably lead to undesirable or unintended consequences.
Aside from the potential discontinuance of hundreds of public and private dental-care plans, a two-tiered oral health system could result in private sector dentists refusing to treat patients insured by the federal dental-care plan, especially if its prescribed fees for services are less than what dentists can charge privately insured or cash-paying patients. The best dentists will treat top-tier patients, while everyone else awaits treatment from the remaining practitioners or public dental clinics.
Means testing for access to dental plan insured services may open the door to means testing for certain health-care insured services like cataract surgery and hip and knee replacements. And a two-tier oral health system would set a dangerous precedent as provincial governments continue to litigate with medical professionals seeking to establish private clinics for wealthy patients seeking to skip long lineups for insured medical services. Litigants could point to the dental plan to counter government arguments against a two-tiered health-care system.
Rather than rush to deliver a new national dental-care program, the Liberals could pause and renegotiate with the NDP, extend the timeframe and launch a revised plan before the 2025 election. The government can use the extension to consult widely and create a comprehensive oral health-care system for Canada. We should strive for world class excellence in oral health and not settle for the sake of political expediency.