The Canadian Dental Care Plan (CDCP), which could eventually provide dental insurance to at least nine million Canadians, is slowly being implemented.
Children under 12 already have coverage and, by mid-2024, so will many people over the age of 60, followed by Canadians with disabilities, before the publicly-funded dental insurance program is extended to the general population (with conditions) in 2025.
Meanwhile, the Canada Pharmacare Act, which was supposed to be adopted into law by the end of the year, has been stalled.
If enacted, it would provide publicly funded prescription drug coverage for all (or some) Canadians, but the all-important details, such as who and what would be covered when and to what extent, have yet to be revealed.
Both of these legislative measures are key clauses in the supply-and-confidence agreement between the Liberals and NDP. (New Democrats pledged to prop up the minority Liberal government on budgetary and confidence votes until Parliament rises in 2025, in exchange for the adoption of a number of initiatives.)
To date, there has been much chatter on the speed of implementation of dental care and pharmacare plans, and speculation on what will happen if the Liberals don’t follow through on their promises (i.e. will the government fall?)
Affordable access to essential drugs and dental care is important, especially to the millions who don’t have that now. But should building massive new programs (rather than filling in the gaps in existing ones) be a priority when we have so many other systemic problems – such as 6.5 million Canadians without primary care, and overflowing ERs?
We should also be paying a lot more attention to how the structure of these new programs could fundamentally reshape medicare.
What will the federal dental insurance plan mean to the average Canadian? Here’s what to know
The underlying philosophy of Canadian medicare is that no one should be denied essential health care because of their ability to pay.
Medicare has five guiding principles: universality, portability, accessibility, comprehensiveness and public administration.
Every one of those is challenged by the new programs, which will be delivered very differently from core medicare services.
Currently, physician and hospital services are considered “medically necessary” and covered 100 per cent by medicare.
But under the CDCP, “medically necessary” dental services will not be 100-per-cent covered. Some dental procedures won’t be covered at all.
There will not only be means testing (wherein eligibility depends on family income) but a co-pay of 40 per cent to 60 per cent, which is again income-dependent. Rates of reimbursement will vary by province.
Furthermore, the 55 per cent of Canadians who already have employer-sponsored dental insurance will not be eligible. (Yet, employers won’t be obliged to provide coverage, so maybe they will just drop benefits and dump workers on public plans?)
Finally, the administration of the plan has been contracted out to a private insurance company, Sun Life.
Taken separately, or together, dental care and pharmacare constitute the largest expansion of medicare since its inception in the 1950s and 60s. We could see a big shift in spending from private insurers to public insurers, at a substantial cost.
Even a “fill-in-the-gaps” program like this (meaning it targets those with no private coverage now) will cost at least $4.4-billion annually. That’s already double the initial estimates.
A pharmacare plan would cost a lot more: an estimated $13-billion annually, if it covers basic drugs for everyone.
When the Pharmacare Act is unveiled in 2024, it will almost certainly feature a means test and co-pays and other limits on who is eligible, which will almost certainly not include the 56 per cent of Canadians who already have private drug insurance.
We often believe, mistakenly, that for care to be universal, it must be paid 100 per cent through the public purse, and delivered by public institutions and employees.
That’s not the case in most countries with universal care.
As long as everyone gets essential care, it matters not who pays the bill – a public insurer, a private insurer, the employer or the individual.
What these new programs do, with their means tests, mixed payment models and limits on who is covered, is raise important questions. If it’s acceptable to expect a goodly portion of Canadians to pay for prescription drugs and dental care privately, then why isn’t it acceptable for them to also do so for hospital and physician care? If dentists can bill private and public insurance plans, then why can’t doctors?
The new programs should also refocus our attention on an eternal question: What are the limits of publicly funded health care? What are the limits of medicare?
login
who are we?
contact us
qosheapp
Toi Staff
Gideon Levy
Belen Fernandez
Andrew Mitrovica
Mort Laitner
Rami G Khouri
Ali Fathollah-Nejad
Nikkei Editorial
visit website
