I am a dentist. I am tired of seeing patients who have tried to extract their own teeth because they were unable to afford dental care.
One out of every three Canadians lack dental insurance, and over one in five avoid the dentist each year due to financial constraints. These numbers have been rising as fewer employers are providing dental insurance and the cost of dental care has been rising faster than inflation.
This federal minority parliament could deliver the largest investment in dental care in Canadian history, but ultimately politics will determine whether it happens.
In the 2022 Supply and Confidence Agreement, the federal NDP secured a staged implementation of their dental plan. This was one of the conditions the NDP demanded in exchange for their support of the Liberals in votes of confidence until the next election.
Known as the Canadian Dental Care Plan (CDCP), the program would provide dental insurance to those with no private insurance and a family income below $90,000 per year. The plan would have no copayments for those with a family income below $70,000 per year.
The Liberals agreed to a staged implementation of the dental program, which means that the program was supposed to cover those below 12 by the end of 2022. Since the Liberals were slow to get an insurance program up and running, the federal government provided cash payments to families with children under 12 in need of dental care to keep the NDPs support. This cash payment program is called the Canada Dental Benefit (CDB) and helped approximately 340,000 children access dental care.
The federal government is planning to expand the actual CDPC insurance program—and not just the CDB cash transfers—to those below 18, above 65, or have disabilities by the end of 2023. It will then further expand the CDPC to cover the remaining people below the income threshold before the next election in 2025. The CDCP is expected to help 9 million people.
The 2023 federal budget set aside $13 billion for the first five years of the dental program and $4.4 billion per year after. This is a significant increase from the 2022 federal budget, which only set aside $5.4 billion for the first five years of the program.
This increase in funding is a tacit acknowledgment of three things from the federal government. First, more people lack access to dental insurance than they originally anticipated. Second, those who would be eligible for the program have more unmet dental needs than expected. Lastly, if the CDCP were to provide a decent level of dental coverage, it would need more funding.
The Need for Public Dental Care
Despite the increasing struggles people are facing accessing dental care, public dental spending as a share of total dental spending has been decreasing. In 1980, public dental spending accounted for 20 per cent of overall dental spending, but now it is only six per cent. Canada ranks second to last amongst OECD countries in its share of public dental spending as a share of total dental spending. Canada ranks even worse than the United States.
The lack of public dental spending in Canada is both cruel and inefficient. One per cent of all visits to the emergency department are for patients with dental pain. This costs taxpayers over $150 million per year, while still leaving these people in need of treatment from a dentist.
On top of this, poor oral health worsens outcomes for diabetics and increases risk for heart disease and aspiration pneumonia. Lack of access to dental care leads to increased health spending that could have been prevented with public dental programs. Missing front teeth or visible decay affects employability, leading those without access to dental care to get trapped in the cycle of poverty.
We have a moment to seize
Recent polling has consistently shown the Liberals would lose to the Conservatives if an election were called today. This means the Liberals will need to follow through with their commitments to the NDP in order to stay in power, which gives hope that the 2023 portion of the CDCP will be implemented.
The likelihood of the remainder of the program is more uncertain. Polling can change significantly, meaning the Liberals can renege on their commitments to the NDP with less fear of losing power—and the last phase of the program is planned to be implemented just before the next election. The Liberals could say they ran out of time and that people need to vote for them in the next election if they want the rest of the program to be implemented.
Even if the CDCP is fully implemented, there is still more work to be done in order to fully treat dental care as health care. People with public and private dental insurance will still avoid care due to copayments and millions of middle-income Canadians will be left uninsured. Ultimately, we need to incorporate dental care into our universal healthcare system to ensure everyone has access to care, but also for the long-term viability of the program.
The CDCP is targeted rather than a universal program—it only covers those below the income threshold who do not have private insurance. Targeted programs tend to create resentment from those who pay into the program through their taxes, but do not receive any benefits. This makes targeted programs less popular and easier to undermine. Universal programs, in contrast, are harder to undermine as everyone has a vested interest in the program working, and cutbacks receive much broader backlash.
Even if the CDCP program starts strong, the politics of targeted programs may lead to the program being undermined over time. This can take several forms—the government reducing the amount of procedures it covers, reducing the fees the program pays out, and the income cutoffs being deindexed from inflation. This is how the existing public dental programs became so meager.
Far too many people live with dental pain because they are unable to access care. This minority parliament presents an opportunity for change, but this work is only the beginning. It is time we finish Tommy Douglas’s dream of Medicare covering the entire body, from head to toe.