Instead of making the Canadian dental program look more like Canadian public health care, why don’t we do the reverse — move health care to the dental-plan model?

Every year at Christmas time, The Line runs a series of articles about things we should be thankful for — just like we’re thankful for you. Happy holidays from your friends at The Line.

By: Ken Boessenkool

American style two-tier health care has arrived in Canada. And I can’t decide whether the folks who brought it don’t realize what they’ve done, don’t care what they’ve done, or just hope you don’t notice what they’ve done.

Now, you would expect American two-tier health care would drive defenders of Canadian universal health to mount national scare campaigns. You would expect fines and fees flying left and right for violation of the sacred principles of the Canada Health Act. You would expect federal Liberals and New Democrats to be in high dudgeon.

But they’re not. And that’s because this American-style two-tier health care reform was the brainchild of the federal NDP and is being implemented by the federal Liberals. I’m referring to Canada’s newest expansion to Canadian health care: Canada’s new national Dental Care Plan.

To make my case, let’s review dental care provided to Americans under the U.S. Medicaid program.

The U.S. Medicaid program is a “a joint federal and state program that helps cover medical costs for some people with limited income and resources.” Medicaid provides dental care “for people with Medicaid under the age of 21.” States administer Medicaid programs with many differences, but the national “Health Insurance Marketplace” helps match Americans with an insurance company, the premiums of which are fully or party subsidized based on your income. As to coverage, Medicaid requires states to “minimally include relief of pain and infections, restoration of teeth, and maintenance of dental health.” In short, not all oral services are covered.

One final point about U.S. public health care: The American Medicare program (not Medicaid) covers seniors and certain people with disabilities but doesn’t cover most dental care.

Now let’s take a look at the new Canadian Dental Care Plan. The Liberal government says it is a program that “is helping make the cost of dental care more affordable for eligible Canadian residents.” The program is currently available for “eligible Canadians residents” who are over 65, are disabled and/or under the age of 18.

The eligibility rules for the Canadian dental program? First, you cannot be enrolled in a private dental program through work or pension. Second, you must have filed for income taxes, so that third, the government can make sure your “adjusted family income” is below $90,000. Finally, you have to be a Canadian resident.

Who administers the new Canadian Dental program? If you google “administrator for Canada’s Dental Program” the fine print will list a private insurance company, Sun Life. Sun Life, understandably, has a portal through which you can access the program. And what is covered? There is a very lengthy Dental Benefits Guide that states “not all oral services are covered.”

Let’s put this in a summary table.

Two. Tier. Is. Here.

But, wait, isn’t Canadian health care subject to the sacred (I need a sarcasm sign) five principles of the Canada Health Act?

In theory it is.

And what are those principles? First, Public Administration, which means “operated on a nonprofit basis by a public authority.” Second, Comprehensiveness, which means “all medically necessary services provided by hospitals.” Third, Universality, which requires that “plans must entitle all insured persons to health insurance coverage.” Fourth, Accessibility, which requires access to insured services “without financial or other barriers.” Finally, Portability, which means Canadians must be covered “when they move to another province or territory.”

How does the new national dental program stack up?

Public Administration? Nope, it administered by a private insurance company. Comprehensiveness? Nope, not all oral services are covered. Universality? Nope, it only covers seniors, disabled Canadians and children under 18. Accessibility? Nope, it is limited to those with family income under $90,000. Portability? Yep, this is a federal program that presumably works across provinces and territories.

Which makes me wonder, where are the raging grannies? Does the Council of Canadians still exist? Have any of these groups even noticed?

Now to be fair to the federal NDP, it is clear that they hope some day for a universal single-payer dental program (they hope the same for pharmaceuticals, which is arguably a second proof point of my thesis). The Liberals are less clear.

But, and I do apologize for taking so long to get to my point, what if instead of making the Canadian dental program look more like Canadian public health care, we start to think about how to make Canadian public health care look more like Canadian Dental Care Plan?

Conservatives (with notable exceptions), heretofore reluctant to embrace private health care as a political third rail, have had that rail removed by Jagmeet Singh and Justin Trudeau — one of whom doesn’t know what he’s done, the other hopes you don’t notice, if he cares at all. I’ll let you decide which is which.

So what now?

The task is, first, to make this new national Canadian dental program a resounding success. And second, to determine how to best make the Canadian dental program a model for future reforms to Canadian health care. And for now, I’m just grateful for the chance — even if I’m not sure this is what the architects intended.