Is dental covered under the Canadian health care system ?

[Huckebein the Raven]

just wondering.

[SidDithers]

1. Not generally, no...

Alot of employers (most I would say) either provide benefits or share the cost of benefits which supplement the Provincial Health Plans. These additional benefits usually include dental, glasses, perscription drugs, physio, massage, counselling etc.

Those without additional benefits are responsible for their own costs on the above items. However, Provincial programs do exist for assistance for low income earners to cover these costs.

As far as dental, I've had friends who've recieved free dental care at the Faculty of Dentistry at our local University. Students perform the procedures as a learning experience. I think they're motto is "We do it 'till we get it right!"

Sid

[iverglas]

2. not necessarily

The Canada Health Act provides that services defined as "medically necessary" *must* be covered by the provincial health plans. Dental care is not defined as a "medically necessary service". Those plans *may* cover anything else they like.

(Health insurance is under provincial jurisdiction; the feds get involved in setting national standards in the exercise of the federal spending power.)

I'm an Ontarian, so I don't have any of this stuff, and (shamefully) I'm not even sure who does.

This is an oldie (1987), about Saskatchewan's plan:

http://www.legassembly.sk.ca/hansard/21L1S/87-09-01.PDF

The cost per enrolled child were compared to those of Canada's four other universal children's denticare plans, operating over the same time period. It was concluded that the Saskatchewan health dental plan appears now to be performing with better, or at least equal, cost. And although the ultimate test of the Saskatchewan health dental plan will be how it influences the oral health status of the people of Saskatchewan in the long run, the performance to date gives early indications of the likely achievement of this long-term goal.

Now that's a very telling study, Mr. Speaker. And I just will summarize the points that Mr. Lewis makes once again. He says there was very high utilization of the plan and, of course, ultimately that leads to better dental health. He said the utilization was higher than privatized plans in Canada. He said one-quarter of the services were preventative; fillings dropped; extractions dropped. He said the cost per enrolled child dropped by more than 50 per cent, yet the quality of service remained. And he said that the cost was no more -- no more than privatized dental health care plans, and probably less.

In Ontario, people on social assistance receive basic dental care -- very basic, as in, mainly, emergency -- but that's under the social services budget, not the health care plan. Dental care is not as widely available to low-income people and seniors as prescription drugs are.

One of the concerns about NAFTA in Canada is that it could be used to prevent expansion of the health care plans beyond what they provided when NAFTA was entered into:

http://www.tommydouglas.ca/articles/articles-oct02.htm

Friday, October
25th, 2002
Winipeg Free Press
NAFTA's threat to medicare

Frances Russell -- The North American Free Trade Agreement would have prevented the creation of medicare in 1968, says an authority in international trade law who worked in the prime minister's office during the administration of Brian Mulroney.

NAFTA also is the only international trade treaty that threatens both the survival and the expansion of Canada's universal public health care system, he warns. In a discussion paper prepared for the Commission on the Future of Health Care in Canada headed by former Saskatchewan premier Roy Romanow, Jon Johnson of the Toronto law firm of Goodmans LLP, attributes NAFTA's unique danger to its now-infamous Chapter 11 private investor rights clause. It alone among the world's trade treaties gives foreign investors and corporations the right to sue governments directly. All other pacts are state to state.

Mr. Johnson is the son of Manitoba's former Conservative health minister and lieutenant-governor, Dr. George Johnson. He was a speech writer for Mr. Mulroney, NAFTA's Canadian author. The Mulroney administration -- and now the Liberal government -- keep insisting that NAFTA cannot touch any of Canada's universal social programs.

NAFTA poses three additional serious threats to medicare, Mr. Johnson says. Although medicare as it exists today "is largely shielded from the NAFTA national treatment provisions by reservations ... the effectiveness of these may erode over time." Further, the lengthy patent protection afforded multinational drug companies also has "a potential indirect effect on the public health-care system by affecting costs". NAFTA's 20-year patent rights became the template for other international trade pacts such as the General Agreement on Trade in Services (GATS), which now contain similar "intellectual property" guarantees.

And finally, Canada's longstanding use of and preference for non-profit over for-profit ancillary health services is vulnerable to NAFTA's privatization thrust. NAFTA's national treatment and nationalization/expropriation provisions are "the most important" in any of the trade pacts to which Canada is a signatory "in terms of their potential impact on the organization and structure of the Canadian health system," warns Mr. Johnson.

NAFTA guarantees U.S. and Mexican investors "national treatment", endowing them with more rights than Canadian investors. That's because a foreign business or investor can now sue the Canadian state without its permission while a domestic one cannot. "The potential effect of the NAFTA investment provisions is compounded by the private rights of action conferred by NAFTA on U.S. and Mexican investors. However, there are no private rights of action under the GATS or under any other agreement under the World Trade Organization (WTO)."

NAFTA's Chapter 11 nationalization/expropriation provisions and accompanying threats of investor lawsuits demanding vast sums in compensation could stop governments from expanding universal medicare into areas now covered by the private market, such as dental care, home care and pharmacare, he continues. "Substantial interference could occur in the health context in Canada if the public component of the system were expanded in a way that increased the exclusion of private firms."

Mr. Johnson uses universal denticare and home care as examples. "Insurers providing dental coverage would be forced to exit that business," he says. "While the decision would have been taken to fulfil the public purpose of ensuring increased accessibility for those who could not afford dental coverage or dentists' fees, it is likely that a NAFTA Chapter 11 tribunal would treat this as an expropriation and require the payment of compensation. The same applies to other health services such as home care."

Compensation could also be demanded if a province delists a medical service from its universal plan and later tries to recapture it. Privatization is a "one-way street," he warns. "There is considerable pressure on provincial governments to reduce the public component of the health-care system. ... Any provincial government that responds to these pressures should carefully consider the impact ... because returning to the public status quo ante could be difficult and expensive."

On that last point, "recapturing" delisted services, eye exams for adults (for the purpose of prescription eyeglasses) by optometrists have recently been "delisted" by the govt of Ontario: the plan no longer pays for them. One might now expect to see USAmerican firms entering the market, undercutting Ontario optometrists as a result of the economies of scale they have available, and, for instance, hiring Ontario optometrists at low wages when they are unable to afford to afford the expenses of their own practices. (The Walmartization of optometry, as it were.) If a later Ontario govt tried to reinstitute the coverage, the US firms could sue that govt.

There are a lot of things wrong with NAFTA, besides the ones that USAmericans complain about.

[hermetic]

3. That really stinks

I deal with insurance companies on pretty much a daily basis and I can tell you that they are basically a bunch of crooks. Health, dental, property, whatever, they can do whatever they want, charge whatever they want and it frequently amounts to flat out theft, IMHO. You need to fight with all you've got to keep what's left of your systems intact or you'll just end up as neocon fodder, like a whole lot of us have down here. Good luck.

[Canadian_moderate]

4. Most provincial health plans never covered dental to start with

This is not about keeping our systems in tact, this is about prioritizing. While important, dental care expenses are generally not catastrophic. Most Canadians are covered through their emploer-sponsored dental plans.

[hermetic]

5. Right

I understand that. I was just trying to show what is very likely to happen if Canada keeps moving towards the type of system we have because I know there are many up there who believe it is the way to go. I just wanted to say, "don't let it happen".

[Canadian_moderate]

7. We won't let it happen

Basic medical insurance will always be universally accessible in Canada.

The issue is trying to contain the costs. While it is nice to have Chiropractic care covered by the provincial plans, on the list of priorities that are medically necessary it is not that high. For this reason, the Ontario government is delisting the coverage, thus placing more burden on the private and employer-sponsored plan.

The problem is that the population is ageing and the costs are increasing rapidly. One way or another, someone will have to pay for these costs.

I totally agree that universal healthcare systems are the best way to contain these costs. All you have to do is look at all other major developed nations (other than the USA) and see how their healthcare spending level compare to those in the USA. On top of that, the USA's mortality and life expectancy rates are no better, if anything they're worse than most.

[iverglas]

6. and those are two separate issues

Most Canadians are covered through their emploer-sponsored dental plans.

I wonder whether you actually have facts to back that up. Me, I'm self-employed. I've never had coverage of this type (i.e. all the supplementals -- eyeglasses, prescription drugs, dental, long-term disability ...) except for the 10 months I worked for the fed govt many years ago. I did try to buy into the Canadian Bar Association's group plan to get coverage for me plus my employee and her family, but as a sole practitioner with only one employee, I didn't qualify. (I could have bought my own coverage, but not hers; obviously, small outfits like me would have self-selected in or out based on likely costs -- had I had an employee whose spouse had coverage, I would not have subscribed -- and so the costs of accepting such members into the group would have been skewed.)

An increasing number of people are self-employed in often precarious work, and insurance coverage of this nature is expensive.

Ah, here we go: http://www11.sdc.gc.ca/en/cs/sp/arb/publications/research/1998-000168/page04.shtml

The bivariate and multivariate analysis that follow are based on the 1995 Survey of Work Arrangements (SWA), an addendum to the November 1995 Labour Force Survey.3 In total there were 25,721 respondents to the SWA.4 Of these, 21,261 were paid workers in their main job and the remaining 4,460 were self-employed. The self-employed are not included in this analysis since the questions regarding employer sponsored health and dental plan coverage do not pertain to their situation. Full-time students ... were excluded from the analysis (this eliminated 1,428 records, or 6.7 percent of sample, from the data set).

Obviously, the retired, the unemployed and social assistance recipients were also not included.

Overall, the SWA shows 63 percent of Canadian non-student employees are entitled to an extended health plan (59 percent to a dental plan) through their employer. Gender differences in coverage rates are apparent with 69 (59) percent of males having an extended health (dental) plan compared with 58 (54) percent of females.

... Here, the bivariate results show that 69 (64) percent of full-timers have extended health (dental) coverage compared with just 26 (23) percent of part-timers.11 Furthermore, permanent workers are roughly three times as likely to have extended health (dental) coverage as non-permanent workers.

... The sectors with the lowest percentage of workers with health (dental) coverage are agriculture, business, personal and miscellaneous services, wholesale and retail trade and construction, while utilities, communications, finance, insurance and real estate (often federally regulated sectors) and public administration have the highest extended health (dental) coverage rates.14 The low coverage rates in the above industries are a concern as more than one in three workers in Canada are employed in these industries. Furthermore, since service and trade are rapidly growing sectors of the economy, the share of paid workers in these industries, along with the percentage of workers without extended health and dental coverage, is likely to increase.

... The data from Table 1 show that younger workers (under 25 years) are roughly two times less likely than older workers (25 years and over) to have extended health or dental coverage.15 When examining the effect of family status on extended health (dental) coverage, married workers with children are more likely to have extended health (dental) coverage than those without children. This reverses for single people, with single parents roughly half as likely as other singles to have health (dental) coverage.

So ... I don't think that 63% of a population that excludes the self-employed, full-time students, the unemployed, the retired and social assistance recipients (who are perhaps more likely to have children than the "employee" category?) really constitutes "most Canadians". And when the people least likely to be covered are those most likely to need coverage -- part-time workers, single parents (women), people in lower-wage occupations -- the relevance of the number of people covered has to be qualified by the fact that those without coverage are more likely to be those most in need of it.

But back to our sheep. "This" may well be about "prioritizing" -- but the entirely separate issue is whether we will have the power to prioritize public dental care if we choose to do it.

One's individual opinion about the priority that should be assigned to such a plan is one thing. The collective ability to implement a collective decision to assign it priority, if such a decision is made, is another.

It is certainly arguable that if public dental care is collectively decided not to be a priority, there is no harm done if the ability to implement such a plan is bargained away as part of a free trade deal. It's arguable -- but it's not some sort of universal truth. Someone who, or some society which, regards a public dental care plan as a non-priority at the present time might still consider it to be a good idea, and might well wish to have the option to implement one in future if it becomes possible to prioritize it.

Dental care might not be a priority, and expenses may not be catastrophic, for the average person (although the three grand I spent on a disastrous dental chain of events a couple of years ago was no picnic even for me). But dental care for children, including preventive care, is actually quite important. And the cost of such care can be difficult for many low-income working families, and certainly for families receiving social assistance, which does not provide adequate coverage for this care.

Perhaps unlike you, I do think that dental care for children, at least, is a priority at least equal to some other things that we collectively spend money on. So I, at least, would prefer to have the option of implementing such a plan in future.

[Canadian_moderate]

8. Try this options

http://www.coverme.com/LH/CoverMe/Consumer/PlanListing.jsp?lang=E&province=&module=P

As an employere, you generally need at least 3 employees to qualify for a group plan.

Individual coverage is quite expense and you're often better off paying as you go. Consider yourself lucky that most catastrophic medical expenses are covered by the provincial health plans.

The costs of dental, drugs, paramedical practitioners, etc, is relatively low compared to the overall amount of money spent on healthcare in canada.

[iverglas]

9. hmm

Perhaps you thought I was complaining that I don't have dental coverage. I wasn't. The three grand in question barely qualified for income tax consideration, given my income. (And as an employer, my concern was for my employee and her family, not myself.)

"Individual coverage is quite expense and you're often better off paying as you go."

But if I were a low-income working single parent without group insurance, and my child had needed expensive dental work, or even if I wanted my children to have regular preventive care, the situation would be rather different. That was kinda my actual point. A person in that position has no choice but to pay as she goes -- except she doesn't have the money to do it.

"The costs of dental, drugs, paramedical practitioners, etc, is relatively low compared to the overall amount of money spent on healthcare in canada."

That's true. In the case of drugs, the low cost is in large part attributable to the relatively low cost of drugs here. And from the individual's perspective, many people with high drug costs (e.g. seniors) are eligible for full or almost full coverage under some public assistance plan.

In the case of dental, there are undoubtedly quite a few people who simply go without care because they do not have access to employer-based coverage and they cannot afford to pay as they go. Failure by many people to obtain reasonable dental care is a factor in the low costs.

Of course, regardless of how they were paid for and how many people had access to them, drugs and dental care would represent a small fraction of health care costs.

But that doesn't mean that the cost is affordable to all individuals who need the care, and particularly to all children who need the care.

So what's your opinion, anyhow? Should trade deals include a right of action by non-national private parties against a government that decides to extend health care coverage (i.e. preclude the private delivery of services outside the public plan) to areas not covered when the deal is signed?

[Canadian_moderate]

10. I realize that it's not affordable for all

but I think Canada's provinces are trying to keep our healthcare plans somewhat affordable. Earlier this year Ontarians were in an uproar when, effective July 1, 2004, the new Ontario Health Premium (read Tax) was implemented. People have to realize that, one way or another, healthcare has to be paid for.

I know where you're going and universality is the best way to deliver healthcare as efficiently and inexpensively as possible, but most Canadians are simply not willing to pay higher taxes to have more comprehensive health and dental coverage.

One negative about universal healthcare is that it does restrict the supply end when funding is insufficient, thus resulting in longer waiting lists. Most people believe in a consumerist approach for these types of medical/dental services.

As for your question about trade deals, I believe that a right of action should not be granted to non-national private parties against a government that decides to extend health care coverage to areas not covered when the deal is signed. This would infringe on that nation's sovereignty to make decisions about healthcare.

[iverglas]

11. there we go!

"People have to realize that, one way or another, healthcare has to be paid for."

Absolutely. I, personally, am willing to include dental care for children in what I'm prepared to pay for.

"One negative about universal healthcare is that it does restrict the supply end when funding is insufficient, thus resulting in longer waiting lists. Most people believe in a consumerist approach for these types of medical/dental services."

A perfectly valid point -- dental care is far more "discretionary" than other kinds of medical care. (Except for kids ...) So yes, many (if not most) people would probably prefer to make their own decisions about their discretionary spending in this respect. Even if not because of the spectre of waiting lists -- simply because it's money that they'd rather spend some other way, and they are perfectly willing to assume the risk of catastrophic dental expenses themselves. ;)

"This would infringe on that nation's sovereignty to make decisions about healthcare."

Yeah ... well ... it would ... if the nation in question hadn't been so stupid / bullied / corruptly governed that it signed it away voluntarily.

[HEyHEY]

12. Only if Jean Chretien knocks out yer teeth

Or you lose them in a Hockey game.