A Canadian Dental Plan has been a dream of many for decades now. It always seemed a little strange that universal health care didn’t include your mouth. But the Supply and Confidence Agreement between the Liberals and the NDP has finally allowed it to happen. Earlier this year, the program opened, but not without some problems. The problem we have, some dentists have, is we’re not really happy about the contract because it has a number of parameters in it that we don’t feel are appropriate.

Not everyone is eligible for this plan. Not all dentists are on board. Not all dental associations think it’s a good idea. And many of them haven’t been hesitant to voice their reluctance to sign up for this plan.

Recently, the government made some tweaks to the plan in an effort to expand it by convincing more dentists to provide these services. And at the same time, eligibility for Canadians is also ramping up, just slowly.

So what do you need to know about Canada’s Dental Plan? What will it take to make this plan a success? How far away from that are we? And will we get there before Canadians get a new government? I’m Jordan Heath -Rawlings, this is The Big Story.

Dr. Brandon Doucette is a dentist as well as the founder of the Coalition for Dental Care. He’s joining us from Halifax. Hello, Dr. Doucette. Hello, thanks for having me. I guess I just want to start by asking you, when you first heard that the NDP and the Liberals were going to use their supply and confidence agreement to introduce a dental care plan, what did you think of it, just as like your initial reaction?

My initial reaction to the announcement was one of excitement, but I was under no illusion that this was going to fix all the problems with access to dental care in our country. Just with the structure of the program itself, there are gonna be co -payments in quite high ones for people with a family income between 70 and $90 ,000 per year.

You know, in around four and a half million Canadians or so would still be left uninsured. But considering how poorly Canada has done on this issue, keep in mind public dental spending as a share of total dental spending in Canada has been second lowest amongst developed countries, ranking even worse than the Americans.

So with this in mind, I was definitely happy to see progress and hopeful we could build off of this program to fully integrate dental care into our universal healthcare system. Give us some more context and history there then.

How long had you and others been campaigning for this kind of plan? Had there been pushes for or ideas in the past that weren’t adopted? What had happened leading up to this moment? I started advocating for this issue around late 2018.

and form the group coalition for dental care a few months afterwards in an effort to find like -minded individuals to create a unified push for universal dental care. There have been other voices on this issue, but I don’t think it’s been able to take such a center stage.

And most of the voices from my experience have been pushing for more tweaks around the edges of a broken system, rather than voices calling for, you know, saying our dental care system is structured much like the dysfunctional U .S.

health care system and we need to fundamentally change it. I do think that there was a great example of expanding public dental care in Saskatchewan in the 1970s and 80s, when there was a school -based public dental program that came to fruition and was wildly successful.

This program actually, you know, was viewed as a… threat from organized dentistry as kind of encroaching on their territory because they used a model that was different than the traditional private practice model.

There were dental clinics in schools, and they actually lobbied successfully to dismantle this program. So, you know, there have been examples in the past of pushes for public dental care, but not at as big of a scale as we’re seeing here at a national level.

Why wasn’t dental care just included in universal health care from the start? Like it’s always kind of been a mystery to me. And I think anybody who’s ever had a need for serious dental work, why this isn’t the same as a normal health problem?

So it’s important to keep in mind the historical context of achieving universal health care because there was significant pushback from physicians and doctors to universal health care to the point where doctors even went on strike when the Saskatchewan government tried to implement the program.

And it was a very tumultuous time. So there was a strategic decision basically to implement universal health care for physician services at the moment in return for things like dental care, pharma care, things like that at a later date.

Also, within this context, there was justification from the dental community being brought out saying things like there weren’t enough dentists and things of that nature. And even if we look back at something like the Hall Commission, which was a very influential report in the formation of universal health care, it’s stated in the program that we should expand universal health care for physician services now,

have public dental care for some limited populations. But once we can alleviate the shortage of dentists, which in comparison to the 1960s when this report has come out, we have alleviated those shortages.

It said we should include dental care at a later date within our universal health care system. That’s such great context about. doctor’s resistance to the initial plan because, and correct me if I’m wrong here, there has been some initial resistance to the current dental plan from dentists.

Can you explain why some of them have voiced that and what their concerns are and why some of them have been reluctant to sign on? Absolutely. So I would like to make a distinction from dentists and the dental associations that represent them because the dental associations have significantly more power and influence over both policy and dentists’ opinion on the Canadian Dental Care Plan because this is where they get most of their information from.

And when the program was first announced, let’s keep in mind the Canadian Dental Association sent an email to dentists referring to the program as, quote, one size fits all solution that could jeopardize access to care for millions of Canadians.

Wow. So clearly the dental associations were against this program from the beginning. Why was that? What did they mean by that? Basically, they viewed the expansion of public dental care as encroaching on their territory, something that could reduce their status.

There’s also a view that many of the existing public dental programs are so meager, so expanding the programs are going to hurt dentists. But this program is very different. This is the largest expansion in public dental care in Canadian history.

Dentists can charge their normal fees. So there’s been a lot of misinformation that, to be honest, has been spread by the dental associations and the dental community at large that has allowed many dentists to not know what the reality of this program is because many dental providers are told they’re going to lose money and drown in paperwork if they sign up for this program, which is not true.

For example, in Nova Scotia, the fee guide for this federal program is 88 .6% on average of the provincial fee guide, which is far higher than the provincial programs that are less than 50% of the fee guide.

And dentists can also balance bill the remaining portion, which means they can charge their normal fees. And the coverage under this program is far better than all of those other provincial programs.

So this is a much better program that is set up to be a mutual win -win for both dentists and providers. The dental associations are shifting towards getting dentists not to sign up for the program because if people gain coverage and are unable to use it, the program is going to be viewed as a failure and it’s going to be easier for conservatives to take this program away after the next election,

either in part or in whole. Whether or not you think that the dental associations concerns are legitimate, the federal government has made some changes to the program in response to them, right? Can you just maybe plainly explain what those concerns were and what the government is changing?

concerns revolved around having to sign up for the program, rather than just billing it on a case -by -case basis. They’ve talked a lot about patient choice. And what patient choice means is if a dentist isn’t signing up for the program, people who would normally be their patients might have to change providers.

So it’s limiting patient choice. But the dental associations have been trying to get providers not to sign up, which is increasing this problem. And it’s something that their solution has been. We basically want to be able to bill patients the full amount up front and give them the paperwork to get reimbursed on the back end, which is obviously going to get in the way of patients being able to use their insurance because they don’t have the money to pay the full amount up front.

And one of the things the… federal government has done to try to alleviate some of these concerns is making it so that dentists no longer need to formally sign up for the program, but rather being able to build a program on a case -by -case basis, which was one of the concerns by the dental associations.

But let’s keep in mind, this is something that even though the federal government has done, they’ve been hearing many of these concerns from the dental associations. The dental associations are still not endorsing this program and they’re just moving the goalpost.

Let’s leave the associations out of it then for a minute. What do we know about uptake from regular dentists on the ground and what their feelings are on participating in this program and on the change, which I imagine makes life easier for them?

The actual providers from what I’ve heard people who have used the program have been very positive because the program has been set up to function like any other private insurance plan, which is something that dental offices are already set up to accept.

It’s something that in some ways, this program’s even better because most private insurance plans, you have to wait a few weeks to get paid versus programs paying providers in two days. It’s actually very, very good if we can get providers to start seeing these patients.

That’s something that I think this case -by -case base will give providers a chance to try out the program, see that it’s not as unreasonable as they’ve heard, and it gives an opportunity for more of them to sign up.

If we’re looking at the uptake right now, we’re seeing between 40 and 50% of dental providers have signed up. Let’s keep in mind that when we look into that, we’re looking at both dentists, independent dental hygienists, and denturists.

If we look at the breakdown of who’s signed up, we see a far greater uptake as a percentage. percentage of providers amongst the independent dental hygienists and denturists that have signed up because their respective associations have been very positive towards the program, whereas dentists, it’s a slower uptake, although it is still increased.

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So even before the announcement of a few months ago, there was what was known as the Canada Dental Benefit, which was cash payments for children under 12 who didn’t have private insurance or came from a family with a family income of less than $90 ,000 per year.

That was because the Liberals were unable to get an insurance program up and running on the timeline the NDP demanded. So they did cash payments as an interim measure to help kind of keep the supply and confidence agreement going.

Now, basically for the program over the last few months, the insurance aspect of the program has been brought up and running and currently seniors over 65, children under 18 and people with a valid disability tax credit are eligible for the program assuming that they meet the income threshold so that they have a family income of less than $90 ,000 per year, do not have private insurance and you also have to have things like having filed a tax return last year.

You know, originally people were told that they were eligible for the program, but now people need to know that they’re eligible and actively seek it out. So those are some barriers that can get in the way for people.

When it is fully up and running, and I’m not sure when exactly that’s planned to be, I read that, you know, the eligibility will continue to expand into 2025. Who will be covered at its peak? Currently the program is being expanded.

based on age and whether or not somebody has a disability tax credit but ultimately by at some point in 2025 I don’t know exactly when but it’ll have to be before the election in the fall the program is going to be just based on means testing so if somebody has a family income of less than $90 ,000 per year and they don’t have private insurance as I’ve mentioned they will be eligible for the program you know the age restrictions at the moment are just a way to not overwhelm the system and to try to roll out the program now as somebody who’s lucky enough to have private insurance I think most people who are listening who do would also agree it can vary wildly in terms of what it actually covers,

how much of it it covers, what is considered, I guess, like cosmetic versus necessary, and it can get pretty complicated. Do we have a simple grasp on what this plan covers and who provides it? Basically, coverage under this plan is geared towards, you know, relatively routine dental care, not luxury and cosmetic services, so things like fillings, cleanings, but also, you know, some of the things that are pretty exciting is seeing things like most root canals will be covered,

people can get crowns to a certain extent, like there’s certain criteria that need to be met, but the criteria are pretty reasonable and are standards that often would apply to private insurance as well.

Dentures are covered as well as certain orthodontics, so braces. Now, that’s something that basically they have certain criteria set aside to say whether or not it’s deemed medically necessary, and from what I’ve read about it, I do think that the eligibility will be fairly restrictive, so if your child’s just going in, looking to just get their teeth straightened for more of a cosmetic reason, that won’t be covered,

but if there’s some sort of severe dysfunction with the bite and it meets the criteria, it then will be, but we also have to keep in mind when we talk about what this plan covers, we also need to look at the mechanisms in place that will limit how people can use their coverage.

For example, you know, can you find a provider to accept these services, but also other things, like originally the program had no co -payments for those making less than $70 ,000 per year, but in an attempt to appeal to dentists, the federal government decided to allow dentists to build the difference between the Canadian Dental Care Plan Fee Guide and dentist normal fees, a practice known as…

balance billing. And this balance billing has created on average a 15% co payment for those making less than $70 ,000 per year. And those who have a family income between 70 and $80 ,000 per year, in 80 and $90 ,000 per year have a 40 and 60% co payment respectively.

Keep in mind that balance billing will add another 15% on top of this. So these financial barriers will result in people not being able to use full use this coverage. So I’m someone who’s listening now.

I’ve heard the qualifications. I think that I qualify in terms of income or age and everything else. What is my next step? How do I go about, let’s say I haven’t had my teeth cleaned or checked for cavities in a few years?

What do I do? There is an application process on the Government of Canada webpage. It’s pretty straightforward to try to work your way through, but you need to apply for this program and actually receive your card before you’re able to start receiving those benefits.

And that can take some time once you submit the application to actually receiving your card, maybe a month or two. So it’s something for people to be proactive and also keeping an eye out for the eligibility.

So currently, adults who are between 18 and 65, if they don’t have a disability tax credit, aren’t eligible. But once we’re in 2025, they will be. So, you know, it will get simpler as of 2025, but at the moment there’s some age restrictions to keep in mind.

As you look at this plan right now, is it what you thought it would be when it was announced and how could it be better? The program is largely what I imagined it would be when the program was first announced.

Other than the balance billing element, which has been a disappointing step in the wrong direction, in my opinion, as far as how we could make this program better, there’s a very simple way. And, you know, it’s kind of obvious of just cover everyone with no copayments like our universal health care system.

But if we’re looking at within the framework of, you know, hoping that this program B could be a stepping stone towards that, there’s elements within the coverage itself that could be a little better, kind of minor tweaks around the edges.

But what I think we really need to focus on now is looking at some of the economic interests. that are in place within the status quo that are making the dental care system dysfunctional. The traditional private practice model isn’t necessarily the best way for a lot of people to access dental care.

We see a lot of poor and rural communities who do not have the dental workforce needed to meet the population demands and having some sort of public delivery model would be a far more effective way at delivering these dental services to these populations because many people’s concerns are, once I get this coverage, will I be able to find a provider willing to do those services?

And with this public delivery model, those people would be able to bring dental providers to rural communities where there’s an inadequate dental workforce would also be able to bring dental providers to communities that have a dental workforce but don’t have enough of them signing up for the program to meet the population’s needs.

So this would be a better way at making sure those people are actually looked after. This public delivery model, it also would encompass what is known as dental therapy, which are basically like the nurse practitioners of dentistry who can do some basic dental services like cleanings, fillings, and some simple procedures like that.

They’ve done this at a fraction of the cost of a dentist for a long time, but organized dentistry has fought tooth and nail to exclude these people, which is one of the reasons they were so opposed to the Saskatchewan Children’s Dental Plan that I mentioned, but they were very effective.

It made it so that basically the inequalities in access to care from poor and wealthy individuals were eliminated and dental care was effectively provided based on need rather than the ability to pay.

So this public delivery model is very, very successful. And it’s something that I’ve been advocating for with the health minister, with Health Canada and the NDP. I’ve been trying to push them over the last few years to take this delivery model more seriously.

And basically they wanted to take an approach that did not confront dentists. And I tried warning them basically saying, even though you’re taking this approach in an attempt to appeal to dentists, there’s going to be a section of this population that just don’t want public dental care.

And you do need to confront that if you want this program to be more successful. There’s gonna be a limitation towards taking that hands -off approach. Now, it’s still ultimately a step in the right direction with this program, but I still think there’s a lot of room for improvement.

Dr. Doucette, thank you so much for this. This was an incredible explanation. Dr. Brandon Doucette, a dentist and the founder of the Coalition for Dental Care. That was The Big Story. For more from us, you can head to thebigstorypodcast .ca.

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