Some will say that any new, large social program invariably requires adaptations during implementation. The Canadian dental care program is no exception, with Justin Trudeau’s government recently easing the participation criteria in the hopes of convincing more dentists to participate. A simple tweak, they will say. The Quebec government will, however, rightly see it as the perfect demonstration of a federal encroachment that is ill-adapted to the realities of the field on which it is imposed.
Dental insurance, born from the Liberal-NDP alliance, promises to be more generous in the long term than equivalent provincial programs. Offered to Canadian seniors since May, the program now also covers those under 18 and people with disabilities and will be extended to the entire population next year. To qualify, you simply need to have an annual family income of less than $90,000 (although a co-payment is required for incomes between $70,000 and $90,000 per year) and not have private insurance. The basket of reimbursed care is also larger, but the fee schedule is lower than that of dentists.
More than 2.1 million Canadians have already registered, including a little over a third in Quebec (747,000 Quebecers). The public’s interest is there. That of dentists, however, a little less. When there are dentists.
Indeed, the creation of this Canadian Dental Care Plan (CDCP) has exacerbated the challenges of a shortage of dental professionals outside of Quebec’s major centres. A denturologist from Gaspésie told Radio-Canada that her phone was ringing off the hook. About a hundred calls a week in search of dental prostheses that are now reimbursed by Ottawa. Enough to fill her diary by 2025, confided Lise Fillion of Matane. In New Richmond, in Chaleur Bay, dentist Karine Martin, also overwhelmed, has to turn away new patients.
The access promised loudly by Justin Trudeau and his NDP coalition partner, Jagmeet Singh, to a full range of dental care is uneven, and in some places inaccessible nearby. And this is true even for those who already have a dentist, since not all of them have joined the federal plan. Because of more demanding paperwork than other public or private plans, they deplore, or complicated alignment with existing provincial programs.
Everything that François Legault’s government was precisely worried about.
The federal Liberals have just modified their program to allow dentists who wish to participate piecemeal, by sending a client’s invoice without formally registering for the plan themselves. Less than half of Canadian dental professionals are currently registered with the RCSD (47%) and 67% in Quebec.
The Trudeau government is arguing, in order to defend its umpteenth federal intrusion, that it is appreciated by Quebecers. The Quebec government’s plan would benefit from being expanded, particularly to young people aged 10 to 15, and the basket of care would benefit from being improved, to include at least preventive services, such as teeth cleaning for children.
However, it is not up to Ottawa to force him to do so. And certainly not to persist in refusing his request for compensation, unconditionally, to the full amount of the three billion dollars claimed.
A worthy heir to his boss, federal Health Minister Mark Holland, in turn, argues that patients suffering from toothache have no interest in jurisdictional battles. He even allowed himself to say mockingly that the provinces, which are so jealous of them, have done nothing with these skills to offer themselves coverage as comprehensive as his. Any compensation, he emphasizes, will only come to finance an identical basket of care.
As if constitutive autonomy were subject to the aims of the federal state. It is not.
Quebec is no longer alone on the front lines. Alberta Premier Danielle Smith has warned that she will withdraw from the federal system by 2026, also demanding her share of compensation. Ottawa’s program “unnecessarily duplicates” provincial coverage and “infringes on this exclusive jurisdiction” of Alberta, she denounces, in perfect echo of François Legault’s remonstrances.
The provinces did not want this federal program, which would inevitably create a demand that would be difficult to meet. At a cost of $13 billion more, after having refused them the full increase hoped for in health transfers. The implementation of the dental insurance plan is proving them right. However, it is a safe bet that Ottawa will not learn its lesson.