Health care advocates are applauding a Liberal-NDP deal promising dental care for lower- and middle-income Canadians as well as progress toward universal pharmacare, saying the programs are long overdue and could have significant downstream impacts on health care costs and outcomes.
The groups say they are awaiting further details of the supply-and-confidence agreement announced Tuesday, which would see the NDP prop up the minority Liberal government until the next election in 2025 in exchange for progress on the key NDP policies.
“It’s a good day today,” said Steven Staples, national director of policy and advocacy at the Canadian Health Coalition. “We think this agreement could deliver important improvements to public health care. There’s work to be done and there are details to be filled in, but particularly on issues like pharmacare, it really gets things back on track.”
The new dental care program would start with children under 12 in 2022 and expand to include those under 18, seniors, and people with disabilities in 2023, according to terms agreed upon by both parties. Full implementation is expected by 2025.
The program would be restricted to families with an annual income of less than $90,000, with no copays for anyone making less than $70,000 annually.
Carlos Quiñonez, a dental public health specialist and a professor in the Faculty of Dentistry at the University of Toronto, views the income thresholds as generous and said they underscore the fact that dental care is also an issue for middle-income Canadians.
Dr. Quiñonez said he would also like to see national standards, as well as legislation to protect the integrity of the public dental-care program and add federal policy leadership.
“I really want to stress the fact that this is a very, very welcome announcement – very good news for many Canadians and very healthy for the oral health system overall,” he said. “But ultimately I do think that the devil is in the details: Who will be covered? We have an income threshold, but is that for a family with no children? How do you factor in family size? What services are covered? How will they be delivered?”
Bruce Wallace, associate professor at the University of Victoria’s School of Social Work, said while it’s well-known that those living in poverty face significant hurdles to dental care, it’s now becoming clear that there is also a broader gradient of need.
“There is actually a huge part of the population who face financial barriers, on top of other barriers, to be able to access dentistry,” said Dr. Wallace, who holds a PhD in dentistry and co-authored a 2016 study on oral health among people experiencing social and health inequities.
“Because it’s an out-of-pocket expense, it’s an expense that’s going to be competing with all the monthly bills. It doesn’t matter how much we reduce the fee guides to enable access; if you don’t have enough to pay your housing, you’re still not going to have enough to prioritize preventive and restorative dental care. So it gets down to an emergency: Many people only access dental care when it’s an emergency.”
Dr. Wallace said a truly effective program must have no financial barriers, and consider other service delivery models, such as community health care centres.
The Canadian Dental Association said it was surprised by the announcement and cautioned that any new, federal initiatives must not disrupt access to dental care for the majority of Canadians who have coverage through employer-provided benefits.
Details of the pharmacare program were limited on Tuesday to the passing of a Canada Pharmacare Act by the end of 2023, and tasking the National Drug Agency to develop a national formulary of essential medicines and bulk purchasing plan by the end of the agreement.
Mr. Staples said there is broad support for the universal, single-payer pharmacare program described in the Advisory Council on the Implementation of National Pharmacare’s June, 2019 final report, led by former Ontario Health Minister Eric Hoskins.
“We consider this, really, a ‘shovel-ready’ social program that could start right away,” Mr. Staples said. “Particularly, we’ve called for $3.5-billion for the list of essential medicines coverage to go into this budget. We realize that there’s going to have to be discussions with the provinces on this, but we need to see a financial commitment from the government to make those discussions move forward.”
On the election-campaign trail last August, NDP leader Jagmeet Singh said his party’s plan to implement universal pharmacare would cost the federal government $10.7-billion annually but would ultimately save provinces $4.2-billion in prescription drug spending. An average family would save $550 a year, he said.
The Liberals and the NDP have also agreed to table a Safe Long-Term Care Act. The Canadian Health Coalition is calling for national, enforceable standards through the legislation that would include eliminating for-profit operators in long-term care – another NDP pledge.
“We know that’s controversial, but it’s important to us because of the evidence that showed that privately-owned, for-profit long-term care facilities fared so much worse than nonprofit and public ones,” Mr. Staples said.
The NDP’s deal to back the minority Liberal government until 2025 in exchange for progress on key policies could have far-reaching implications. Columnist John Ibbitson says the deal puts pressure on the Liberals to deliver on issues like dental and Pharmacare, but means that Jagmeet Singh is acknowledging he may never be Prime Minister and that the NDP has accepted its role as the conscience of Parliament.
The Globe and Mail
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