Closing the tooth gap

In Ontario, the election campaign is on. A topic of note is public dental care. Back in July, the NDP started the ball rolling:

Calling poor dental health a “silent epidemic,” the leader of the Ontario New Democratic Party said Tuesday that the provincial government should provide care for children and low-income earners.

Howard Hampton said an initial four-year program would need $100 million to provide checkups, fillings, tooth extractions and emergency care through community dental teams.

The current system is broken and unfair, said Hampton.

“If you have an infection in your foot you can see a doctor and have it covered, but if you have an infection in your tooth or gums you are barred from getting the care you need unless you can afford to pay out of pocket or are fortunate enough to have private dental insurance,” said Hampton.

My only quibble is that we should be calling for a universal plan, not just one for children and the poor. If Canada did not have public health insurance, would Hampton be calling for such a plan only for children and the poor, like so many Democrats in the US are? I would hope the NDP could be a bit bolder than that.

Still, as only the Liberals can do, they have now stolen the gist of the NDP proposal:

Ontario’s working poor would get basic dental care under a $45 million-a-year program to be promised by the Liberal government, the Toronto Star has learned.

The pledge, part of the Liberal election platform being released later this week, comes two months after New Democrat Leader Howard Hampton promised a $100 million-a-year denticare program called “Ontario Smiles.”

The Liberal plan is aimed at the working poor because most low-income workers don’t have private health coverage for their teeth, said a senior Liberal source, who estimated about 500,000 Ontarians would be eligible.

Here’s my bid in support of universal public dental insurance, a column I wrote for The Tyee in 2006:

Money Where Your Mouth Is

Why private dental insurance really bites.

By Marc Lee

Published: April 26, 2006

Let’s talk about teeth. Our experiences with dental care are a great way of getting our heads around how private health insurance works and whether this is a road we want to travel. For Canadians, going to the dentist approximates what our American cousins experience when they go to the doctor.

Take me, for example. A couple months ago, while crunching on a pistachio nut, I broke off a big piece of one of my molars. A week later, it was good as new after half an hour in the dentist’s chair. (The only reason it took a week, was that I was in Mexico at the time. Back home I likely could have been in the chair the next day.)

What about payment? Simple. I didn’t pay anything. Behind the scenes, an electronic form was processed and my private health insurance company paid the dentist directly. I never saw a bill and had no idea how much the cost of my treatment was.

Out of curiosity, I looked up my recent visits to the dentist on my insurance company’s website. I received about $600 in dental services last year. My semi-annual checkups come to $190 per visit, plus an extra $220 to fix the broken molar.

Unlucky 40 percent

I am one of the lucky ones with gold-plated coverage. Thanks to my employer, who pays the bill for a workplace extended health care plan, my family gets excellent dental care.

My own access to dental care is a model for the way it should be for everyone – health care should not stop where your mouth begins. But according to the Canadian Institute for Health Information, only three-fifths of people are covered in some form by a private health insurance plan. There are differences in the quality of private insurance plans. Some people have to pay a monthly fee, and have a co-payment or deductible associated with their treatment. But they are still fortunate, as the bulk of their dental costs are paid for.

The remaining two-fifths of the population, those without any coverage, have a simple choice: pay up or go without. And the data shows that the majority of those without coverage simply do not get the care they need. Over a quarter of adult Canadians did not seek needed dental care in 2004 because of cost.

This is essentially how private health insurance works: some get top-notch coverage, some get adequate coverage, others get nothing. And the higher your income, and the better your job, the more likely you are to have private health insurance.

There are a few exceptions: most provincial health care plans cover dental care for people on welfare, and if you were ever in really bad shape, the public system would cover an operation (at a greater cost than preventative checkups, of course).

Huge hidden subsidies

Ironically, private health insurance is highly subsidized by the public system. Going to the dentist has an economic value to me, but I pay no tax on the “income” I receive in the form of health benefits. And if my employer were a for-profit operation, they would be able to deduct the costs of the workplace health plan.

All counted, the Canada Revenue Agency’s forgone tax revenue is a subsidy to the private health insurance industry of around $5 billion per year, according to UBC Health Economist Robert Evans. In the US, the subsidy is closer to $250 billion, worth one-third of companies’ premium revenues.

In spite of the large public subsidy to private insurance – and public coverage for the very poor, seniors and veterans – there are 45 million uninsured Americans who live in fear of a health care crisis. And rising health care costs are prompting companies to reduce or eliminate their private health insurance benefits in the name of staying “competitive.”

US switcheroo?

As a result, Canada’s public insurance model is getting some attention. American economist Paul Krugman points out that in the US system “government pays directly or indirectly for more than half the nation’s health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we have now.”

Just as Americans are starting to wake up, private health insurance in Canada is on the verge of intruding into the public system. Last year’s Supreme Court Chaoulli decision was heralded as a victory for private health insurance in Canada – and without a single shrill cry of “judicial activism” by conservatives. This year, private options are on the move in BC, Alberta and Quebec.

We should be moving in the opposite direction, by rejecting the inequities and inefficiencies of private health insurance and by expanding the coverage of the public system. For starters, let’s put our money where our mouth is and add dental coverage to the list of publicly insured health care services.

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