How will Canada expand a health-care system that’s already struggling?

Posted on September 10, 2022 in Health Debates

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Sep 9, 2022.   Written by Matt Gurney

Everyone should have access to routine dental and vision care. But we can barely afford the failing, insufficient system we already have

Until Thursday’s world-historical events intervened, Prime Minister Justin Trudeau was set to make an announcement from Vancouver about cost-of-living supports the federal government hopes to roll out quickly. The death of Queen Elizabeth II put paid to those plans, but multiple news agencies have reported that the package will include GST rebates for low-income Canadians and some kind of ad hoc, temporary dental-care supports.

The dental-care proposal is interesting on two levels. The federal Liberals are currently being kept in power via a so-called confidence-and-supply agreement with the federal New Democrats. This is not a coalition government, which would typically involve NDP ministers joining the cabinet. This is a more limited arrangement wherein the NDP has pledged to vote with the government on confidence motions, keeping the Liberal minority in power; in exchange, the government will provide certain policy goodies to the NDP. (Yes, yes, my NDP friends: I know you would insist that the goodies are provided to the Canadian people.) The federal government has often struggled to execute its policy initiatives in recent years (so much for “deliverology”), and the NDP is not unaware of that. That’s why it insisted that its deal with the Liberals include tangible targets for the delivery of certain elements.

One of the larger pieces of the agreement was a national dental-care plan, which was to be rolled out in stages. The first deliverable is due in only a few months. To the surprise of no one who has been paying attention, the Liberals seem to be behind. Thursday’s reports suggest that the Liberals are considering some kind of direct cash transfer to low-income Canadians, nominally for dental care, while they take longer to figure out how to actually deliver the specific program they have fallen behind on. That will require negotiations with the provinces (which actually oversee health care).

So that’s one level: I find all of this interesting from the perspective of political intrigue, especially since the NDP won’t want to be taken advantage of if the Liberals fall behind (which they clearly already have). But let’s not talk too much about the politics of this today. What’s more interesting, says this writer, is how the talk about dental care reveals something interesting about another national conversation we are having about the overall state of the system and how hard it will be to reform it.

Contrary to a lot of talking points you’ve probably been exposed to of late, a ton of health care in this country is already provided by the private sector, on a for-profit basis. And it’s amazing how often we overlook this. Dental care is an obvious example. Years ago, I had a fascinating conversation with a young man who had grown up in poverty and never benefitted from dental care in his childhood. This had left him with sustained dental- and oral-health challenges. He was often in pain, and the pain — plus some of the cosmetic effects of his dental issues — was impairing his ability to find steady employment and improve his circumstances.

He explained to me the sheer absurdity of the system he was forced to navigate. With his dental and oral health something of an all-around clusterfuddle, the young man was constantly seeking medical attention for the various symptoms and causes. Sometimes, it was determined that the issue was fundamentally dental and therefore not covered by OHIP. Other times, it was found to indeed be a medical problem — an oral infection, for instance — that was considered a “medical” issue, not a strictly “dental” issue, and he could receive treatment under OHIP.

The underlying issues, though, were dental, and without the financial means to pay for them and lacking insurance, he was basically stuck with them. He had no way to correct the key issue, but OHIP would spring into action periodically when his dental issues triggered other health issues. This was the most expensive, most disruptive, and least humane way of dealing with his issues. But it was the system.

There are other such absurdities. I need corrective lenses for nearsightedness, and the glasses atop my nose at this very moment (or the contact lenses I could’ve put on instead this morning) put me out several hundred dollars a year, which I am lucky enough to have largely covered by private insurance. If not for that, it would all be out of pocket. Pharmacare is, of course, another missing piece of our true health-care puzzle, and, again, my costs there are largely defrayed by private insurance. Thankfully! Basic things — oral health, the ability to see properly, the ability to take needed medications — aren’t part of our health-care system’s coverage.

There’s a patchwork of programs in place that can help with all these issues. Some of them are funded by the Ontario government; others are charitable efforts. None of them is comprehensive, and most of them are not well known. And yet I think most would agree with me that routine dental care, vision care, and access to necessary medications are part of what we would call health care. They are, in general, not funded by the government via taxation revenues in this country or province. Most Canadians have insurance, but many don’t — particularly low-income Canadians and seniors.

This lays bare one of the greatest challenges of Canadian health care. We talk a lot about specific failures in specific areas, but there’s also the meta-failure: our concept of universal, single-payer-funded Canadian health care actually covers only a limited part of what we’d consider health care … and it does so at enormous cost. Even those parts of the system that are fully funded are struggling. We are spending an astonishing amount of money to achieve incomplete coverage, and the coverage that is offered is, as is increasingly obvious, often insufficient — even poor.

The dental-care announcement is worth watching because it could indeed make a difference for many (and for the above-noted political aspects). But it’s also a fascinating sign that we’re seeking to expand a system that is already collapsing in other areas.

Everyone should have access to routine dental care and vision care and necessary medications — and other things, like mental-health supports and physiotherapy, which we haven’t even gotten into. This is important on humanitarian grounds. It would also, though, optimize the primary-care system: a person who is kept out of hospital by proper dental care means one more bed available for someone who truly needs it.

But we can barely afford the failing, insufficient system we already have, covering what little it does. No one has proposed anything yet that addresses this key challenge. The challenge of this moment is trying to reform and expand the system even as it struggles and collapses. It’s hard not to fear that our political leaders are struggling simply because the scale of this challenge is beyond them.

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