NDP's dental plan seen as smart policy - but some costs are uncertain

The Claim:  "It's about choices. $860 million to assure that 4.3 million Canadians have dental services is a priority for us."

-- NDP leader Jagmeet Singh, announcing his party's vow to provide free dental care to Canadians whose household incomes are less than $70,000 a year and don't already have private or public coverage.

The Facts: The NDP plan, unveiled Wednesday morning at an event in Sudbury, Ont., aims to provide full, federally funded dental coverage to uninsured individuals with a household income of less than $70,000 a year. It would also pay a portion of the costs — on a sliding scale — for uninsured households making up to $90,000. 

The plan would begin in January 2020 and cover an extensive array of preventative and restorative services, including exams, cleanings, fluoride treatments, X-rays, filings, crowns, root canals and treatment for gum diseases, as well as the cost of dentures and braces for non-cosmetic purposes. 

And the NDP hopes to extend it even further, with Singh billing it as "our first step toward the dream of universal denticare for all." 

The Office of the Parliamentary Budget Officer has costed the NDP plan, crunching data on the number of currently uninsured individuals, household income, the prevalence of dental problems and treatment fees, estimating that about three-quarters of all eligible people would actually use the program. 

On that basis, the PBO says that the cost for the first, partial fiscal year would be $560 million, then rise to $1.884 billion in fiscal 2020/21 — a "one-time" surge due to oral diseases that had previously gone untreated. After that, the program will cost around $830 million a year through 2024/25, rising to $856 million by 2028/29.

The PBO says its estimate has "moderate uncertainty," due to its assumptions about population growth, disease prevalence, utilization rates, inflation and the possibility that the new federal plan might cause existing public and private insurers to reduce or cancel their coverage, thereby increasing Ottawa's costs. 

How far would all that money go?

The NDP provides an example of a family of four — two adults, two children — with an income of $70,000. Assuming that each family member has one dental exam, two cleanings, and that each child has a cavity filled, the party says their savings under the program would be $1,240, or $310 each.

Many have no coverage

According to statistics provided by the Canadian Dental Association, the estimated total expenditure on dental services in this country in 2015 was $13.6 billion — about $380 per capita. But given that up to a third of Canadians have no public or private coverage and visit the dentist infrequently, if ever, the actual average cost per patient is surely much higher.

And if the NDP were to succeed in convincing 4.3 million more people to seek dental care each year, the Parliamentary Budget Officer's estimates might be on the low side. For example, in the unlikely scenario of 100 per cent utilization, the $831 million earmarked for 2022/23 works out to just $193.26 per person.

A lot will depend on details that have yet to be provided.

"We're very interested to understand clearly who is going to be covered and what will be covered and to what degree," says Dr. Sandy Mutchmor, president of the Canadian Dental Association. 

Mutchmor says it's hard to assign a per procedure cost; there are small cavities and big ones, some cleanings are more difficult than others — it's a matter of time and complexity. And as the PBO has estimated with its second-year surge, people who haven't been seeing the dentist on a regular basis are likely to need more extensive and frequent treatment, at least initially. 

Still, the CDA welcomes the NDP proposal. "Anything that provides more treatment is a step in the right direction," says Mutchmor.

There could also be a net saving to other parts of the health-care system.

Would relieve a lot of suffering

Dr. Gerry Uswak, an associate dean at the University of Saskatchewan College of Dentistry and past president of the Canadian Association of Public Health Dentistry, says the NDP plan would relieve a great deal of dental pain and suffering and help with the treatment of other chronic diseases.

He points to non-insulin dependent diabetes as an example. Some patients develop a related periodontal disease. And their diabetes is much harder to control if the reciprocal gum infection is left untreated. 

"That's the best use of public funds," says Uswak, "getting people the care they need sooner rather than later." 

Dr. Carlos Quiñonez, an associate professor of dentistry at the University of Toronto who studies the intersection of politics and teeth, says the plan addresses a need.

"There's clearly people out there who can't access dental care," he says. "And it's not just really low-income groups. We've done research that shows that affordability challenges are now reaching into even the middle-income categories." 

Quiñonez says the budget estimate for the program sounds a bit low — provincial dental plans are spending between $300 to $700 per patient. However, the NDP proposal would effectively double the amount that Canadian governments are spending on dental care, which would be a good thing.

"The idea of providing more coverage is definitely a laudable and worthwhile endeavour," says Quiñonez. "But the devil is in the details."

The Verdict: It's complicated. The Parliamentary Budget Officer has provided a price tag for the NDP plan, but the absence of details makes it hard to say whether the amount will be enough to provide dental coverage to 4.3 million more people, as Jagmeet Singh has promised. 

Sources: NDP promises free dental care for households making under $70K starting in 2020, CBC News; Why won't Justin Trudeau put some teeth into Medicare?, The New Democratic Party of Canada, Cost Estimate: Dental care for uninsured Canadians, Office of the Parliamentary Budget Officer of Canada; Oral Health Statistics 2007- 2009: Canadian Health Measures Survey, Government of Canada; The State of Oral Health in Canada, Canadian Dental Association; Filling the Cavities: Improving the Efficiency and Equity of Canada's Dental Care System, The C.D. Howe Institute.