PS. Denticare & Federalism

In my previous post on denticare, I forgot to explain the relationship between denticare & Canadian federalism, probably because it seemed obvious. But here it is, just in case. Nothing prevents any province from listing denticare or any other service, like pharmacare, as medically necessary, and receiving funding for it under the established legislation, criteria (Cda Health Act) and transfer agreements. That has been part of the architecture of medicare from the beginning, from Hall to Pearson to Trudeau and on, and oft-praised by Tommy Douglas. To date, no province has agreed to recognise general dental care as medically necessary, which would trigger its integration within the current health care system. So a Federal Government intent on following the Obama example of offering a public option for dental insurance would present provinces with three options:

1) Continue to refuse to recognise dental care as medically necessary, offer no universal dental insurance, and their citizens will be covered by the Federal Plan.

2) Continue to refuse to recognise dental care as medically necessary, but propose to offer their own universal dental insurance that respects Federal criteria, so they can run it themselves, but get Federal funding.

3) Recognise general dental care as medically necessary (rather than just emergency dental care, as now). In this case, they would be obliged to fold it within their current health care system. But they would be able to assert that it was provincial jurisdiction.

Unless provinces are willing to stipulate that denticare is medically necessary, hence part of the Canadian & provincial health system architectures, they cannot claim it is provincial jurisdiction. A Federal Government that proposed a public dental insurance option, modelled on Obamacare, would no doubt be overjoyed if provinces stepped up and recognised denticare was medically necessary, and we could save 20 years by integrating it within the public health care system immediately. But unless a province was willing to do so, it would have no grounds for objecting to a Federal plan that clearly did not touch provincial jurisdiction, since by its own admission, denticare was not health care. The Federal Government already offers unemployment insurance - it can also offer dental insurance.

I don't doubt that there might be a province or two that might maintain the incoherent position that denticare is medicare, hence provincial jurisdiction, even though they refuse to accept it as such themselves. That being the case, the Federal Government could attempt to satisfy them by proposing to transfer equivalent funding to a recalcitrant province to run its own equivalent dental insurance plan. Where partial public plans exist, for youth, welfare recipients, etc., the Federal plan would cover all the other uninsured, unless the provinces expanded their own coverage to all citizens, whether through an equivalent plan, or through the simple, logical expansion of public health care.

In effect, the political dynamic would be such that provinces would be obliged to sign on now or sign on later. The quicker denticare was folded into medicare, the better - we could save the 20-year transition. But they would be free to continue to insist that denticare was not health care, and as long as they did, the Federal Government would be free to offer its own universal dental insurance plan.