December 2003

Corporate policy and chiropractic

by Dr. Jeffrey Shay

Recently, I was driving to lunch and passed by our local Walgreens outlet. The sign outside advertised a sale on bottled water, toothpaste, and also noted "Flu Shots on Wednesday." This was no surprise, as this was the same drugstore chain that had attacked the chiropractic profession on its website. The reasons were apparent. The chain worked hand‑in‑glove with the medical profession ‑‑ that's where the money is.

The ACA has always told the profession that our problem was lack of scientific research. By extension, if we spent enough money on research, we could justify chiropractic and assume our place among medical professionals. If one studies this premise, the holes become obvious. Yes, some barriers to chiropractic have been breached, but others have appeared. These are usually erected by the insurance industry and CMS (Medicare's new moniker), taking the form of treatment restrictions, payment refusals and audits.

The Wal‑Mart situation is instructive. While Wal‑Mart claims it dropped coverage of chiropractic because of an austerity program, the facts point in a different direction. Wal‑Mart claimed that coverage was not cost‑effective, but made real no effort to study our profession fairly.

In a previous column, I discussed Wal‑Mart's abysmal labor relations situation, including low pay, rotten benefits, and questionable legal problems. These included the largest sex discrimination suit in history, due to an alleged two‑tier salary policy, as well as a glass ceiling for promotions for women and the fact that Wal‑Mart has 38 state and federal lawsuits. Further, NLRB has charged Wal‑Mart with violations of workers' rights in 25 states. It should be mentioned that Wal‑Mart contacted the WCA offices with a complaint about my previous articles.

This month, Wal‑Mart made it easier for me to write my column by getting caught with undocumented aliens working for its cleaning contractors. Federal law requires firms with contracts to assure that contractors are not using illegals for worksite activities. 300 aliens were arrested at 60 Wal‑Mart stores. What was more interesting was the coverage of this incident by various news sources.

Most news releases told the story about the arrests and printed Wal‑Mart's denial of knowing anything about the aliens. They also mentioned that the government claimed it had taped conversations indicating that some Wal‑Mart executives were aware of the duplicity. USA Today had the most complete coverage, which indicated that the illegals were being paid (unbelievably) as little as $2.00 a DAY.

In its coverage, The Wall Street Journal forgot to mention the low wages. Heck, they even forgot to mention the good part about the audiotapes. They did, however, include a bit on the editorial page about the need for the government to abandon its pursuit of illegals because of a need for companies like Wal‑Mart to have something called "affordable labor." It should also be remembered that this newspaper has long been an opponent of chiropractic, and a friend of the medical profession, having published several anti‑chiropractic articles this year.

CNBC, the cable business channel, did mention the government tapes, but within 24 hours also produced a program on the need for cheap labor, and how service companies were being hurt by having to pay for "expensive" labor. They also kept repeating Wal‑Mart's denials of wrong‑doing. There was never a discussion of the working and living conditions for the laborers. Really, how high can these guys have been living on $10‑12 per week?

A side note: If convicted, Wal‑Mart could be fined up to $30 million. That sounds impressive, until one realizes that Wal‑Mart runs that much through its cash registers every seven minutes. While there is a possibility of criminal charges being brought against some Wal‑Mart executives, it's not likely. Look at the lack of convictions in the Enron and Worldcom cases.

Another question could be asked is how much did Wal‑Mart save by accidentally using illegals? For that matter, how much has it saved by cheating all of its workers out of an honest day's wage?

While Wal‑Mart has always made a big deal of its flag‑waving and Buy America policy, one independent study noted only 17% American‑made items out of 105,000. Another study by the National Labor Committee of New York turned up a Wal‑Mart contractor in Bangladesh paying workers between 14 and 17 cents per hour. Even in the U.S., many workers' salaries put them in the food stamp category. Wal‑Mart also pays 40% less than other companies for workers' health benefits. Check this out on the website of the UFCW (United Food and Commercial Workers). It even mentions the cut in chiropractic coverage.

The connection between these companies is money. They really don't care about medical literature and results, just money. They feed off each other, with all the business opportunities that go with the hospitals, clinics, and medical supplies. And the drugs, that's the best part.

With prescription costs skyrocketing, and consumer demand being pumped up by television advertising, what approach is taken by the insurance industry and Medicare? They try to increase coverage.

Several years ago, most insurance companies paid much more for physician services than for prescriptions, with about 30% for drug coverage. Over the last few years, for the first time drug coverage has exceeded payment for physician services in many health plans. Medicare's answer has been to make further cuts in services while making big plans for future coverage for medicine. In any normal business, when one item becomes too expensive, an effort is made to find a substitute.

Not Medicare. While it would make sense to encourage patients to use drugless approaches, such as chiropractic, acupuncture, or biofeedback, Medicare instead lowers chiropractic payments and increases audits.

Chiropractic can't provide the kind of profits that big medicine can. A good example is the cancer business. Anyone who watches CNBC is subject to regular announcements about new wonder drugs for cancer, especially in the spring. Each new chemotherapy product is ballyhooed as the next great cure. But at the end of the year, it's often mentioned that the drug has not worked as planned, not mentioning some problems with side effects (like death).

The first drug blurb drives the company's stock price drastically upward, the second one drops the price, often markedly. If you don't believe me, check out Martha Stewart's problems. They all revolve around a drug company with the usual cancer breakthrough. The problem is that she bailed out early before the official "oops" announcement.

If you've got the time to spare, count the drug advertisements on the so‑called business channel. Maybe they should change their name to Prescription‑NBC.

No one really cares about the people damaged by the side effects, or the giant profits rung up by these companies ‑‑ or at least, no one in the media. What makes everything acceptable is the money.

Another example is the beer industry. It's no secret that alcohol use has been skyrocketing among adolescents. One study showed that 40% of beer sales should never have been made, being sold either to minors or those already inebriated. The national drunken driving figures are also on the increase, as well as highway deaths. This has been accompanied by an increase in beer ads on television and other outlets. Independent studies have shown that the industry has deliberately targeted minors.

In Iowa, it took four years to pass a bill that lowered the blood alcohol level to .08 for drivers to be considered drunk, with the delay costing the state of millions in federal road funds. This year, the industry has been successful in fighting a proposed tax increase on alcohol, in an effort to keep beer affordable. A minor can buy a 30‑pack of beer for $13.00, or a little over 40 cents per can, much less than what it takes to buy bottled water, fruit juice, milk, or even soda.

I'm sensitive to this issue, having lost a family member to a drunken driver. But I've seen how the system works. Every bit of progress against drunk driving has been difficult, and lately there has been little. The beer industry buys all the support it needs, and the killing continues.

It works the same way in the healing arts business. There is less concern with medical efficiency than with money and hype. That's why I could only shake my head when the ACA claimed progress in its talks with Wal‑Mart about coverage for chiropractic services. The fact is that Wal‑Mart, through its prescription outlets, is now one of the largest dispensers of prescription medicine in America. That, in a nutshell, says it all. Wal‑Mart would hardly give its employees chiropractic coverage, when doing so would slash the amount of prescription drugs sold in its stores.

It's much more profitable to send them to a place where a prescription could be written that would make a round trip through the local Wal‑Mart store. And maybe they can sell some beer at the same time.

As long as the money is there.

(Dr. Jeffrey Shay, a graduate of Palmer College of Chiropractic and the WCA's 1996 "Chiropractor of the Year," is the World Chiropractic Alliance Director of Insurance Relations. He welcomes comments or questions regarding any insurance‑related subject appearing in this column. Dr. Shay is available to speak to your state or local organization. Contact him at 1300 Cedar St., Muscatine, IA 52761, or the WCA offices, FAX 480/732‑9313.)