January 2005

Insurance ‑‑ The future

by Dr. Jeffrey Shay

The Presidential election is over and George Bush and the Republicans have won. From the standpoint of health care in this country, it was probably not the best outcome. While neither party really produced a plan that will effectively correct our foundering health care system, at least John Kerry was willing to take the first steps.

President Bush has virtually no plan other than to offer a grab bag to health insurance companies and drug cartels. Witness his new Medicare drug coverage with the famous “doughnut hole.” Sen. Kerry talked about offering health insurance options to all citizens and making Medicare an option for many just under the present eligible age. Yet, he failed to mention much about funding.

The sad truth is that the health insurance system in this country is completely broken, and its treatment of the chiropractic profession is emblematic.

Chiropractic has been dropped from many policies, subjected to severe restrictions and reduced payments, and many plans gave limited access to our services. Most of this was no fault of our own. Like most members of my profession, I am paid at rates well below those of a decade ago.

The real culprits are hi‑tech procedures and drug coverage, viz, the cost of heart transplants and specialized imaging, not to mention the cost of obscene drug profits and TV advertising (even the American Medical Association isn't too happy about the ads). To his credit, John Edwards talked about controlling prescription drug advertising.

While admittedly there are problems in the malpractice system, this only explains part of the medical cost increases. The cost of routine services has not changed that much. President Bush has claimed that modifying malpractice laws will cut the cost of health care. In truth, it would help some, but not enough to make a real difference in a system geared to offering the most costly treatments as opposed to the most efficient.

Our system, while supposedly capitalistic, incorporates a lie.

In a real for‑profit program, an expensive service is usually discouraged and a cheaper service substituted. In America, no matter how high drug costs climb, every insurance company scrambles to offer more coverage. Alternative services that are most cost‑efficient are actively discouraged or completely eliminated, hence the limitations on chiropractic and lack of coverage for other options, e.g. acupuncture, herbalism, etc. Unbiased studies document the cost‑effectiveness of chiropractic, yet how many plans offer reasonable alternative care?

As an example, recently a representative for United Health Plans came into my office, touting a new insurance plan under Medicare Plus Choice, which is really more corporate medicine. Under this particular expansion of Medicare, companies are allowed to offer their own private plans and can eliminate other options (chiropractic ‑‑ no surprise).

Believe it or not, these companies are even being given government subsidies to guarantee their profits. Let's see, the government taxes chiropractors in order to give cash to corporations so they can eliminate chiropractic coverage. If this makes sense to you, you'll really like privatization of social security.

In United's case, they are going to cover chiropractic. However, there will be a $20 co‑pay for chiropractors, while just $5 for a medical doctor. In Iowa, the allowed charge for a chiropractic adjustment is around $24. This is, in essence, a non‑benefit. My suggestion to the United rep was to have her company cover various lubricants to offer to anyone stupid enough to buy their policies. This, of course, didn't go over well.

Most practitioners are paid more than those in Iowa. I think the theory is that the extra money would be wasted in a state where hogs outnumber humans. The so‑called “Big Event” in this state is the annual Iowa‑Minnesota football game, with the winner taking home a bronze hog trophy (“Floyd of Rosedale”). Our northern neighbors in Minnesota think Iowa is like Palm Beach with tractors.

When I asked the so‑called “insurance consultant” why there was no real alternative coverage, she replied that her company was only offering what the public wants. When I pointed out that a recent study that showed that up to 40% of the public used various alternative services, she stated she was unaware of a demand for anything but drugs and surgery.

I'm not sure why an insurance consultant would offer a policy ignoring the public's wishes. I suppose it's like an in‑law I have who calls himself a gift consultant. Last Christmas he sent gifts that looked suspiciously like those shelved in a local truck stop. My wife really treasures her chrome trucker's mug. All we need is a 16‑wheeler to go with it.

In some places, insurance co‑pays are approaching $40 per visit. I once took an insurance course taught by Dr. John Hanks in which he pointed out that any co‑pay over $15 was punitive. 'Nuff said.

Another item: Wellmark Blue Shield pays less for a chiropractic visit in any of their plans than Iowa Medicaid does for a welfare patient. This is not to mention any deductibles or co‑pays.

The U.S. spends $1.4 trillion on health care each year, which amounts to 14% of our GNP, and insures 70% of the population. Most nations with national health care spend less than 10% of their GNP to insure 100%. This is not to mention millions of underinsured in this country (insurance coverage that rhymes with Wal‑Mart). Where does the rest of the money go? How about insurance profits, high CEO salaries, stock options and paying for drugs without cost controls.

The idea of universal health coverage is not a new one, and was originally proposed by the AMA in 1916. Harry Truman brought it out again in 1948. Even the president of Blue Shield recently proposed a mild form of it (similar to Kerry's) in a recent interview in USA Today.

If your patients have secondary coverage the game is even more fun. Once it took me six months and a trip to Des Moines to clear up a case of a patient with two family insurances ‑‑ and both policies were with Blue Shield in the same building!

My insurance claims take longer to clear than they did a decade ago. This happens in a world with instant communication by e‑mail and fax and telephone. The installation of voice mail systems is one reason for delays, i.e., it's difficult to talk to anyone responsible for claim handling.

I have patients from Germany who tell me that treatment options over there are more varied. In America, chiropractic is involved in a constant battle just to maintain its status. Witness our recent lobbying efforts, not to mention the ACA's action against CMS (to this point not successful) due to private contracts just like the one mentioned above. Chiropractic's position is that our services were guaranteed by Congress 30 years ago. Contracts like this are merely an effort to mainstream health care.

Costs are the usual excuse, but almost anything would cost less than our present fiasco. National health plans could take many forms, with varying cost options, ranging from a mere guarantee of coverage to outright federal centralization. At the very least there should be some discussion of change.

Even the worst scenario would have a yearly cost of not much more than a month of costs and casualties in Iraq. Yet it's much easier to sell the public on weapons and military adventures than to sell health care options. Most countries, as well as the United Nations, consider health care to be a personal right, while we look at it as an option.

Our system is corporatist, controlled by giant insurance and drug cartels. A real free enterprise system would allow people to make cost‑effective choices. Instead, chiropractic is always having to fight to even remain on the radar screen. Cost has nothing to do with it ‑‑ control does.

I'm a Kucinich Democrat and therefore more liberal than the average bear. That doesn't change the fact that the current system doesn't function, at least for the health care consumer.

Last spring during the Iowa political campaign, Dennis Kucinich proposed a centralized universal health care system, only to be criticized by the party headquarters. The reason? They admitted they didn't want to alienate the insurance industry, which was contributing not only to the Republicans, but also to the Democrats. In essence, the insurance industry was covering both options.

One interesting fact. In Britain, doctors have the choice of practicing privately or staying with the national health system. Under Medicare, all chiropractors who treat Medicare patients must participate. Remember that when someone renders a litany about American freedoms.

We will have universal health insurance in the future, probably sooner rather than later. Not because either party wants it or the industry wants it. It will happen because the system will literally hit the wall. Studies show that nearly 10,000 people die in the U.S. each year due to lack of health insurance. Barring change, this can only get worse.

Wal‑Mart note

Coming up with new Wal‑Mart depredations is never a problem. A new Wal‑Mart in Honolulu has been constructed on an ancient Hawaiian burial ground. The land was plowed up anyway. Wal‑Mart has announced that the human remains found there have been treated “respectfully” and placed in an air‑conditioned and darkened trailer.

(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.)