June 2007

Iowa Rediscovered

by Dr. Jeffrey Shay

Just like clockwork, every four years the presidential election rolls around, along with national election coverage. Suddenly, the media remembers Iowa, with its first‑in‑the‑nation caucus, right in the middle of fly‑over country, which provides a break from the usual 24/7 coverage of celebrity bad behavior, disasters and weird animal stories that normally passes for news.

The Iowa caucuses historically represent a chance for presidential contenders to take an early lead on the pack. This year, the primaries are more front‑loaded than ever, with almost every state trying to move up its primary date. Now Iowa will be quickly followed by New Hampshire, Nevada, and then 200 other states during the following week. In all the rush by states to jump ahead, many people forget why Iowa and New Hampshire have traditionally led the way.

Both states are small, with few large cities and population centers (except Des Moines, which has all the entertainment possibilities of towns many times smaller). The advantage of this is that candidates have a chance to actually meet average people and listen to them. Unlike large states, it doesn't take a big bankroll to campaign here, as expensive media hype isn't effective in places where there's a chance for one‑on‑one meetings.

In both states, candidates travel by bus or car to destinations such as school gyms, hog lots, cattle barns and small town cafes. The crowds are more like gatherings, often only a few dozen voters at a time. While it doesn't sound very efficient, people here expect things to be on a more personal basis, and big media blitzes are considered to be major turn‑offs.

The small‑town format presents unusual opportunities, giving people a chance to actually visit with candidates instead of listening to canned speeches, and I've been able to talk with several politicians over the last few elections. One would think this would give chiropractors a chance to sell chiropractic programs and ideas to those who could shortly be our next president. Only the Iowa Chiropractic Society could blow a chance like this.

For example, when Bill Clinton came to Iowa after announcing his candidacy, I had a chance to talk to him about Medicare coverage. ICS didn't pay much attention to his first trip into the state, telling me that it would be a waste of money to send anyone else, since no one could beat George Bush that year.

This was about the same time that ICS sent contributions to the campaigns of two Iowa legislators in my area, both of whom were opposed to chiropractic and had voted against every bill supported by our profession. When I asked for an explanation, I was told that "we're trying to show we can work with them."

In a previous election, I had wondered about letters I received from some ICS officers supporting President Reagan, even after his administration had proposed removing chiropractic from Medicare. I was told that supporting him was necessary, since it looked like he was going to win anyway.

Since then, I've had the impression that anyone trying to remove chiropractic from all insurances would probably be invited to speak at the ICS Fall Convention.

This election is more critical than most, as health coverage is emerging as one of the two most important issues, the other being Iraq. More than 40 million people in this country lack health insurance, with another 50 million underinsured. Coverage has been reduced for almost everyone, with accompanying increases in premiums. Chiropractic coverage has been subjected to managed care, with artificial treatment guidelines and limitations, not to mention reductions in Medicare fees. This doesn't even include problems with private insurance companies operating under the Medicare program that are allowed to cancel chiropractic coverage altogether.

The Republican Party is dodging the issue, uttering the same inanities proposed by the Bush administration. The whole concept of using medical savings accounts to cover millions of Americans is as promising as rearranging the deck chairs on the Titanic, and is only useful to those looking for a tax dodge to go with their hedge fund.

Health coverage is a major topic in the Democratic Party, with proponents having one of three approaches:

***  A Band‑Aid approach, with candidates promising to encourage group insurance coverage to get the benefit of numbers. This approach also mentions possible expansion of Medicare and allied programs. We've already seen this approach. It's the one mentioned every four years after it failed during the previous four.

***  National health coverage, leaving the insurance companies in place. Coverage would largely occur through the workplace, following mandated coverage and standards. This would be similar to programs now being created in Massachusetts and California. The main proponent at this time is John Edwards, who is making it the cornerstone of his campaign. This program is better, but leaving the insurance companies intact is similar to raising chickens and foxes in the same pen.

***  Single‑pay national health coverage, which would be similar to a national Medicare program. This would not involve the workplace at all. America, by the way, is the only country that bases insurance coverage on the ability to work. Insurance companies would be eliminated under this proposal. The main proponent of this plan is Rep. Dennis Kucinich.

I talked with John Edwards about his plan, which is an improvement over the status quo, but with some problems. While he admits to some difficulties, he points out that passing single‑pay at this time would be nearly impossible, but that problems with the coverage could be changed as the program progressed.

He's probably right. The insurance lobby is too strong to keep out of a program they've been abusing forever. Remembering that the concept of national health coverage was first proposed during the Truman administration, it seems they've been very effective in delaying it for half a century.

On the other hand, the single‑pay proposal offers the greatest economy. Rep. Kucinich points out that the insurance system entails $2.2 trillion. One third of that amount is absorbed by insurance company stock options, executive salaries, promotions, advertising and profits. That's over $700 billion per year.

I would think alternative health care could provide real savings in the health care budget. Have you ever noticed that when drug costs get out of hand, the government's answer is always MORE DRUGS? We need to present the alternative possibilities to candidates when they pass through our states.

By the way, both candidates had favorable attitudes toward chiropractic in the last presidential campaign.

The point is, if your chiropractic association isn't talking about the coming changes in health care, it's time it started. Chiropractors can change the focus of this debate, especially if they live in a state with an early primary or caucus.

(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 1501 Mulberry Ave., Muscatine, IA 52761, or the WCA offices, FAX 480‑732‑9313.)