November 2007

National health and chiropractic

by Dr. Jeffrey Shay

Fifty years ago the Truman Administration proposed a radical new idea... the concept of making health care available at low cost to all Americans, i.e., a form of national health care. Calling it a form of communism, conservative interests and insurance companies pooled their resources and soundly defeated the measure.

Over the next half century, little changed. Health care costs have climbed through the roof, drugs have skyrocketed, health care access has become more limited to most Americans. The one thing that hasn't changed is the opposition. The very power of the insurance interests has thwarted change in health care throughout most peoples' lifetime.

When health care approached a crisis in the early 1990s, the Clinton Administration, led by first lady Hillary Clinton, proposed sweeping changes in the health care system, but wound up taking a bloody nose from massive opposition that included (you guessed it) the insurance and pharmaceutical companies. The Clinton plan, which was really not that drastic, disappeared and was never mentioned again.

Under the Bush regime, the health care system has nearly bottomed out. The only remedies proposed by the administration are "more competition" and "health savings accounts." Both of these propositions are sops to the far right and business interests.

Competition in health care doesn't really exist, as chiropractors are well aware. Although our profession exists as an alternative to the medical approach, business interests move heaven and earth to keep their employees from having a reasonable choice. Punitive co‑pays are the new method of choice, making it proportionately more costly to seek conservative care than to ask for more drugs.

While there has been some controversy about changing the system, the hard truth is that there are only two options in health care models: Government health care and corporate health care.

At first glance, it would seem to be a Cadmean choice. Both have a number of drawbacks, and have little allure for most of us. But the choice is fairly simple.

Under corporate medicine, health care is dominated by special deals with the insurance interests. Chiropractors will have no input, nor will their patients.

Under a government plan, there will still be a battle with the big interests. However, representative government offers something the other plan omits, viz, the possibility for patients and chiropractors to access their representatives.

Any doctor who thinks that private plans will allow chiropractic benefits to continue is simply in denial. Every year insurance companies dream up new ways of limiting or eliminating alternative care, either by paying doctors less, requiring referrals, increasing co‑pays, or requiring more paperwork. The paperwork has a purpose, as it's invaluable in identifying "unnecessary care," which is another term for "chiropractic care."

An example of the corporate model is in evidence at this time in Iowa. All chiropractic claims filed with Wellmark Blue Shield now (as of the end of this past September) have to be preauthorized. This rule is not for one or two of their health plans, or for visits that exceed set limits. Every visit for every patient in every Blue Shield plan is included. The paperwork is not designed to help patients get well. It is simply created as an impediment.

Anyone who thinks this system will have any function other than limiting chiropractic care is sadly mistaken, and probably also thinks that statin drugs are important for good health and are provided by drug companies as a public service.

Millions of Americans are without health care in modern America, either because it's not affordable or they are denied access. According to government figures, more than 11,000 people die every year due to lack of health insurance. The Republican candidates are all touting health savings accounts as the answer to this problem. Let's see... people are dying because they can't afford health insurance, so the answer is to offer them tax breaks. This approach is not only cynical, it's downright vicious.

Among the Democrats, there are two main approaches to the problem. Senators Edwards and Obama are proposing plans that are fairly similar. Both are in favor of a national health care plan that requires coverage in the workplace, with government plans such as Medicare and Medicaid used to fill in the gaps. Sen. Edwards indicates that his plan will be financed by increasing taxes on the upper one percent of incomes. Sen. Obama has not given many details on his plan.

Rep. Dennis Kucinich is the only one to propose a national health plan with a single payer, the government. His model features no co‑pays or deductibles, with complete national coverage, a plan similar to those in Canada and Europe. Almost one‑third of America's $2.2 trillion spent on health care goes for insurance profits, CEO salaries, stock options, advertising, et al. Eliminating these costs would save nearly $800 billion each year.

Yet, this plan is the one most likely to be blocked by corporate interests trying to protect their profits.

Three years ago, when candidates discussed their health care plans on a television program, only Kucinich was not allowed to discuss his plan. When he mentioned it, the moderator called it "socialism" and would not allow him to speak further.

The fact that there are several varieties of national care being discussed shows that either the country has progressed in its thinking, or things are going to hell in a handbasket.

I once talked with John Edwards about his approach, and found some real advantages in it. However, when I mentioned using a single‑pay system, he told me that the opposition would be too great. On second thought, he may be right. Rep. Kucinich has often been skipped over on the recent television debates, and his health care plan has a lot to do with it.

So much for freedom of speech.

The reality is that this time, there will be some change in the national health care picture. It may not happen as fast as it should, but it's going to happen.

Chiropractors need to see this and prepare to take a seat at the table. While I'm not happy about some aspects of national health plans, it's obvious that the alternative offered by corporate interests would serve only to drive us out of business. I prefer a system where my patients may still have some input.

(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.)