Is there a Doctor in the House?
A Chiropractic View of Obama Health Care
Robert A. Hayden, DC, PhD
I usually pick out a specific healthcare issue or condition to highlight in my Scoop article. This time, however, I am apprehensive about something that overrides specific issues and conditions, and I need to vent. If you read further, you might need to vent, too.
A patient recently asked me how the new administration's healthcare plan will affect me as a healthcare provider. I did not have a ready answer.I have thought about it much, though, and my thoughts comprise the bulk of this article.
Recent spending sprees in Washington, DC have me concerned in part because I know I will have to help pay the bill, as will future generations that we are robbing. In the trillion dollar "stimulus" bill, the American Restoration and Reinvestment Act of 2009, there is language that sets the stage for reshaping health care. As you know, the bill passed with no one apparently having read it, but the health care ball is rolling.
Most chiropractors are in private practices, and most of those are single doctor clinics. We are small businesses that work hard to provide a unique service in the stormy waters of changing economies, uncertain reimbursements, and increasing costs of commerce. Many of us are troubled that what we uniquely offer in health care could be obscured or lost to the patients we serve if changes in health care are not made with intelligence and careful planning. We also, by the way, employ between two and five people each, and we are concerned for our employees and their dependents as well.
I believe that good decisions depend on good information. Unfortunately, I do not see an abundance of informed decisions being made by the current Congress (e.g., voting on an 1100-page stimulus bill without reading it first). This has fueled tea parties everywhere.
An example of bad information is this: politicians, policy makers, and others have stated often that 47 million Americans do not have health care. Data like these that are quoted often enough are sometimes accepted as fact, but I cannot find anywhere a legitimate source for this figure. This figure is refuted convincingly by the conservative Business Media Institute, which asserts that a better estimate of the number of citizens legitimately classified as uninsured is more like 8 to 10 million. The numbers seem to be consistently inflated by some in order to justify a push for publicly funded insurance, also known as universal health care, or "socialized medicine."
Whatever the numbers, the debate over the direction of health care policy appears focused upon the laudable goal of increasing the number of those covered by some kind of health insurance. At the heart of this debate?but seldom voiced--is a complex philosophical question of whether health care is a basic right of all citizens or a commodity to be bought, like homeowner's insurance.
President Obama's health care plan begins with complete assumption of veracity of the 47 million figure discussed above. While he stated during the campaign that he wants all 47 million uninsured to have health care, this clearly includes coverage of illegal aliens at public expense. This unnerves me as one who will be expected to pick up the tab for the program. His discussion contains some good points, however, that should be a part of whatever emerges.
First, Obama's plan states that only $0.04 of every health care dollar is spent in health education and prevention. He proposes investing more here, and here I agree. Chiropractors are nearly universal in their belief that it makes more sense to prevent a problem than it does to treat it after it occurs. It is also less expensive. Traditional health care almost ignores this potential and is focused on treating disease instead. Certainly, too, this unfortunate failed strategy is fueled by the influence of the pharmaceutical industry that feeds on a disease-based system. Evidence of the force of the drug companies abounds on television: the purple pill, the little blue pill, Sally Field's bones, etc.
Second, health insurance in Obama's plan would be portable, featuring affordable copays, premiums and deductibles, easy enrollment, and federal subsidies for anyone who cannot afford the expense. For me, the hardest part of his plan to believe is that promise of quality and efficiency?from a federal program. Examples to support my misgivings are too numerous to print.
Third, a promising aspect of the Obama plan is the establishment of an independent institute to "guide reviews and research on comparative effectiveness." If such an institute were reality, chiropractic would welcome it, as the research from the Agency of Health Care Policy and Research (AHCPR) to the Rand study and beyond supports chiropractic care as safe, effective, and cost-efficient for many patients that traditional medical care cannot help. A down side of this approach might be, as some assert, that it could be used as a data base to justify rationing of health care. This is done in the European socialist model that appears to be the Obama paragon.
Obama specifically recognizes the untapped potential of chiropractic in helping a sluggish, expensive system become more efficient and less costly. First, he would expand chiropractors' roles and scope in Medicare, a population we serve less expensively and more safely than pharmaceutical therapy. Second, he recognizes that neither the Department of Veterans Affairs nor the Department of Defense has integrated chiropractic into the military in a manner consistent with the will of Congress, and he supports full integration of the chiropractic skill set for our soldiers. Third, Obama's plan promises that under an evidence-based (research driven) system, chiropractic will fare well. Additionally, the focus on wellness and prevention in Obama's plan would echo chiropractic's call for healthy living to prevent unhealthy conditions, which is always less expensive and more efficient than treatment after the fact.
A side effect of all of this is a huge federal spending program, of which health care would be a pricey part. Taxes will escalate, and shelters will diminish. This may create a hostile environment for small business, where most chiropractors operate.
I like some of the concepts of the Obama plan. However, as a small business owner, I am deeply disturbed by the potential increase to my cost of doing business represented by the tax scheme proposed by an Obama administration that sees paying more taxes as a patriotic duty. As an American, I am distressed by an approach to punish success, thus to diminish the incentive for excellence in health care and every other aspect of our society.
President Obama has been hampered in his efforts to get his agenda underway by the very ironic neglect of many nominees to pay taxes. One casualty was Senator Tom Daschle, who was tapped well before the election to be the administration's point man on health care issues. Taking his place is Gov. Sebelius, whose tax problems were smaller, and whose background is insurance.
I went to Washington in late February to talk with our Georgia elected leaders in the House and Senate as well as leaders in my field from all over the country. I hoped to find answers, but I came away with more questions instead because so little was actually known then about how the health care plan would shake out.
What seems to be shaping up at this writing (times are volatile) is that Congress is likely to build upon the employer-based health care system rather than create a single-payer system. My sources tell me that Democrats in Congress would support a plan to create a new federal health plan (public plan) that people would be free to access, and that meets the imposed requirements of portability, no penalties for pre-existing conditions, etc. This is likely to meet opposition from Republicans and the insurance industry.
Of critical importance to us all is what benefits will be included in any plan advanced by Congress. One option being discussed (Daschle's plan) is the formation of an omnipotent national health board that would make these decisions. This very approach, however, is feared by some who view such a board as an instrument for rationing health care, thus making assessments and choices heretofore reserved to the Deity.
The major battleground for the Obama health plan may be in the Senate, specifically in the Finance and Health Education Labor and Pensions (HELP) Committees. It is possible that the plan could be hammered out as soon as the Fall of 2009. Perhaps if it can be slowed down to a rational pace, unlike the stimulus plan, the 2010 elections could be a referendum on health care, among other issues.
The possibilities for how health care could be shaped are to numerous to predict outcomes with any accuracy or confidence at this time. Much is at stake, however, and it will affect us all. For example, with government in control of health care, I cannot see how the freedom to make our own choices can be enhanced, not the least of which are your choice of the type of care you receive and your choice of caregivers. The tax increases required to pay for universal health care also do not contribute to personal freedom.
It is clearer than ever to me what motivated many of us to engage in the tea parties that took place across the United States recently. Health care choices are a part of the financial issues we face, and they impact freedom more than we think.
What Chiropractors Want
I now get to a partial answer to the patient's question that started this discussion. Honestly, I have no idea how a small practice like mine, or other private health care clinics, will be affected by whatever is coming down the pike. Here, however, is what I really want to happen, irrespective of who wins this policy debate.
I want to be free to see patients who need what I uniquely provide. There are patients with musculoskeletal problems that traditional medicine (where I worked for two decades) does not address, or does not treat with success. There are also patients in my clinic who have no medical provider, either through choice or by circumstance. My mission in life is to serve both to the best of my ability. I hope that nothing in the Obama plan interferes with that goal.
I want to be recognized by the Obama plan as part of the answer to the problems of a health care system that is not really about health care, and is terribly inefficient and too expensive. What I do as a chiropractor is safe, effective, cost-efficient, highly satisfying to patients, and validated by reams of research. I am part of a solution.
Most of all, I want always to have the delight I get daily from seeing people walk who could not walk before. I want to continue to see people liberated from the ravages of acute and chronic pain. I want to see people actively turn from sickness to health, from danger to wholeness. I want to continue to serve both God and man in a way that makes my own life abundant and fulfilled.
These are uncharted waters for America. Our decisions in the near future will have very long-lasting implications for the survival of our healthcare system and all of free enterprise. May God, who is the Great Physician, guide us all.