Robert A. Hayden, DC, PhD, FICC
Much has been said and written about the debacle known as the Affordable Care Act (ACA), better known as Obamacare. It sparked a feeding frenzy of lobbyists who represent the full gamut of health care from providers to patients to payers. The lobbyists agree privately that Obamacare is fatally flawed, cannot be sustained, will ruin all of health care, will speed the bankruptcy spiral for America, etc., but they will all fight valiantly to be sure their constituents are not left out. In some cases, lobbyists are further attempting to be sure competitors are left out.
The Department of Health and Human Services (HHS) has sent a committee on a "listening tour" across the country to gather input directly from stakeholders (aforementioned providers, patients, and payers) on what services should be considered "essential" as a benefit package is constructed for Obamacare implementation. I was honored to represent the other ACA, the American Chiropractic Association, and Griffin citizens as I testified in the recent HHS meeting in Atlanta.
Many believe, and many hope, that the mandatory insurance portion of Obamacare will be struck down by the Supreme Court by June in time for the next election. If it is not, the same people hold out for a President Gingrich, Cain, or Bachmann who will stop it altogether before American collapses under its weight. Considering the likelihood of one of these scenarios, composing an essential benefits package for a plan that will not emerge from Congress seems to me like refueling the Titanic so that it can sink well provisioned.
I went to the Federal Building in Atlanta on the 17th of November to participate, armed with a few facts and thoughts to share with the committee. There was a long line inside the front door where only one metal detector was present, and there was no "frisking" option. Had I been in charge, I would have installed a separate line for people to frisk themselves and labeled it the "express lane."
When I was called to the podium in the conference area, I did not use a prepared statement so that it would not appear that I was reading anything and could maintain eye contact with the committee. Here is my recollection of what I said:
First, thank you for this opportunity to give input to the committee. I am Dr. Robert Hayden, representing the other ACA—the American Chiropractic Association. I speak for my colleagues in saying, 'It is always less expensive, more effective, and more efficient to get people healthy than to treat illness.'
"Members of the committee, I am also here to represent the citizens of my town. Griffin, Georgia, is about fifty miles south of here. It is a mill town whose mills are long gone. Unemployment runs in excess of 13%, and the per capita income is about $18,000. One in four of my fellow Griffinites is uninsured. One third of those, related to the socioeconomic and cultural issues of poverty, are clinically obese. Twelve percent of them are already diabetic. Given these realities, I shudder to think what the aggregate future cost might be in treating illnesses in this population. Again, strategies and methodologies aimed at helping our citizens to regain their health offers more hope for them and for the economy.
"I echo the sentiments of many who have spoken today about obesity. It is a focus of my practice and that of many of my colleagues across the country who deal with nutrition in their patient populations, many of whom do not have access to medical care. Indeed, if we could eradicate obesity, perhaps the Affordable Care Act would actually be affordable (nervous chuckles from the crowd there).
"We at the ACA ask the committee to consider that in addressing the awesome task of creating an "Essential Health Benefits" package, HHS should identify common conditions that are operant in America. We have heard much about obesity already, but 80% of Americans will experience back pain in their lifetimes and seek care for it. This is an incredibly expensive condition when treated pharmacologically or surgically.
"A 2010 study by Blue Cross/Blue Shield of Tennessee found that for low back pain, one of the most frequent entities plaguing Americans, care from doctors of chiropractic saved 40% of health care costs compared to care from a medical doctor. This study suggests that in this category alone, serious money can be saved. Not accounted for in this study is the fact that patients treated conservatively are more likely to return to work and resume a productive working life—and even pay taxes.
"Second, with major conditions identified, HHS can evaluate options for interventions based on research evidence. Interventions considered for implementation should be the most cost-effective, most efficient, most efficacious, and least invasive of all alternatives.
"ACA would urge HHS to listen closely to patients' wishes. The Patient Centered Outcomes Research Institute (PCORI) has their fingers on the pulses of patients and gathers data about what consumers really want in health care.
"I can tell you that the patients I serve are not the ones of fifty years ago who visited Dr. Welby. They are savvy. They know what they want and how to get it. The internet has had a huge impact here. The result is that the patients I serve do not want to be drugged, and they do not want debilitating surgeries. They want non-drug, non-surgical answers to their issues, and they are turning in ever-increasing numbers away from what they do not want in favor of treatment modalities that are natural, holistic, user-friendly, and patient-centered.
"Members of the committee, I represent chiropractors. We are patient-centered, cost-effective, holistic, and evidence-based. We stand ready to serve our country and HHS. Thank you.
I left the committee to get back to seeing patients here in Griffin. I wish HHS great success, but I don't have much optimism for a socialist approach to health care that Obama designed to eliminate the private sector. I felt good about taking fuel to the Titanic.