Unless you are someplace with no television, internet or newspapers you know that the health reform train is gathering steam. Obama has decided to insert himself directly into the debate and attempt to ensure that there will be a government plan to go along with all the other reforms. From everything I’ve been reading there’s a good chance he’ll get his way.

I have no desire to argue the pros and cons of a government health plan or whether or not real change will happen – at this point the issues are much more pragmatic. For instance - if it’s coming, will chiropractic be included? The leadership in the profession has decided we should be included so if you believe we should just stay completely out of it – you’ve been outvoted.

Further to this, the leadership has decided that we should be included to the fullest extent of our scope of practice as defined by the states. Not sure how a national health plan will navigate that one so it’s probably unrealistic. Of course, there is no mention of subluxation in any of the pronouncements by the national chiropractic leadership – interesting.

If we are included (and there is no guarantee we will be) it will most likely be based on the Medicare model. No exams, no x-rays, no instrumentation, no other diagnostic or analytical procedures. Of course our chiropractic leadership is pushing to expand services based on scope - but let’s be real. The Office of Inspector General has just released a scathing report that much of the chiropractic payouts on Medicare are not medically necessary. Coincidentally, Obama plans on paying for a new national plan with $300-400 million dollars in savings from Medicare cuts. Hmmm.

Considering the OIG report, a dearth of research suggesting positive health outcomes from chiropractic and (as far as I can tell) the fact that Obama and his family are not under lifetime, family wellness chiropractic care – where does this delusion that we’ll even be included, never mind get an expansion of services, come from? Positive mental attitude and all that stuff I suppose.

Experts such as MIT’s Professor of Economics Jonathan Gruber give us a reality check. An article in Time stated:

“For universal coverage to have any meaning, there will have to be a minimum set of guaranteed services. But what does that mean? Does it include preventive care? How about mental-health care? Abortion services? These are the kinds of decisions that will determine how expensive health-care reform will be for consumers, business and government. And what goes into the basic benefits package is a political minefield — which is why many health-care experts say they don't want it left in the hands of Congress and lobbyists. ‘If you start fighting over whether chiropractors should be in the benefits package, this bill is dead.’ Stated MIT’s Gruber.”

If we have any luck we’ll end up included with 12 visits for subluxation as long as there is an associated neuromusculoskeletal disorder – just like Medicare. And what do you want to bet that one of the chiropractic managed care companies currently strangling the profession to death right now somehow weasles its way into administering the chiropractic benefit?

You see it’s the old saying about success. Success is defined as “Preparedness Meets Opportunity.” So here is an opportunity but once more the profession is not prepared. Had we not squandered our resources during the Mercedes 80’s and put some of that cash into health outcomes research beyond NMS disorders we might be in a different place. Had we not wasted $8 million on suing the federal government to “Save Our Subluxation” and instead went back to congress and asked them to clarify their intent regarding chiropractic in Medicare and who really owns subluxation we might be in a different position. Had we pushed for the ability to opt out of Medicare when there was an opportunity to do so – we might be in a different position. No one is opting out now – that’s for sure. Oh – but maybe some football player, some D list celebrity, or some unknown MD’s testimonial will convince the government to entrust 16% of the GDP on chiropractic. The delusion continues.   

Of course you have heard Obama’s mantra about reducing costs and improving outcomes. The theme is everywhere. There was a time when it was just us chiropractors that went around ranting and raving about errors in medicine, quality, prevention etc. It gave us plenty of material for our Wednesday night lay lectures. Now, the average middle class worker can tell you a thing or two about health care quality and economics. We’ve lost our voice on this because we didn’t lead. We didn’t produce the data to substantiate the 100 + years of rah-rah-sis-boom-bah anecdotes about the miracles of chiropractic. We have failed in our stewardship of this great profession and the mission it was given. We complained for decades that they had no evidence to support what they do and never tended to our own garden. 

So do we just give up? Of course not. But half-ass attempts at turning this ship around and deluding ourselves into thinking we are actually part of the conversation won't do. The goal line is not this national health care debate - this isn't even first down. The goal line is 10-15 years from now when the wheels will be coming off the wagon. It will take an organized and concerted effort from the entire profession to get us on the right track and collect the massive amounts of data needed to turn the tide. Will we be ready then? 

Or we could just pray that they’ll pay us for muscle stim and heat.

As always I look forward to your feedback, comments and suggestions.

Matthew McCoy DC, MPH matthewmccoy@comcast.net
Editor
Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net