There are currently more than 40 bills before the U.S. House and Senate proposing a variety of schemes for reforming our national health care funding and delivery systems. The administration has consistently opposed any federally mandated or federally administered system of national health insurance. Administration spokespersons have publicly argued that consideration of such proposals should be delayed until the mid-1990s for economic reasons and have been clear that a plan by the administration would be slow in coming if one were to be presented at all.
A major rethinking of the issue has recently taken place within the administration based on the increasing criticism being leveled at the president for neglecting domestic issues in recognition of growing popular support for a national health insurance program. On October 10, 1991, in testimony before the House Ways and Means Committee, Budget Director Richard Darman promised that the administration would propose a comprehensive health care reform plan sometime in 1992, though action would not come until after the presidential election. This pledge was made even prior to the dramatic Senate defeat in Pennsylvania.
It is a matter of urgent priority for the chiropractic profession to participate fully in the debate and discussion on the issue of national health insurance. At the present time, no consensus exists on the nature of a national program, how it would be funded, what it would cover, and how it would be administered. A year ago, most analysts agreed that such a consensus was many years away. Political differences, the federal budget crisis, and a lack of attention to the issue on the part of the administration were interpreted as signs that national health coverage was a long-term issue. Today, a new popular wisdom has evolved which holds that some major reform will take place in the next two to four years.
Even the casual observer of the health care system in the United States today is aware of the enormous pressures, both social and economic building up within our failing system. Costs are out of control, quality of care is seriously in jeopardy and even though our nation spends nearly $700 billion each year on health care, tens of millions of citizens have no health insurance coverage at all, and many millions more receive only minimal, often substandard coverage and services.
Something is obviously very wrong; on that we can all agree. Beyond this inescapable conclusion, the agreement ends. The hunt for solutions has yet to uncover anything remotely resembling a consensus on how our national health care crisis can or should be resolved. Is a system of national health insurance the answer? How would such a system operate and how would it be funded? The questions are endless, and the answers seem beyond the immediate grasp of our national leaders.
For the chiropractic profession, this great national debate presents an enormous challenge. In their recently published paper, "Health Access America," the American Medical Association told the Congress and nation that the answer lies in spending vast new sums of public money, eliminating state mandated benefits, and establishing a core of services (all medical, of course) that would make up the "uniform benefits package of required services," which insurance would be obligated to cover, with additional benefits paid for by the consumer, the individual states, or simply be foregone altogether.
Spending vast new sums and giving it all to the medical community will certainly solve physician income problems, but will do nothing for the nation except bring about a greater, more costly failure. In this process, the chiropractor and the chiropractic patient will be dropped by the wayside to make room for this expensive new medical extravaganza. For us, this represents a direct challenge; it also represents an enormous opportunity.
Organized medicine's response to the current health care crisis is being met with an unprecedented skepticism by our national health care policy makers. The reality of funding the AMA proposals, in combination with the recognition that these are some of the people who got us into this mess in the first place, erodes the credibility of this or any other big spending plan offered by the U.S. medical community. Chiropractic's opportunity comes in the desire on the part of national policy makers for a genuine alternative to more and more of the same.
The ICA is taking both the challenge and opportunity very seriously. ICA has no higher priority than the development of a credible, practical set of proposals to present to national decision makers on national health care reform. ICA has established a 15 member Task Force on National Health Policy to research, study, and develop a comprehensive set of legislative proposals that will address the real causes of rising health care costs and secure to the American consumer the benefits of a rational national health care policy based on prevention, early detection, patient responsibility and conservative care.
The mission of ICA's Task Force goes well beyond the role of chiropractic science and practice in the future health care system, thought it by no means neglects this important responsibility. It recognizes however that health care is a $700 billion stream, and that chiropractic cannot hope to alter the nature, volume or direction of that stream by changing the $4 billion chiropractic component alone. As well, ICA's proposals stand in stark contrast to the self-serving, enormously expensive recommendations of organized medicine. These proposals will greatly enhance the capacity of chiropractic to play a major role in the shaping of all future national health policies.
The initial report of ICA's Task Force will be published in February, 1992. This 100 page document will, among other initiatives, urge Congress and the Bush administration to immediately:
- Fully integrate cost-effective alternative approaches to health care, such as chiropractic, into all publicly funded health care delivery programs.
- Significantly shift the focus of publicly funded health research away from increasingly expensive, dramatic end-state intervention towards basic prevention, early detection, and conservative and alternative care research.
- Enact legislation to establish a National Institute for Nutrition, Prevention and Wellness within the framework of the National Institutes of Health and provide major funding for its activities.
- Develop a model program of health and prevention education to be incorporated into the public education system at all levels.
- Encourage health professionals to incorporate prevention information, advice, and assistance into the routine program of care for every patient. New prevention skills must be developed, changing, if necessary, basic health care education to emphasize this responsibility. Prevention and wellness counseling and activities should have established procedure codes and be covered by all insurance, both public and private.
- Focus national attention and debate on the personal responsibility individuals must assume for their own general health.
- Make every American aware of the true cost of health care by requiring full disclosure to the patient of the actual cost of every health care procedure regardless of the patient's personal obligation to pay any or all of that cost.
- Establish a system of personal health Individual Retirement Accounts which individuals who have the resources and the desire to provide for themselves might have a means to do so.
- Immediately implement current proposals for establishing a uniform, nationwide system for the electronic processing of all insurance claims, both public and private.
- Provide 100 percent deductibility for the cost of health insurance for self-employed persons.
- Impose strict and severe penalties for fraud, waste, and abuse in the health care reimbursement system.
- Ensure that adequate numbers of health care professionals are available and appropriately distributed throughout the U.S. through sufficient federal support for the system of health education. A portion of the costs of a health care education should be tax deductible and other supports should be available to those who are willing to work in remote or underserved areas.
These are but a few of the ideas that will be presented with full and detailed explanations in the upcoming "Report on the Future of Health Care in the United States" by the ICA's Task Force on National Health Policy. This has been a historic effort, and the report of the Task Force will be a historic document. Our effort will not end with the publishing of the report. The enactment of ICA's proposal, including the full integration of chiropractic into our nation's primary care system at every level, is ICA's immutable goal.
Finally, it is very important to recognize the limitations of our national government in dealing with this crisis. How can a government that cannot balance our national budget, cannot adequately educate our nation's children, cannot keep our streets safe and free from drugs and violence, cannot police our national financial institutions or keep our environment clean and hazard free be relied upon to provide solutions to our current crisis? Likewise, the dominant system of medical care. Regrettably, if real solutions do not come out of the experience of or profession, they might not be forthcoming at all.
The solution to our national health crisis, economically and in terms of demand, lies in the hands of those who are the front-line soldiers in the struggle against disease and for national wellness. Individual providers from all disciplines are facing an ethical and moral calling to change current patterns of thinking and change current patterns of practice. The nation cannot afford business as usual. The health care delivery system must lead in this effort to engineer basic changes in the way we do business. This much be done in the national interest, not in self interest. In this effort, ICA is committed to playing a full, positive and active role for the sake of our own professional future and for the stability of the system as a whole.
Dr. R. James Gregg
President, ICA
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