I have seen chiropractic education change from what many would say was a politically-driven eyesore to what it is today: a sophisticated level of higher education that is the rival of any other health care profession. I have seen and been involved in the political transformation of the profession. I remember a time when I could not get a meeting with a legislator to discuss an issue, or get an interview with a reporter. Today, legislators seek our counsel and reporters from prestigious newspapers like the Wall Street Journal and the New York Times call us for a quote in advance of a story. Even HCFA, despite our current litigation against it, maintains a relationship with our lobbyist. There was also the recent HHS appointment of one of our doctors to an important Medicare advisory committee.
But in spite of these triumphs, the one important ingredient that would allow this profession to reach its full potential continues to elude us: unity. At a time when we should be combining our resources with other more powerful organizations to compete for the shrinking health care dollar, we are fighting among ourselves over what seem like non-issues.
It is fair to state that while there has never been a time when this profession was stronger and better respected, there has also never been a time when the forces that would like to destroy us have had a greater opportunity to succeed.
There is an old saying: "Liars figure, but figures never lie." After you've studied the chart below that shows the relative strength of the other major organizations that are competing with us over the same health care dollar, tell me there is no need to be unified.
The AMA statistics are a bit off, as was reported soon after the Association Yellow Book was published. The AMA took a $12 million hit earlier in the year and had to lay off 90 employees. I wish I had their problems.
You would expect the AMA to have these types of resources. It has to concern all of us when the one profession that is trying to preempt us in spinal manipulation (the physical therapists as represented by the APTA) has an annual budget nearly five times as large as ours.
This means that the APTA has the capacity to put on a public relations effort five times greater than ours and a government-lobbying campaign five times greater than ours. And whether you like it or not, we live in a society where politics controls the agenda and the strong are the ones who survive.
ACA has accomplished a lot with less resources, but the struggle is more difficult when the government and private sector find new ways to reduce the cost of health care and everyone scrambles for the same dollar. And yet, many in this profession seem to ignore the need to be a member of a national organization.
No more than 30 percent of the profession is involved in any national organization. I could almost understand that reasoning if ACA wasn't doing anything, but that isn't the case. Can you identify for me another national organization in the health care community that has as many initiatives with a better-than-reasonable chance to succeed than we do today? Among our most notable initiatives are the DoD and Veterans Administration programs, antitrust legislation, the HCFA lawsuit, and our public relations campaign.
Could ACA do more? Yes, we could, with more resources. Can you imagine what we could accomplish with a single organization? Instead of the expenses for two or more executive directors, there would be one; instead of competing for the same sponsorship dollars, all the funds would be flowing into one group. (Have you noticed how many bedding companies now carry a chiropractic logo?) Instead of two or more boards of directors, we could have one; instead of two or more journals, there would be one to receive advertising revenue from all the companies, instead of the current situation, where some vendors are concerned about being politically correct.
You would think that the profession would learn the lessons of the 1980s, when court documents uncovered that one of the AMA's objectives was to quietly encourage the split that existed in the chiropractic profession. The Veterans Administration clearly understood this reasoning. Do you think the VA invited all the different chiropractic groups to meet because they really cared about getting the opinions of a cross-section of the profession? They invited the Duvalls and Rondbergs, et al., to the meeting because they knew it would end up in chaos. I would have done the same thing if I didn't want to implement a policy mandated by Congress. Can you imagine how successful we would have been had we presented a single voice? We did show what we could accomplish together when ACA and ACC acted as a single voice and pushed through legislation forcing the VA to establish a policy in the first place.
One organization, one voice, one staff ... why not?
Yes, I have heard the argument that you need two associations just like you need a two-party political system (a Republican and a Democratic party). And I guess in the best of worlds - where insurance companies pay on time, government encourages a level playing field, and where there is plenty of money in the system -two or more organizations would be fine.
But these aren't the best of times. We are at war. And just as the two-party system in America became blurred in WWII and all Americans marched under the same flag to fight the common foe of fascism, we are in a war for survival and we need to be under the same banner and wearing the same uniform.
Unity isn't a bad word. In fact, it is an essential word if we are to survive as a profession.
Our current arrangement makes no sense.
Garrett Cuneo
Arlington, Virginia
Executive Vice President
American Chiropractic Association