As I prepared to write this column, I read a front-page New York Times (April 27, 2009) article about how healthcare reform could be stymied by the shortage of primary care providers—a trend that has reached crisis proportions. What will universal healthcare insurance solve if there is a severe lack of practitioners?
It is unlikely that the government can provide sufficient incentives to lure more MDs and DOs into primary care. Conventional medicine seeks to close the gap by relying more and more on “physician extenders” like physician assistants and nurse practitioners.
Part of the solution could come from recognizing the value of naturopathic physicians, chiropractors, and acupuncturists/doctors of oriental medicine and including us, and our academic institutions, in federal healthcare programs. This would enable us to bring a wellness orientation to primary care that a lot of conventional practices are not able to provide.
In February, Drs. Mehmet Oz, Mark Hyman, Dean Ornish, and Andrew Weil testified before the Senate Health, Education, Labor and Pensions Committee. They advocated for training a new cadre of integrative physicians to incorporate health and wellness throughout the continuum of care, to prevent more expensive interventions and cut the costs associated with treating preventable conditions.
These are worthy goals, to be sure. But there was a glaring oversight in their testimony: there are thousands of licensed (or license-eligible) providers fitting that description, already trained in preventive and therapeutic interventions based in lifestyle change, environmental health, mind-body modalities, nutrition, botanicals and other natural approaches.
It is essential that the holistic/CAM professions be involved in the early planning stages of healthcare reform if we hope to achieve lasting, effective change. We are the professions that responded to the explosion of public interest in nutrition, botanicals, acupuncture, physical medicine, and mind-body approaches more than 30 years ago. We represent the disciplines that embodied the kind of relational care that patients sought but rarely found from conventional physicians working under managed care.
The allopathic profession systematically denigrated and excluded these approaches for most of those years, using all its power in research, academia, and media to do so. I believe it is inappropriate, therefore, to put allopathic physicians in sole or primary charge of a reform process that should involve—and will greatly impact—diverse practitioner groups. All parties should be at the table.
During a hearing chaired by Senator Mikulski on Feb. 23, there was discussion about establishment of an Office of Wellness & Prevention that would help to incorporate integrative healthcare into federal programs. This idea first surfaced in 2001 as a recommendation from the National Policy Dialogue on Integrated Health Care (http://ihpc.info/resources/resources.shtml). It is still a great idea, but this new office must have the power to direct action, not just report on it. It will need independent funding and an overarching mission. System-wide reform will involve many federal agencies and offices; an Office of Wellness & Prevention needs to have authority and visibility that facilitates effective leadership.
To really solve the healthcare crisis, we must recognize that the current federal healthcare system is not committed to the ultimate principles of good medicine, but to the narrow interests of conventional medicine, the pharmaceutical industry, and private insurance companies.
Five congressional committees—two in the Senate and three in the House—are working on reform legislation. The consensus emerging from the two Senate committees echoes key elements of Massachusetts’ state-level reforms, including a requirement that all residents purchase health insurance, with premium subsidies for the poor, and an insurance exchange through which uninsured adults could purchase coverage.
National health insurance has considerable support within the medical profession, but it overlooks the degree to which patient empowerment, individual choice, competition, and market incentives could be and are being successfully used to solve healthcare problems. More than 10 million US families are managing some of their own healthcare dollars through Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs). More than half the states have Medicaid Cash & Counseling pilot programs, allowing disabled people to manage their own supportive care budgets.
Support for universal insurance-centered reform is based on a narrow construal of selected data, while all too often ignoring contrary data. The reform discussion would benefit greatly from careful examination of the successes and future potential of reforms outside of insurance-based solutions.
Holistic Primary Care readers should be aware of various opportunities to participate in healthcare reform:
- Doctors for America: www.drsforamerica.org, www.voicesofphysicians.org
- Wellness Initiative for the Nation (WIN) created by the Samueli Institute in collaboration with the Integrated Healthcare Policy Consortium and many other visionaries. www.siib.org
- H. Con. Res 58, introduced in August 2008 in the U.S. House of Representatives by Congressman Langevin (D-RI): “Congressional reform of our disease-based system must incorporate patient-centered care that addresses the underlying causal factors associated with chronic disease and facilitates the inherent ability of the human body to maintain and restore optimal health. This definition of sustainable wellness is essential to any and all reform initiatives.” Supported by the American Association of Naturopathic Physicians, American Holistic Medical Association, American Holistic Nurses Association, American Medical Student Association, Citizens for Health, Consortium of Academic Health Centers for Integrative Medicine, Integrated Health Policy Consortium and the Natural Products Association.
- Americans Living Life Well (“ALL WELL”), an alliance that will be walking to Washington together in Spring 2010 to promote this fundamental and essential change. Contact Karen.howard@naturopathic.org
Michael Traub, ND, FABNO, DHANP, is past-president of the American Association of Naturopathic Physicians, and Board Member of the Integrated Healthcare Policy Consortium.
