Erik Goldman10.01.08
Tearing Down Fences
We may not need politicians to dictate healthcare reform—MDs, naturopaths, consumers and other healthcare practitioners can handle it on their own.
ByErik Goldman
In a few weeks, we’ll know who the next President will be. No doubt there will be a lot of back-slapping, glad-handing, confetti dropping, photo-oping, position-seeking, pontificating, hand-wringing, salt-rubbing, wound-licking, name-calling and blame-laying.
And then, whoever is chosen by the American people (and their electoral college proxies), and whoever rides into power with them, will wake up to some very sobering challenges.
There’s the downward-spiraling economy and our disastrous dependence on non-renewable petro-based energy. There are the wars in Iraq and Afghanistan, and the threats of further conflict in Pakistan, Iran and Georgia. There are the faltering education systems, and the corroding infrastructure. Oh, and healthcare. There’s that.
Whether it’s Mr. McCain or Mr. Obama in the White House next year, we’re likely to hear a lot of talk about national healthcare reform.
Personally, unless we’re talking about a major league reform in the direction of a U.K. or Canadian style single-payor system, I’d prefer that the government leave healthcare alone. Why? Because both major party reform plans will center on trying to increase the number of Americans who have health insurance. Politicians and health policy advisors, be they Donkeys or Elephants, seem to have this unshakable faith that health insurance coverage equals healthcare, and that without insurance, no healthcare is possible. I think both notions are highly questionable.
Many people see healthcare reform as the Democrats’ pet issue, owing to Kennedy’s effort to establish Medicare, the Clintons’ failed attempt at reform in the early 1990s, and the party’s alleged “liberal/socialist” streak. It’s interesting then, that the most ambitious, coercive, and some would say disastrous state-level healthcare reform was forwarded by Mitt Romney, a Republican governor of Massachusetts, one who might have been the party’s presidential nominee.
“Romneycare” in Massachusetts amounts to a mandate to buy health insurance, much in the way all states mandate that drivers have car insurance. If a Massachusetts resident cannot afford insurance, and doesn’t qualify for Medicare or Medicaid, the state is supposed to buy it for them. To be sure, more people in Massachusetts now have insurance. No doubt, this pleases insurance companies. But does it translate into more or better healthcare? Nope. At least not so far.
With physician reimbursement as low as it is, there are fewer doctors practicing in Massachusetts, which means that people have to wait longer to see doctors who have less time to spend with them. There’s no evidence (yet) that the Massachusetts plan is leading to any meaningful improvements in health outcomes. Perhaps time and good public health research will prove the wisdom of “universal coverage.” So far, though, the picture isn’t pretty.
So what gives here? Aren’t the Republicans always talking about free choice? Small government? De-centralization? What’s with the mandated insurance, Mitt?
It’s really not hard to understand. Republican “market-based” solutions tend to be about expanding markets for large corporations. Insurance companies are among the largest and most corporate. If the people want health reform, that’s fine with the GOP, so long as large insurance corporations can make more money in the process. It’s not so different from the notion of privatizing social security.
At the national level, it’s hard to say who stands for what, healthcare-wise. Mr. McCain and Mr. Obama have both deemed it a major issue, and say they intend to address it. So far, there seems to be little difference between the candidates’ reform plans. Both share the “insurance equals healthcare” doctrine, so reform, whether from Obama or McCain, will likely amount to running more of our dollars through the for-profit insurance sector.
If we don’t like the current state of insurance-based healthcare, with its harried, 10-minute office visits, duplicative testing, poor follow-up, lack of human touch, absence of preventive services, and nonexistent coverage for supplements, fitness plans, or other health-promoting services, what makes us think it will be any better if the Fed pushes more people into these systems?
The needed reforms in healthcare won’t come from insurance companies, sweeping federal reforms or state mandates. Nor will they come from technological breakthroughs or new “wonder-drugs.” They’ll emerge from the ground up, as health-conscious people, health-conscious practitioners, and health-conscious companies figure out new ways to work together toward common self-defined goals.
There are some very promising signs, like this year’s annual meeting of the American Association of Naturopathic Physicians, a group representing graduates of the four-year naturopathic medical schools. The conference was a showcase in bridge-building within the notoriously balkanized world of “alternative” practitioners.
The meeting—held at the beautiful Biltmore in Phoenix, AZ—was more or less a shared meeting with the American Holistic Medical Association (representing holistically minded MDs and DOs), although neither organization felt comfortable promoting it as such. It was extremely heartening to see naturopaths and holistic physicians—doctors who share so many core principles, visions and goals—learning together, sharing clinical information and having a good time.
At the organizational level, the relationship between AANP and AHMA is still a bit awkward; both groups carry a lot of baggage vis a vis their relationship to conventional allopathic medicine and its economic power structures—baggage that in the past has hindered the groups’ abilities to work together for common goals.
But on the ground level, where people were connecting as people, not simply representatives of a particular medical degree, everyone seemed to get along fine. The AHMA, which traditionally did not allow NDs to join as full members, appears to be changing its policy. AANP for its part graciously welcomed MD attendees.
Also well-represented at the meeting were the American College for the Advancement of Medicine (ACAM), the American Holistic Nursing Association, the Natural Products Association and the Academic Consortium for Complementary and Alternative Healthcare. In a sense, this year’s meeting—over 800 strong—was something of a United Nations of holistic health professionals. It was one of the liveliest and most inspiring conferences I’ve attended in years, and interdisciplinary collaboration like this deserves the utmost support from the natural products industry.
While out in Arizona for AANP/ AHMA, I had the opportunity to visit Canyon Ranch. For nearly 30 years, this Tucson-based spa has been at the forefront of the healthy living movement. Twenty years ago, Canyon Ranch established its Life Enhancement Center, which has become a veritable greenhouse for new models of healthcare. The center brings together an astonishing array of healing services, including nutrition counseling, functional medicine, healing touch, yoga and pilates, chiropractic care, acupuncture, psychospiritual counseling, exercise physiology, and various forms of massage, all thoroughly integrated with conventional allopathic medical care.
Two years ago, Canyon Ranch launched a very impressive executive fitness program in conjunction with the Cleveland Clinic, one of the nation’s leading medical centers. Talk about building bridges!
To be sure, the cost of this comprehensive health-centered program will be out of reach for most people, but down the road it could have a significant impact on healthcare at large. For one, the Canyon Ranch-Cleveland Clinic collaboration will generate a wealth of knowledge about how best to integrate diverse therapeutic modalities and disciplines. It will also, hopefully, provide a better understanding of what modalities work best for all sorts of conditions.
Secondly, executives who go through the Canyon Ranch wellness experience often become advocates for healthcare change in their own communities. They see and feel first-hand what truly health-centered holistic care can be, and they begin to wonder why they, their families, and their employees have so little access to comprehensive, high-quality healthcare at home.
I believe it is processes like these—the tearing down of fences that have divided various health practitioners, and creative collaborations aimed at harmonizing the healing disciplines—that are our best hope for real healthcare reform.
Nonetheless, we’re likely to witness some sort of national healthcare reform in the next four years. Let’s just hope that on the way to creating “universal coverage” on a national level, the politicos and policy-makers don’t trample the truly innovative healthcare changes quietly emerging in the margins.NW
Later this month, Holistic Primary Care is holding its first conference, “Heal Thy Practice: Transforming Primary Care,” on October 31 through November 2, 2008, at the Westin La Paloma Resort in Tucson, AZ. The subject of healthcare reform will likely be among the topics explored and the keynote speaker will be Dr. Stephen Brewer, medical director of Canyon Ranch-Tucson. For more information about Holistic Primary Care or the “Heal Thy Practice” conference, visit www.holisticprimarycare.net or e-mail erik@holisticprimarycare.net.