Hot in the chiropractic news these past few months are a number of controversial and complex matters: Palmer and FSU; Medicare; the VA; DoD; Blue Shield/HCFA litigation; the pro-chiropractic manipulation exclusivity bill; and the PTs who wish to utilize manipulation under the mobilization banner, as is going on in my state of Pennsylvania.
There have also been a number of legislative controversies on general health matters: the "Patients' Bill of Rights," and the use and development of stem cells, for instance.
My list of issues is certainly not exhaustive, but I want to make it clear that this article is not about those issues or legislative controversies, but why our profession so often focuses on the wrong things.
Based on my experience in the political arena as a nonprofessional lobbyist for more than a dozen years in Harrisburg, PA and as an active participant on the national level, I would like to offer my thoughts. Perhaps my point of view will not be readily accepted, because it flies in the face of what the average politico would have you believe. And it is an opinion some really do not want to acknowledge, because it requires accepting a new level of personal and professional responsibility when dealing with legislative initiatives.
Chiropractic allows itself over and over again to be misled, misused and taken advantage of by legislators who see our profession as too eager and too naïve to recognize and understand the tactics played in the political game. The Patients' Bill of Rights, the manipulation initiative in Pennsylvania, and the long history of attempted Medicare changes illustrate how chiropractic(tors) get played like a Stradivarius by both sides of the political establishment.
The Florida Chiropractic Association (FCA) undoubtedly has significant legislative clout in Tallahassee. The ACA has demonstrated influence in Washington, D.C., and the Pennsylvania Chiropractic Association has demonstrated effectiveness in Harrisburg. Each of these organizations has established itself over the years in specific legislative endeavors, and one would conclude they fully have the process under control, with influence on lawmakers, and can get a bill passed.
Yet, the lessons still to be learned by all of us are overwhelming. The simple lesson is that we are being fiddled with. Promises are being made by legislators when they need financial support, but these promises are soon forgotten when we need voter support. And the most effective remedy, as I view it, is a complete adjustment to our approach. We need to hold legislators' heels to the fire. And better yet, we must become the legislators (state and national), as several doctors have in Florida, Texas, Minnesota, Louisiana and California, but not in Washington, D.C. Where the profession needs to concentrate its efforts is on the inside where the action begins and the fraternity is close, and where the real influence takes place.
Concerning Florida State University (FSU), the Florida Chiropractic Association (FCA) and others worked hard for many years to get the FSU program to a point where it was ready to be voted on. However, as old political warhorses know, until the bill passes, or as they say, "until the fat lady sings" and the bill is signed by the governor, everything is still in a state of limbo made up of hopes, dreams, speculation, anticipation, and too often, too much publicity and bravado.
The FCA and its supporters thought it had the bill under control. With continued work, they felt confident it would eventually pass.
Enter Palmer (and I am certain there were other groups working behind the scenes to see this initiative defeated perhaps medical groups wanting to contain and eliminate chiropractic?), and the dynamics of the legislative process changed. For whatever reason (we will learn the facts later), the outcome is still the same: The bill failed! Some place the blame on Palmer. My question: Does Palmer really deserve that much credit for the success or failure of this bill, or is it the process that killed it? What chiropractors need to inspect, discuss, analyze and debate are the internal workings of the political bodies that lead you to believe they will zig, when in reality they are set to zag. Surprise!
The debate about the "moral" or "ethical" issues surrounding FSU or any other internal chiropractic discussion can be saved for another day and another forum. For now, I want to concentrate on the legislative process. I want to make it clear, however, that this article is not about FSU, Palmer, the ACA or any other group. It is about the legislative process and a view that may be often overlooked. The profession and the doctors of chiropractic will ultimately have to decide which side of the issue they wish to support from an ethical and professional point of view. That debate should and must continue, because it is healthy and is focused on the decision the profession must make for its collective advancement. The debate should not, however, cloud the legislative issue, which is the focus of this article.
From my personal observation over the past 30 years, I have seen legislative initiatives in Washington, DC, and in every state of the union go right to the wire and then get defeated. Once defeated, you can expect an excuse for the defeat to be forthcoming. It was the AMA; it was the state medical society; the physical therapy group; the osteopaths; the chamber of commerce; the arthritis foundation; a legislator who did not like us; and oh, don't let me forget "those other chiropractic groups who lobbied against our measure." The list goes on.
Every legislative initiative or proposal undertaken in chiropractic has with opposition by medical groups; by self-proclaimed anti-chiropractic organizations and spokespersons; by insurance companies who did not want to see chiropractic licensed; and others. I've heard bizarre stories of legislators having their votes influenced: the son of an orthopedic surgeon who told his dad, a legislator, to vote against a chiropractic measure, or the legislator who was influenced by his daughter because her husband's employer did not believe in chiropractic. We have never known where or in what form the opposition to our initiatives may come. Since the early years, chiropractic has fought to obtain licensure, and to this day, chiropractic initiatives have been opposed, sidetracked, or so "massacred" by legislators that they were unrecognizable in their final forms.
However, when a favorable chiropractic bill is passed (which happens rarely), headline-grabbing groups within the profession use their spin machines to "thrust it to the hilt." News releases are spit out about "champions of justice," "legislative friends who would not succumb to influence," "an opposition that was simply out-maneuvered or ineffective." Headlines talk about having "friends" in the legislature; the "effectiveness" of our political action committee, the clever "tactics of our lobbyists;" etc.
As the backslapping takes place, you are led to believe there could have been no other outcome, because of the prowess and power of the group promoting the effort. Hogwash! After it's all over, everybody wants to take credit. "Success has a thousand fathers and failure is a bastard" is a line that comes to mind during these times.
Meanwhile, fierce battles are waged in the profession, chiropractor-against-chiropractor, which are portrayed as an effort by some to expand chiropractic, and by others to preserve true chiropractic, pitting fundamentalists against reformists, conservatives against liberals, and the "mainstream" against "free thinkers."
But look deeper and you can see that there is more foundation to chiropractic's losses than the natural debate chiropractors have among themselves about philosophy and practice. While certainly these arguments are significant to the parties presenting them, chiropractic's inability to present a single front is used as a smokescreen to cover the support we earn, buy and should expect from legislators, but don't get.
Come, now! Ours is not the only profession that does not speak in a single voice! All professions, including medicine and law, have opinions, arguments, factions and dissension within their ranks. Yet, they are strong enough in the legislative realm to not only get the preliminary pledge, but also, in many cases, the final and decisive vote required to make things happen.
One has only to look at Illinois to read statutory language that is expansive, and compare it with Michigan, a state in close proximity, which has a narrow chiropractic statute. In the other states, there is a myriad of variations. Everyone recognizes that fierce battles have been fought and many tales can be told about the victories and defeats. Controversy, dissension, conflict, disagreement, and discord have been present in every battle that has ever been won or lost in this profession. It's a natural phenomenon.
There have been chiropractic battles dealing with the inclusion of the title "physician"; the use of nutritional supplements; the right to provide adjunctive modalities (physical therapy measures); the use of injectables; the inclusion in insurance equality legislation; the right to sign death certificates and birth certificates; the right to deliver babies; the right to practice acupuncture; and dozens of other initiatives. Every one of these has been met with opposition from within the profession, and from those outside sources who did not want to see chiropractic achieve its objectives.
Let's step back a moment and take a closer look inside the legislative process, and begin to focus on where the real problems may be lurking when a chiropractic initiative fails. There is so much "smoke" in the air that too often the real issues cannot be seen. The problem often resides with the legislators. These clever political types are forever taking our political contributions (small as they may be), and are forever providing us with early hope and late excuses as to why they can or cannot stand up and vote for an issue.
A popular joke about legislators is: "How can you tell if a politician is lying?" The answer: "See if his (or her) lips move!" We need to have more legislators who are willing to put their "feet to the fire" and "carry the water" for chiropractic, even defeat a proposal, if necessary, with the assurance to the profession that their support is not just talk; that they will do what they tell us they will do, and not "change their colors midstream."
We should all be growing weary of legislators telling the chiropractic profession that we need to "get together" before they will or we can do anything. (Of course, this can only be done after they take our contributions!) Why don't they look at their own fractured parties before they vote and the majority carries the day? Why does chiropractic have to "get together" before anything can get done? We have been bamboozled by a double standard from the legislators for so long that we are beginning to believe their nonsense.
I am certain there are legislators in every battle who tell DCs or association lobbyists that they support their views. How many of these legislators are speaking to both groups? How many of those who claim to be our friends in the privacy of their offices would conveniently not recognize us in public? How many of these legislators who claim to be our friends and understand our view and support our cause, are also speaking the next week at the legislative function of another chiropractic group, or to the AMA and the insurance industry?
And if the opponents to a certain legislative initiative are not an opposing chiropractic group (because through some miracle all the chiropractors agree on the same issue, which is about as unlikely as me becoming pope), then these very same legislators (this includes governors, presidents and attorney generals) are at AMA, HMO, insurance and PT functions making overtures and/or perhaps empty promises to each of these groups.
At the same time, they are pacifying chiropractors. The legislators skillfully and carefully craft a message that is pure "vanilla," which still sounds good and is relevant to the particular group's objectives. They take the dollars of support and go home from the function knowing they are being disingenuous to both groups.
I am neither suggesting for one moment that all our legislators are for sale or uncommitted, nor that or uncommitted, nor that they should not represent all their constituents or attend multiple functions. But I believe when legislators portray themselves as having a favorite color, it should not be plaid. Legislators should remain true to promises, which should be based on their convictions; anything less is fraudulent misrepresentation.
The problem is quite simple: There is no penalty for walking the middle of the road, for straddling the fence, or for posing one way and then acting in another way.
Since their lack of commitment for the initiative in question is not a contract, in spite of the fact that we may have paid for their support in many ways with our energy, emotions, election efforts in their behalf and dollars, there is not much we can do except go back and start all over again. When the battle is over and they have disappointed us, we go right back to them again, groveling for their disingenuous support. Often akin to an abusive marital relationship, the abuser promises it won't happen again, and woos the victim, asking for time, understanding and a further investment in the dysfunctional relationship. Foolishly, like an abused spouse, chiropractic goes back to be hurt over and over again. What we do then to justify the disappointment is turn and blame each other in the profession.
We lament in print and in speeches: "If only this one within our profession would not have opposed our measure," or "if only that legislator or lobbying group were not involved, we would have won," "if only we had done more PR," "If only this, or only that" all pure speculation!
I am suggesting that we need to quit blaming ourselves and stop looking for scapegoats. We must begin a process of truly finding out where our legislators stand on every issue. Understanding and fully realizing that they cannot be with us (whichever side) on every legislative initiative we introduce, we must also recognize that there are many conflicting issues that will impact the legislators, and will force them to abstain or vote "no." If that were the case, we must demand they tell us up-front, by simply stating: "I cannot be with you on this one!"
Wouldn't we much rather deal with a legislator that is honest and up-front on issues? Wouldn't we be better off focusing on initiatives we can win, instead of spinning our wheels on legislative efforts that are doomed from the start? Wouldn't we be better off flushing out the soothsayers and money-takers, instead of deceiving ourselves with false hope? If a legislator or governor is anti-chiropractic and will vote against every chiropractic initiative, it's better to know it.
It's the flip-flopping legislator that alarms me most. Our fight should not be with each other, but with the elected official. We should mount a single-minded, clearly focused, unrelentingly directed campaign toward replacing this legislator with one we can trust. Even if we fail, the effort will get noticed and taken seriously by legislators. Can we do it? You bet! And in some states, the chiropractic community (whichever group is committed) can essentially determine the outcome of the election. Remember: Twenty-five percent of any initiative supported by 100 percent of the group is a success, while a 100-percent initiative supported by 25 percent of the group will fail.
Can we win in every state? No, but we can certainly exert strong influence in many. Have we done it in the past? No, but that doesn't mean it won't be an effective tool in the future.
A few legislative defeats, or even near-defeats, are all it will take to get legislative attention. The word will soon spread that the chiropractic community means business; that if you say you are going to support the measure, you damn well better do it, or state your position up front. We do not need legislative zealots for chiropractic (although a few would be nice). What we need is to be taken seriously by those who can support our position and can move initiatives for us.
Sometimes I think chiropractors are more intent on blaming other chiropractors than on attacking the real problem. And we wonder why we are not taken seriously!
The profession is getting tired of hearing excuses about why our initiatives are defeated, and is being subjected to a barrage of accusations and counter-accusations. When the blame game begins, the fingers begin to point. There is a release of emotions against what we perceive to be the enemy, usually someone or group within our own profession. Meanwhile, legislators have no qualms about calling us to attend their $1,000-a-plate political functions, saying afterward "Oh, by the way, I'm sorry about the defeat," and going away unscathed.
If we look back in history, we will see that in every state, the battle for licensure was filled with many groups that supported the effort and other groups that opposed it. We won in every state! Why? Perhaps because the time was right, the legislators knew the issue was right, and they had no problem standing up to those who opposed chiropractic; maybe also because the legislators were forthright in their promises to their constituents and the chiropractic groups that supported them.
Chiropractors and their patients once lobbied with a personal passion that may be difficult to recreate today. Yet, if the desire for a cause is stronger than the apathy, even in today's complex society, we can win. This applies to every measure we introduce as a chiropractic initiative. There will be supporters and detractors; there will be legislators and chiropractors for and against; but the determining factor will be the sum of the total commitment gathered.
We must garner the support of solid legislators early on, and we must hold them to their word. A few unreliable legislators defeated on election day by a concerted chiropractic effort might be just what the doctor ordered to regain our legislative health.
My objective in this article was not to rehash specifics of any legislative measure, but the need to re-examine the legislative process and accept the responsibility for allowing ourselves to be taken advantage of, and for allowing our elected officials to get off the hook without recourse.
Our issues will be resolved by those who are committed to objectives. These forces will reintroduce bills in their states and continue to work until they are passed. Meanwhile, we must clearly identify those legislators we can trust and those who need to be sent back to their home as ordinary citizens. Let the chips fall where they may. Nothing focuses the attention of legislators to their commitments more than the knowledge that there may be a legislative defeat on election day namely theirs. That is a Capitol (Hill) idea.
Click here for previous articles by Louis Sportelli, DC.