Reserve Your Seat on the Health Care Train

By Louis Sportelli, DC

Despite the changes taking place in our government following the election of a new president and the economic collapse of financial institutions, the auto industry and insurance giants, the biggest change is yet to unfold. If you haven't guessed it by now, it involves the health care system. The forces that are converging are enormous, and the health care system of tomorrow will be shaped by the vested interests of many powerful groups. These interests are by no means consistently parallel, so it would appear compromise is both a necessity and a certainty.

The need for cool heads and strong data will be imperative as the debate on health care moves forward. Health care professions will be forced to develop new cultures, values, models and evidence to support their positions. As a profession, we must develop new attitudes and a model that encourage coexistence with the medical community, bureaucrats, legislators, the insurance industry and even the Office of the Inspector General.

The 21st century has mandated a shift from a traditional society of factionalism to an integrated, cooperative effort utilizing the latest and best procedures, outcomes and technologies of every discipline for the good of the patient. By good, I mean economic good as well as curative good, with both needing to be backed by solid data and patient satisfaction.

Gone are the days when a discussion of economics was inappropriate when dealing with health care providers. Every health care provider and organization will have to learn to serve an economic master. Put together rising health care costs, the ongoing battle over who should provide health care, the disastrous aftermath of a failed managed care system, the increasing number of uninsured and a new president who has promised health care for all, and the impetus for something to be done in a relatively short time is well-established.

Health insurance costs have soared beyond the point of rationality. The ever-increasing cost to the Medicare program alone has created an economic tsunami waiting to happen. Large corporations have been brought to the brink of bankruptcy by the cost of health care. With all of the challenges related to costs, there has been a significant decrease in availability and services. A system has been created that rewards inefficiency and cost increases. In doctors' offices and hospitals, the golden goose of yesterday is taking its last breath and the new model will be focused not on self-enrichment, but rather fiscal responsibility and electronic oversight.

Without question, government will play an unprecedented role in health care delivery. There are financial incentive programs currently proposed by Congress to provide billions of dollars for electronic medical records (EMR). Some states have already set the bar very high for implementation, passing legislation stipulating that if a provider does not have EMR by a certain date, they will not be able to practice in that state; and that if hospitals fail to do the same, they will not be reimbursed for services (or even reaccredited). Now that is incentive - implement EMR or lose your ability to practice. It does not get any more mandated than that.

Concepts long espoused by the chiropractic profession are being touted as the models of tomorrow. Disease prevention, health promotion and maintenance, outcomes, and alternative and conservative care models are all being discussed, with some consumer responsibility sprinkled generously throughout the deliberations. There are very sharply contrasting bookends of care: the low-cost, high-touch approach (chiropractic) and the high-tech, high-cost, space-age benefits of technological advancements (surgical), each vying for dominance.

The medical care of tomorrow will be radically changed from what we know it as today. Evidence for what does and doesn't work appears to be a key variable in how care will be delivered in the future. Outcomes and evidence-based care will dominate the discussions.

There are other forces at work in this health care debate, such as labor and business. Business is concerned with its obligation to stockholders and profitability while being able to provide benefits to employees. Labor, a force weakened in past decades, but buttressed by the most recent elections, is now viewing health care as one of the most significant demands, equal to wages and working conditions. Each party will want to be heard and treated fairly in the final analysis.

Then there is the forgotten consumer, whose attitudes are changing, whose demands are more sophisticated and whose needs are increasing. The dilemma for many practitioners is that the Internet has leveled the playing field. Consumers demand options, transparency and participation in the decision-making process regarding their health. They are open to alternative treatments and willing to demand treatment that works and has outcome effectiveness to support its claims. The paternalistic model is dead, and a participatory model laced with the contrast of "high touch" and "high tech" will mandate a change.

President Obama, in a recent meeting that marked one of the most promising signs for health reform, discussed the topic, including saving more than $2 trillion on health care costs. Talks included representatives from hospitals, the insurance industry, medical device and pharmaceutical companies, labor and physicians. They came to the White House to discuss major steps to lower health care costs.

Following that meeting, the president said: "What's brought us all together today is a recognition that we can't continue down the same dangerous road we've been traveling for so many years; that costs are out of control; and that reform is not a luxury that can be postponed, but a necessity that cannot wait. It's recognition that the fictional television couple, Harry and Louise, who became the iconic faces of those who opposed health care reform in the '90s, desperately need health care reform in 2009. And so does America."

Chiropractic was not at that table. In the final analysis, that places the burden of responsibility on another master - ourselves. We have to serve ourselves effectively. We must protect our ability to practice, our approach to health care intervention and our integrity. Without integrity, we have no profession. We must also shed the tarnish of the past and the perception of distrust that permeates many high-level discussions regarding inclusion of chiropractic services.

Just surviving in this volatile climate of the 21st century sets the stage for new relationships between each of the health care disciplines and with patients. It opens the curtain on a scene that is long overdue; less factionalism and protectionism, greater cooperation, and more efficiency, dedication to ethics and transparency of participation.

Chiropractic has to do some soul searching and some homework. We are going to have to do some fast learning in the area of societal demand. We are going to be forced to be better, not only with professional skills, but also as managers and as team players. Additionally, the individual practitioner will soon be a rarity. It is almost impossible to go it alone anymore. We live in a world of big corporations, government, politics, advertising campaigns, budgets and protests. The cost to run an individual practice is simply more than most can withstand. Group practices offer the comfort of camaraderie, the inducement to strive for excellence, and cost-sharing - all powerful incentives to join forces.

We must learn to use our associations more effectively by actively participating. This means we must perceive ourselves differently; not as harassed, second-class citizens trying to carve out a place for ourselves, but as modern and informed health care professionals who have an important service to offer in the mainstream of the American health care system. That representation comes from organizational clout and individual participation.

Never before in the history of chiropractic has the profession been poised to jump on a fast-moving health care train with the possibility of a reserved seat. We all need to do our part to ensure that seat remains open. Internal bickering and excuses won't work this time. If we miss this opportunity, it may take another 100 years for it to come around again. We simply cannot wait that long. What are you going to do about it? Each practitioner needs to consider the collective strength in numbers and simply make participation a priority.

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