"I support you enthusiastically. You have a friend at HHS." - Tommy Thompson, Secretary of Health and Human Services, addressing the ACA House of Delegates.
Although the northeaster failed to materialize over our nation's capitol, Washington was taken by storm in March by 400 chiropractors and students. Never before has Capitol Hill been deluged by so many enthusiastic lobbyists for chiropractic, and never before has one convention left such an indelible mark on legislators and chiropractors.
The 2001 National Chiropractic Legislative Convention (NCLC) was an unforgettable experience for those fortunate to attend, and a major turning point in our profession's political history. As George McAndrews told me afterward, "This is a giant leap for chiropractic. We've finally arrived. Every DC should scream for joy!" And this comes from a man known for his guarded comments.
The excitement surpasses our victory in the Wilk antitrust trial, the Agency for Health Care Policy and Research (AHCPR) recommendation of spinal manipulation for low back pain, and even made the incredible events of the last World Federation of Chiropractic (WFC) and Congress of Chiropractic State Associations (COCSA) meetings pale in comparison. This event took chiropractic to a new level of political awareness, unparalleled in our 106-year history!
The theme of this year's convention, "Serving Those Who Serve Us," featured the DoD bill that includes provision for DCs for active military personnel. On Wednesday afternoon, the guest speakers included a few members of the oversight advisory committee (OAC) of the five-year Chiropractic Health Care Demonstration Project (CHCDP): DCs Rick McMichael, Richard Beecham, Ron Evans, plus guest speaker and former B-52 bombardier Dr. Lance Armstrong, who gave a stirring talk about the need for chiropractic care in the military, citing his own epiphany as an example.
These OAC members, and a few of the DCs that provided care at the military bases, proudly recapped the near-decade-long joint lobbying effort by the ACA and ACC to incorporate chiropractic into the military. Dr. Mike Flynn, chairman of the ACA, deemed the legislation passed last year that requires the DoD to "develop the plan to provide chiropractic health care services and benefits as a permanent part of the Defense Health Program (including the TRICARE program) for all members of the uniformed services" as "the biggest chiropractic legislative victory in 26 years." He said, "This bill opens up a huge market, and achieved inclusion on a broad-scope basis instead of the narrow Medicare-like benefit."
What made the CHCDP a success was the remarkable results of the field doctors who acted as pioneers, boldly going where no chiropractor had gone before - into the bastion of medical supremacy - the military health system (MHS). Although some were met with open arms, others met the expected medical resistance, but that quickly turned to friendship, as the DCs attained the kind of treatment success we see all the time in chiropractic. At bases where medical gatekeepers were used, referrals increased as the good results became obvious to everyone.
Even the DoD's majority report admitted the higher levels of patient satisfaction with chiropractic care vs. traditional medical care; that chiropractic resulting in superior outcomes and fewer days in bed for patients; and significant improvements in military readiness due to a large reduction in lost duty time.
Despite these glowing results, the majority report failed to recommend the inclusion of chiropractic care into the MHS, due to a supposed high-dollar cost estimate for adding chiropractic care as a benefit for military personnel. Fortunately, the OAC had done its homework and submitted its own "minority report" that proved to save the day for us by showing that including chiropractic care would produce a net dollar savings of $25 million a year for the DoD. Congress accepted the OAC report, and mandated the chiropractic benefit over the DoD's objection.
The DoD's plan for implementing chiropractic in the active military is scheduled for October 31, 2001. (Editor's note: Congress "required" the Secretary of Defense "no later than March 31, 2001" to develop the plan for chiropractic care in the military. "No later than" was the subject of the article "Three Li'l Words" in the Nov. 30, 2000 issue of DC (see www.chiroweb.com/archives/18/25/07.html.)
The OAC achieved a broad-scope inclusion of "at a minimum, care for neuromusculoskeletal conditions."If the testimonies of the DCs at the 13 military sites are any indication of their huge popularity among troops and medical personnel, their participation will be anything but "at a minimum." The medical directors are fighting among themselves as to which department warded by the patient satisfaction reports (as in the case at Jacksonville Naval Air Station, where a department received a $25,000 bonus for high rates).
On March 8, the NCLC hosted several U.S. representatives and senators that have helped in our political battles on Capitol Hill: Sen. Charles Grassley (R-IA), chairman of the Senate Finance Committee, which oversees Medicare and HHS, spoke of his involvement with chiropractic. He "went to the well" on the MHS bill, and spoke of his "shock by the lack of understanding of chiropractic by colleagues,"although they've seen an "increase of realization of benefits." He mentioned the need for Medicare legislation to modernize a 1965 system that "put everyone in the hospital" whereas today the goal is to "keep patients out of the hospitals." He also spoke of the $11 billion wasted in medical abuse and fraud last year, down from $23 billion 10 years ago.
Perhaps one of the most ardent supporters of chiropractic was Rep. Neil Abercrombie (D-HI), ranking Democrat on the House Armed Services Subcommittee on Personnel. He said this was his 51st year as a chiropractic patient, joking that he is "either very loyal, or something isn't working." He had severe scoliosis as a child, was put in a brace, and told by his MD that he would eventually be crippled. Instead, his father took him to a chiropractor, and he later played high-school sports, including football.
The congressman spoke of the "social revolution of chiropractic" and encouraged us to "not to take one step backwards." As a member of the Armed Services Subcommittee, he said the next step is to include chiropractic in all federal programs, the VA system, and all retired programs, citing that "the MHS doesn't recognize the money to be saved." His bottom line: "Renew your vows. Now is the time to persist. Get involved in political life until chiropractic care is available to everybody."
Senator Tim Hutchinson (R-AR), chairman of the Senate Armed Services Subcommittee on Personnel, mentioned that he is now "carrying the flag for chiropractic" in place of 98-year-old Sen. Strom Thurmond (R-SC). He intends to attend Senator Thurmond's 100th birthday celebration. When he asked Mr. Thurmond how he does it, he was told, "I eat right, exercise daily, and go to a chiropractor." Senator Thurmond's chief of staff, Duke Short, is a former chiropractor. When Senator Thurmond leaves office, chiropractic will lose a friend.
Dr. Kerwin Winkler introduced Senator Tom Daschle (D-SD) saying the senator "has never swerved" from helping chiropractic." As the ranking Senate Democratic leader, Daschle gave high praise for the ACA's lobbyists and leaders, saying they were a "first-rate operation" and did a "great job every day." He said that chiropractors "not only adjusted backs, but filled voids" in our health care system. "In South Dakota, 25 percent of citizens used DCs as PCPs," according to the Democrat leader.
Senator Daschle admitted, "Congress failed to recognize the efficacy of chiropractic for too long." He stated the "next step is to implement chiropractic in all MHS and the VA." He recited the $25 million to be saved, the 199,000 lost workdays and the better readiness of the troops. He was adamant that it's time to "fix the problem and not to keep studying it," which drew loud applause from the ACA's House of Delegates.
He spoke of a "real Patient Bill of Rights that doesn't allow HMOs to discriminate by licenses; to appeal denial of care to independent boards; and to allow providers of their choice." He supports the Cain/Kennedy/Edwards bill that includes all these measures. He said that the ACA has "done the work and provided the studies to prove chiropractic works." "Hang in there. Keep your tenacity to make these changes into law," he urged.
The next speaker was Rep. Cliff Stearns (R-FL), a member of the House VA Committee, and among our greatest allies. He authored the Millennium Health Care bill that incorporated language to require the DoD to establish chiropractic's role in the MHS, and convened the hearing to "hold the VA's feet to the fire." Rep. Stearns is also vice-chairman of VA Affairs, which covers 25 million veterans, has a $20 billion budget, 600 medical sites, and not one DC on staff. "Somewhere there must be a need for chiropractic," he said with sarcasm. He wants the wording changed from the VA "may" offer our services to "shall have," and he assured us that "President Bush is committed to implementing chiropractic in the VA system."
Senator Chuck Hagel (R-NE), member of the Senate Health, Education, Labor and Pensions Committee, told us: "Chiropractic has been long overlooked and undervalued." He said America needs a "new paradigm focusing on prevention," but noted that Medicare has no such focus. He spoke of the need to change this "upside-down effort," and to "refocus an approach to prevention." He said that chiropractors are on the "cutting edge" of this effort.
Perhaps the most enthusiastic speaker was Rep. Shelly Berkley (D-NV), member of the House Veterans Affairs Committee. "Chiropractic is the best thing since sliced bread," she opined. She credits her chiropractor with introducing her to her husband after an auto accident. She pointed out that Las Vegas is the fastest-growing city in America, and that the personnel at nearby Nellis AFB "want chiropractic and are entitled to it." She supports legislation for patient rights. As she said, "Only two groups cannot be sued: foreign diplomats and HMOs. The HMOs may think they're God, but they're not foreign diplomats." She also urged us all to "make relationships with each representative and educate your senators." Her energy was infectious, and her love of chiropractic was obvious.
The last speaker was Senator Tom Harkin (D-IA), member of the Senate Appropriations Committee, and our long-time advocate. He admitted he held a special place in his "heart and back" for his chiropractor, Dr. Dow Bates. "All Americans should have access to chiropractic care," he asserted. Sen. Harkin was responsible for the creation of the Office of Alternative Medicine (OAM), but admitted that initially there were no grants for DCs because of MD peer review. From an initial $2 million budget, the OAM now has a $100 million budget and two DCs on the peer review for grants.
Senator Harkin also supports the Patients' Bill of Rights, and mentioned his plan for chiropractic, which included: ending outdated regulations to services in Medicare Part B; supporting the Watkins bill; allowing payment in Medicare for all DC services allowed under state laws; and admitting DCs into the National Health Services Corps program (which allows DCs to exchange their work in rural areas for student loan repayment).
After the politicians finished, the OAC introduced Dr. William Morgan, the Capitol Hill chiropractor in the Office of Attending Physicians (OAP). This self-effacing chiropractor spoke of his acceptance at both the Capitol and at Bethesda Naval Hospital, where he also practices. He noted that according to the admiral in charge of the OAP, chiropractic is the most popular form of care. His patients include members of Congress; staff at the Supreme Court; the crew of Air Force I and II; NIH; and flag officers who later became business leaders upon retirement from the military. Dr. Morgan's philosophy was as refreshing as his welcome by the military brass and congressmen: "Do what is best for the patient, then chiropractic will succeed."
Thursday afternoon was spent lobbying on Capitol Hill. With issue briefs in hand, conventioneers swarmed the legislative offices speaking to aides of local representatives and senators, who were in chambers debating the tax cuts and budget. To my surprise, every aide was very positive about chiropractic, although most were rather unschooled about our profession. This fact alone proved to me the value of constituent lobbying efforts on the grass-roots level to meet and discuss these important matters with the aides who inform our elected officials. Every aide seemed delighted by our visit, and enjoyed he information and issue briefs we gave them.
After walking around Capitol Hill for hours, the NCLC brigade, sore of foot and dry of throat, met in the lobby of the Rayburn Building for a cocktail party and schmoozing with new friends and allies; students; college presidents; ACA officials and reps; and state association leaders. We shared our lobbying efforts and enjoyed the camaraderie of the proactive DCs from around the country. It's refreshing to rub elbows with the movers and shakers in our profession, something we all need on occasion to renew our spirits and to wet our whistles.
Without question, the biggest surprise of the convention came on Saturday when Tommy Thompson, the secretary of Health and Human Services, came to speak to the House of Delegates (HOD). As governor of Wisconsin, he passed the first insurance equality bill that gave coverage for chiropractic, and when he left office to assume duties at HHS, he had a 78-percent approval rating. His personal relationship with chiropractic goes back 34 years as a friend of Dr. Ken Ludke. He recalled that as a child, it was a chiropractor who put his father back to work after an auto accident.
What an endearing, humble man Tommy Thompson is! He attended the convention alone, without aides or escorts, and spoke of Elrod, Wisconsin, his hometown of 1,500. "It's so small," he said, "that even when you dialed a wrong number, you still talked for 30 minutes."
Thompson admitted that "health is the biggest issue in America," and that "HHS impacts every family in America." HHS alone has the fourth largest budget in the world (only after that of the U.S., Germany and Japan) with an annual budget of $435 billion, and employs 65,000 people, but not one DC.
The secretary of HHS began his remarks: "I support you enthusiastically. You have a friend at HHS." He concluded his 20-minute talk with these words: "I appreciate your profession," and remarked about this convention as a good example of "grass-roots politics in action." The standing ovation Tommy received was accompanied by thunderous applause. His exit was slowed by doctors shaking his hand, as if he were the president concluding a State of the Union address.
Although the secretary was a tough act to follow, the ACA's chairman, Mike Flynn,DC, gave his own succinct, inspiring charge to the troops. Mike's words were well chosen and to the point; "Our focus must be on achievement. Bigotry and discrimination will not be tolerated. We will not let our specialty be substituted." (This last comment was made in regard to the ACA lawsuit against HCFA)."
Dr. Flynn revealed that over $2.3 million had been raised by the ACA-PAC, and over $285,000 had been spent in the last election cycle, with an 88-percent success rate for ACA-sponsored candidates. He also mentioned that the ICA had spent a mere $6,000 in the last round of elections. He summarized his poignant speech by concluding: "The future of this profession is in your hands. Let's do it." His leadership, along with that of ACA leaders Jim Mertz (president), Jim Edwards (executive committee member), and Daryl Wills (vice president) is the largest reason why the ACA has become the "new" ACA in the eyes of members and legislators alike.
Another interesting segment of the NCLC that Friday afternoon was a panel discussion about the future of chiropractic education among eight presidents from Parker; TCC; NUHS; WSCC; Logan; Cleveland; NYCC; NWUHS; and Palmer. There are now 37 colleges worldwide. Although the number of students in North America has dropped 20 percent in three years, Dr. William Dallas, president of Western States Chiropractic College, observed that 15-20 percent of Western's students had never been to DCs, yet are making informed decisions to enter the profession.
Perhaps the most significant step the college presidents have done as a whole is the development of the "ACC Paradigm," a rallying point for the entire profession. Dr. Winterstein, president of NUHS, paraphrased the consensus of the ACC: "(We) legislate as broadly as we can, and practice as narrow as we want, " a belief long held by his predecessor, Dr. Joseph Janse. He urged the profession to accommodate diversity, but not to allow small groups to dictate what we are. (Unity without uniformity Æ now there's a novel idea!)
Dr. Carl Cleveland, who spoke of the need for "more consensus-building," shared this attitude. He agreed that there has "never been a better time to be in this profession," chiding the "pallbearers" in the profession, and applauding the "torchbearers."
Another interesting panel was the claims solution work group, headed by Pat Jackson of the ACA staff, which included representatives from Geico; State Farm; American Family Mutual Insurance (AMFI); and the National Association of Individual Insurers (NAII). As Elaine Rodgers of AFMI said, their "inevitable interdependence requires ongoing dialogue." Mike Falvo of Geico was candid: "Most insurance adjustors don't understand what we do, and most providers don't explain their bills."
Clem Bezold,PhD, president and founder of the Institute for Alternative Futures, and president of Alternative Futures Associates, explained his scenarios for chiropractic in the year 2010, which were outlined in his book, The Future of Chiropractic: Optimizing Health Gains. He believes that our profession faces huge challenges: leadership conflicts; "faith-based" versus science-based chiropractic; consumers with low or negative opinions of chiropractors; the question of DCs as primary care physicians; inclusion of complementary and alternative medicine (CAM); potential doubling of the number of DCs; and overtreating.
The doctor's explanation illustrated why the ACA's Managed Care Reform initiative (PARCA) and the Patients' Bill of Rights are so important, as are the VA bill and the Watkins bill, allowing DCs to be reimbursed for services within their scope of their licenses.
Although these are the highlights of the convention, probably the most enjoyable aspect was the opportunity to meet with chiropractic notables and our elected leaders. Sometimes isolated DCs become disenchanted with the slow pace and problems we face, not knowing what is being done to correct them. We sometimes become discouraged when our local or state leaders act in strange and selfish manners, as we in Georgia are used to seeing.
For those field DCs disappointed by the historical animosity between the ACA and ICA, take heart. A new age is here. The "ACC Chiropractic Paradigm" has been the center of attention. It is a document that the chiropractic college presidents and the ACA and ICA have accepted. The ACA and ICA have urged the WFC to also adopt it. Although there may always be separate organizations, at least we can have this common ground.
Personally, I've always enjoyed meeting the movers and shakers of these organizations, even when I don't agree with their policies or ideology. I've found the leaders of the ACA and ICA to be honorable men and women who all share the same love Æ chiropractic care. While they may disagree what's best for our profession, there's no doubting their sincerity to do what they think is best.
I urge you to jump on the bandwagon immediately to help claim our rightful seat at the health care table. We have the proof of our care, we have the public's support, and now we have federal legislators and people like Tommy Thompson at HHS who supports us unlike ever before.
My biggest thrill was meeting and dining with brothers Jerry (the DC), and George McAndrews (the attorney). My wife, Megan, and I sat for hours entertained by their anecdotes. I hope these men will put these stories in book form one day.
The McAndrews told me about their father, who suffered from terrible asthma as a young man. Medical methods failed to help him, but after one adjustment, he was finally able to sleep through the night. It was this that motivated their father to move his family to Davenport and begin his chiropractic education. Thus began the family's ascension into the annals of chiropractic history: 26 DCs in the family.
I had the opportunity to ask George one simple question: What does he recommend for the future of chiropractic? His first response was for DCs to "get over their paranoia." He elaborated by saying that DCs should "lose their hostility to MDs." He also believes that DCs are "specialists," and should stop the "innate cures all" rhetoric. He was adamant that DCs should be the primary care providers for all nonmusculoskeletal conditions: "Why pay a chemist instead of an electrical engineer to fix a bridge?" the highly respected attorney queried.
On the afternoon that George spoke to the ACA House of Delegates about the lawsuits against HCFA, Trigon Blue Cross/Blue Shield, and the national Blue Cross/Blue Shield Association, the ACA presented him with $378,000 for the legal defense fund. The irony of the HCFA suit is Medicare allowing MDs to perform SMT, despite decades of MDs vilifying spinal manipulation.
"The Blues were obnoxious in the treatment of chiropractors," Mr. McAndrews observed, referring to the Trigon et al. suit. They forced chiropractic patients to leave their DCs and go to MDs, and paid DCs 40 percent less than DOs and MDs for the same services."
George McAndrews noted: "Chiropractors have been a miracle for what they do, not for what they say." Many legislators and their aides might disagree with him. The legislators now know what chiropractors say is as important as what we do. Having more than 400 enthusiastic constituent lobbyists made for a great impact on these important people in Washington, and I'm certain it would enliven both the legislators and ACA members on the state level, too.
The 2001 NCLC will go down in chiropractic history as a political turning point. Chiropractic inclusion in the military is nearly at hand after decades of work; there's more congressional support and understanding of chiropractic; there's support for chiropractic by the new secretary of HHS; and the support of hundreds of DCs willing to take time away from their practices to lobby for the good of their profession. Imagine the impact if there were a state chiropractic legislative conference each year in each state.
I hope to see you next year at the NCLC. Be part of the "social revolution" of chiropractic. Imagine if we doubled the number of DCs and students "stormin' the capitol." As Rep. Abercrombie told us, "Renew your vows. Now is the time to persist. Get involved in political life until chiropractic care is available to everybody." Are you willing to commit to his charge?
J.C. Smith,DC
Warner Robins, Georgia
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