In the January 29, 1996 edition of Dynamic Chiropractic, the new executive v-p of the ACA felt compelled to respond to my column article, "The Latest Hoax." In his writing, Mr. Cuneo referred to me as being "controversial at times." The word controversy comes from the Latin, controversus. Contro means against and versus means to turn. If Mr. Cuneo suggests I "turn against" political spin and creative excuses for our profession's failure in Medicare, managed care, lower levels of reimbursement for similar professional services, etc., he is correct.
When the chair of the ACA writes, "They used to call me a doctor," I know that we all better get controversial and turn against the present policies which are going to improve only one statistic: higher unemployment within the chiropractic profession. While the ACA meets with HCFA over the obvious inequities affecting chiropractic, what is the ICA doing to help bring about social/economic justice?
In March 1995, ACA's national legislative conference had all the stars: Senate Majority Leader Robert Dole and Speaker Newt Gingrich; yet we got zero yield for our profession. The ACA leadership met with Secretary of Health and Human Services, Donna Shalala, to discuss our problems. Great, but what about solutions! HCFA ruled that DCs and not PTs may perform spinal manipulation in managed care plans for the Medicare population in California. We are pleased for California DCs, but there are 49 more states to consider. Let's get the rest of us similar relief. Mind you, this HCFA ruling appears fair and reasonable but not broad enough to shake the bigotry which continues against us.
However, when ACA uses political spin to claim a great new day is dawning because they have co-sponsored a bill with 40 other provider groups for a federal standard which will guarantee patient access and choice to managed care plans, I believe they should be denounced for pulling the profession's leg. They should know, and I hope their lobbyists have informed them that a federal standard of this type has a snowball's future in hell of getting signed into law. If our profession is serious, we need to change today's status quo leadership, particularly when they laugh at us by using the big lie.
Okay, let's suggest some strategic priorities:
- No PAC money to anyone who will not openly fight for fairness in health care.
- PAC money to those who are libertarians and who support individual rights and freedom of health. No phony lip service, however.
- Convene a federation of ACA, ICA, FCER, FCLB, NCMIC, COCSA and the research and educational components. Our task cannot be successful without these vital interests.
- No more going it alone by ACA or ICA. Let us realize we are too small to be factionalized.
- We need as priority one, a federal/state advocacy of the patient's right to the choice of the type of health caregiver they want. There is no compromise of absolute patient autonomy. Politicians must be brought to respect their constituents' wishes for choice. Thus, priority for the patient's point of view will eliminate the ongoing battle between medicine and chiropractic by giving the patient this empowerment, we eliminate the MD vs. DC controversy.
- We must enlist intellectuals outside our profession to advocate that patients must control their health care and not any profession.
- Develop policy position papers on the role of chiropractic care in America's health delivery system. These papers are to be done by outstanding intellectuals in the fields of law, economics, government, and business. These are not to be an apology for chiropractic, rather, a document based on complex factors which support our profession's vital health care role.
- Network with public health professionals to advance their knowledge of our services and help integrate us within the public health system.
- Introduce legislation on the state/federal levels which promotes competition with medicine within specific areas of illness and disease management.
- Demonstrate a willingness to cooperate with agencies of government to end rip-offs and fraud by the small group of DCs who have injured the competent and ethical DC.
- Advocate collaborative research with MDs to study our philosophy of health to determine if our caring of patients is more or less effective. It is time to put up or shut up.
- Stop egocentric thinking. Encourage new ideas outside the power structure which presently appears comatose.
- Develop a plan for the DCs who belong to no state/national association. Today, the nonmember DCs outnumber those who belong to associations. Look at the success of some state societies and imitate their approach.
- Reignite our love for this profession by demanding the highest level of ethics, competency and compassion. We must eliminate pseudo-science from our discipline. No longer should we sit silently while entrepreneurs fleece the innocent.
I firmly believe these strategies are achievable if we start today. Future DCs deserve to join a noble profession, not a demoralized provider group which is characterized by political spin and diatribe.
We need the pursuit of excellence and parity in reimbursement. No more excuses for ACA and ICA ineptness. How do you feel?
Arnold Cianciulli, BS, DC, MS
Bayonne, New Jersey
