A Strategy for Health Care Reform

It's a presidential election year and politicians are confronted with constituents clamoring for solutions to our existing health care crisis. Health care spending in the United States first soared above $2 trillion in 2006 and is projected to exceed $4.2 trillion by 2017.¹ Federal forecasters have projected that within a decade, health care expenditures will represent 20 percent of the gross domestic product (GDP).² According to a 2005 report by the California HealthCare Foundation, health care spending in 2003 was about 4.3 times the amount spent on national defense.³

Medicare hospital insurance is projected to become insolvent by 2019, the date of the predicted exhaustion of the Trust Fund.⁴ Where is all the money going? Seventy percent is spent on chronic illnesses such as: cardiovascular disease and stroke ($210 billion), diabetes ($92 billion), obesity-related conditions ($75 billion) and arthritis ($22 billion).⁵

What are we getting for it? In 1994, an article in JAMA noted, "180,000 [people] die each year partly as a result of iatrogenic injury, the equivalent of three jumbo-jet crashes every 2 days."⁶ The situation remains grim. Medical errors and iatrogenic episodes still are a leading cause of death in the United States.⁷ Despite the tremendous cost of health care, both economic and human, the United States ranks 37th in the overall health system performance of 191 countries evaluated by the World Health Organization.⁸

Relatively little of our money goes to "health care." It supports sick care. Consider Medicare. The Medicare Act requires covered services be "reasonable and necessary for the diagnosis or treatment of an illness or injury, or to improve the functioning of a malformed body member." Specifically excluded as "not medically necessary" is "maintenance care," defined as follows: "A treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition."⁹ This strategy and the philosophy behind it are responsible for the current crisis.

Economist Paul Zane Pilzer summarized the situation well: "The sickness business is reactive. Despite its enormous size, people become customers only when they are stricken by and react to a specific condition or complaint ... the wellness business is proactive. People voluntarily become customers - to feel healthier, to reduce the effects of aging and to avoid becoming customers of the sickness business. Everyone wants to be a customer of this earlier-stage approach to health."¹⁰

What solutions do our politicians propose? Some of the ideas being bantered about include the following:

• Free drugs. Give the baby boomers the same thing they wanted when they were burning their bras and draft cards in the '60s.
• Indemnify drug makers. This makes as much sense as saying the way to stop drunk driving is to indemnify drunk drivers.
• Cap damages to victims. Sure - penalize the victims.
• Subsidize malpractice insurance. No, they aren't kidding.

These ideas stem from the two prevailing political paradigms today: idiocracy and pharmacracy. Idiocracy, according to Pulham, holds that we are stupid.¹¹ The folks who select the president seem more concerned with the sex lives of politicians and movie ratings than science or health care. The second perspective, which complements idiocracy, is pharmacracy, a term coined by psychiatrist Thomas Szasz. Pharmacracy is: "a state where all sorts of human problems are transformed into diseases and the rule of law extends into the rule of medicine."¹² A corollary is there must be a drug for every human problem, from gonorrhea to gambling to gun violence. An uncritical idolization of medicine is pervasive in politics and law.

Thankfully, there is a strategy that could have profound impact on the health care crisis. What is it? Chiropractic care. Nope, I'm not talking about the episodic, symptomatic treatment of musculoskeletal symptoms. I'm referring to the economic and health benefits of chiropractic care in the context of a lifetime health care strategy.

The results of several patient-based studies suggest chiropractic care might result in significant savings of health care dollars. One such study conducted an analysis of an insurance database comparing people over 75 years of age receiving chiropractic care with nonchiropractic patients. The analysis showed those receiving chiropractic care reported better overall health, spent fewer days in hospitals and nursing homes, used fewer prescription drugs and were more active than the nonchiropractic patients. Furthermore, the chiropractic patients reported 21 percent less time in hospitals over the previous three years than the nonchiropractic ones.¹³

Another study surveyed 311 chiropractic patients, ages 65 years and older, who received chiropractic care for five years or longer. Chiropractic patients, when compared with U.S. citizens of the same age, spent only 31 percent of the national average for health care services. The chiropractic patients also experienced 50 percent fewer medical provider visits than their comparable peers. The health habits of patients receiving maintenance care were better overall than the general population, including decreased use of cigarettes and decreased use of nonprescription drugs.¹⁴

Spectacular decreases in the utilization of medical services and their attendant costs, were noted when DCs or other "CAM-oriented" practitioners were used as primary care providers. In an Independent Practice Association (IPA) which permitted patients to select a doctor of chiropractic as their primary care physician, clinical and cost utilization based on 70,274 member-months over a seven-year period demonstrated decreases of 60.2 percent in hospital admissions, 59 percent hospital days, 62 percent outpatient surgeries and procedures, and 85 percent pharmaceutical costs when compared with conventional medicine.¹⁵

The chiropractic profession is perfectly poised to provide the leadership desperately needed in health care today. Will you accept the challenge?

References

1. Keehan S, Sisko A, Truffler C, et al. Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming to Medicare. Health Affairs, Feb. 26, 2008;W145-55.
2. Health Care Spending to Rise to $4 Trillion, or 20 Per Cent of GDP, USA. Medical News Today, Feb. 22, 2008. www.medicalnewstoday.com/articles/38206.php.
3. California Health Care Foundation. Health Care Costs 101. March 2, 2005. www.chcf.org.
4. A Summary of the 2008 Annual Social Security and Medicare Trust Fund Reports. www.socialsecurity.gov/OACT/TRSUM/trsummary.html.
5. Kessler A. The End of Medicine. New York: HarperCollins, 2006.
6. Leape L. Error in medicine. JAMA, 1994;272(23):1851-7.
7. Null G, Dean C, Feldman M, et al. Death by Medicine. www.lef.org/magazine/mag2004/mar2004_awsi_death_01.htm.
8. Tandon A, Murray CJL. Lauer JA, Evans DB. Measuring Overall Health System Performance for 191 Countries. GPE Discussion Paper Series No. 30. World Health Organization. www.who.int/healthinfo/paper30.pdf.
9. Chiropractic Services in the Medicare Program: Payment Vulnerability Analysis. Office of the Inspector General. June 2005. OEI-09-02-00530. www.oig.hhs.gov/oei/reports/oei-09-02-00530.pdf.
10. Pilzer PZ. The Wellness Revolution. New York: John Wiley and Sons, 2002.
11. Pulham EG. The View From Here. http://newsletters.spacefoundation.org/spacewatch/articles/id/61.
12. Szasz T. Pharmacracy: Medicine and Politics in America. Westport, Conn.: Praeger, 2001.
13. Coulter ID, Hurwitz EL, Aronow HU, et al. Chiropractic patients in a comprehensive home-based geriatric assessment, follow-up and health promotion program. Topics in Clinical Chiropractic, 1996;3(2):46.
14. Rupert RL, Manello D, Sandefur R. Maintenance care: health promotion services administered to US chiropractic patients aged 65 or older, Part II. JMPT, 2000;23(1):10.
15. Sarnat RL, Winterstein J, Cambron JA. Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3‑year update. JMPT, 2007;30(4):263-9.