More Power to the Patient

Health care reform has been a hot topic lately and will likely take center stage in the coming months as the new president and his leadership team assume office. Many believe Obama's election, coupled with a new Congress, makes significant health care reform (including a major overhaul of the Medicare program) inevitable.

Both the chiropractic profession and the Obama team seem adamant about involving patients in the health care discussion, so much so that each has established grassroots campaigns designed to give consumers a voice. The American Chiropractic Association (ACA) mobilized immediately following the election, announcing it would launch a campaign in January 2009 "centered on the development and activation of a chiropractic patient advocacy network," while the Obama Health Policy Team announced in early December that the team would host "Health Care Community Discussions" throughout the holidays to help formulate final recommendations for the incoming administration.

ACA President Glenn Manceaux, DC, emphasized the value of grassroots participation in advancing the chiropractic profession: "Imagine how much stronger and influential the profession would be if it were able to communicate with and then mobilize large numbers of chiropractic patients," he said. "A strong and well-organized patient network could be a unique grassroots tool that will be the difference between victory and defeat. It could be the weapon that places us on equal footing with our larger and typically better-financed opponents."

President Obama also made clear that patient input is a key component of health care reform: "[I]n order for us to reform our health care system, we must first begin reforming how government communicates with the American people. These Health Care Community Discussions are a great way for the American people to have a direct say in our health care reform efforts and I encourage Americans to take part." To learn more, visit http://change.gov.

ACA leadership laid the groundwork for its campaign nearly two years ago, when the House of Delegates approved a management system that, among other capabilities, could maintain a national database of patient e-mail addresses, matched to members of Congress. The ACA Board of Governors, Legislative Commission, and Political Action Committee (PAC) Board developed campaign specifics in 2008, and details were finalized at a joint Legislative Commission-PAC meeting in mid-November.

The ACA is promoting the program with ongoing conference calls with state associations, as well as a series of teleseminars open to all doctors of chiropractic who would like to provide input or ask questions about the grassroots campaign. For more information as it becomes available, visit www.amerchiro.org.

The ACA, along with other members of the Patients' Access to Responsible Care Alliance (PARCA), also sent a joint letter to Obama and members of Congress on Dec. 1, emphasizing equal access and reimbursement as key elements of any reform plan. PARCA is a coalition of health care organizations that includes the ACA, the American Academy of Nurse Practitioners, the American Physical Therapy Association, the American Optometric Association and the National Association of Social Workers, among others, representing patients and non-MD health care providers. PARCA's letter to Obama stated, in part:

"As you go about the important work of improving the existing employer-based reimbursement system, and work to establish new protections related to pre-existing conditions, patient health status, transparency and other important features of reform, we request that you lend your support to the adoption of appropriate legislative provisions that would prevent existing healthcare plans, as well as any new federal plan, from discriminating against classes of healthcare providers with respect to plan participation, indemnification, and reimbursement based on the class of health provider, and the provider's licensure or certification.

"The elimination of such discrimination and the establishment of a 'level playing field' for all providers would more appropriately focus the provisioning of patient care towards those issues dealing with the efficiency of care delivery and the important need to improve quality outcomes."

If President Obama's official statement on chiropractic is any indication, he may be responsive to PARCA's request and to the chiropractic profession in general, particularly in light of the fact that patient access to health care seems to be high on his list of priorities. In his statement, released in the final months of the campaign, Obama is specific in his support for chiropractic expansion in Medicare, the Department of Veterans Affairs and the Department of Defense. He also supports commissioning doctors of chiropractic as officers in the Uniformed Corps of the U.S. Public Health Service.

President Obama concludes by saying, "[U]nder the universal healthcare plan I have proposed, Americans will have access to a public insurance plan that will include comprehensive coverage, including all essential health care benefits. Benefits that are evidence-based or meet the current accepted standard of care would be eligible for coverage, and as such many, if not all, chiropractic services provided by doctors of chiropractic would be included in the public benefit package.

"My health plan also prioritizes preventive care, and chiropractors play a significant role in this effort. As we shift our health care delivery system toward a culture of wellness and disease prevention, I believe that chiropractors must play an integral role in expanding access to preventive care and expanding our public health system."

With all this as backdrop, it will be interesting to see how health care reform efforts unfold in 2009, and what role chiropractic patients and the chiropractic profession play (and are afforded) in those efforts. So far, so good.