There is an adage in politics: Unless you are perceived as a player, your influence is limited. Politics is hardball, and national health care issues are challenging because of the competition between health care providers and shrinking health care dollars. Even the American Medical Association(AMA), with its $10 million lobbying budget, doesn’t always get its way.
Chiropractic can argue that it will always have a seat at the table because of patient satisfaction, but a relatively low number of patients seeking chiropractic services reduces that argument.1 There must be something more about why our profession continues to survive even though the AMA and some insurance carriers would like to absorb or eliminate us.
In my mind, it has been the perceived political power of the profession by the legislators, both on the state and federal levels. Our involvement in national and statewide races provided that fear for years.
Most health care organizations, particularly smaller ones, were reluctant to get involved for fear of losing. However, we assumed that if you get involved in a targeted race by doing more than just endorsing the candidate, you will be successful whether your candidate wins or not.
Politicians worried that the profession would make them the next target. You certainly don’t win every time, but most importantly, politicians think about you when making health care policy. This is an essential part of lobbying. Perception is reality; if you are perceived as significant, even if your participation is small, the net effect is positive.
Chiropractic has always had an outsized image due to earlier decades of involvement. Do we still hold the perception of power? Maybe, but it needs to be recharged.
Our First Big Moment: Jan. 15
The Iowa presidential caucuses provide the first opportunity. The Republican caucuses are scheduled for Jan. 15.2Additionally, the Democrats and Republicans schedule their caucuses on the same date. However, the Iowa Democratic Party, by order of the Democratic National Committee (DNC) and the request of President Biden, has to switch its date to March 15. The state party wasn’t happy and was pushing back by proposing that its presidential caucuses be on Jan. 15, but offering to allow mail ballots.3
The DNC initially wasn’t satisfied. It continued discussing the issue and came up with the following compromise: Iowa’s Democrats would register for the Iowa caucuses and request presidential preference cards beginning in November 2023. The cards will be mailed starting Jan. 12, 2024, and counted on March 5, Super Tuesday, the date the DNC initially requested.
The local Democrats have scheduled their “caucus” for Jan. 15, but not for voting their presidential preferences, which the mail ballot will do. Instead, they will conduct other party-related business, including developing a platform.4 Confused yet?
To complicate the problem, the Republican-controlled legislature passed a law during the summer that only allowed for in-person vote presidential preference, not vote-by-mail balloting. What I am hearing at this point is that the Republicans haven’t indicated whether they will go to court for this issue.
Since the proposal comes from the Democratic Party as a private organization, enforcing the Republican-passed legislation may be more challenging. Whatever the outcome, if you are a registered Democrat, you should register for a mail ballot and still participate in the Jan. 15 caucuses. Party activists and others will participate, and contacting them will help in the profession’s future activities.
While I would prefer that both caucuses were on the same day and without consequences, the Republican caucuses are still worth highlighting. It will be the first national presidential caucus of the year, with its results closely watched by both the media and political types, and announced the following day.
Equally significant is that since 1972, the Iowa caucuses have had a 55% success rate of predicting which Democrat and a 43% success rate at predicting which Republican will go on to win the presidential nomination at their party’s national convention.5
The Iowa caucuses operate substantially differently from primaries used in other states. In a primary, the state sets the rules for the election, including the size and location of the precinct. Campaigning up to 200 feet from the polling station is prohibited in many forms.
The caucus system is different. Only registered voters can vote in their party’s caucuses. The two major parties set their caucus date, time, location, and rules with minimum state oversight. Over 1,500 caucus locations in Iowa are published in the Iowa newspapers, including the Des Moines Register, approximately three weeks before the caucus date. Anywhere from 10 to more than 300 people participate in each caucus location.
In the Republican presidential caucuses, only registered Republicans can participate and vote by secret ballot. This is retail politics at its best. The publication of the ballot results is given wide media attention and is the first indication of the leading candidate’s strength, improving their fundraising efforts. Losers must review their strategies or sharpen their resumes for future cabinet positions.
Chiropractic’s Iowa Opportunity
Consider chiropractic in this Iowa environment. It has the highest ratio of chiropractic offices to the population of any other state. Equally important is that its offices are distributed almost equally around hamlets and towns, which coincide with caucus locations. Chiropractors can potentially impact every Iowa caucus as participants or even as local chairs.
Recognizing this potential power, the Iowa medical professional in the early ‘70s sounded an alarm that launched the AMA Committee on Quackery. The essence of concern was the above ratio, and its potential influence on state politics was more significant than in any other state.
Additionally, the founding school located in Davenport is essential. History will show the influence of Senators Charles Grassley and Tom Harkin, and their positive impact on the chiropractic profession. Yes, constituency counts.
When I was at the American Chiropractic Association (ACA), we looked at opportunities to impact the Iowa presidential caucuses. The best chance was the 2004 Democratic caucuses. President George W. Bush was running unopposed. On the Democratic side, there were many prominent candidates. The early leader was Vermont Governor and physician Howard Dean.
Our Vermont doctors alerted us that Gov. Dean was not favorable to chiropractic. The race was tightening, so we decided to oppose him. As a courtesy to Senator Tom Harkin, Dean’s state chairman and chiropractic supporter, we advised him of our plans.
He asked that we meet with the governor’s staff first, as our opposition might have been construed that he approved of the action, and we agreed. We met with his finance director, but it wasn’t helpful. Not satisfied, we wanted a personal meeting with Gov. Dean.
Just 30 days before the election date, Gov. Dean met us at the office of the Iowa Chiropractic Society when his race was getting tighter. Our ACA lobbyist, two chiropractic doctors from Vermont, and local leadership represented us at the meeting.
Gov. Dean was appreciative and acknowledged that he knew nothing about the profession, but indicated that his physician wife and son were patients. He pledged that if elected president, he would improve communication. We decided not to oppose him. Gov. Dean lost the Iowa caucus, but we understand that his relationship with the chiropractic profession in the state improved.
Generating Political “Noise”
Even if you are not a political junkie, you must appreciate the significance of a major presidential candidate interrupting his campaign to meet with us less than 30 days before his election. This is the kind of political “noise” I hope we generate in 2024. It all depends on you.
The Iowa Chiropractic Society is encouraging its members to participate in the caucuses. It is appointing a committee to encourage its members to support a candidate of their choice while attempting to represent all candidates to maximize their support. The society also plans to send out a press release to the profession, communicating its position.
Hopefully, the students at Palmer Chiropractic College will participate in this effort and, through their leadership, will coordinate with the executive director of the Iowa society to maximize the profession’s participation in the caucuses.
Whether your candidate wins doesn’t make any difference; your participation (and thus chiropractic’s) in this environment will be noticed, whether it’s in Iowa or the opportunities in other states that will present themselves in 2024. Isn’t that what it’s all about?
References
- Gallup-Palmer College of Chiropractic Inaugural Report: Americans’ Perception of Chiropractic. Published July 2015.
- McCullough C. “Iowa Republicans Set 2024 Caucus Date.” Quad City Times, July 8,2023.
- Pfannensteil B. “Iowa Demorcats Vote to Approve January 15th In-Person Caucus Date. Mail Ballots Are Unresolved.” Des Moine Register, Sept. 5, 2023.
- Iowa caucuses. Wikipedia.com.
- FindLaw Legal Writers. “How Does a Caucus Work?” FindLaw.com; updated March 17, 2020.
