| Detecting disease early is, of course, far better than detecting it late. But the true holy grail of prevention is found not in detecting disease but in undertaking the lifestyle changes – whole foods diet, regular exercise, stress management and social support – that keep us well. There are clear indications that the Obama team recognizes the importance of these lifestyle changes. The key question is: will this recognition lead to a true paradigm shift, with large-scale increases in lifestyle-based primary prevention efforts backed by genuine budgetary muscle? Or will it amount to little more than lip service? In the coming months, generating support for broad-scale primary prevention through lifestyle changes must be among Americans’ highest priorities.
It is worth noting that if every primary care medical physician in the nation delivered all preventive health services recommended for every patient by the U.S. Preventive Services Task Force, these physicians would have no time for anything else.1 No other patient care, no record keeping, no continuing education and no time for creative thinking. Therefore, simple mathematics dictates that either preventive services recommendations must be drastically scaled back (precisely the opposite of what policy analysts from left, right and center are proposing) or other delivery channels must be developed. Any meaningful prevention and health promotion plan must mobilize the efforts of other health providers (nurses, physician’s assistants, chiropractors, naturopaths, acupuncturists and others) for these preventive services, consistent with their training and licensure. Like medical physicians, however, these other providers have additional responsibilities. Enlisting their help is necessary but far from sufficient.
A new prevention and health promotion infrastructure must be developed as well, along the lines of the Samueli Institute’s superbly crafted Wellness Initiative for the Nation (WIN), which proposes implementation of new policies to “establish standards in comprehensive lifestyle and integrated health care approaches, and train individuals with qualifications to focus full-time on prevention.” A new cadre of Health and Wellness Coaches is envisioned to fill the gaping holes in our current prevention and health promotion infrastructure. Also included in the WIN model are “specialist certification for health professionals in prevention, health and wellness delivery in specific settings and populations – for example, schools, worksites, the military, health care settings, and long-term care facilities,” and creating “a Health Corps to provide an army of young and older people that would learn and model wellness behavior and support delivery of wellness education and training by the coaches.” The current draft of WIN – at www.siib.org – should be read by everyone seeking to understand the transformative potential of the health reform moment.
Chiropractic: Time for Full Inclusion
As a profession that over the past generation has made great strides into the American health care mainstream – with widespread utilization and patient satisfaction; a strong research base; inclusion in most private insurance plans, worker’s compensation insurance, Medicare, military and veterans health care; and full recognition in Olympic and sports medicine – chiropractic now has the hallmarks of an essential health service.
Whether it is specifically recognized as essential in the core benefits package of the emerging health reform plan may prove a bellwether (along with lifestyle-based prevention) as to the extent to which genuine, paradigm-shifting change is embodied in the Obama program. Chiropractors (DCs) and their 22 million patients in the U.S. were quite heartened when Obama sent three separate letters of support (link, link, link) to the American Chiropractic Association (ACA) during the presidential campaign. Most encouraging was the fact that Obama, the eventual winner, was the only presidential candidate in either party to specifically respond to ACA’s detailed candidate questionnaire.
Aside from inclusion in a core benefit package, arguably the most critical goal for chiropractors (and other non-MD practitioners) is to codify in federal law a policy of nondiscrimination among types of providers, for both coverage and reimbursement. In other words, if spinal manipulation (or massage, physical rehabilitation, nutritional counseling, mindfulness meditation instruction, or any other procedure) is covered when performed by a medical or osteopathic physician, then it must always be covered at the same rate of reimbursement for any health practitioner licensed to provide it. Freedom of choice among providers and a level playing field on coverage and reimbursement are ideas whose time has hopefully arrived. |
