When planning strategy – for a family or corporate budget, a military operation or a grassroots political organizing campaign – two initial steps are essential. First, gather all the available facts. Then, face them squarely. Denial, wishful thinking and yearning for the good old days are a recipe for failure.

Two recent developments in the chiropractic profession call for strategic thinking. Consider the following: when chiropractors fought successfully for inclusion in the U.S. Medicare system in 1973, the profession and its patients were able to generate a very impressive one million contacts (mainly letters) to members of Congress. Twenty years later, in the health reform battle of 1993-94, the number was 500,000. In the current health reform effort, where the stakes are arguably even higher than in the two previous campaigns, the number (as of mid-October 2009) is below 100,000.

At the same time, the Foundation for Chiropractic Education and Research (FCER), the oldest chiropractic research-funding institution in the world, recently shut its doors. Founded in 1944, over its lifetime the FCER served as the source of (or conduit for) $10 million for chiropractic research projects, research training fellowships, and other academic infrastructure grants. By the middle of 2009, the profession’s level of financial support for FCER had diminished to the point where the Foundation’s work could not be sustained.

Generational Change

I am acutely aware that one of the last things the world needs right now is one more Boomer’s lament about younger generations’ levels of apathy. Generalizations and slogans about Generation X, Y or Z, usually involve substituting drama for genuine insight. Furthermore, declining levels of political involvement by chiropractors cut a broad swath across all generations, from recent graduates to those who themselves now qualify for Medicare. All of us need to take a good look in the mirror.

That said, a generational change has clearly occurred in the chiropractic profession. Indisputably, each year there are fewer remaining chiropractors who experienced first-hand the struggles for professional survival and learned at a gut level the importance of active citizenship. It may also be that those among us who came of age in the 1980s or 1990s believe more strongly that success depends entirely on one’s own individual efforts rather than group actions.

It is, of course, quite true that much of one’s lot in life is determined by individual talent and drive. But that’s not the whole story. Broader forces at work in society have major effects on all individuals, in some cases quite dramatically. Just ask the hundreds of thousands of blue and white collar workers laid off in the past year through no fault of their own. To some extent, we are all surfers on unpredictable ocean waves. Individual skills matter greatly, but the waves we count on to carry us smoothly to shore are also capable of causing many a painful wipe-out.

Possible Costs of Inaction

To chiropractors of all generations who believe they can ignore political participation now and in the future, I urge you to consider these possible consequences:

Passage of a national health reform bill that eliminates state insurance equality laws without substituting a federal nondiscrimination policy, will likely mean that some of your patients, perhaps many of them, will lose their chiropractic coverage. For those doctors who participate in insurance plans, the risk is obvious. But even those with cash practices are not immune. Particularly in times of economic hardship, many patients who can no longer count on insurance reimbursement may feel compelled to cut back on chiropractic care at the same time that they cut back on various other expenditures.

Passage of a national health reform bill that duplicates Medicare practice requirements without including a “freedom to practice” clause may make it impossible for doctors to receive direct payment from patients at rates different from those in government programs. Thus far, individual “cash practices” have been possible because Medicare (which forbids such arrangements) only covers a minority of the population. If plans are implemented that would significantly increase participation in Medicare-like plans for those who are not over 65 or disabled, without “opt-out” or “freedom to practice” guarantees, non-insurance based practices could be outlawed.

This is not an argument against the parts of health reform that would guarantee nearly universal coverage, ban pre-existing condition exclusions or otherwise correct the current system’s worst abuses. It is, however, the strongest argument I can make to urge you to participate in the creation of your own future.

Doctors, if you do not sign up NOW at www.chirovoice.com (ACA) or www.adjustthevote.com (ICA) to learn how to let Congress know your views, and if you do not tell your patients to do likewise, you are putting your future in the hands of people and organizations whose interests and values may be quite different from yours. Pharmaceutical, insurance and other health industry corporations and groups (who have hired nearly 3000 lobbyists and spent hundreds of millions of dollars to advance their interests) are not remaining silent and inactive. You and your patients shouldn’t either.

Daniel Redwood, DC
Editor-in-Chief and Associate Professor, Cleveland Chiropractic College–Kansas City

editor@healthinsightstoday.com