With so much talk during an election year about a national health insurance program (which is really a euphemism for socialized medicine), perhaps we should begin dialogue within the chiropractic profession as to how it will affect us as a profession and as individuals. First, let me say that insurance of any kind involves a number of issues. It has financial implications which is one reason why I am reluctant to be critical of those who feel the need to take insurance. It involves a chiropractor’s need to make a living and that is a personal, a very personal matter.
It also has philosophical implications and in addressing that issue I have no reluctance to speak up. Lastly, it involves some practical issue like the future of the chiropractic profession to exist at all, let alone as a separate and distinct profession with a unique objective.
There is also an issue of what is best for our country. As citizens, as well as chiropractors, we must be sensitive to issues that affect the well-being of our country and that is not just a matter of patriotism or altruism. What affects the economy of a country directly affects the success of our profession as a whole and our income as professional individuals. I can remember the hit my practice took in the 70’s with the gas crisis. I am sure that we are already feeling the effects of the cost of gasoline because the country has not resolved the causes that precipitated the problem three decades ago.
So how will socialized medicine affect the profession? I guess we can assume that we will be included on some level since we are already part of the Medicare program. An interesting question is whether we will be required to be a participant in the program. People tell me we are required to be a provider for Medicare but for 30 years I have never been officially informed of that fact and I have yet to be informed of my failure to participate. In some countries, doctors do opt out of the socialized medicine program and seem to have thriving practices seeing people who do not want to wait to be seen by a doctor, something which universal care seems to create. Whether we can opt out or not remains to be seen.
One thing those who participate in the program can look forward to is mountains of paperwork and dealing with bureaucrats. I am not sure which is worse, dealing with some IME who is trying to save the company a few dollars or a federal bureaucrat who has a Napoleonic complex. Either way, it will not be fun. It will be interesting to see what kind of services chiropractors will be reimbursed for.
Other changes that can occur will be the possible absorption of the profession as a medical specialty. Will we as a profession have to become more medicalized? Will we have to set aside our lifetime-maintenance care programs?
There are most definitely philosophical problems with being included in a socialized medicine program. Because it is medicine, allopathy will set the standard for care, for objective(s) and the parameters of practice. It will be medical and so likely will not be consistent with our non-therapeutic chiropractic objective.
A person who takes insurance or participates in insurance programs has an altogether different agenda than does someone who does not. The chiropractor who is paid by the practice member is able to concentrate his efforts solely on educating the public and bringing more people into the office. The insurance taker, on the other hand, must also influence government and private insurance companies. He must constantly be working to improve his ability to be paid and to prevent loss of his insurance privileges. He must address the practical problems of doing this. He must balance his philosophy with his ability to be paid. All of these factors may affect his practice, his professional objective, how he sees the future of chiropractic and the direction it should take. It will be an interesting time. V23n3