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Health Reform: Does Senator Wyden's Plan Include CAM and Integrative Medicine Perspectives? PDF Print E-mail
Written by John Weeks   

Health Reform: Does US Senator Wyden's Plan Include any Integrated Care Perspectives?

Summary:  In this, the first in an irregular series, the Integrator examines the health reform proposal announced by US Senator Ron Wyden (D-OR) in mid-January. The plan, which features a strategy for universal coverage, was widely reported. The Integrator focus is not on the financing strategies but whether the reform suggested actually transforms the system in profound ways which are philosophically aligned with the integrated care movement. Your comments and counters are welcome.
Send your comments to
for inclusion in a future Your Comments article.

US Senator Ron Wyden (D-OR)
On January 16,
US Senator Ron Wyden (D-OR) a member of two powerful committees of the US Senate - Budget and Finance - revealed a 168 page health reform package in a widely covered press conference.

I reviewed the proposal with a particular view to discovering where Wyden's proposal may parallel or reflect strategies to fundamentally transform US health care. I define this broadly as moving away from our presently reactive, pharmaceutically-based and tertiary care-oriented priorities.

Promoting Wellness

A primary strength of the Wyden proposal is on its focus on wellness and health-promoting behaviors. We see:

  • requirements to provide wellness programs, including incentives to prompt wellness-promoting behaviors such as discounts on premiums
  • a focus on primary care, and particularly on development of care plans which require prevention and wellness-promoting activity
  • a tax break for employers who offer work-site wellness and work-site health programs.

Wellness programs are defined this way:
"Wellness programs must consist of a combination of activities designed to increase awareness, assess risks, educate and promote voluntary behavior change to improve the health of an individual, modify his or her consumer health behavior, enhance his or her personal well-being and productivity, and prevent illness and injury."  (Section 131)

"There is no national
nanny established
under the legislation
to watch who is hitting
the snack food bowl."

- US Senator Ron Wyden

Participation in programs is voluntary and does not appear to be imaginatively promoted or highlighted. In Wyden's statement which accompanied the presentation of his reform plan, he states that he is opposed to "heavy-handed mandates" and that "there is no national nanny established under the legislation to watch who is hitting the snack food bowl."

I asked Melissa Merz, in Wyden's Portland office, to what extent various other licensed practitioners who see their services as wellness-oriented may be eligible to provide such wellness services in the Wyden plan. (In Wyden's home state of Oregon, chiropractors, naturopathic doctors, massage therapists and acupuncture and Oriental medicine professionals are all licensed, and Oregon Health Sciences University has an active integrative MD initiative.) Merz responded: "Wellness is left to the insurers as long as they can show their programs are making an actual impact on promoting health and are evidence-based. Nothing prohibits these practitioners from being involved."
Inclusion of Non-Conventional Practitioners and Practices

The plan calls for continued mental health parity. A financial analysis by the Lewin Group notes that the plan also includes "up to 10 spinal manipulations per year with a $15 co-pay." But other than these brief indications, there is no specific mention of any non-conventional approach, therapy practitioner group.

I asked Merz about inclusion of natural healthcare and integrative medicine practitioners in the basic benefit delivery. Her response echoed ther statement regarding the wellness programs. Merz directed me to the benefit definitions in the Federal Employee Health Benefits Plans (FEHBP) managed through the national Blue Cross Blue Shield. The Wyden plan bases its core benefit on the current FEHBP offerings. The FEHBP Standard Option states that "we cover any licensed medical practitioner for any covered service performed within the scope of that license.” Merz clarifies: "Basically, it’s up to states."

A Wyden initiative to enhance services through school-based health centers follows the same pattern. Says Merz: "T
he legislation only states the services school based health centers must provide at a minimum." She adds: "That way they have flexibility." In the basic plan, insurers are able to offer plan models which include additional benefits, if they wish.

Comment: Economic status - including access to healthcare services - is a significant determinant of health. So is stress, as in, I can't afford to be sick. (See Belly of the Beast: Part 3 on my hospitalization last year to see such stress quantified.) Thus, any plan that provides universal coverage might be construed as part of a whole system for health creation. I accept this as a given.

The Wyden plan is
relatively thin on
such transformative,
language or action
except in the critical
areas of financing
and universality.

Now, add to this health benefit the potential to finally get over the shame of a country as wealthy as ours being alone among the developed nations in failing to provide universal coverage. Limiting shame would also count as health promoting.

The wellness elements also appear to be strong. Interestingly, the language on wellness is not as powerful as that in a Bipartisan Blueprint for Health Reform of
10 Senators (5 Republicans, 5 Democrats - with Wyden among them) issued on February 13. The group was calling on the executive branch to co-create on a reform strategy. Aomg the six goals are wellness:
"Take steps to create a culture of wellness through prevention strategies, rather than perpetuating our current emphasis on sick care. For example, Medicare Part A pays thousands of dollars in hospital expenses, while Medicare Part B provides no incentives for seniors to reduce blood pressure or cholesterol. Employers, families, and all our constituents want emphasis on prevention and wellness." (bold added)
The Wyden plan is relatively thin on such transformative, paradigm-shifting language except in the critical (and not to be downplayed) areas of financing and universality. Nor was I, in my review and in the responses from Wyden's office, readily able to point to any focus on changing medical education to better prepare primary care doctors for new roles in which they may be asked to better integrated wellness strategies. Nor does the promotion of primary care appear to have the muscle behind it to actually begin to shift a system where power is firmly ensconsed in the hospitals and the specialists who, sad to say, economically benefit from the worsening health of the nation.

Send your comments to
for inclusion in a future Your Comments article.


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