Health Reform: Does Senator Wyden's Plan Include CAM and Integrative Medicine Perspectives?
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.
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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 nationalBlue 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: "The 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, paradigm-shifting 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.
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