You know how you feel when someone takes the words right out of your mouth? That's how I felt this morning when I read my alumni email. One of my colleagues posted an exchange about the acupuncture profession and it's engagement with the insurance industry.
The analogy that comes to mind for me is that of a marriage where the man lusts after his mate, courts her, wins the day and then they married. BUT, that's just the beginning of the story.... Because, as so often happens in marriage, we change each other over time in a relationship. Often, this change is for the good, but sometimes, one spouse loses themselves so completely in the relationship that they are never quite the same. The spark and joy of life seems lost forever. And so, that is one possible (and some say probable) outcome of the acupuncture profession "engaging" in a relationship with the insurance industry.
Another, simpler, analogy is that of the praying mantis, or the black widow spider, both of whom kill their mate immediately after coitus.
Here, is the dialog between a chiropractor, who has seen this soul changing relationship dynamic with the insurance industry, and an acupuncturist who is seeing the "writing on the wall" of our profession's leadership courting the "black widow", otherwise known as the insurance industry. This exchange really pinpoints the beauty of the community acupuncture movement. We in community acupuncture, offer simple treatment, for low fees, and tend to people as unique individuals, not as insurance codes or reimbursement vehicles.
Dear friends,
Even though the thread about insurance has waned, I really want to share my
thoughts and feelings about it.
I am a chiropractor and so a member of a profession which has gone from
being excluded from the insurance game to being a player within the last
thirty-some years. While chiropractic and Chinese medicine differ in many
important regards, I think some aspects of my profession's experience are
likely relevant to you as you--individually and collectively--consider how
you want to engage with the insurance industry.
Industry--there's the key word. Insurance is an industry, born of an
industrial paradigm and keyed to the sensibilities of an industrial
society. While those sensibilities are changing a bit as we move from an
industrial to an "information" age, the basic assumptions are not radically
transforming. Insurance is wedded to, inextricable from, a view of the body
as a thing (an old fashioned machine or a computer, take your pick), and to
a view of illness and injury as technical problems to be "fixed" or "solved"
in the most expedient way possible.
Everything about the process of dealing with insurance hammers this point
home. One must reduce the living patient--a unique spark of Divine
creativity manifest here on Earth--to a set of numbers otherwise known as
diagnostic codes. One must likewise reduce one's experience of and work
with this person to a set of procedure codes, and one must make sure that
one's notes justify the numbers one has chosen in both cases. This is not
optional. If one is going to play the insurance game, one must play by
these rules. Sure, people bend them all the time, but to do so compromises
one's integrity in ways that are subtle but pervasive and powerful, and also
puts one's financial security--the very security most of us are seeking when
we choose to bill insurance--at risk. Here in Vermont, insurance companies
have taken to auditing chiropractors' notes and demanding that the
chiropractors repay the insurance companies--to the tune of tens of
thousands of dollars--if there is any sign of discrepancy between the
diagnosis and procedure codes and the chiropractor's notes.
The real issue is not the hassle of dealing with insurance--this is truly a
technical problem which is easily managed in a variety of ways. The deeper
question is whether the insurance paradigm is commensurable with the
paradigm of Chinese medicine, and if not, what engaging with the insurance
industry will do to your soul, as individual practitioners and as a
community of healers.
Americans are prone to believe that we as individuals or minorities can
engage with these vast collective entities and transform them from within.
We tend to consistently over-estimate the power of the individual and to
underestimate the power of the collective. Looking at the history of
chiropractic's enfoldment by insurance, I would say that the collective
entity has had far more effect upon us than we have had upon it.
Before the 1970's, chiropractors served a small minority of their
communities but were greatly trusted and often beloved within those
communities. Most were low-tech, high-touch family doctors, similar in
tone, although not in method, to the allopathic family doctors of earlier
generations. The trust and love were, I believe, rooted in part in the fact
that chiropractors lived close to the economic standards of the (often
working class) communities they served.
Since the 1970's, many chiropractors have gotten quite wealthy, but because
the insurance paradigm defines us as musculoskeletal specialists, we are
increasingly working as--and rightly viewed by the public--as such. Here in
Vermont and in some other, mostly rural or poor urban, communities some
chiropractors still play a wider role, one more in keeping with our
profession's historical roots and beliefs, but we are the exception, not the
rule. Meanwhile, I do not see that the insurance industry has become
significantly more receptive to the understanding of the soma, health, and
healing that was traditionally embedded within chiropractic thought and
practice.
While chiropractors have undoubtedly gained a certain measure of credibility
among allopaths in the years since we gained insurance recognition, we still
serve a tiny minority of the public (less than 10%), and I would say that we
have sacrificed some of the love and trust we historically enjoyed within
the communities we served. Engagement with insurance has also deepened
existing divides within the profession. The schism between those who want
to play the allopathic game, with its relentless and exclusive demand for
"scientific validation" and "evidence-based medicine" and those who insist
that illness, health and healing are fundamentally mysterious and cannot be
wholly encompassed within a Western mechanistic, reductionist scientific
paradigm is probably irreconcilable.
Chinese medicine is rooted in a much more powerfully articulated tradition
than modern chiropractic, a tradition that insists on mystery, even poetry,
as necessary aspects of the dance of healing. This tradition is a powerful
ally, but I question if even it is strong enough to withstand the daily
assaults offered by engagement with the dominant mechanistic/reductionist
paradigm so fully embodied in insurance. You, your traditions, your
practices, will be changed by such engagement, and you will not have as much
choice about the form such changes take as you might like to think.
I do not say there is a right or wrong answer here. I do think full
consciousness of the risks as well as benefits of dealing with insurance is
necessary. The allure of greater accessibility and income is great, but so
are the potential losses. Caveat emptor.
love,
Lisa
Edward (acupuncturist) Responds:
Lisa, what's interesting to me is the irony found in a recent cover article in "Acupuncture Today". Titled "The Bright Future of Acupuncture", it's authored by the former president of the AAOMA, our national organization. It lays out his vision of our future. The way he sees it, we will all be Doctors, and we will be working at Whole Foods and Costco doing "Occupational Medicine". He says we'll have to give up our language of liver qi stagnation and Five Elements, and learn to communicate properly. (Quickest way to dismantle a culture is to take away its language). This is surely a vision borrowed from China's Cultural Revolution, when the medicine was stripped of its more profound aspects and Barefoot Doctors were created. They practiced Occupational Medicine, their skills were directed at getting workers back on the factory floor as quickly as possible, just as we will be doing at Costco.
So I think we need not worry about the outcomes of engagement with the insurance industry. Our own leadership is doing just fine, it has already envisioned the dismantling of our culture!
Please help acupuncture in maintaining it's spirit and unique culture..... Spread the word about community acupuncture! Tell your friends about us and what we are doing to keep health care sane and accessible.
