Second Plea to Alternative Health Practitioners: Help With Health Reform!
A debate over healthcare is currently raging in Washington. Health professionals are rightly being consulted. President Obama recently spoke to the American Medical Association about it. The AMA has plenty to say about how healthcare should be structured. What do non-physician health practitioners have to say? In particular, how would practitioners of Alternative Medicine advise the President?
(One month ago today I asked Homeopaths and Naturopaths to help protect consumers from less-scrupulous folks hawking “remedies” that don’t work. How, I asked, can consumers avoid being taken in by snake-oil salesmen? I got very little uptake. I’m hoping my next plea will be more successful.)
So, my question: Which “alternative” health services ought to be covered by insurance plans (private ones, or public ones like Medicare), and which ones should not? Presumably all practitioners of alternative medicine would agree with this: some alternative or “natural” therapies probably work, and some probably don’t. How can insurers (public and private) tell the difference? Presumably Homeopaths believe Homeopathy should be covered, and Chiropractors think Chiropractic should be covered, and so on. That’s understandable. But what other services do Homeopaths and Chiropractors think should or shouldn’t be covered?
In fact, to foster discussion, let’s stipulate (even if only for sake of argument) that Chiropractic, Homeopathy, and Naturopathy should be covered. I don’t want to get dragged into current debates over those. I want practitioners of those disciplines to be able to help with my question, without having to debate the merits of their own fields.
This is a serious matter. If insurance companies cover things they shouldn’t, they’ll end up having to reduce coverage on things that truly help people. And if public insurers like Medicare cover things they shouldn’t — well, we all know the kinds of financial difficulties governments are facing these days. Every dollar spent on ineffectual healthcare is a dollar not spent on education, etc etc.
So, to the practitioners of alternative medicine out there: Help! It’s your patriotic duty!
The Business Ethics Blog 
The answer is simple. There is zero evidence that homeopathy or naturopathy are effective at all. All evidence suggests that they ARE the snake-oil salesmen. It is not surprising that they didn’t respond to a call to limit insurance coverage to treatments of demonstrated value.
It is tempting to think that some probably work and some probably don’t, but there is no evidence that popular therapies are any more promising than anything you might dream up. Basically they all don’t work.
However, given that the placebo effect is important and that it depends on belief (the “Tinkerbell” effect), it may be beneficial to provide insurance coverage to a limited number of “legitimated” alternative therapies in order to boost their standing and hence their placebo effect.
Asher:
I’ve gone ahead and published your comment, but do note that it is off- topic. I didn’t ask about evidence for homeopathy or naturopathy. I’m asking practitioners of those disciplines what standard THEY propose to apply to purported health disciplines generally.
Chris
Private insurance firms should offer services according to the laws of supply and demand. To do anything else would be to the detriment of their stakeholders. No, I don’t think that health insurance firms ought to be in the business of passing judgment on the desires of their customers. The health insurance firm will offer the best services going (alternative or mainstream) at the best prices. The health insurance firms are not in the business of medicinal instruction. What they know best is health insurance, not health itself.
Medicare, or any public health insurance offering, should offer both Western and alternative medicine. I will support this contention with three chains of thought.
The first is financial. Currently Medicare encourages a Western medicine monopoly through the subsidization of their services with tax dollars at the expense of all other approaches to health care. This helps explain the high prices of Western medicine. By putting all of the health traditions on equal footing, Western medicine will be forced to improve its services and lower its prices. Of course to help lower prices and improve services other conditions must obtain, but that is outside the scope of this discussion. And no, I don’t recognize the objection that money will be wasted on alternative medicines as reason to thwart my contention. This isn’t because money won’t be wasted on alternative medicine – at least some alternative programs don’t work. But it’s because the same is true of Western medicine. One figure is that a mere 1/3 of prescribed drugs prescribed in Nova Scotia actually accomplish what they were prescribed to do. And some Western drugs lead to costly collateral damage (sort of like how some anti-depressants list as a side-effect suicide!).
The second is moral. Canada prides itself on being a multi-cultural nation, one where all types of people coexist in harmony, where all types of people are free to live their lives just like everybody else, and are free to act on their values provided they don’t hurt anybody in the process. Medicare today contradicts this multiculturalism. In fact, it borders on institutional racism by willfully neglecting certain health traditions and the mode de vivre that go along with them. It does this in two ways: by harming the practitioners of alternative medicine economically (by monopolizing its competitors), and by harming the culture from which alternative health programs grow. In either case, members of the fringe group suffer as their identities are marred by their country and compatriots. As Joseph Raz observes, minority group members often share an intimate relationship with the identity of their group. By stigmatizing harmless characteristics of a group, we stigmatize its members.
The third is for improved success. Which government is more rightly classified as dogmatic, the one that monopolizes Western medicine or the one that doesn’t? By channeling the lion’s share of resources into one tradition, we neglect potential merits in the other. I am not debating the merits of either – I have no stake in either. But both traditions do have values to offer, which are at least important for the contrast they provide. For example, Eastern medicine emphasizes the importance of treating the cause of the illness and not just the symptom (unlike Western medicine whose policy it is to alleviate primarily the symptom). While Western medicine, on the other hand, emphasizes the importance of grinding to-be health products through the scientific method (which the Eastern tradition does not do with the same intensity). In other words, both traditions have room for improvement, and it may be for the common good were they to get along. What’s more, Aristotle argued that a society composed of dissimilar members is self-sufficient whereas one where everybody is alike isn’t. He was right. For the sake of combating illness, we’re better off with both.
Kirk:
Thanks for your thoughtful comment. Some quick points to make in reply:
1) The problem with the roughly free-market approach you advocate is that health care products are typically what economists call “credence goods,” goods the effectiveness of which consumers typically cannot evaluate for themselves. In many case it’s almost impossible for a consumer to tell the difference between a) an actual physiological effect of a drug, b) a placebo effect, and c) the natural course of their illness. The prescribed drugs you’re talking about are, of course, subject to variability in effectiveness, but at least all of them *have* been proven to have some biological efficacy. And their side effects are known & measured. Not so for most alternative medicines.
2) Do you propose, then, to promote only those alternative therapies that are tightly associated with a particular culture? How about Angel Therapy, or Therapeutic Touch? Are they to be rejected because they’re not rooted in a specific culture?
3) As for success: if our goal is to provide things that are useful, should we not test things in advance of offering them? Casting the net wide is fine, but presumably at some point we want to focus more tightly on ones that work, in order to use tax dollars efficiently. No?
Chris.
As a chiropractor and an advocate for healthcare, I believe (of course, you might say) that Doctors of Chiropractic deserve a place on the “front-lines” of health care. We should be categorized as primary care physicians/general practitioners in EVERY state. As a result, and with the simple stroke of a pen, the human resources dearth that exists in primary care services would be instantly mitigated with a crop of more than 60,000 doctors. As chiropractic care historically proffers a more cost-effective careplan, this would also positively impact the payor systems. And, because chiropractic care is centered around conservative measures as a first line of defense, prior to referral for more invasive procedures only if/when necessary, this system upgrade would also more fully promote prevention (worth a pound of cure) and wellness, leading to increased overall population health.
Along these lines, it would be prudent for other care practitioners to educate themselves on the nature of chiropractic, as its demand is consistently increasing. This would include learning that the roots of spinal manipulation date back to Hippocrates and ancient Greece, and that part of the “dark cloud” that might exist of our collective heads dates to healthcare monopolization activities by the AMA (seriously), for which they were convicted under the RICO Act (but not before they negatively influenced an entire generation). It would also be wise for other practitioners to realize that the chiropractic education tracks very closely to a “traditional” allopathic degree, including all the basic & clinical sciences, and in some states even attending the same clinical rotation programs in the same hospitals (even in the Texas Medical Center – largest medical center in the world). I think that if everyone educated themselves in multi-disciplinary practices, the reformers that be would institute at least this improved practice.
Additionally, its important to remember that health care is DIFFERENT from health coverage. Insurance companies, that are profit-driven, were never created to ensure adequate care, but to make profits off of needed services. And, as providers, we have inherent duties to our patient populations to ensure that their needs are attended to, and not just our own. Therefore, we should take decision-making out of the hands of those with concerns OTHER than to provide care to vulnerable people in need. (And, yes, I understand that more & more of our GDP is taken up by Insurance & the increasing HC costs, so no one really wants to erase the insurance industry – except me, maybe…) So I believe the system should simply provide care, and let the people who provide care be paid a reasonable sum for their educated expertise. Period. And if the government is the payor, not a problem for me – as long as the patient receives the care.
(As you can probably tell, I have more suggestions on how to better integrate licensed & regulated CAM providers more fully into the system, but thats it for now. Thanks for the forum, and good luck with it!)
daejanmiel:
Thanks for your comment, but notice that you didn’t actually address my question.
Chris.
daejanmiel:
p.s., no offence, but I really wish people would stop referring to how ANCIENT various forms of alternative medicine are. It doesn’t do anything to convince me of their value; in fact, it does the opposite.
The fact that something is old is no proof of its value. (Compare: “Belief that the sun revolves around the earth is ancient!”)
Chris.
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