by John Weeks
This last month, Integrative Practitioner ran a poll on Presidential politics. The question was: “Whose policies reflect your view of integrative practice in McCain & Obama’s health reform proposals?” The responses were:
9% Directly supports McCain
15% Directly supports Obama
13% Philosophically aligned with McCain
39% Philosophically aligned with Obama
14% Neither will make a difference
10% Don’t know/no opinion
One way to view these outcomes is that 54% view Obama more positively and 22% view McCain in a more favorable light. Another view is that 76% of respondents don’t think either will directly make a difference. Additionally, 24% of all respondents either don’t know or don’t think either will make a difference.
Can we provide any more clarity?
I recently searched for definitive information on what John McCain or Barack Obama say about complementary and alternative health care or integrative medicine and its various modalities. The pickings are slim. I found a clear statement on chiropractic care from Obama and one clear set of statements by his campaign spokespeople. (If you find others, please add them to the Discussion Forum.) Beyond that, we are left to speculate on what might be the best alignment of each candidate’s positions in terms of the principles and practices of integrative medicine. Below are some direct statements, musings and reasons for developing a personal preference.
Positions of candidates on chiropractic care
In mid-October, the American Chiropractic Association (ACA) sent their members a link to a letter from Obama (http://www.acatoday.org/userImages/File/LettertoDoctorsofChiropractic-1013(1).pdf ) which stated:
" I believe steps should be taken to acknowledge the important care provided by doctors of chiropractic medicine. We need to knock down unreasonable barriers of access and discriminatory insurance coverage so Americans in need of quality chiropractic care can access it without difficulty. We need to expand the range of chiropractic services covered by Medicare, facilitate integration of doctors of chiropractic into the health care systems of the Department of Veterans Affairs and Department of Defense, and allow commission of doctors of chiropractic as officers in the Commissioned Corps of the U.S. Public Health Service. And again, under my health care plan, many, if not all, chiropractic services would be included in the benefit package offered in the public plan."
Notably, despite strong Republican leanings in the chiropractic profession, no similar statement from McCain has been published. In fact, the ACA notes that a central tenet of McCain’s plan would allow more consumers to purchase plans from other states, which do not include mandates that chiropractic care (or other services of distinctly licensed complementary healthcare providers) be included in individual healthcare policies.
(http://www.acatoday.org/userImages/File/McCain_Health.pdf)
Statements of surrogates on complementary/integrative medicine
The more broad set of direct comments on the topic of complementary and integrative medicine comes from September 18, 2008, during a forum on Presidential Perspectives on Health sponsored by the Scientists and Engineers for America and held at George Washington University. The forum was moderated by Julie Rovner from National Public Radio. Obama was represented by Doris Hughes, MD, MPH and McCain was represented by Jay Khosla, MHA.
In their 10-minute opening remarks, neither Hughes nor Kholsa directly mentioned the topic of integrative medicine. Hughes referenced Obama’s view that there has been a “chronic under-investment in prevention” and noted a plan to “double federal funding for basic science research.” On McCain’s behalf, Kholsa spoke of enhancing consumer choice through a health savings account (HSAs) and the need to look at “new treatment models with integrated teams of healthcare professionals for chronic care disease management.” Here were places where an overactive integrative practice might imagine some fits.
Rovner then posed questions from members of the audience and about 30 minutes in, one hit directly on the subject of integrative medicine:
Rovner: We’ll move to another question for both. This is on complementary and alternative medicine. Given the high cost of prescription drugs, would you be in favor of greater research into the various complementary and alternative therapies, and how would you integrate these therapies with conventional medicine? Dr. Hughes, you can start.
Hughes (for Obama): Certainly that is a question, to be fair, that has not been addressed by the campaign. I always just have to take a step back that, of course, in terms of doubling federal funding for basic science research, those dollars would be available through the NIH and obviously, they have existing research studies on this very area. In terms of how it would be integrated, certainly we have said that the basic benefit package could be modeled on packages available through the Federal Employees Health Benefits Program (FEHBP), to the extent that those programs currently now cover complementary alternative medicine. Certainly we would expect that to continue. But I have to be very fair to Senator Obama, he has always had an open-minded attitude and willingness to genuinely look at the data, the evidence for all types of healthcare. We know that Western medicine, traditional medicine, certainly is not a panacea for so many medical conditions and illnesses now and to the extent that we could identify effective therapy across other areas, certainly that is something that should be on the table.
Rovner: And Senator McCain?
Kholsa (for McCain): Like you said, rising drug costs—and I think this is an area of commonality between Senator McCain and Senator Obama’s healthcare plans—we both recognize that rising drug cost is a huge issue for the U.S. healthcare system. And there’s a lot of stuff that we are in agreement about when it comes to generics, when it comes to making sure that we have safe importation put into place. As far as alternative medicines go, I think it’s a very interesting question, and I would like to go back to the idea that I started off my comments with and that is choice. If the American family feels like they need greater choice, now they’ll have an opportunity under the McCain healthcare plan, to go across, even across state lines, to look at plans that do offer alternative medicines as part of their coverage. And they’ll be free to get that plan if they feel like that best meets their family’s needs. So, once again, we put the choice in the hands of the American people. And I think innovation is something that should be encouraged in all arenas.
Hughes’ tone as she admits that the subject has not been addressed by the Obama campaign suggests that maybe the campaign should have done something. Her reference to the NIH indicates an awareness of some supportive research. However, Obama’s call for doubling basic science research shows no sensitivity to the importance of whole practice, whole systems and economic outcomes research to the integrative practice community and to research on chronic disease in general. (Of course, neither is our own research community taking a lead in this area!)
The FEHBP, referenced by Hughes, does include some manipulative therapy, typically provided by chiropractors. However, services of licensed acupuncturists (who have been pushing legislation to gain FEHBP inclusion), naturopathic physicians, massage therapists and other integrative practices are not included, unless as add-on discount products. Still, Hughes’ reactive response is to want to say something positive. There is the opportunity to appeal to Obama’s open-mindedness.
On McCain’s behalf, Kholsa seems to try to put a positive spin on McCain’s openness to non-conventional practices. Kholsa calls the subject “very interesting.” Consumer choice is imbedded in two of McCain’s core ideas. One is the possibility of looking across state lines to buy a more CAM-rich benefit. This, however, as noted by the American Chiropractic Association, would specifically allow a person to purchase plans with no covered benefits from complementary healthcare practitioners which may be mandated in one’s own state.
The second area of consumer choice lies in McCain’s support for HSAs. This is a direction that many in the integrative practice community support. The International Association for Yoga Therapists, for instance, contracted for a legal position which affirmed that HSAs can be used for yoga therapy as long as the treatment is for a medical condition. Other integrative practice services would merely need to meet the same benchmark. WebMD’s analysis of the two candidates’ plans states that Obama’s plan is silent on the topic of HSAs. (2)
Alignment with integrative principles
What about content in each candidate’s healthcare plans that may be viewed as supportive of integrative principles and holistic thinking? Here, one finds much more potential in Obama’s plan. Obama supports employer-based wellness initiatives, specifically noting the value of nutrition and exercise programs. He wants to ensure that schools are healthful environments and promises to increase investment in physical education. The Obama plan also supports increased investment in preventive services. Yet while enticing to integrative views, the details are without much imagination, focusing on immunization and screening.
For those whose vision of optimal healing environments extends from home to neighborhood to community, Obama offers a holistic, if somewhat dreamy, pastoral image of the way healthy communities can be the key to an individual’s health. According to Obama, “Americans also benefit from healthy environments that allow them to pursue healthy choices and behaviors that can help ward off chronic and preventable diseases. Healthy environments include sidewalks, biking paths and walking trails, local grocery stores with fruits and vegetables, restricted advertising for tobacco and alcohol to children and wellness and educational campaigns.” Obama’s support of the medical home movement also suggests that, when it comes to medical services, he supports putting more resources into outpatient care. Such a direction might open doors for non-conventional practices, most of which are offered in the outpatient environment.
McCain’s healthcare proposals and reports on his positions tend to have fewer specifics. This may be because, philosophically, he sees a smaller role for the government and therefore less use for proactive programs. McCain’s approach may put additional tools in the hand of individuals, but he offers little information about focused ways to “encourage innovation,” as Kholsa states. Like Obama, McCain has pledged to double NIH funding, though in recent years he has not been a significant supporter of increases for the organization, which houses the National Center for Complementary and Alternative Medicine.
Why was neither opportunistic on the issue?
Think of this issue from a strictly opportunistic perspective. We know from legitimate polls from CodeBlueNow that 69% and 75% (respectively) of citizens in the red state of Iowa and the blue state of Washington believe services of licensed complementary healthcare practitioners should be in basic benefits. (3) We also know from the history of grassroots campaigns that alternative medicine can be an important single issue for people. In short, either campaign might pick up a few votes by starting a viral internet campaign after tossing the integrative practice community a bone. (4) Perhaps we haven’t been yipping enough.
I cannot leave off without a personal statement. In 1983, when I first got involved in the integrative practice universe, my professional work was in politics, legislative work, business and political journalism and, yes, community organizing. I was drawn to the concepts of integrative practice, not as a patient or as a practitioner. I was attracted to what I perceived a citizen and activist stood for. The concepts that draw me still are healing, wholeness, environmental health, community, respect for both male and female principles, and acknowledgement of and respect for differences and contributions from distinct traditions and cultures of the world. The current U.S. president has been aggravating dis-ease on all of these accounts. McCain has voted with those directions 90% of the time.
I believe that the candidate who looks, from the research above, to be most open to integrative practices is also the candidate who is also most aligned with the values advanced in integrative practices. At Obama’s worst, most of our present wounds will be less likely to be continuously inflamed. At Obama’s best, we have an historic chance for healing. Conclusion: vote Obama.
References:
1. Links to a live broadcast (the comments are at almost exactly 60 minutes) and the transcript (see pages 43-45) are here: http://www.kaisernetwork.org/health_cast/health2008hc.cfm?hc=2986
2. http://www.webmd.com/election2008/comparecandidates
3. For the survey data, go to www.codebluenow.org. Because I serve on the organization’s board and know that these outcomes were sent, repeatedly, to officials of both campaigns.
4. An article on the survey is at http://theintegratorblog.com/index.php?option=com_content&task=view&id=432&Itemid=93
Additional articles by John Weeks: