The Lunatic Fringe + Insurance = Pay Cut

So, as a typical community acupunk, I get each issue of Acupuncture Today, but I rarely ever read the thing. More so than most mainstream magazines, this “publication” strikes me as a rather transparent vehicle for vendors and other monied interests to have a forum to push their agendas. This comes with an air of legitimacy, very thin air, in the form of “articles”. (It’s all about these great articles, man!) However, here’s an article that caught my eye:

Acupuncture No Longer Golden in California?

The first thing that came to mind is that somehow this is about insurance. The fact is that the California medicare program needs to make cuts, and guess who’s on the block? Well, in addition to us there’s: dental, audiology, optometry, chiro, podiatry, psychology, speech therapy. Notice anything about our chopping block peers? Yeah, it’s all highly specialized and services that aren’t often covered by private insurance. When was the last time you heard of dental or vision being covered by an employer? I mean, outside of the Fortune 500. . .

Even before I knew a thing about acupuncture or even healthcare I could see that insurance was a cancer. What could be more maniacal than making a business, a for profit business, out of denying people healthcare? Well, besides out and out death for dollars–that would be our current war profiteering gov’ment. . . But, I digress. No, I’m gonna digress big-time here.

I love Obama. At first it was just fun to say his name. Then it was knowing that finally, here was a decent fellow midwesterner in politics–I think Dan Quayle was the last person of national note from the ‘I’ state region (Indiana, Illinois, Iowa). (Man, how embarrassing was THAT, fellow Hoosiers?) Then he came out with a brilliant speech about race. Now, the subtext for all of us Marxists out there was loud and clear. Obama seemed to be saying, “Yes, we have a race problem, but the root of that problem and so many others in this country appear to stem from a class problem.” Now, I liked Obama for all the above reasons, but at the beginning of the primaries I was an Edwards man, all the way. Why? Well, I care a whole hell of a lot about healthcare, and Edwards had the best plan (and wasn’t a Clinton). What’s more than that, he actually seemed to care about this issue and was the only one of the three who _openly_ acknowledged this whole class thing, in fact, he based much of his campaign on it.

Now, Obama has a decent plan. (Just between you and me, I think he’s way more radical than he’s letting on, just being savvy until he gets in power, I can deal with that.) To quote some ten year old on Daily Kos “Obama gonna win.” Once that happens, I think he just might be able to push through something close to a national healthcare plan. Guess what happens then? That’s right, we’ll see the utter collapse of the insurance industry as we know it.

Now, I’m not naive, things may never change at that level in this country, but there are a lot of forces at work that are changing the landscape. There are a couple of scenarios here:
1. We FINALLY join the rest of the modern world (and Haiti) in getting nationalized healthcare. In which case, the insurance companies will be hard pressed to remain in the insurance business. I wouldn’t be surprised if they did indeed collapse. Guess what insurance-dependent acupunks, you’re now SOL. If you think even for a minute that the Feds are going to warm to acupuncture more than the state of California, you’re living in Aculand. (As an aside, guess what the rate for MediCal reimbursement was? $15!!! OMfreakinG!)
2. We get some freaky government backed hybrid monstrosity (lord knows, we don’t like hybrids ’round here) that competes directly with the current insurers, thus forcing them to try and stay competitive. Guess how they’re gonna do that? That’s right, they’ll do exactly what they’ve done the last couple of decades–cut benefits. Once again, who do you think’s gonna be on the block? That’s right, acupuncture!
3. Not a damn thing changes, but all of this renewed interest in the cost of healthcare makes the insurance companies nervous, people start asking pesky questions, the cost of healthcare continues to escalate–once again all of these “medically unnecessary procedures” are going to get the axe.

See, I think what must acupuncturists don’t get–at all–is that we are STILL part of the lunatic fringe. We’re no more highly esteemed then trepanning. Even though the entire USA might “know” what acupuncture is, that doesn’t mean they accept it. In fact, all they know is that it’s Chinese and involves needles. Ask anyone who’s actually had acupuncture and that becomes a woefully inadequate description. The schools do a good job of tooting the “integrated medicine” horn, but to be honest, most of that amounts to simply saying, “No, acupuncture isn’t completely crazy, probably just a delusion. But hey, if the delusion helps our cash flow, I mean patients, great!” How many “integrated medicine” inner city/rural clinics do you know of? No my friends, we’re a bunch of nut-balls operating in a grey zone of the unknown. What little coverage we’ve been able to gain on a state by state basis is probably due more the efforts of other modalities and we’re just along for the ride, thanks LMT’s and DC’s.

What’s my point? Well, I’ve been out of school for almost 2 years now, and guess what? Of my cohort, very few are supporting themselves through acupuncture alone. The ones that haven’t moved anyway to exploit an upperclass area that lacks a nice acu-boutique are now turning to the insurance cash cow to make ends meet. There are quite a few of us who have joined the Community Acupuncture movement. I think we all recognize that we’re operating on our own out on the fringes. Of course, I really see this as grass roots change. CAN is much like Dean’s 50 state political plan and Obama’s massive support coming from outside the establishment, we’re working from a model that seeks to give power to the people, not depend on wealthy donors. Which is what insurance companies amount to in the end.

We believe by helping people we can change what people “know” about acupuncture, and in that way it can change the world. As more and more CAN clinics open and more and more people get better we can give birth to this miracle of healing that is acupuncture. But, for now, we’re weirdoes, and until that changes, the insurance teat will always be a dodgy basis for your livelihood, even in California. . .

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.

Responses

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  1. Sorry Matt, but I can’t just

    Sorry Matt, but I can’t just praise this post. Although I agree with many of your ideas, its full of internal contradictions.

    First, Clinton is the only candidate who is advocating for the kind of health care-for-all program that you seem to desire. Obama is advocating exactly the kind of “government backed hybrid monstrosity.” that you claim to fear. Don’t believe me? Check Obama’s own web page. (Talking to people who hate Clinton so vigorously as to completely discount her, I find the reason behind this hate usually comes down to good old fashioned sexism – although they all deny this. Go ahead – do so yourself…I’m waiting….)

     

    You claim to hate insurance but also desire to have insurance. Which is it? Do you desire to work outside of the health insurance arena or do you hope that they will accept you someday? I personally don’t care at all whether California takes health insurance. My practice doesn’t need it. I intend for it to never need it. I can charge a fair price right up front.

    As for not “getting it” about being part of the lunatic fringe – this is the most arrogant statement I’ve heard in a long time. Most of us realize we are out there and we likeI it that way. You are far from alone in realizing we are “weirdos.”

    Personally, I hope that my weirdo status never changes.

  2. Getting Very Livery in Here

    Ok, first off, the Clinton thang. Just watch Sicko, the whole thing’s good, but go ahead and skip to the segment about Hillary. Now just contemplate this set of numbers and names: 1989-1993-Bush 1993-2001-Clinton 2001-2009-Bush 2009-Clinton?!?! Sound like a healthy democracy to you? I could care less about Clinton’s gender, I didn’t say I “discount her”, nor did anything approaching “hate” spill forth from my pen. I think she’d do a hell of a lot better job than most, but I’m for Obama for a number of reasons, none of which have to do with what he’s got in his pants. While we’re talking Obama here, I’ll quote the very blog you are commenting on “Just between you and me, I think he’s way more radical than he’s letting on, just being savvy until he gets in power. . .” we can debate the wisdom of this position, but the implication here is that Obama will be a populist/socialist wolf in moderate/placcid sheep’s clothing. Part and parcel of a modern New Deal would necessarily be a national healthcare system. I am very well informed of the short-commings of Obama’s _official_ positions. (Incidentally, it is very poor form to pull the sexism card and a political arguement in the same breath, do yourself a favor and don’t do it. If you want more reasons I am not a Hillary supporter, just peruse Daily Kos, where you will find plenty of women who are supporting Obama and not Hillary, for many of the same reasons–and many more.)
    Now, insurance. *AHEM* I work at Working Class Acupuncture, you would be VERY hard pressed to find a much more anti-insurance establishment. In fact you’d be VERY VERY hard pressed to find a more anti-insurance practitioner than myself!!! The whole tone of my blog is to show the inherent risk of relying on the “insurance cash cow” for the vitality of your practice. I have never and will NEVER desire insurance coverage for acupuncture, but there are apparently a whole hell of a lot of people who do. And, even supposing they are the minority, they seem to be a very VOCAL minority.
    The whole weirdo thing is not about your lifestyle or political leanings, it’s about acceptance of acupuncture–take a little bit of your own ego out of this–by the population at large. My point was not some revelation about how we’re a kooky bunch, it’s a wake-up call for those of us (read: not me, and obviously not you) who are seeking some sort of establishment pat on the head and support (again if this is a minority they sure do make some noise).
    The whole point here is that most people think acupuncture is “way out there” stuff. Other CAN’ers please call me out on this if I’m wrong, but the whole mission of CAN seems to be getting acupuncture to these same people! People who don’t know what a chakra is, or how to “feng shui” a space. It’s about creating something that includes them. This has nothing to do with “letting your freak flag fly”, this has to do with uncle Fred’s carpal tunnel and Grandma Betty’s hip pain. A teamster with a bad back and a stressed out paralegal. Regular people, they aren’t “the Man”, they don’t know what Qi is and a fair amount don’t give a good goddamn either. Put your needs aside and do what serves them.
    Sorry for the lengthy reply, but you seem to have not really read what I had to say, in the very least, it was quite consistent, regardless of how you felt about it.

  3. (I couldn’t let this go…forgive me…)

     

    Raven,

    Many forward thinking folks remember Hillary with great fondness for her work to help lead the US towards Universal Health Care back in the 90’s.  But it appears those days are in the past.

    Hillary has done more in the past year to cast herself as a candidate whose moral compass has broken than any other viable Dem candidate, IMHO.

    For what it is worth, our family of two HC supporters have been discouraged with her campaign’s low-blow tactics.

    One of us is a man, the other is a woman. She will now get neither of our votes.

    Clinton’s gender has not one thing to do with our disappointment & disdain for her negative campaigning – including recent vitiate religious/race-baiting efforts.

    Just sayin’…

  4. yes we can heal the world

    I certainly have my unhealed internal biases – sexism, racism, classism, ageism, homophobia – the gamut.  Don’t we all? Why hurl insults back and forth and pretend otherwise? 

    In psychology – east or west – all of this stuff is acknowledged as being rooted very deeply. Fortunately, I am not running for political office and have the luxury of not worrying about full self-disclosure while putting most of my energy on healing these internal separations from truth rather than defending and hiding them.

    All of that aside though, it sure feels good to be serving regular people at $15 a treatment rather than serving the insurance masters.  Yes we can (heal the world). For what other reason do you drag your corpse out of bed in the morning. I mean, the ice sheets are breaking of Antartica and Greenland as we sit here on our American carbon footprints  – to name just one symptom of the global Chi imbalance.

    Today we had an open house at CommuniChi. We donated 50% of donations to Acupuncturists Without Borders. About 60 people came for treatment.  At one point, practically every conceivable chair in the clinic was full…people on couches, even one friend in a beat up recliner next to the computer. (He loved it.)

    Equally remarkable was that we had around 15 volunteers helping out…bringing organic chocolate balls, greeting patients, answering phones, answering questions, and just generally adding their Chi to this grass roots movement.

    More and more Bastyr University acupuncture students are coming to us for treatments (Our rates may be cheaper than the school clinic) and more of them are inquiring about doing preceptorships with us, indicating that this is the type of business model and Life Chi they want to create when they graduate, nay before they graduate. 

     Acupuncture can change the world. Life has meaning. 

    Cynicism is a smokescreen for laziness and fear. Clear light mind awaken! Pierce through all layers of doubt and delusion! Inspire me onwards in ceaseless waves of selfless activity.

  5.  Hi MattIt is so nice to

     Hi Matt

    It is so nice to see you wade into the fray here. I read this at 4am this morning , couldnt sleeo with all the myriad details needed to get my clinic open and then opened up my front page and there it all was.I am interested to know what about Obama’s plan he might be keeping close to his chest right now.? I am still a little wistful for what might have been had Edwards got up with his plan

    What has happened in Australia with the health insurance industry is that it is able to offer those with extra money add ons like private rooms in hospital, vision,dental  plans and health club membership, sometimes chiro , mt and acup.

    When I live there I am fine with just being able to get into see a doc when I need to : I do not need those add ons.I just enjoy the fact that for 1.5 cents in every dollar that I earn I am able to not worry about basic health care needs; the government picks up the tab.

    Our patients here in the US think about their health care needs and the cobbled together nature of their coverage or lack of it daily.They may ,like me, push it from their mind in the wee hours of the morning just so that they can get back to sleep.

    Our model in time will become part of their safety net as our numbers grow.

    I for one would rejoice in the streets if Obama did have a mandate to really work to take this worry from peoples minds with an affordable universal health care solution.I , for one would love for my patients to get in to see their doc with the ease and affordability that we are trying to provide with this model