It seems the holistic community has little love for the ACA or the individual mandate. Many respondents say the plan fails to address the main drivers of the country's health crisis, and does little to foster a meaningful shift toward holistic care. Further, since many practice outside of insurance, they are leery of any reform plan that keeps insurance companies in the Catbird seat. (For predictions on how the ACA will play out in physicians' offices, check out Healthcare Reform Makes Primary Care a Prime Focus...But Don't Expect a Raise.)
That said, most respondents see a pressing need for major reform of health care in this country.
Ninety percent of those participating in our straw-poll predict that the current reform plan will not survive the Court's ruling, which is expected in June. As has been widely pointed out in the media the individual mandate is central to the reform plan, and the Administration has not forwarded a Plan B, should the Court rule against it.
The more interesting question is whether the mandate—and by extension the reform plan itself—should stand. Here, too, the majority of respondents--70% to be exact--say "Nay!"
"I disagree with ObamaCare for the simple reason that it basically mandates conventional health coverage. As long as we are a society that produces illness and pays for treating symptoms, we cannot solve the crisis," said Carol Bowman, MD, an internist, board certified in integrative holistic medicine.
"Regulation of the food and chemical industries that produce sickness, and incentivizing individuals, companies, and insurance coverage for healthy living will make more of an impact than just forcing more people to buy into a system that is severely broken and fueled by special interests," said Dr. Bowman, who practices in Bel Air, MD.
Several common themes emerged from respondents' comments:
• A mandate forcing people to purchase insurance is morally wrong and economically questionable.
• Being against the ACA is not synonymous with being against health care reform.
• Elimination of 3rd party payors and restoration of direct relationships between patients and practitioners is the true corrective for the system.
• Holistic & integrative modalities have tremendous potential for cost savings and for improving health outcomes---if only they were given a fair chance.
• Partisan politics & the influence of corporate special interests have corrupted the process, making meaningful large-scale reform difficult if not impossible.
Abandon the Mandate
Some clinicians, like Lonna Larsh, MD, a holistic family physician in Santa Cruz, CA, contend that the ACA contains important elements that should be preserved. "I do support parts, like requiring insurance companies to allow parents to buy insurance for older children, and requiring them to cover those with pre-existing conditions." But ultimately, the individual mandate left her cold. "It is a gift to the insurance companies."
(How do insurers influence public policy? Check our interview with Wendell Potter, former communications director for Cigna, and author of the book, Deadly Spin.)
David Blyweiss, MD, a functional medicine practitioner who directs the Sanctuary Medical Center in Boca Raton, FL, aligns with the view that a mandate to buy insurance is simply unconstitutional. "The idea that someone sitting in their living room not engaging in any form of interstate commerce would be mandated to purchase a product is, at the least absurd, likely unconstitutional, and should not be the law of the land. This is not the answer to making our population healthier. It only makes the insurance companies healthier."
Like many others, Dr. Blyweiss believes the real game-changer will be education: "Educating the population to make better food choices, teaching whole system detoxifying methods, stress reduction techniques, immune strengthening, digestive rebalancing, and other functional medicine concepts are the ways to deal with the ills we are seeing ...which can only get worse if we stay on the same road. Healthcare must face the truth that the urgent or emergent treatment paradigms successfully used for acute care do not meet the needs of the majority of health issues we see."
Not Far Enough
Some respondents believe that the main flaw with the Obama administration plan is that it didn't go far enough.
Hyla Cass, MD, a holistic psychiatrist in Pacific Palisades, CA, believes a full-on single payer system would go further toward increasing access, improving outcomes and saving money, than the ACA's hybrid insurance-based system. Born and raised in Toronto, she speaks from experience.
"We should have free, single payer, government-funded health care like Canada and other western countries. It may have it's problems but we have far worse problems here in the US, with people becoming destitute as a result of catastrophic illness, insured or not. The profits in medical care are ridiculous. Health care should be like education and other public services."
However, she added that, "more nuanced is the role of prevention, self care, CAM, functional medicine," none of which have been widely incorporated by single payor systems abroad.
Jonathan B. Murphy, MD, of the Arizona Center for Advanced Medicine in Scottsdale, would also prefer a single payer system, though it's very unlikely.
"I do believe a developed nation like the US can have national healthcare coverage, but at this point in time, there are too many shortsighted politicians and bureaucrats, and we will have to wait until things become even more difficult before real reform will happen. The potential for savings just in administrative costs alone says we should have a single payer. If there is to be a mandate, it won't work as well through many different insurance pools as it would through a single risk pool."
Like many, Dr. Murphy stressed that how we finance healthcare should be secondary to the question of how we engender health. "I can see many simple ways of saving money, but they require folks to take better care of their health through lifestyle and diet. With all of the ads for great tasting processed foods, these simple ways have an uphill climb to be accepted."
The ACA certainly has supporters within the holistic/integrative community. Sanford Levy, MD, a holistic internist in Buffalo, NY, and member of the Board of Directors of the American Board of Integrative Holistic Medicine, believes the reform plan will withstand its Supreme Court scorching---and it should.
"(The mandate) is essential to spread risk. If individuals choose not to insure, as is currently an option, and then they have a catastrophic illness, society ends up absorbing the cost, and/or the individual must go through personal bankruptcy. All other 1st world countries have either national insurance or an individual mandate."
Bill Manahan, MD, professor emeritus of Family Medicine & Community Health at the University of Minnesota Medical School, believes the Obama administration's reform plan does have merit, but he does not think it will stand. "I suspect that the vote in the Court will be 5 to 4 against it. If it is defeated, I hope it will force the administration to move toward a single-payer system.
(3rd) Party's Over
"But the real problem is with our entire way of life, which is wasteful, arrogant, disconnected from nature and spirit, and run by corporations that believe that their primary obligation is to make money for shareholders. No matter what we do with healthcare payment systems, so long as allopathic medicine dominates, we in the US will remain in big trouble," said Dr. Manahan.
William "B.J." Lawson, MD, a physician, entrepreneur, and 2010 Republican candidate for Congress, believes health care could right itself if 3rd party interests—both corporate and federal—were removed from the healing equation.
"What is healthcare? At its most basic, healthcare is a patient and practitioner together in the same room, seeking to treat symptoms, reverse disease, or promote health. Where's the interstate commerce in the patient/provider interaction?"
A libertarian conservative with a strong anti-corporate streak, Dr. Lawson contends that "the government forcing individuals to purchase a product is well outside of its constitutional jurisdiction and a perversion of the commerce clause. The intent behind the clause was to create a free trade zone among the States -- so that North Carolina would not be erecting tariffs against Massachusetts, for example. The intent was never for the federal government to regulate commerce and ultimately individual behavior for the profit of the monied interests whose lobbying drives our current crony capitalism."
He holds that many of the basic goals of healthcare reform would be achieved by pushing insurers out of primary care, and he has developed a comprehensive practice platform called Physician Care Direct that enables doctors to do that.
"My vision for true health care reform is to ensure that everyone has access to affordable, high-quality primary care by disconnecting basic outpatient medicine from the expense and overhead of the third-party payer system. When primary care is purchased directly, without costs of coding, billing, and collections, it is much more affordable. When patients and employers have access to affordable primary care, the need for insurance changes.
True insurance -- the pooling of risk for relatively rare but financially devastating events -- is actually relatively affordable. Our current 3rd party payer system, however, is not actually insurance at all -- it's just an expensive middleman that prevents price transparency and enables massive cost shifting and cost inflation."
Guess Who Coined the Mandate?
Bare-knuckle political brawling has done little to bring clarity to the health care issue, as many respondents noted. Michael Traub, ND, a naturopathic physician in Kailua Kona, HI, and former president of the American Association of Naturopathic Physicians, says he strongly objects to the term, "ObamaCare."
"I think the term is pejorative and something that has been created by Republicans to polarize the ACA. Obama had little to do with creating this law other than asking Congress to bring him a law to sign that reformed healthcare and provided patient protection and affordability."
Dr. Traub's point is well-taken, given the astonishing degree of flip-flopping by many of the nation's top policy-makers---Democrat and Republican alike—on the matter of the mandate. As was pointed out by the New York Times on Day One of the Supreme Court hearings, the concept for the individual mandate was supported if not invented by the Heritage Foundation, the prominent conservative think-tank, during the Clinton Administration's reform effort. At the time, it was seen as a business-friendly alternative for handling healthcare reform without resorting to a "socialist" single-payer model. The Heritage Foundation has since disavowed the concept, declaring it unconstitutional.
The individual mandate was publicly endorsed by Newt Gingrich in the early 1990s, though he is now outspoken against it, and actually implemented in miniature by Republican front-runner, Mitt Romney, during his governorship of Massachusetts. What's really interesting is that as a presidential candidate, Barack Obama said he was against individual insurance mandates.
Life in Washington has a way of shifting peoples' firm convictions, or so it seems!
Here are some more reader comments:
Sunil Pai, MD, Founder & Director, Sanjevani Health & Lifestyle Center, Albuquerque: "I don't think it will stand, and I don't think it should stand as currently written. But we do need to have universal coverage. I am caught between the two as I support Obama and the concept of mandating insurance coverage but ONLY if it was through the government as the universal carrier NOT private insurance. I will vote against the latter, as I don't believe private insurance has done anything positive for most Americans. Forcing them to pay into a system which is not regulated and thus the premiums can go higher without any limitation or penalties for those who don't participate does not make them any healthier.
If everyone was mandated to pay into a universal coverage such as a Medicare/Medicaid then I would be for it as it would drive costs further down. The public through its purchasing power collectively would bring the costs down through one payer. But if we are forced to buy private insurance which has the highest premiums, along with many carriers, then there is no cost savings, only 40 million new people forced to pay into a system which has not been shown to create a healthier population, only to somewhat reduce the costs of life threatening illnesses."
Tara Zandvliet, MD, San Diego, CA: "I think the Affordable Care act has a lot of good things in it if we are trying to maintain an Insurance based system and do the least disruption. I think mandated insurance will be found unconstitutional because it is demanding we partake as consumers in a for-profit (private) market. I think we can make the case to provide care for all Americans, just as we provide fire and rescue and 911 services even if people don’t want them. But that would have to be through a tax system, which some Americans are wholly against.
I support “ObamaCare” and hope it is upheld, but am doubtful that part of it will. It seems to be the least disruptive of the alternatives as it does not dismantle the entire insurance system and put those people out of work, and it seems the only way for an insurance based payment system to work – many healthy people paying in and distributing the risk for the ill.
If it is struck down as unconstitutional, then as I see it, the options are: status quo and continue to have people dying of treatable illnesses or losing their houses in the process; universal health care through government reimbursement systems as exist in some countries (where we pay, and then are reimbursed); or a flat rate rebate of some type (we get a certain amount of money to go toward healthcare, or the insurance company is paid by the government based on numbers of enrollees at a particular date each year). The rebate (or voucher) idea is interesting – we have a choice of plans and can “buy up” if it is high on our priority list. The cost is offset by a flat amount per person. Note that all the main solutions involve increases in taxes – either a new healthcare tax or an increase in income tax."