Representatives of holistic health care were largely absent from the Clinton-era health care reform debates a decade ago. But a lot has changed since then: the field of natural medicine has evolved, the integrative medicine movement has gathered momentum, the research is stronger, and the conventional health care system is in far worse shape. As the health care crisis once again moves to the political center stage, I am confident that the voice of a more mature, scientifically-grounded, politically aware holistic health care field will make itself heard in Washington, DC.
In May, we took a major step in this direction when the Congressional Caucus on Complementary and Alternative Medicine and Natural Foods held its inaugural meeting. The session was attended by about 20 Congressmen, Capitol Hill staffers, and industry representatives. The CAM Caucus is a bi-cameral bi-partisan organization co-chaired by Rep. Dennis Kucinich, Rep. Dan Burton, Sen. Tom Harkin and Sen. Orrin Hatch. Its is, in its own words, "to offer an opportunity for members of Congress and their staff to learn about complementary and alternative health practices and natural foods—and the growing role they are playing in improving the health and well-being of millions of American citizens."
During this meeting, the Integrated Healthcare Policy Consortium (IHPC), of which I am a member, had the opportunity to educate caucus members on the key points of IHPC's agenda: an integrated health care system, and changes in federal policy governing health care education, research, access, delivery, and reimbursement that support a greater role for holistic and preventive medicine.
IHPC is an outgrowth of the "National Policy Dialogue to Advance Integrated Healthcare: Finding Common Ground," a meeting held at Georgetown University in November 2001, that brought together representatives from over 50 national organizations with an interest in the advancement of integrated healthcare. This meeting led to the National Policy Dialogue Report (Alternative Therapies in Health & Medicine. May/June 2002. Vol. 8. No. 3) that identifies areas of common ground between the various CAM professions and sets an agenda for political action. IHPC is one of the working groups of the Collaboration for Healthcare Renewal Foundation.
IHPC's Executive Committee and Advisory Committee, which I chair, include representatives from all licensed CAM professions, conventional medicine, and other stakeholders in integrated medicine. Our report is a strong complement to last year's White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP) report, and we were pleased to have the chance to present our views to the Congressional Caucus.
Rep. Kucinich and is one of a growing number of policy-makers interested in how the preventive, non-pharmacologic orientation of natural medicine might translate into better health and cost savings. He did a nice job of setting the stage at the caucus meeting, pointing out that the fact that it was being held in the Capitol is symbolic of the level to which this discussion has been raised.
IHPC representatives made presentations on four cornerstone objectives:
- To create a federal office on integrated healthcare.
- To increase appropriations for health services research that could foster health promotion and disease prevention.
- To secure federal support for education and training programs for both conventional and CAM schools to produce a core, integrated curriculum.
- To enact legislation prohibiting discrimination against CAM providers, schools, and educational programs in all federal programs and initiatives, with particular emphasis on removing barriers to integrated health care in rural and underserved communities.
"This gave us a chance to explain who IHPC is, and it serves as a foundation for future efforts to launch our common ground agenda," said IHPC chair Candace Campbell, who spoke at the caucus meeting.
She praised her fellow IHPC presenters Wayne Jonas, MD, of the Samueli Institute; Aviad Haramati, PhD, of Georgetown University; David O'Bryon, JD, of the Association of Chiropractic Colleges; and Paul Mittman, ND, of the American Association of Naturopathic Medical Colleges. Caucus members left the meeting carrying copies of the National Policy Dialogue Report, a briefing paper on the IHPC, and a report from the Samueli Institute on standards in research. "We expect that IHPC will prove to be an invaluable resource for members of Congress grappling with issues ranging from discrimination against CAM providers in federal health programs to the allocation of federal research dollars."
There are currently 173 Congressional caucuses, the largest number to be active at any time. Most of these (107) are House caucuses; a minority (25) are in the Senate; and the rest (41) are bicameral. Although little media attention is given to caucuses beyond a few high-profile ones like the Congressional Black Caucus, they can have significant impact on policy development.
Congresspeople must address many complicated issues cutting across traditional party lines—CAM access is a good example. Caucuses enable members to consider these issues and what should be done about them. They are a "logical, adaptive response" to the inadequacies of formal political structure, according to political scientist Susan Webb Hammond, of the Woodrow Wilson Center, Washington, DC. In studying caucus impact, she found that caucus membership has an independent, statistically-significant effect on floor votes.
The formation of a congressional caucus on CAM is a very good sign. It is an acknowledgement that leading Congresspeople want a vehicle for educating and informing their colleagues, as more and more issues and legislation regarding CAM will be coming across their desks. Since caucuses often serve almost like "pre-committees" for introducing new legislation, this new caucus could prove to be an important channel for bringing an agenda for integrative medicine to the floors of Congress. We have some strong allies: Mr. Harkin and Mr. Hatch are senior senators. Mr. Kucinich is running for President. Mr. Burton has a reputation for taking on CAM causes in a very agressive way.
It is time for holistic health care to take its place at the policy-making table. We need to work together across our academic and professional divides to help build a prevention-oriented, cost-efficient and compassionate health care infrastructure. As holistically-minded physicians we have much to offer. Let us bring the strengths of all our professions and organizations together and speak to the nation's policy-makers loudly and with a unified voice.