Detailed Discussion of Insurance & The Bill we should support.

[LonnyJ]

Here I discuss why I've never supported insurance reimbursement,
what's wrong with the current bill, and what bill I could support for
the sake of unity in the profession. If we are going to do a bill we
should get behind one that could e a national model. It is my
consideration that the current bill is greatly flawed. I discuss
parity and why it's vitally important. If we can get behind a bill of
the sort I'm proposing I'll endorse it and work for it.

Regards, Lonny Jarrett






Why I am highly suspect of Insurance Reimbursement

I am against insurance reimbursement for many reasons. These can be
summarized as follows:

1. The insurance system reflects the reductionist and materialist
values of Western biomedicine which are at cross purposes to the
wholistic and integral values inherent in Chinese medicine at it's
best.
2. The insurance system was instituted to help the average person
avoid loss of their life savings in the face of catastrophic illness.
I think that's a good and noble use for it.
3. The Insurance system, as it exists, is broken and very
dysfunctional.
4. The Insurance system has no understanding or valuation of the
principles of holistic/integral medicine and forces practitioners to
change how they practice in order to optimize profits.
5. Taking insurance will drive up costs long before it reduces them.
These include:

a. Paying for billing.
b. Charging for the time it takes to do extra paper work.
c. Charging for the time it takes to resubmit paper work and make
calls to collect payment. My experience is that it takes 1-3 hours/
claim to receive payment from a company regardless of the cost. Last
year I had two claims to submit totaling less than $600 and it took
about 3 hours of time to collect the money-all paper work was
submitted correctly the first time.


6. With insurance reimbursement as the goal for the sake of enriching
the profession, as opposed to advancing the medicine, I've watched
schools such as NESA offer ever more biomed courses in the last 25
years. Yet I've never met a student from such a school that could
render a competent pulse diagnosis or, for that matter, a
sophisticated integrated diagnosis of a patient. And, I've taught
students for 24 years who have graduated from every school in America.
I see every indication that the "holy grail" of insurance
reimbursement and "integration" into the Western medical system has
only compromised the potential of Chinese medicine in America and has
done nothing to enhance it.

7. Lastly, CM is about wellness care and prevention. The insurance
industry does NOT recognize these values at all (a little lip service
at best). Force fitting a wellness medicine into a symptomatic and
trauma care paradigm compromises it's core values.

TO SUM: While access to our medicine might be seen as an ethical and
public health issue it's unethical and ironic to compromise the
integrity of our medicine for the sake of granting that access. Only a
bill that set's the stage for us to practice according to the
principles of our medicine should be considered or supported.

Why Insurance could be good


1. The right kind of coverage could allow deep penetration of our
medical values into hospital and outpatient settings and could promote
the evolution of truly integral medicine that could help evolve
culture.




Why the Current Bill is no Good

1. This is a least common denominator bill. On the one hand it asks
for universal coverage, a mandate from the state to fund a profession,
and on the other hand it says "we'll take whatever we can get".

2. While the bill mandates that all policies cover Acupuncture it
allows the insurer alone to set the terms of it's coverage.

3. Assuredly it will be bureaucrats, physicians, and physician
acupuncturists who will set the terms of our our coverage. What power
do we have to negotiate with? Ultimately, it will put the companies in
the position of dictating terms.

4. This will result in further tensions with physician acupuncturists
who will undoubtedly receive significantly more favorable terms than
those licensed practitioners who have far more extensive educations in
the medicine.

5. The outcome of this bill could undermine our position as physicians
of the world's oldest and deepest medicine by making us little more
than indentured servants to a system with a very different value
system than ours. If we don't value ourselves enough to request and
not compromise on parity, then why would others hold us in any higher
regard.



What Parity is and why we should only support a bill that takes stand
for it.


1. There are three possible bills we could submit.

A. The current Least Common Denominator bill That has no parity
clause.

B. Parity Bill #1: We could insert a clause into the current bill
stating "Licensed acupuncturists will be reimbursed for their services
according to the same terms as licensed physicians who render those
same services."

C. Parity #2 (The bill I'd support and that I think could pass!): We
should write a bill that says, "Any policy that covers acupuncture
performed by a licensed physician must also cover the same services
performed by a licensed acupuncturist according to the same terms of
coverage."



Assessing these bills:

A. This bill sends the message "We want a mandate from the state for
universal coverage but we'll take any terms the industry offers". If
acupuncturists do not have parity, then tensions between us and
physician acupuncturists will intensify. It's likely they will oppose
our bill from the outset and if it passes it leaves them in control.
Also, it's VERY unlikely that this bill will pass because (1) I can't
see the state giving us such a mandate and (2) because there will be
opposition both from within and without the profession. Lastly, it
doesn't specify what we will be covered for! That means a company
could say, "sure we will cover you, you get three treatments to cover
pain syndromes and we'll pay $35 dollars for each session."

B. This bill is better but:

I. It seems greedy.
II. I also can't imagine that the state will give us a universal
mandate.
III.What will be the result when 2 million people show up to
their providers asking for acupuncture the day the law takes effect?

C. THIS IS THE BILL WE SHOULD SUBMIT!:

I. It's moral and makes perfect intellectual sense.


a. The state has licensed us for 20 years.
b. We have data to prove our safety record and efficacy.
c. It makes total sense that we should be covered
according to the same terms as physicians given our education and the
fact that we are licensed to perform the procedure by the same board
that licenses physicians.
d. It's elegant, there is dignity in it, and puts us in
the position to negotiate.

II. It creates an allegiance with physician acupuncturists
(after it passes) and in every negotiation going forward they will
have the same things to gain and lose as we do so we can work together
as colleagues which is how it should be.

III. It lets the free market work! As Companies like Harvard
Pilgrim demonstrate the benefits of covering acupuncture and CM, other
companies will want to, and have to, compete with them. This puts the
onus on us to prove ourselves rather than asking the state for an
across the board mandate-but no specific valuation of our education,
medicine, or services.

IV. I think this bill offers a perfect balance of coverage on
the one hand and valuation on the other. It just plain makes sense.



Questions I would like answered about insurance coverage:


1. If the current bill passes what leverage to we have to negotiate
terms with? (none that I can see but please enlighten me).
2. If I pay someone to do billing for me, do I have to pay their
Social Security and health insurance too?
3. When insurance companies reimburse in 15 minute increments do I
have to go into the room and stick a needle in every 15 minutes to get
a decent rate of pay? Harvard Pilgrim reimburses an extra 20% or so if
you hook the patient up to Estim. What are the ethical implications of
this? Why are services worth $16 more each session if I put 5cents
worth of current into the patient's body-a procedure that many in our
profession would feel was antithetical to the patient's health?
4. To what extent will we have to treat the patients symptoms vs. just
noting my true CM diagnosis and treatment plan?
5. TO what extent does insurance value WELLNESS care which, after all
if what CM really is about?