National Health Policy Debate Gets Underway

By Elisa Behnk, AAAOM SO VP, Communications

What’s AOM Got to Do with It?

Health care has been headline news in Washington, D.C. during the past month, and acupuncture and Oriental medicine (AOM) has been one of the vocal stakeholders at the table where health-care reform issues are now being hammered out.

With numerous Senate hearings, a White House summit (March 5), and a “Summit on Integrative Health” (February 25-27) at the National Academy of Sciences (NAS) by the Institute of Medicine (IOM), it has been a breathtaking several weeks. There is excitement in the AOM community – a time of both challenge and opportunity – a good time to understand and engage in the future of medicine and health.

First, a quick recap of the significant health events over the past few weeks, and then two simple questions:

President Obama Vows to Pass Health Care Reform in ‘09

On February 24 President Obama announced his intention to pass comprehensive health care reform legislation this year. The cornerstone of the plan, he said, must be “wellness and prevention” to keep people healthy and reduce crippling costs.

“Fixing what's wrong with our health care system is no longer just a moral imperative, but a fiscal imperative,” he said when dedicating $634 billion of economic stimulus to the task—a sum he later called a down-payment for what is likely to be a $1 trillion system overhaul. (Note: Congress passed the administration’s stimulus legislation on February12 with $1 billion dedicated to prevention and wellness and another $1.1 billion to comparative effectiveness studies.)

Health care reform has proven to be an insurmountable challenge in the United States since the 1940s. President Obama appears to be working hard to avoid the mistakes that foiled reform when it was last undertaken in 1993-94. His approach brings together lawmakers, special interest groups, and the public in order to mine personal and professional experience, and to propose and debate approaches.

When the President followed up his February 24 announcement with a March 5 White House health care summit, he took this opportunity to bring together 120 members of the pharmaceutical, insurance and medical establishments along with lawmakers, corporate and labor leaders, and seven citizens who participated in the Transition Team’s community discussions on health care.

While the event placed health care reform on the national agenda for this year and was praised as a positive step by Congressional members on both sides of the aisle, any notion of a government-run health care system immediately began to divide opinions along party lines.

Top Scientists Convene Meetings on “Integrative Health”

The President’s late-February announcement coincided with a February 25-27 series of unprecedented Institutes of Medicine (IOM) Summit on Integrative Medicine at the National Academy of Sciences.

Well over 600 attendees packed the IOM Summit hall in Washington, D.C. AOM representatives—including Will Morris, former (AAOM) president and current president of the Academy of Oriental Medicine in Austin, TX, and Carla Wilson, former AOM Alliance president—were among the many practitioners, educators and researchers from a broad spectrum of health and social sciences.

“We are now at a great moment of change and transformation in AOM,” said Ms. Wilson during the IOM Summit. “We have the possibility of engaging in trans-disciplinary health care that will enable us to reach more people and impact the health of the nation.”

To thunderous applause, Senator Tom Harkin (D-IA), a long-time champion of integrative health, said, “I will do everything I can to place integrative health at the front of the agenda.”

Together with the Bravewell Collaborative—a heavy hitting, well-connected group of philanthropists focused on transforming healthcare—the IOM tee’d up an agenda of high-profile panelists to discuss and debate the science, issues, and potential new models for integrative health and healthcare legislation.

Here, the phrase “integrative health” virtually replaced the standard “complementary and alternative medicine (CAM)” moniker, which was rarely heard throughout the days-long discussions.

Much of the focus was on research and the evidence base for both alternative and allopathic healing methods. As IOM President Harvey Fineberg emphasized in his keynote speech, "We need to apply the same standard of evidence to what will and will not work in healthcare."

Highlighting the fact that corporate employers and many other stakeholders in the healthcare debate favor new directions, Reed Tuckson, MD and EVP of Medical Affairs for UnitedHealth Group, noted the historic opportunity for change, saying, “Employers have no stake in perpetuating disease.”

Senate Hearings Focus on Prevention and Wellness

On February 23, Senator Barbara Mikulski (D-MD), co-chair with Senator Edward Kennedy (D-MA) of the Senate Committee on Health, Education, Labor and Pensions (HELP), opened the Working Group on Health Quality hearings by announcing that the committee would examine the principles of integrative healthcare to “design a new healthcare format for the United States.” The Senator emphasized that to transform healthcare, we must address the environmental impacts of disease, focus on prevention and wellness, and engage the private sector to ensure an economically sustainable model.

The first of two hearings, Monday’s panel featured ten distinguished health experts in research, education and business, who provided testimony on substantive health outcomes and the economic benefits of integrative health programs already in place around the world. Robert Duggan, President of Tai Sophia Institute in Senator Mikulski’s home state of Maryland, provided testimony on the power of wellness and prevention as an orientation to healthcare and the need for advanced wellness coaching education.

Establishing a White House Office of Wellness was chief among the panelists’ recommendations. The office would be charged with ensuring that the new health system is focused on patient health rather than insurance reimbursement, informed by research on measurable health outcomes, and truly integrated to draw upon the wellness practices of healing traditions together with contemporary medical interventions.

Testimony from Cathy Baase, MD, global director of Health Services, Dow Chemical Company, drew particular attention with regard to the economics of prevention and wellness. Dr. Baase reported that, by developing a culture of wellness and prevention, Dow Chemical expects to add ten cents per share to the company’s bottom line through reduced sick days, reduced healthcare costs, and increased productivity. Senator Mikulski reiterated this as proof of the efficacy of wellness and prevention programs and, further, recommended that Dow’s program serve as a demonstration model for healthcare reform programs. Senators and their aides described the hearings as “watershed” and “a turning point” for health and health care policy in the United States.

Senator Harkin “Lays Down a Marker”

A related Senate hearing was held February 26, convened by Senator Tom Harkin, who chairs the working group on Prevention for the HELP Committee. In it Harkin said, "I want to lay down a marker: if we fail to seize this unique opportunity to adopt a pragmatic, integrative approach to health care, then that … would constitute a serious failure."

The hearing featured testimony from four outspoken “health pioneers”—Andrew Weill, MD; Mehmet Oz, MD; Dean Ornish, MD; and Mark Hyman, MD—who spoke of the missing elements in today’s health care system: simple wellness practices such as deep breathing, sensible food and exercise choices, the sense of personal responsibility for one’s own health, and solutions to many unhealthy urban and suburban environments.

Senator Harkin introduced Berkley Bedell, the retired Democratic congressman from Iowa who had contracted Lyme disease and sought alternative therapies for it and, later, prostate cancer. In 1992 these events prompted Harkin to propose legislation for what is now the National Center for Complementary and Alternative Medicine (NCCAM) to investigate alternative therapies. The senator noted that he considers NCCAM a failure, stating that, “Most of its focus has been on disproving things, rather than seeking out and proving things."

In the weeks after the hearing critics of NCCAM seized the opportunity to call for the closing of NCCAM as part of comprehensive health care reform, citing its $122 million a year budget as an exercise in “pseudoscience.” NCCAM Director Josephine Briggs, MD, who took the helm in January 2008, has countered such arguments by citing statistics from the National Health Interview Study (NHIS) indicating that Americans are increasingly turning to CAM in particular for effective relief of musculoskeletal problems such as back, neck, or joint pain.

Senate Finance Chair Baucus Focuses on Health Economics

In March, health care reform debates moved into the realm of finance. On March 10 the Senate Finance Committee—led by Senator Max Baucus (D-MT), chair of the Senate Finance Committee, and Senator Chuck Grassley (R-IA), ranking Republican member—heard testimony by Peter Orszag, PhD, director of the White House Office of Management and Budget, on the president's health care proposals for the 2010 budget.

Dr. Orszag described President Barack Obama's strategy as "moving the nation toward the proven and successful practices adopted by lower-cost areas and hospitals," investing in information technology, conducting comparative effectiveness studies, moving away from Medicare’s fee-for-service system, and promoting prevention and wellness. To provide health coverage to the uninsured, the necessary funding would come from reduced Medicare and Medicaid payments to health providers and reduced tax breaks for high-income couples.

Senators Grassley and Baucus announced their intent to pass health reform legislation by early July, 2009. Looking forward to swift legislation passage, Senator Grassley said that Republicans and Democrats agree on 80% of proposed changes to the health care system, and that a third way needs to be found for consensus among the other 20%.

Kudos and Concerns

While there is much for AOM students and professionals to celebrate in the health reform stories of the past month, there is no a glass slipper just our size that Congress and the Obama administration are looking to AOM only to fill. AOM is part of the discussions and some AOM practices were validated in the Congressional hearings and at the IOM summit.

It’s a start. From here it is clear we stand on the shoulders of giants—the practitioners and educators who have earned respect for the work we do.

From these events a number of key themes arose that, at the outset, seem to resonate well with AOM practices:

Concerns arise as well:

As students of acupuncture and Oriental medicine, what are we now creating as a legacy for students 10 years from now? How are we serving our communities? And, how can we demonstrate the value and benefits of this work for policy decision makers who, at this very moment, are determining how we will practice and conduct business in the coming years?

“Demonstration models” are out there. What are you doing and what is working effectively in your community? The AAAOM Student Organization would like to hear more.

In March, AAAOM hired a Washington lobbyist [link to web announcement] to work closely with legislators and health care allies to advance AOM interests and discern new opportunities. You can support this work now by contributing just $10 per month to the AAAOM Political Action Fund.

You can meet AAAOM’s new lobbyist and learn more about the AAAOM legislative agenda in April by joining AAAOM in Sacramento, CA, for Acupuncture Awareness Day on April 23. It is a great chance to engage in the current health care discussion at a state level to learn the concerns of legislators and the public.

If President Obama and the Congressional committees are realistic in targeting July for passage of health care reform legislation, the next few months are sure to be eventful. Now is the golden hour for AOM students to join the discussion. Tell us what you, your colleagues, and your school are doing to promote AOM in the new healthcare world.

Elisa Behnk, AAAOM SO VP of Communications, can be reached at behnk@mac.com.