The following is an updated version of an article I wrote for the April issue of Santa Fe’s Green Fire Times.
Although New Mexico is considered a poor state, we have a wealth of options for healthcare that many other parts of the country can hardly imagine. How can we turn this wealth into not only better health outcomes but also a brighter economic future?
There is broad agreement at every level of society that maintaining wellness is better and cheaper than trying to fix things that have already gone wrong. However, the market forces that we allow to rule, more often than not, work against this ideal. For example, if people use at-home methods of preventing influenza, huge profits can’t be reaped from selling millions of flu shots. That’s horribly backwards because healthcare costs are eating our country alive. There is very little that is healthy about our “healthcare” system, financially or otherwise.
In Oriental medicine we think in terms of keeping patients well through educating them about diet, emotional balance and the like. A famous proverb says that the mediocre physician cures illness, the good physician prevents illness, and the superior physician teaches people how to live so that they stay well. We’re also told that in ancient times doctors were paid when people stayed healthy, not when they got sick– the original HMO plan! Unfortunately, things have changed quite a bit, and despite efforts in that direction, so far our modern system hasn’t figured out how to pay healthcare providers for having patients who don’t need treatment. But if we can somehow manage this kind of emphasis on wellness instead of sickness, our healthcare costs will surely drop. Many of our most financially draining patients are those with largely preventable chronic diseases like Type 2 diabetes. We know we have to get such “lifestyle” illnesses under control. Oriental medicine is an excellent framework for doing that.
To a large extent health insurance has ignored wellness-based care, and our Health “Maintenance” Organizations even specify in their plans that they don’t cover treatment intended for maintenance. We do have a relatively good situation in our state, in which acupuncture and some other aspects of Oriental medicine are covered, albeit sometimes poorly, by insurers based in NM. However, there is no Medicare coverage at all, and Medicaid is limited to a few special circumstances. This means that many of the people who could benefit most are left out.
And then there is the geographic problem. Medical care of all types is scarce and often of poor quality in the less-populated parts of the state, and non-mainstream care is even harder to get. (I am the only provider of acupuncture in a large swath of western NM, and I’m only there once a week.) This is exacerbated by the fact that those areas tend to have a higher proportion of low-income people.
Could financial incentives help with getting more providers into rural areas? So far, that hasn’t seemed to be enough. MDs are already paid much more in some underserved areas, yet it’s hard to get them to go and live there. Doctors and nurses can get their student loans forgiven if they practice in such places for a certain period of time. While that’s a good idea, it doesn’t encourage practitioners to put down roots in a community. And Doctors of Oriental Medicine aren’t eligible for this help with their loans. Still, there are a great many DOMs, and we do a lot of primary care. In a state that is short on MDs, there must be a way to use us to fill some of the gaps.
The Affordable Care Act mandates that states must have health insurance exchanges in place by 2014 to make coverage available to most of the population. In New Mexico, it looks like acupuncture will be included as an essential health benefit. This should make a real difference in access for our citizens– when it happens, which may not be the date originally prescribed. At the 11th hour of the 2013 session, our state legislature finally came up with a plan for an exchange. However, the plan that emerged was a compromise that left out consumer protections that many legislators wanted.
The health insurance exchange plan, alas, will leave the insurance companies in charge no matter what the details are. It will also contribute to high costs by adding even more plans to the mix– the cost of dealing with a multitude of plans is a huge reason why American medicine is so expensive. Analyses done so far say that this approach is unaffordable for our relatively small population. New Mexico does have another option, one that’s homegrown and tailored for us, one that enjoys wide support around the state. The Health Security Act, which was submitted yet again in this year’s legislature, provides a framework that could cover most of us and have a real shot at controlling costs. The exchange could morph into a more efficient model like this if we ever muster the will to do it. This year the HSA did very well early in the legislative process, and looked as if it would at last come to the floor for a vote. However, political infighting involving some of Health Security’s formerly loyal “friends” (Reps. Stewart and Garcia, you know who you are) prevented the bill from reaching the House floor.
If we in New Mexico and elsewhere continue to destroy our chances to build a workable health care system on the basis of greed or because of petty, short-term concerns, then we deserve what we get. We can do so much better.