Alternative medicine omitted from Clinton plan

December 04, 1993|By John Fairhall | John Fairhall,Staff Writer

Tom Peterson stretched comfortably across an examining table at the Centre for Traditional Acupuncture in Columbia, thin needles sticking out like quills from his forehead, feet, hands and bare chest.

It was just a "checkup," said the 62-year-old Baltimore resident, who started acupuncture years ago to treat chronic hay fever. "I still have it, but it is much milder."

Although tens of millions of Americans like Mr. Peterson have turned to acupuncturists, chiropractors, massage therapists and other practitioners of alternative medicine, they would not get any encouragement from President Clinton's health reform legislation.

The president's bill maintains the supremacy of traditional medical doctors, longtime foes of alternative medicine, while explicitly recognizing only one alternative practitioner, the nurse-midwife.

That decision was a disappointment for many advocates of alternative medicine, who met with White House officials in March and expected the Clinton plan would allow them to compete more effectively with traditional medicine. They say the reform legislation falls far short of the revolution in health care they believe is needed.

The administration "really lost an incredible opportunity for creating a new agenda" that would emphasize diet, exercise, self-awareness, relaxation and other behavioral changes that people can do for themselves, says Dr. James S. Gordon, president of the Center for Mind-Body Medicine in Washington, an educational organization that encompasses health's physical, emotional, social, environmental and spiritual components.

For patients, the Clinton plan would mean most would continue digging into their own pockets for alternative treatments -- something an increasing number are already doing.

Clinton administration officials, while acknowledging they are not pushing for alternative medicine, insist their plan does push health care in a new direction, stressing prevention by providing for regular checkups, diagnostic procedures such as mammograms and services for pregnant mothers and children. Alternative-care advocates laud these steps, but say they don't do anything to change the focus of medicine from costly treatment with surgery and drugs to less invasive techniques designed to prevent illness.

Some alternative health practitioners fear that the Clinton plan could even cause them to lose ground because it would encourage people to join "managed care" groups like health maintenance organizations. Although administration officials believe HMOs are the most efficient models of care, critics say they are controlled by traditional medical doctors who limit patients' access to other kinds of practitioners.

In Maryland, for example, two of three HMOs run by Blue Cross and Blue Shield don't cover acupuncture.

Harvey Kaltsas, president of the American Association of Acupuncture and Oriental Medicine, warned Mr. Clinton in a letter in October that "acupuncturists may not be included if the choice . . . is left up to the voluntary decision of doctors and insurers."

Chiropractors want a written guarantee that their services will be covered in a system dominated by HMOs, because those insurance plans have "historically not included doctors of chiropractic," says Paul Kelly, director of government relations for the American Chiropractic Association. It's "far from guaranteed that the 19 million chiropractic patients are going to be able to use chiropractors" under the system proposed by the president, he says.

This possibility alarms chiropractic patient Donald Bauer of Catonsville, whose insurance pays for treatment of lower back pain that medical doctors were unable to improve. He warns would-be reformers of the health system: "If it's not broken, don't fix it."

Clinton administration officials have made clear they won't fight for alternative medicine.

Health and Human Services Secretary Donna E. Shalala told a Senate committee in October that the administration would leave the issue to the 2-year-old federal Office of Alternative Medicine, which is just now funding research into the effectiveness of unconventional therapies. "One of the wonderful things about that Office of Alternative Medicine is it will, over time, change our attitudes and the kinds of medicines and approaches we use as part of health care," she said.

The Clinton plan spells out a long list of insured services to which all Americans would be entitled, but it doesn't specify which practitioners will provide them. It leaves this decision to the states and to "health alliances," regional organizations that the Clinton plan would create for the purpose of collecting

premiums and negotiating coverage for consumers.

This also worries alternative-care practitioners. Many states -- under pressure from the medical establishment -- have blocked their efforts to become licensed and to be covered under insurance plans. Alliances, which would be governed by state appointees, would become a new battle ground.

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