A broader definition of healthcare

Acupuncturists, dietary-supplement makers and other alternative health practitioners, some of whose treatments are considered unproven by the medical establishment, would be brought more squarely into the mainstream of American medicine under the health legislation now before the Senate.

The legislation would allow doctors to incorporate alternative health providers in some treatment plans. It also includes language that some believe could require insurance companies to expand their coverage for alternative therapies, on which Americans now spend $34 billion a year.

Insurers and some scientific watchdogs say the measure would undermine one of the central principles of the healthcare overhaul: that the system cut costs by eliminating medical treatments that aren’t proven effective.

“These provisions are anti-science and anti-consumer,” said Dr. Steven Novella, a professor of neurology at Yale School of Medicine, who is mobilizing opposition to the Senate bill.


The leading champion of these measures is Sen. Tom Harkin (D-Iowa), chairman of the Senate Health Committee, who credits bee-pollen pills with curing his seasonal allergies. He is also the leading recipient in Congress of campaign donations from chiropractors and dietary-supplement makers.

Harkin’s staff says he supports healthcare that has shown itself to be effective.

“Sen. Harkin has done everything he can to ensure that supports for proven preventive practices, be they traditional or complementary, are included in this bill,” said spokeswoman Bergen Kenny, referring to a version of the legislation that cleared Harkin’s committee over the summer.

The provision that has provoked the most concern among insurance companies and doctors says that insurers “shall not discriminate” against any healthcare provider who is licensed by the state.

Insurance industry officials say it could mean that if they cover a physician’s treatments for back pain, for example, they must also cover treatment by any other state-licensed health provider or risk a legal challenge.

California licenses acupuncturists, chiropractors and naturopaths, who use supplements, nutrition, medicinal plants, exercise and other techniques to promote health.

Many states require insurers to cover alternative therapies, but the rules vary. For example, 12 states mandate coverage of acupuncture treatments. Every state but four mandates coverage for chiropractors. California mandates coverage for both.

“These are practices that are well-established,” said Beth Clay, a lobbyist who represents acupuncturists. “They’ve been around for decades or centuries. They are regulated, as is appropriate for medicine, at the state level.”


However, Amber Pasricha Beck, a spokeswoman for the California Medical Assn., expressed concern about the Senate provisions, saying: “They raise red flags because they could potentially open the door to practitioners with less training and expertise, which could endanger patient safety.”

Insurers also dislike the provisions. “Requiring health plans to provide access to unproven therapies would increase costs and reduce the quality and safety of patient care,” said Robert Zirkelbach, spokesman for the health insurers trade association in Washington, America’s Health Insurance Plans.

The American Medical Assn. has been largely muted in its response to the Senate provisions. But a coalition of 19 physician groups wrote to Senate Majority Leader Harry Reid (D-Nev.) to protest the “nondiscrimination” provision, claiming it “would create patient confusion over greatly differing levels of education, skills and training among healthcare professionals.”

The Senate bill defines health professionals to include chiropractors and other alternative practitioners licensed by states. It provides grants to create teams of health professionals who would collaborate on patient care. The teams could include alternative healthcare providers and might even be led by those providers -- a feature that some physicians say could be dangerous.


The Senate bill also would create a pilot program in 10 low-income communities to draw up “wellness” plans for people at risk of preventable conditions, such as obesity. The plans may include nutritional counseling and stress-management counseling, as well as dietary supplements.

Makers of supplements, which unlike pharmaceuticals are not subject to federal drug-testing standards before they are marketed, pushed for the pilot program. Its inclusion would enhance the credibility of supplements and, manufacturers say, introduce them to lower-income consumers.

The battle over the Senate bill is part of a decades-long struggle between alternative healthcare providers and the medical and insurance establishments.

In the early 1980s, lobbyists pushed successfully for federal health plans to cover nonmedical specialties such as chiropractic care. More recently, makers of dietary supplements lobbied without success for federal food stamps to cover their products.


During the first half of 2009, chiropractors, supplement makers and other advocates for alternative therapies spent nearly $870,000 lobbying lawmakers, according to data compiled by the Center for Public Integrity, a nonpartisan research group.

Over the years, they have cultivated a small coalition of loyal supporters in Congress, including two senior members of the Senate’s health committee, Orrin G. Hatch (R-Utah) and Barbara A. Mikulski (D-Md.).

Harkin has also been an especially important supporter, particularly since he became chairman of the Senate’s health committee after the death of Sen. Edward M. Kennedy (D-Mass.) earlier this year.

Harkin negotiated the “nondiscrimination” language. And the “wellness” pilot program that includes dietary supplements “is in there because of Sens. Hatch and Harkin,” said Daniel Fabricant, who heads the Natural Products Assn., a dietary-supplement trade group. “Because they are believers.”


“Tom Harkin did a wonderful job this year,” says John Falardeau, the Washington lobbyist for the American Chiropractic Assn. Chiropractors have donated more money to Harkin -- more than $150,000 during his career -- than to any other member of Congress, according to the nonpartisan Center for Responsive Politics.