The outcome of the recent presidential election should have been a surprise to no one. It certainly was no surprise to ICA. Early on in this political year, it was obvious to our political and legislative staff that this was going to be a year of great change, both in personnel and in direction for our nation. For many months, we've been working closely with the Clinton/Gore campaign staff and will continue this relationship as the transition to a Clinton administration gets underway.
The president-elect appears to be holding to his pledge to submit to Congress a national health care reform initiative within the first 100 days of his administration. The Clinton/Gore campaign platform was not very specific in this area. They have pledged to provide coverage for those in America who are presently uninsured. They have vowed to work to cap health care costs. They have expressed an interest in standardized billing and electronic claims filing to reduce administrative costs and improve service.
The president-elect how has his health care transition team in place, and the process of drafting detailed health reform initiatives as promised in the campaign is about to begin. Three working groups have been organized by Clinton and will operate under the direction of Judith Feder, who is on leave from her job as co-director of Georgetown University's Center for Health Policy Studies, and Atul Gawande, who directed health policy issues during the campaign:
Prior to assuming her new responsibilities, Judith Feder had written articles favoring strict government regulations and price controls for health care. There are concepts, however, that Mr. Clinton may not favor since he came out hard for "managed competition" in the closing days of the campaign. Managed competition is a rather vague approach in which the federal government mandates coverage and insurance plans compete in the marketplace to offer the most attractive package to employers who are obliged to provide coverage for their employees. The government will assume responsibility for the unemployed, either through an enhanced and revised Medicaid program, or through some new mechanism. This view is favored by conservative Democrats and many in the business community.
No matter what direction the Clinton team chooses, the difficult budget situation, coupled with a divided and uncertain Congress, will have far more to do with the final outcome, if there is one, than the president-elect. Already, groups within Congress are organizing to shape health care reform according to their respective visions. One influential group of conservative Democrats, lead by Texas Representative Mike Andrews and Louisiana Senator John Breaux, is planning to push the managed competition concept according to the outline of Tennessee Congressman Jim Cooper's bill from the last Congress, the Managed Competition Act.
Provider groups and some public interest groups are concerned that the planning process has already become too exclusionary and dominated by academics and theorists who have a limited understanding of how possible reforms will impact the patient and the actual delivery of care. In the final analysis, only an actual field test will tell what reforms are likely to be most effective. However, the inclination among most Clinton transition planners seems to be for universal, standardized solutions with little room for experimentation. Some groups and policy officials, particularly democratic governors, would like to see the federal government propose a series of options for covering the uninsured and then allow the states to select and implement the solution which appears to best fit local needs and conditions.
Does chiropractic have anything to fear from a Clinton administration? An inactive, self-isolated, politically ignorant and confused chiropractic profession certainly does. An aggressive, positive, well-informed and politically active profession does not. Every member of the chiropractic profession must play an active part in this process because success in national health policy is entirely dependent on the strength and nature of the message the grassroots of our profession sends to Washington.
In the months ahead, ICA will work to:
There will always be surprises in the legislative and political arenas where health care reform and national health policy will be forged. Some surprises will be good and some will be bad. Under all circumstances however, ICA has an obligation to provide each individual DC with the information, timely warnings, and a plan of action to turn every challenge into an opportunity and every opportunity into progress.
R. James Gregg, D.C.
ICA president
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
