What's old is new again: Chiropractic's current troubles with Medicare are rooted in past struggles

Journal of the American Chiropractic Association, May 1999 by McAndrews, George

While chiropractic has faced repeated attacks by the medical establishment over the years, one of the most hostile-and potentially effective-has always been the effort to undermine the professions inclusion in insurance programs. The medical establishment tried, and failed, to accomplish this before, but it's happening again now with the proposed Medicare Part C (Medicare Choice) regulations, said attorney George McAndrews, who is spearheading the American Chiropractic Association's legal efforts against the Health Care Financing Administration (HCFA).

The fact that Medicare is a publicly funded program, subject to congressional mandates regarding covered services, makes this latest attack even more serious. By failing to comply with congressional language and provide beneficiaries with access to chiropractic services from chiropractors, Medicare HMOs are not only disobeying congressional intent, but also misappropriating taxes. "My attitude is that money has been stolen," said McAndrews, who spoke recently at the ACAs National Congressional Leadership Conference (NCLC) in Washington, D.C.

McAndrews told the chiropractors and students gathered at NCLC that he believes a congressional oversight committee should be formed to investigate where the money that should have gone to chiropractic, and the patients who need it, has gone. He pointed out that a preliminary survey of 10 managed care organizations (only four actually reported data back) conducted by HCFA, after the filing of the lawsuit, found a steep drop in the use of chiropractic when Medicare beneficiaries joined Medicare HMOs and were subject to referrals by medical doctors acting as gatekeepers for specialty services. In fact, the survey results show chiropractic utilization dropped from four percent in Medicare fee-for-service to less than 0.5 percent in the Medicare MCOs having a medical physician gatekeeper. HCFA is currently conducting a followup survey, the results of which will be reported to Congress. ACA expects the results to track those in the preliminary survey.

McAndrews criticizes the MCOs for denying chiropractic benefits, but he also places blame on HCFA for not doing its job to make sure that Congress' directions are followed. "You just don't funnel tax dollars through an HMO and let them do what they want," he said. "This is horrendously illegal, what has taken place....This has been an outrageous assault on congressional intent."

Past is Prologue

As it happens, the current assault may be more based in the past than is initially apparent. McAndrews pointed out that medical doctors who were involved in the effort to eradicate chiropractic back in the 19&Os and 1970s were involved with the Department of Health, Education and Welfare-which is now the Department of Health and Human Services.

In the years leading up to chiropractic's 1972 legal victory in Wilk vs. AMA, McAndrews uncovered evidence of a vast and organized plan by the American Medical Association (AMA) and other conspirators to eliminate chiropractic and discredit chiropractors.

The plan was originated in 1962 by the Iowa Medical Society, which issued a list of recommendations for dealing with the "Chiropractic Menace." (The crudeness of the language used against chiropractors in the plan, which was adopted by the AMA in 1963, caused some physicians to later apologize to McAndrews after the case was over.)

The AMAs strategy encouraged activities such as:

Encouraging chiropractic disunity;

Undertaking a positive program of containment;

Encouraging ethical complaints against chiropractors;

Opposing chiropractic inroads into health insurance, workers' compensation programs, hospitals, labor unions and more;

Containing the growth of chiropractic colleges; and

Never giving professional recognition to chiropractors.

The AMA intended the plan to be carried out surreptitiously, from "behind the scenes whenever possible."

Those who served on the special committee the AMA established to execute the plan operated so that the AMA's "hand would not show."

As a result of the AMA's efforts, chiropractic's inclusion in the Medicare program was delayed for five years. This in turn had an influence on how chiropractic was perceived by other insurance and health care plans.

"But something happened; you people were successful," McAndrews said. "People flocked to chiropractors."

The rise of alternative health care has also turned the tide in respect to the medical establishment's current posture toward chiropractic. McAndrews explained that today the issue is about "turf," and the potential dollars that can be made by offering patients alternative health care options one of the most popular of which is chiropractic.

Nonetheless, he emphasized, chiropractic services delivered by non-chiropractors is not what Congress intended when it included chiropractic in the Medicare program. "There isn't any question," McAndrews pointed out. "In my opinion, this is a continuation of the effort to destroy this profession."