The right of Americans to choose acupuncture and Complementary Medicine in insurance coverage and in governmental health services has long been hampered by failure of our government to finally recognize these low cost and effective health services and mandate coverage options. Currently, popular demand and government interest have resulted in voluntary coverage of a limited nature to our nation's health plans, but often the patients are confused as to the actual coverage benefits and procedures, even when they pay for these options. Passage of fundamental coverage legislation is all important for the the profession to achieve the ability to serve US citizens without discrimination, and to achieve freedom of choice in healthcare. Currently, the mandated government insurance exchanges in each state are encouraged by the federal Affordability Care Act to provide coverage for the acupuncture profession and Complementary Medicine, but each state sets its own rules, and the individual insurance companies may also adopt confusing rules of coverage. The federal acupuncture coverage act has failed to be allowed to emerge from committee for a vote in one form or another since 1992, due to healthcare industry lobbying. In 2014, this bill is sponsored by a Republican, Congressman Christopher Gibson, and has been narrowed in scope, but still has zero chance of emerging from the committee or being enacted, according to govtrack.us. HR 3799 will not cost the federal government any money, but will provide a freedom of choice in Medicare and the Federal Employees Health Benefits Program for individuals, a hallmark of a free democracy. More importantly, this legislation serves as a benchmark for the insurance industry to provide guidelines for acupuncture profession coverage that are uniform, fair and well-regulated. Not only this bill, but also the long-delayed acupuncture professions code, must be supported by the public for this freedom of choice in healthcare to be finally enacted. The acupuncture profession has virtually no lobbying to speak of currently, and depends completely on the public initiative to overcome the big bucks of the healthcare and insurance lobby. So far, there has been little awareness and very little public support in the form of emails, letters and phone calls to their congressmen. This issue is important for both Democrats and Republicans, as well as the majority of the voting public, the independents.

Currently, the cost to the average family and individual for healthcare in the United States far exceeds any other developed country in the world, reaching annual insurance fees and increasing taxation and federal deficits that are unsustainable.

The United States has just 5 percent of the world population, yet consumes about half of all prescription medication in the world, with newer medications rising astronomically in cost, and our healthcare system is increasing focused on more and more pharmaceutical medication. More money spent is not translating into better care, though, or better statistics in disease prevention, quality of life in aging, or even infant mortality. With a rising income disparity the health care industry is producing a system where the richest citizens are able to pay rising out-of-pocket expenses that supports a too-expensive system of healthcare, and a crisis is looming for the aging baby boomer population and the majority of the population now in a lower economic status. A two tiered healthcare system is also being created, with concierge practice and special luxury hospital wards being built, and the removing of public hospitals in poor neighborhoods. The Affordable Care Act was a necessity, not a partisan political act, and it has lowered the rising cost of healthcare to a percentage less than inflation from 2009 through 2013, and provided a way for most Americans to be insured. It is now up to the citizens of the United States to adapt to this changing healthcare paradigm shift, utilizing a more proactive approach to managed healthcare costs, and not just trying to generate as much spending as possible for the insurance and government coverages. Integrating Complementary Medicine into this plan is very important, as this low-cost and proven medical specialty provides more direct care, better disease prevention, almost no adverse health effects from treatment, and better quality of life. By utilizing Health Spending Accounts, Health Savings Account (HSA), and Flexible Spending Accounts (FSA) as tax-advantaged and employee benefit programs to help pay for Complementary Medicine within a framework of higher deductibles and out-of-pocket spending, the majority of the citizens of the United States will be able to receive better healthcare at a lower cost. Of course, choosing the physicians in Complementary Medicine to provide the best and most specific services, and using these physician skills in the most efficient manner is the challenge.

Complementary Medicine and acupuncture is now mandated in the European Union, and an integral part of the health system in Australia, Brazil, Japan, Korea, and many other developed nations, including, of course, China. Studies in these countries have revealed that Complementary Medicine is a cost effective addition to standard health care, and in fact has lowered national health care expenditures. Complementary Medicine and acupuncture is recognized as evidence-based and effective by the U.S. National Institutes of Health (NIH) and the World Health Organization (WHO), and is one of the 28 categories of medicine within the NIH, yet politics still hampers the official recognition of this profession by the federal government and the Medicare system. The U.S. federal government still drags its feet on recognizing the acupuncture profession in the business and professions code, and this can only be attributed to lobbying efforts at this point in time. The public can step up and make clear that this situation is no longer acceptable, demanding that the acupuncture profession be granted recognition with a business and professions code, be recognized as a scientifically proven and accepted medical specialty in Medicare, and be mandated as a free choice of patients in medical insurance coverage. Acupuncture and related physiotherapies are legally recognized as evidence-based and effective treatment protocols in medical practice guidelines in California and New York, and should be given legal support by our federal government to insure that this low-cost and effective practice is an option for citizens who choose it. This would not only promote patient choice and freedom in health care decisions, but would reduce the high costs of healthcare in the United States overall, providing low-cost and effective options for those who choose this type of treatment to be integrated with their standard care.

The National Coalition on Health Care (Affordable-Sustainable-Fair) reported in the year 2012 that health care spending in the United States reached an all-time high of 18.2 percent of of GDP (Gross Domestic Product). This is the highest spending per capita in the world, yet we are no longer delivering the best care, and it is widely acknowledged that countries such as Japan, which spent just 10 percent of its GDP on healthcare in 2012, provides better care and satisfaction, and much less stress in obtaining healthcare for all individuals in their country.

Despite a subdued increase in the rise of healthcare cost per person after the Affordability Care Act was initiated, from nearly 10 percent per year to just 2.2 percent in mid-2011, and 5 years of lowered growth, with just 3.7 percent healthcare spending growth in 2012, just below inflation, the health care industry continued to create jobs at a healthy rate (30,000 in August of 2011), and health care (2013) now accounts for 10.8 percent of total employment, an all-time high. Dire predictions of a massive increase in government health spending, and a negative effect overall on the economy, attributed to the ACA, have not come true. In fact, the first 5 years of gradual initiating of the ACA have resulted in the lowest growth rates of healthcare spending in both the private sector and Medicare/Medicaid in our history. Despite the negative reporting, the health care reform efforts by the entire country, public and private, are working towards the goal of better health care and lowered costs, which should be an ongoing process. This is just the beginning of what is needed, though, not the end game.

Physicians for a National Health Program reported that in 2011 we are spending about $8650.00 per person on health care in the United States, totalling $2.7 trillion. By 2014, Forbes reported, with different methods of calculation (adding the annual costs of Sustainable Growth Rate and the Deloitte additional and imputed costs), that the estimated total healthcare spending in the United States will hit $3.8 trillion! With the ANA, the Congressional Budget Office estimated that the Sustainable Growth Rate changes cost $116 billion so far, much lower than expected, and that expectations are high for a 2014-15 rewriting of the curren Medicare physician payment formula. This spending on health care is much higher in the United States than any other country, with comparable systems in Europe, Canada and Asia spending between 8-11 percent of GDP (Switzerland, with a system very similar to the eventual so-called fully implemented “Obamacare", reports health care costs at 11 percent of GDP, not 18). The choice is not between healthcare affordability or negating this affordability by repealing the ACA, as the politicians in our neurotic binary system portray it. Improvements and reform should be ongoing, with good ideas and workable systems supported by all of us, a truly United States of America. The ways to achieve a lowered total cost and still maintain the best possible health care are many. One of these ways to achieve the goal is to integrate Complementary Medicine, a low-cost, effective, and preventive specialty in health care, and continue to improve this branch of our medicine. Both private and public efforts may be implemented, and individual choices are important in this progress. Complementary Medicine, especially Traditional Chinese Medicine (TCM) and Naturopathy, needs to be transformed from a type of luxury afforded to very few in our society, to a real and effective integrative medicine for all, that achieves great goals in helping cure and prevent disease and injury. The way that this medicine is supported by the individual guides this progression.

Fixing our broken healthcare system and the unfortunate high cost of healthcare for working families in the United States, and a leading contributor to our massive federal deficit, will not happen in just a few years. While healthcare spending increases hit all time lows after the enactment of the Affordable Care Act (ACA), staying below inflation, and now the rise in GDP, for 5 straight years, this is expected to change with the full implementation of the ACA and expanded coverage, as well as a large shift in demographics to an aging population. Unless the public continues to refine healthcare spending and utilization, total health spending is expected to consume an unsustainable 20 percent of the U.S. Gross Domestic Product by 2022, creating an even larger share of household income going to insurance and taxation. By continuing to exert individual control over healthcare spending and utilization this prediction, and its negative impact, could be lessened. Integration of the low-cost, preventive and effective Complementary Medicine of the medical specialty of Traditional Chinese Medicine (TCM), commonly just called acupuncture, could help achieve this goal.

Supporting the Federal Acupuncture Coverage Act HR1479 and HR3799

With the 2009 healthcare reform proposals, entitled the Affordability Care Act, that included offering of a state or federal insurance exchange coverage to any US citizen by 2014, and expanded evidence-based treatment guidelines, the Maurice Hinchey Federal Acupuncture Coverage Act, trapped in committee since 1993, must be brought forward for a vote in Congress. A modified version of this simple freedom of choice in healthcare act of Congress was sponsored in 2013 by the Republican Party and Representative Christopher Gibson, yet till has zero chance of emerging from committee, unless public support is voiced through emails, letters and phone calls to your Congressperson. Implementation of true health care reform is an ongoing process that the citizens of this country should be involved in. If many citizens would take a minute to contact their congressman or congresswoman to urge cosponsor of this legislation, success would be achieved.

The legislation in Congress to add acupuncture as a benefit coverage under both Medicare and the Federal Employees Health Benefits (FEHB) program has failed to emerge from committee for a vote since introduction in 1993 by Congressman Maurice Hinchey of the 22nd District in New York, and now Congressman Christopher Gibson of the 19th District in New York, showing bipartisan sponsorship. The failure of this bill to come to a vote, which would surely pass in Congress, is due to lobbying by large medical business concerns, which results in a failure to generate the necessary 61 cosponsors. In 2007, 59 cosponsors signed onto the bill.

Since the bill incurs minimal expense and causes no harm to the constituents, and would not be required, but rather would be an optional coverage to plan participants, its passage would have little objective reasoning for failure. Its passage is necessary to insure the right of option to acupuncture and Complementary Medicine to all Americans, if they so choose, and to stop discriminatory practices by the insurance industry, which is guided legally by Medicare and FEHB legislation.

Since the healthcare reform instituted by President Barack Obama and others in Congress may eventually involve providing the same healthcare insurance options presented in FEHB to any uninsured citizen, in the insurance exchanges, the passage of HR1479 is very important in 2011 for anyone that believes that our government should provide this freedom of choice to utilize TCM and acupuncture in their health plan. As stated, any citizen that chooses to opt for a plan that does not cover TCM and acupuncture would still have this option under the legislation. The bill does not mandate that an individual pay to have coverage for acupuncture.

It is vitally important that you write a simple letter to your Congressman or Congresswoman expressing your opinion that HR1479, the Hinchey Federal Acupuncture Coverage Act, be passed. This is especially effective since our own Congresswoman Nancy Pelosi is the House Minority Leader, and thus very influential. You may email Congresswoman Pelosi at her website, www.house.gov/pelosi/contact/contact.html, or write her at:

Office of the Minority Leader, Nancy Pelosi: 235 Cannon H.O.B. Washington, DC 20515 The phone contact is (202) 225-4965 / (202) 224-3553 / (415)556-4862. Letters to the San Francisco office may be mailed to 90 7th Street, Suite 2-800 San Francisco, CA 94103.

The South Bay is represented by Congresswoman Jackie Speier and may be contacted at: 2413 Rayburn House Office Building Washington, DC 20515 The phone contact is (202) 225-3531 / (650) 342-0300, and email is found at the website: http://speier.house.gov/email-jackie.shtml

The East Bay areas of Berkeley, Oakland, etc. is represented by Congresswoman Barbara Lee and may be contacted by calling (202) 225-2661 / (510) 763-0370. The North Bay areas of Marin and Sonoma counties are respresented by Congresswoman Lynn Woolsey, and may be contacted by calling (202) 225-516, (415) 507-9554, or (415) 507-9601.

You might also discuss this legislation and the federal adoption of an acupuncture mandate in FEHB and Medicare coverage to friends and relatives in other parts of the country, and urge them to contact their congressional representative. If enough public support for this legislation is expressed, especially to Republican congressional representatives, the bill will emerge from committee despite insurance and Big Pharm lobbying. Once out of committee, there will be no reason to fail to pass the measure, as it costs the U.S. government practically nothing, supports freedom of choice in healthcare, and benefits the public. With increased usage of low cost Complementary Medicines such as professional acupuncture therapies, the cost of health care in the United States will decrease. This is one simple act that may help to correct our budget deficits in a modest manner.

HR1479, the Hinchey Federal Acupuncture Coverage Act, provides a foundation for legal provision of acupuncture healthcare coverage that is missing from our system today. All insurance coverage is based on the Medicare fee schedule and Medicare Part B fee-for-service plan rules. HR1479 would require that acupuncture be finally covered under Medicare Part B, but would not require that health care providers be required to accept Medicare patients, or that acupuncturists be required to accept Medicare patients.

The Federal Employees Health Benefits Program (FEHB) provides health insurance to federal workers, their dependants, federal retirees and their survivors, and may soon be offered to any US citizen that has trouble affording health care. These plan beneficiaries would have a choice from a wide variety of health insurance plans, including HMO, PPO and high deductible catastrophic care policies. HR1479 will thus mandate a choice of acupuncture coverage in the list for minimum benefits for those that these plans serve, and would lay the foundation for the end of discrimination of acupuncture services for all US health plan participants. Currently, about one fourth of insurance plans in the FEHB system voluntarily offer acupuncture benefits due to public demand, but many of these plans only offer coverage when provided by an M.D. or D.O., who do not receive the comprehensive medical school training in acupuncture that the Licensed Acupuncturist receives. An M.D. or D.O. may practice acupuncture without training because of the proven safety of the practice, although a small number of M.D.'s have now gone on to earn an additional medical degree in TCM and become Licensed Acupuncturists. HR1479 would insure that L.Ac.'s, or Licensed Acupuncturists are included in plans.

The European Union mandated coverage for Complementary Medicine and acupuncture in 2006 and has proven that this coverage is cost effective and saves the national health care expenditure much money in the long run in quality of life health care expenditure. The preventative nature of TCM and acupuncture decreases the incidence of future medical problems and expenditures and thus benefits even the patients that do not choose this coverage, by bringing down the cost of policies for us all.

It is also advisable to contact the former University of Washington School of Medicine Board Member and MetLife CEO, Sylvia Mathews Burwell, who will oversee the Health Care reforms of President Barack Obama as Secretary of Health and Human Services. After June of 2014, write to: Secretary Sylvia Mathews Burwell US Dept of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 or call: 1-877-696-6775. An online form for comments supporting the Federal Acupuncture Coverage Act is available by clicking here: http://www.hhs.gov/feedback.html.

To contact the White House and the staff of President Barack Obama on this issue, click here: http://www.whitehouse.gov/contact/

Hopefully, we will be able to achieve some progress in insuring that US citizens have the freedom of choice in healthcare that has resulted in lower national health care costs and better disease and injury prevention through mandated coverage option of acupuncture and Complementary Medicine.

Progress on true healthcare reform and patient protection

Republican Senator Charles Grassley of Iowa and Democratic Senator Herb Kohl of Wisconsin have been promoting healthcare reform for a decade with their work to uncover and make transparent the deceit, conflicts of interest, payoffs, and fraud that are now an unfortunate part of our healthcare system. Senator Grassley has uncovered numerous instances of payoffs to important research directors that alter the research findings which determine treatment guidelines in the United States. He has also uncovered numerous instances of ghost-writing of research articles in medical journals, medical textbooks, etc. Senator Grassley has uncovered illegal practices of promoting new drugs off-label, leading to many billions of dollars of settlements and fines for promoting drug uses not approved by the FDA, and has saved the Medicare system a small fortune with his efforts, while protecting the public. Senator Kohl has worked tirelessly to eliminate inefficient reimbursement systems in Medicare, and reward value of care, not volume. Senators Kohl and Grassley have proposed many reforms that would remove fraud, waste, and abuse from the medical insurance and governmental healthcare programs.

An important step toward this goal is the law sponsored by these two senators that would erect a website listing all financial payments in any form to individual medical doctors and other physicians from pharmaceutical drug companies. The New York Times reported in a January 17, 2012 article that such a website would expose the conficts of interest involving more and more medical doctors each year, where large payments from drug and medical device companies in exchange for promotional lectures, continuing education, and consulting, as well as routine gifts, meals, staff lunches, and large amounts of free sample medications affect which medications are prescribed, which devices are used, and even standard treatment guidelines. A response to this article by a retired cardiologist from Michigan, Stephen H. Humphrey, stated: “The proposed requirement to disclose fees paid by drug and device manufacturers to doctors is on target and long overdue. With luck, this will also help clarify the murky issue of doctors with ties to the industry participating in the writing of clinical treatment guidelines. These guidelines are rapidly becoming the basis of testing, treatment, reimbursement and even medical malpractice...Full disclosure and regulations of financial and other relationships between industry and doctors is essential if patients are to be protected from becoming unwitting commodities in a health care industry that increasingly defines itself at the bottom line."

The Journal of the American Board of Family Medicine, in 2006, reported that “the pharmaceutical industry spent over $12 billion in 1998 to promote its products in the United States. Of this promotional budget, over half was dedicated to supplying physicians with free sample medications for distribution to patients. This expense increased to almost $15.7 billion in 2000, with free samples once more topping the budget, having increased 12.8 percent annually since 1996." They also wrote: “Our data support the conclusion that family physicians who distribute free samples are more likely to prescribe these medications than their counterparts who do not." The prescription of drugs and use of medical devices should be based on the value of care, and not the value of financial promotions, and the medical treatment and reimbursement guidelines need to reflect value of care and outcomes, not financial incentives. The efforts in this area have resulted in a dramatic decrease in the annual rise in national health spending. In 2010, U.S. health spending rose only 3.9 percent, compared to an annual rise of 6-10 percent in the last decade, and even Medicare spending rose by only 5 percent, the smallest rate in over a decade.

Unbiased medical treatment and reimbursement guidelines, and the implementation of a Complementary Medicine mandate, would insure that the treatments of Traditional Chinese Medicine, and integrative Complementary Medicine on the whole, would be available to those patients that wanted to focus on conservative care and preventive medicine to both improve their health, avoid serious side effects and adverse outcomes of surgery, and reduce the total national health care costs even more. Currently, the many billions of dollars spent on these financial incentives by the pharmaceutical and medical device companies insure that acupuncture, herbal and nutrient medicine, and even direct physiotherapies are not adquately supported and reimbursed.

Information Resources

  1. The National Coalition on Health Care, in Washington DC, reports on the progress in health care spending reforms, and the problems, namely that health care now consumes 18.2 percent of the U.S. GDP, while only 8-10 percent in European countries: http://nchc.org/node/1171
  2. The Physicians for a National Health Program reported in 2011 that per capita spending hit $8650.00 per person in 2011, and noted that some experts believe this could rise to $13,700.00 per person by 2020, or 20 percent of GDP, if we do not make changes in the cost and efficiency of health care. This organization continues to urge America to adopt a single payer national health care program: http://pnhp.org/blog/2011/07/28/national-health-expenditures-in-2011-and-2020/
  3. The 2012 statistical abstract by the U.S. Census Bureau presents a wide variety of statistics on both health care spending and health statistics, comparing the U.S. with all other comparable civilizations: http://www.census.gov/compendia/statab/cats/international_statistics.html
  4. A copy of the Federal Acupuncture Coverage Act of 2013, HR3799, now even sponsored by a Republican Congressman, is provided here. This legislation was first introduced by Congressman Maurice Hinchey in 1992, and have failed to emerge from committee each year since due to massive healthcare industry lobbying. It needs public support: https://www.govtrack.us/congress/bills/113/hr3799/text