The Cambodian proverb ?When elephants battle, the ants perish? aptly describes the fight over health-care reform that many hope will transform the $2.6 trillion health care industry and provide coverage to all Americans. At stake is the fate of tens of millions of uninsured and underinsured Americans, not to mention the political capital of President Barack Obama, for whom health-care reform is the most ambitious domestic policy to date. The president?s push for a public health-insurance mechanism, run by the federal government, and a Medicare buy-in program that would allow uninsured Americans 55 to 64 years of age to participate proved the most nation-splitting propositions for the reform of a system that seven presidents, democrat and republican alike, tried and failed to achieve.
The fate of reform, however, has not stopped changes already occurring on the country?s health-care landscape, from attitudes among health professionals and greater emphasis on prevention to new cadres of jobs and vendor contracts.
While the nation remains divided, mainly along political party lines, countless Americans newly downsized from once-stable jobs now find themselves without health insurance. According to The Commonwealth Fund, a private foundation in New York dedicated to researching health issues, nearly 50 million Americans under
the age of 65 are uninsured and another 25 million, mostly those who are earning $40,000 to $59,000 a year, are underinsured.
Such figures have turned many physicians, including African-American doctors, into activists. Carol V.R. De Costa, M.D., is the medical director at Rehabilitation Medicine and Sports Services P.C., in Brooklyn, N.Y. ?Since the number of uninsured and persons with chronic disease is disproportionately higher in the African-American community, I believe that the passage of a robust health-care reform bill will have a positive effect on this population,? she says. ?In my effort to ensure the passage of the health-reform bill, and specifically the public health-insurance option, I broadened my scope as an advocate for my patients. I have been inspired to leave of the comfort zone of my examination room and venture into the halls of Congress, calling the offices of senators and speaking out on the steps of City Hall, all for the sake of seeing health-care reform passed.?
A staunch supporter of a public option, increased funding for public health and expanding the number of primary-care providers, Dr. De Costa insists that the medical profession has a duty to take charge of the health-care system.
In changing the status quo, ?we have a great opportunity as a country to shift the paradigm of medicine to one that focuses on health and wellness instead of disease,? she says. ?In my practice, I encounter patients on a daily basis who are diagnosed with chronic diseases such as diabetes, obesity, heart disease, hypertension and osteoarthritis. For the most part, these conditions could have been avoided if preventive care could have been provided during their doctor?s visits.?
Prevention gains traction
The political battle over health-care reform aside, preventive care is gaining traction among Americans, resulting in a financial boon for the wellness and alternative medicine segments of health care. Businesses like Nike Inc. and Whole Foods Market Inc., which serve the physical fitness and nutrition markets, are taking advantage of the new attitude.
?Ironically, while traditional Western health-care providers are still focused on ?disease care,? it is consumer goods suppliers like Nike and Whole Foods that are taking the lead in delivering preventive health care, demonstrating that a profit can be made from doing so,? says Beverly Blake, vice president of marketing for Life Rx, an integrative wellness center in New York City.
According the 2007 National Health Interview Survey, 83 million Americans spent $33.9 billion in out-of-pocket costs to visits to complementary and alternative medicine (CAM) practitioners, purchases of CAM products, classes and materials. This accounted for approximately 1.5 percent of total health-care expenditures and 11.2 percent of total out-of-pocket expenditures on health care in the United States. The survey is conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention and is administered by the U.S. Census Bureau.
?The American public is supporting holistic medicine with their feet and dollars, and they want to know how this can be incorporated into our health-care system,? says Blake.
Dumisani Kambi-Shamba, Blake?s mentor in traditional Chinese medicine, echoes similar sentiments. ?Health-care reform should include preventive medicine, and the insurance companies need to include alternative care [in their coverage],? says Kambi-Shamba, a licensed acupuncturist who specializes in acupuncture oncology and the owner of New York Life Rx L.L.C., a holistic health spa. ?Other industrial nations such as England are responding to patient needs by rewarding doctors with increased pay for helping patients to take preventive health measures, such as helping them to quit smoking.?
His patients? health insurance often does not cover acupuncture, deeming it an ?experimental? procedure, he says, and the few that do have made reimbursement tortuous. ?Deny, deny, deny is all I hear,? says Kambi-Shamba. ?I don?t have a high-powered billing system to challenge each claim, so the billing process becomes a whole other job in itself and ultimately increases the cost of providing services.??
The U.S. Senate?s version of a health-care reform bill counts licensed complementary and alternative medicine providers as health professionals under the heading ?health-care work force.? The hope is that this will survive the wrangling and tangling on the Hill.
?I applaud the few insurance companies that include preventive programs and reimburse patients for gym memberships, as well as acupuncture and massage therapy.?
?However, with the skyrocketing costs of medical insurance, more people will be uninsured and will have to take their health and wellness into their own hands,? says De Costa, who is certified in medical acupuncture and runs Aria Spa and Wellness Center L.L.C. in Brooklyn. ?This coming year can be one of empowerment for African-Americans and the country as a whole if we begin to refrain from lifestyles that are detrimental to our well-being and become more active. We cannot only depend on health-care reform, we must reform ourselves as it pertains to our health,? she says.
Jobs and contracts
Whatever the fate of reform, the outlook seems bright for health-related jobs and provider contracts. The Office of the National Coordinator for Health Information Technology, created in 2004 under President George Bush to set standards for collecting and using electronic medical records for all Americans, is expected to trigger new jobs and vendor contracts, with the Obama administration?s American Recovery and Reinvestment Act, or Stimulus Bill, kicking in $19 billion ? $2 billion for the National Coordinator for Health Information Technology and $17 billion to encourage doctors to create electronic health records (EHRs) for all their patients by 2015.
Facilities that adopt EHRs early may receive from $2 million up to $11 million, payable over four years, while those not using EHRs after 2014 will see their Medicare reimbursement rates reduced by 1 percent per year and as much as 5 percent in later years. This creates ?great entrepreneurial opportunities? for ?vendors who can develop systems that can create electronic health medical records [and] assist with disease management and ways to get information to patients by accessing patients through e-mail,? says Patrick Carter, M.D., medical director for Care Coordination and Quality at the Kelsey-Seybold Clinic in Houston, Texas. The clinic is the country?s largest community-based physician group that brings together specialists, primary-care physicians and other caregivers as a team to provide the best possible care.
?In ten or fifteen years from now, if we don?t do something about the cost of health care, it will impact medical groups like Kelsey-Seybold,? warns Dr. Carter, who is a family physician specializing in geriatrics.
Health-care providers concerned about privacy and about the absence of universal protocols for collecting patient data and how that data should be shared are reluctant to move forward on EHRs despite the economic incentives to do so. Information technology companies, including heavy hitters like IBM, have jumped in, creating business analytics departments to study patient data and determine how to use stimulus dollars more effectively.
Demand for information technology makes computer-related jobs one of the fastest-growing occupations in employment projections for 2008?2018. The Bureau of Labor Statistics predicts health care and social assistance will add four million jobs to the U.S. economy by 2018. Of the 30 fastest-growing occupations, the majority are computer or information technology and health care. Rather than the higher-paid positions ? physicians, dentists, pharmacists, and therapists, for example ? the employment landscape will favor those who can assume of their duties, such as physician assistants, dental assistants and hygienists and pharmacy technicians, it says.