Chiropractic: Time for Full Inclusion
As a profession that over the past generation has made great strides into the American health care mainstream - with widespread utilization and patient satisfaction; a strong research base; inclusion in most private insurance plans, worker's compensation insurance, Medicare, military and veterans health care; and full recognition in Olympic and sports medicine - chiropractic now has the hallmarks of an essential health service.

Whether it is specifically recognized as essential in the core benefits package of the emerging health reform plan may prove a bellwether (along with lifestyle-based prevention) as to the extent to which genuine, paradigm-shifting change is embodied in the Obama program. Chiropractors (DCs) and their 22 million patients in the U.S. were quite heartened when the new President sent three separate letters of support to the American Chiropractic Association (ACA) during the presidential campaign. Most encouraging was the fact that Senator Obama, the eventual winner, was the only presidential candidate in either party to specifically respond to ACA's detailed candidate questionnaire.

Aside from inclusion in a core benefit package, arguably the most critical goal for chiropractors (and other non-MD practitioners) is to codify in federal law a policy of nondiscrimination among types of providers, for both coverage and reimbursement. In other words, if spinal manipulation (or massage, physical rehabilitation, nutritional counseling, mindfulness meditation instruction, or any other procedure) is covered when performed by a medical or osteopathic physician, then it must always be covered at the same rate of reimbursement for any health practitioner licensed to provide it. Freedom of choice among providers and a level playing field on coverage and reimbursement are ideas whose time has hopefully arrived.

Recognition of chiropractors as an essential part of the U.S. health care system also dovetails exceedingly well with the expanded lifestyle-based prevention efforts that must form the leading edge of health policy in the coming era. Chiropractors have always encouraged patients to take an active role in restoring and maintaining health, with particular emphasis on doctor-guided self-care through exercise and nutrition,2 and new profession-wide initiatives reflect a deepened commitment to prevention and health promotion across the wide range of parameters elaborated by the U.S. Preventive Services Task Force. All students graduating from chiropractic colleges after January 2007 have been required to demonstrate knowledge of evidence-based prevention approaches and mastery of methods for applying these approaches in the clinical setting. This wellness mandate by the Council on Chiropractic Education, the chiropractic accrediting agency, grants individual institutions leeway to craft their own prevention training programs, but all institutions are audited for compliance with the key markers spelled out in the mandate. Thus, all future chiropractic graduates will be required to demonstrate evidence-based wellness assessment and intervention skills, which presumably will carry over into their careers as practicing chiropractors.

One further goal for chiropractors in the health reform process is broadened inclusion of DCs on federal, state and private sector health policy committees of all types. Such inclusion has expanded slowly over the past decade or two. When implemented, it accrues to the benefit of the health care system as a whole, and the millions of patients it serves, by diversifying the mix of ideas and perspectives brought to the table. The knowledge infrastructure that now exists within the chiropractic profession (including many dual-degreed practitioners) justifies the inclusion of qualified chiropractors on health care committees across the board, not just those with a musculoskeletal focus.