Many of us see it as a no-brainer. We want acupuncture to be affordable, insurance/Medicare makes it affordable, how could anyone be against that? This reasoning relies upon a superficial understanding of health care costs and affordability.
- Affordability must take into account premiums as well as co-pays and out-of-pocket expenses.
- Both cost to the individual and sustainability of the system are part of affordability.
- All medical costs are ultimately borne by the public.
- When coverage is provided for the very sick, the premiums of many healthy people contribute to their medical expenses.
- If health care spending exceeds what the insurance companies have planned for, premiums will go up and reimbursements for providers will go down.
- Controlling health care spending depends upon providers accepting reduced payment for their services and upon a bureaucracy determining what services are appropriate.
- The wealthiest in our system typically have the best insurance coverage.
A respected colleague said I give the impression that Community Acupuncture is the only way for people to get affordable acupuncture and that everyone should treat that way. My bad — I don’t believe that. I do believe it is a good way — it accepts the reality that acupuncture isn’t really more affordable if it doesn’t cost the system less. It provides affordable treatment to everyone, not just to those with the best insurance coverage. And it keeps big business out of treatment decisions.
I continue to treat one client at a time, in a private room. I have a generous sliding scale, available to all, to help a wide range of people afford acupuncture. Some practitioners treat in private rooms and charge one low price to all patients. I have colleagues who reserve a certain percentage of their appointments for those who need steeply discounted services, and I have others who volunteer in free or low-cost clinics. These are all ways to make acupuncture affordable.
Disguising the cost of acupuncture by hiding the expense in co-pays and premiums (many so expensive that they are subsidized by taxpayers) doesn’t make it more affordable. Changing the way you treat so that your reimbursements match what you think you deserve doesn’t make acupuncture more affordable (or support arguments for cost effectiveness).
CA is not the only way to make acupuncture affordable and I certainly don’t think it is the only style of treatment that should be available. But insurance increases the big picture affordability of acupuncture only to the extent that it limits reimbursement rates and access. Insurance is not a magic wand, and those practitioners who believe it is are in for a rude surprise.