January 20, 2009

 Ms. Esther Perelman, Policy Director
Office of Vermont Health Access
312 Hurricane Lane
Williston, VT 05485

Dear Ms. Perelman: 
 

I am writing to voice my opposition to the Emergency Rule eliminating adult chiropractic care from VHAP.

It is a truism that “tough times require tough choices.”  It seems to me that tough times actually require wise choices, choices that ameliorate rather than aggravate the root causes of the crises we face.  As our new President has pointed out, health care is crucial to individual and community well-being at all times, and it is even more important when the economy is in trouble.  He has stated that in this deep recession, we need to increase, not decrease, funding for social services that help people adapt to stress and changing conditions.  Decreasing poor people’s access to health education, prevention and primary care during a time of profound economic and social stress is likely to harm, not help, our state’s prosperity. 

We all know that we must find a way to address escalating health care costs—this was true before the recession, and it will be true when this period has ended.  We also know that treating chronic illnesses, injuries and disabilities is incredibly expensive;  if we want to constrain our health care costs, we need to invest heavily in health education, prevention, and low-tech, high-touch primary care.  At the same time, Vermont faces a critical shortage of health care providers who are willing and able to provide this kind of care.
 

Chiropractic education focuses strongly on health education, self-awareness and responsibility, prevention, and low-tech, high-touch interventions in functional injuries and illnesses.  Chiropractic education also prepares us to be primary care providers; we know what we are equipped to help, and to whom to refer when the problem is outside our arena.  The broad scope of chiropractic licensure in the State of Vermont reflects our ability and desire to serve our communities in this capacity.

I have been practicing in the small village of Saxtons River for just over fourteen years.  Many of my clients have been with me since I first arrived here; kids whom I saw through ear infections, teething, and sprained ankles from jumping out of trees are now in high school or college; women I helped through multiple pregnancies are now coping with menopause.  I spend a minimum of half an hour, often an hour, with each of my clients, so I know them very well.  I know their health issues, yes, but I also know a lot about their histories, their families, their hopes and dreams, their secret terrors.  There is a great deal of trust as well as mutual respect and love between me and my clients; this is why many of them regard me as their primary care provider.

 Evidence strongly suggests that the kind of community- and family-based health care I offer is what can improve health care outcomes for individuals while containing health care costs.  In tough times, when we can especially ill afford for folks with conditions that could’ve been resolved easily by early intervention to wait until they are so sick they head to the emergency room, we need to invest in this kind of care, not withdraw support from it.

 Even in the short term, I feel that this cut is likely to cost, rather than save, the state money.  Many people first seek chiropractic care for common complaints like acute lower back or neck pain—complaints that are costly both in terms of direct health care costs and lost work time and productivity.  Research shows that chiropractic care outperforms allopathic care for these conditions—the former is less expensive, more effective, and much more satisfactory to patients than the latter.   Research also suggests that chiropractic is as effective or more effective than physical therapy for these complaints, but chiropractic office visits are often less expensive than physical therapy visits.  People with VHAP are not going to stop suffering from the kinds of complaints that have prompted them to seek chiropractic care; they will either wait until the complaint becomes more complicated and requires more expensive intervention, or they will seek more expensive care immediately.

It is hard for me to imagine that cutting the adult chiropractic benefit from VHAP will save the State money even in the short run; I am sure it will cost us money in the long run.  I truly hope you will weigh these factors as you consider the Emergency Rule set to take effect 02/01/09.