Still Free !

by Bob Braile, D.C., F.I.C.A.
President International Chiropractors Association

Subsidize & Conquer

The history of mankind has been riddled with wars and armed conflict. Many a nation and people were Conquered by legions of armed soldiers who’s purpose was to defeat all enemies. For centuries boundaries changed and cultures changed as wars changed the face of mankind’s history.

Quietly, however, more nations have been Conquered in recent years then in the long history of warfare. These nations have been Conquered not by weapons of war, but rather by weapons of commerce, in other words money! How many nations today are so completely dependent on others for subsidies, loans, and handouts? How many nations could not survive if it were not for massive infusions of capital from other nations.

For years, migrant workers were subject to the same situation where the land owners gave the workers food and lodging and charged enough to keep the workers beholden and in debt to the employer. Sweat shop factories treat their employees in much the same manor by holding over the employee the financial threat of being replaced.

On a smaller front, we see the failure of a welfare system that traps people into a continual program of dis-incentives toward working and climbing out of poverty. Even family members of addictive behavioral individuals will tell you that you cannot continue to support the addictive individual or you will enable them to continue, and not attempt recovery.

The Death of the Medical Practice

The medical practice has now gone the way of the heavily subsidized third world nation. Gone are the days of self determination and direction. The medical practitioner is now so beholden to those who dole out the cash that he or she has effectively surrendered all their rights to individuality.

The mistake they made is they forgot who their consumer was. Not but a few decades ago medical services were purchased and paid for by people. Working individuals went to the doctor, and paid for the services. The fees may have been high for the standard of the day, but the public by in large paid for it themselves.

Then came insurance, and with it a great increase in services and fees. The public was no longer required to pay for the entire cost of their doctor visits. The result was staggering inflation in health care costs, and a public that became accustomed to having someone else pay the bill.

Unfortunately for the medical professional, he or she too became accustomed to someone else paying the bill. The subsidies from government and insurance companies become so common that nearly all of a medical practitioner’s income was from the third parties. No longer was the consumer paying the bill, at least not directly.

Once the consumer was not the driving force behind the financial success of a practitioner, the insurance companies and government agencies could now dictate how the care was to be given. And because the medical fees were unaffordable to the public, the medical practitioner was trapped. He or she in effect became a subsidized slave to insurance. Their freedom is gone and they are now completely owned by those who pay the bills.

Chiropractic’s Close Call

We in chiropractic almost suffered the same fate. The fact that we were still considered outsiders may have ironically been our saving grace. For about chiropractic’s first 80 years of existence, the chiropractor derived his or her income solely from the patient. It was only in the past two decades or so that insurance started to play a bigger part.

But even with insurance at its height, many of the most successful practices still had large segments of their patients who paid for their own care. Those who pushed for maintenance or wellness practices new that insurance companies would not pay for these services. They had to therefore have cash plans or fees that were affordable to the consumer. Many people still never had reasonable insurance coverage for chiropractic care.

For these reasons chiropractors remained mainly consumer dependent for income. Those who were more insurance based were hurt more drastically by managed care then those who were consumer income based. The fact that we as a profession still held on to a percentage of consumer based health care is what has allowed chiropractic to flourish at a time when medical practices were dying.

Recently many prominent individuals in chiropractic have predicted some gloomy figures as to the survival rates for chiropractic practices. Some have said that managed care will wipe out 50% of all practices in the next decade. The fact remains that while some are struggling, others are busier than ever. And the net effect has been that even with more chiropractors entering the marketplace every year, the percentage of the public seeking our services has risen. More people than ever go to chiropractors, and this represents a higher percentage of society than ever before.

The practices that are struggling the most are those who have not adapted to the current trends and are still trying to run an 80’s style practice here in the late 90’s. The subsidies are drying up, and that which is still flowing comes with such regulation and hassle that more are finding it not worth the effort. The frenzy over "Standard of Care" documents is a prime example of non-consumer based thinking. In reality, was there much concern over standards of care before insurance? Who will use such documents? Their only real practical purpose is for third party payment determination. Of all the Peer review panels that were started nationwide, what percentage of cases were actually brought by patients and not insurance companies? And how many cases of over-billing have we seen on cash patients?

Enough Time?

For medicine, it is now to late. Their services are to high tech and expensive for the consumer to afford. The practice of medicine will remain enslaved unless some radical shift takes place in the emphasis of their care away from disease treatment and toward prevention and wellness. This shift has been started by a few, but this represents a very small part of the medical community. Unfortunately for medicine a shift to consumerism would require a major change in the medical paradigm.

To remain free chiropractors will have to sacrifice. We will have to give up some of the beliefs and concepts that themselves were set to enslave us. We must embrace the system of economics that drives the free world, enter boldly, and market our services. We must return to the concept of consumer based income in the practice of chiropractic. Our fees must be such as can be afforded by the consumers in our community, and not some inflated value of self worth.

In my opinion a chiropractic adjustment has always been, and will always be worth more than we charge for it. The fees we set are never a true measure of the worth of our service, but rather a measure of the economics of our market. We can charge a fee as high as we like, just so long as we have consumers willing to pay it.

Still Free!

The practices that are thriving today are those that have remained free. A higher percentage of patients in almost all chiropractic practices today pay for their own care. The larger income practices are today consumer based, much as it was more than two decades ago. In fact chiropractic has narrowly escaped the slavery fate of the medical profession.

The successful practice of the future will be one that remembers who it is we serve. We serve our patients. Presently society is in the middle of a health consciousness revolution. More people are searching for wellness, and health and are questioning allopathic intervention. Amazingly, more people are now looking for exactly what we chiropractors have been preaching for 100 years. Now this message is not only timely, but profitable!

For the first time in chiropractic’s history, the public is becoming more aware or our paradigm, and more willing to pay for it. All this at a time when the medical profession is imploding and relegated to a life of subsidy and market slavery. We in chiropractic have not only found the silver lining, we have found the goose that lays the golden eggs, and the promise land all at the same time.

If we are willing to give up the concepts of the past two decades, and embrace the future marketplace, we will not only survive, not only thrive, but in fact chiropractic has the opportunity to dominate. All this, and we get to remain FREE !