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The Good, the Bad, and the Awful in Health Insurance Reform

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First, understand this: Sunday's House vote was not principally about health care reform. It was about health insurance reform. President Obama is among the few in the debate who consistently used the accurate term. At the signing, he said, "Today, after almost a century of trying ... health insurance reform becomes law in the United States of America."

So let's talk about health insurance reform. I am happy that:

More Americans now have health insurance coverage. The fact that world's wealthiest nation ever had tens of millions of uninsured citizens is an international disgrace.

The bill makes it more difficult to kick people out of the system on the basis of pre-existing conditions.

There is some preventive-care language - albeit modest and brief - in the 2,500-page legislation (due to the commendable efforts of Iowa Senator Tom Harkin and others) that:
  • Provides a mandatory15 billion to support prevention and wellness activities.
  • Eliminates cost-sharing on recommended preventive services that are delivered by Medicare and by all insurance plans that are in the Health Insurance Exchange.
  • Supports two independent, advisory task forces - the U.S. Preventive Services Task Force and the Task Force on Community Preventive Services - as they review research with the aim of adopting proven and effective preventive services.
  • Provides coverage under Medicare, with no co-payment or deductible, for an annual wellness visit. This will include a comprehensive health risk assessment and a five to 10 year personalized prevention plan.
  • Delivers community preventive services by investing in state and local public health infrastructure and by providing grants to implement recommended services.
  • Requires chain restaurants to post calorie counts on menus and make other nutrition information available.
On the other hand, I am not happy that an estimated 23 million Americans will still lack medical insurance in 2019, according to a Congressional Budget Office report. One can only hope that the single-payer system will eventually come to pass.

And I am very upset that a fundamental result of this bill will be funneling billions more in taxpayer dollars to large pharmaceutical and medical technology companies, and to large insurers. These industries already make obscene profits, and their greed is the principal cause of our existing, dysfunctional "disease management system." We'll be on the right track when passing a piece of legislation makes big pharma and insurance stocks tank - rather than soar, as they have lately.

Now that the bill is law, it's vital that we amend it to expand the covered therapies to emphasize diet, exercise, stress reduction, botanical medicines, biofeedback and other safe, low-cost interventions with proven worth. These are invaluable - either as principal treatments, or as adjuncts - to alleviate rampant, chronic diseases that resist treatment by conventional medicine, such as arthritis, Alzheimer's and heart disease, chronic pain, insomnia and many others. These treatments are also generally excluded from Medicare and Medicaid, and likely won't fare well under the mandated insurance plans in the bill. After all, the Department of Health and Human Services will determine the "essential health benefits" that those plans provide.

So we must keep pushing. Integrative medicine - which is the intelligent combination of conventional and alternative therapies for which there is scientific evidence of efficacy - is the medical paradigm that this legislation must be amended to embrace. Only then will we truly have health care reform.

Andrew Weil, M.D., invites you to join the conversation: become a fan on Facebook, follow him on Twitter, and check out his Daily Health Tips Blog. Dr. Weil is the founder and director of the Arizona Center for Integrative Medicine and the editorial director of www.DrWeil.com.

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