As goes Vermont…

I hadn’t realized that Vermont has passed a law requiring insurers to cover naturopathic care.

We’ve covered extensively the quackery that is naturopathy, but really, if a patient chooses to see a quack, it’s their business. But with health care costs soaring, requiring insurers to pay for voodoo is a rather bad idea. Already, many plans cover chiropractic, another unproven treatment. Throwing more health care dollars at more unproved and disproved treatments will help no one (except the quacks who have boat payments to make).

There are many causes of high costs of health care: we hate the idea of rationing, so many American cities have more MRIs than the whole country of Canada; we incentivize doctors and others to order tests and treatments that may or may not be necessary; we inadequately reimburse preventative care. The list goes on.


Health insurance is about pooled risk. Plan members pay in, and hopefully there will be a diverse group of patients so that the healthy ones subsidize the less fortunate. The more benefits are utilized, the less money is left to pay for necessary services. If you pay for bull, you might not be able to provide, say, nutritional counselling for diabetes. The cost to everyone will rise.

Evidence-based medicine has helped us figure out what diagnostic and therapeutic modalities are most effective, but for health and for cost. There are still many grey areas. We need to focus on clarifying what we do and don’t need, rather than paying for care that has no proven benefit.

Comments

  1. #1 Radioactive afikomen
    July 1, 2008

    I imagine the quack lobby had an easier time lobbying the legislature of a small state like Vermont. Hopefully, when the movement reaches the larger states (which it will), the controversy generated will be big enough to, at the very least, cast doubt on the whole thing.

    I can’t shake the feeling that this was a “tester” by the naturopath movement to see how far they can push.

  2. #2 Martin
    July 1, 2008

    What would be good, from a lobbying point of view, would be to find out just how many dollars insurers are having to pay out for quackery – information that I get the impression the insurance firms might be all too happy to provide. Then the hopefully-scary figure can be heavily “memed” and dispersed so that the next time a state considers this, someone goes “but wait, this cost Vermonst five hundred trillion dollars!”

  3. #3 Denice Walter
    July 1, 2008

    This post got me thinking,having just returned from the other “land of mountains and magical thinking” ,i.e. Colorado, and seeing the extraordinary amount of global herbalists, Tibetan Buddhist temples,qi masters, N.D.’s, Native American healers, yoga studios,and so much woo they should re-name Pearl Street (in Boulder), “Wooster Street”:it seems many of the places people “escaped” to in the ’70′s and ’80′s, including Vermont, Colorado,Upstate N.Y., N.California,(places I like)are going this route: escaping not just stress,the “rat race”,traditional roles, corporatism,conventionality, but also reality testing and practicality.And it will cost a great deal of money.

  4. #4 Delta
    July 1, 2008

    Here in Canada, naturopathic medicine is not covered by the provincial government. People still pay out of their own pocket to see naturopaths and most of them are very happy with the quality of care. Nearly half of all canadians will see a naturopath in the future because simply there is not enough canadian trained general practitioners graduating. We don’t accept foreign trained doctors besides the US. Americans will never come to canada to work because there’s not enough money to be made. Naturopaths are filling the void regardless if arrogant MD’s dismiss them, and help their egos by stop accepting new patients.

  5. #5 Kim
    July 2, 2008

    I know this isn’t the point of your post, but the whole idea of health insurance as pooled risk seems contrary to how insured people actually use their coverage these days. As a person with no daily medications or regularly scheduled treatments I feel like a bit of a freak…plenty of people I know — I’m talking healthy professionals in their 20s and 30s — have a handful of pills, an allergist, a chiropractor.

    I’m not saying people should suffer if something is genuinely wrong, but…I dunno. I don’t think we can depend forever on people like me buffering the cost of the people I think of as the “over-treated well”, y’know? If it’s not the naturopaths it’ll be the drug companies.

  6. #6 AndyD
    July 2, 2008

    “Incentivize”??? Yuk! :)

    On a lighter note, perhaps all of us reading this who aren’t already working in the medical field should set ourselves up to practise CAM and get on the insurance gravy train.

    When our numbers reach critical mass, the policy makers and insurance companies will be quick to sort the wheat from the fertiliser.

  7. #7 Stagyar zil Doggo
    July 2, 2008

    One possible improvement on the incentive structure in which the insurance industry operates would be to force them to combine health insurance with life insurance. That way, its in their best interest to care about your health and longevity. Denial of (effective) treatment could cost them a large lump sum immediately afterwards if you croak. It would also force them to take evidence based decisions about which treatments to pay for, by a sort of ‘natural selection’ effect. Companies which use their funds to pay only for effective treatments will have clients survive longer and make more money. Companies which waste their money paying for woo will have more patients die and end up bankrupted by the resulting life insurance payments. Its also likely to encourage companies to pay for and encourage their clients to use preventive care measures.

  8. #8 Martin
    July 2, 2008

    Companies which waste their money paying for woo will have more patients die…

    You’re missing the more obvious fact that insurance companies don’t want to pay for woo in the first place – hell, that’s why this law has been brought in. I’m sure the insurance firms would be more than happy to see claims relating to alternative medicine banned outright, and in fact if I were American and I were going to start a campaign against this crap, the insurance industry would be the first place I’d go looking for powerful allies.

  9. #9 Stagyar zil Doggo
    July 2, 2008

    You’re missing the more obvious fact that insurance companies don’t want to pay for woo in the first place

    Actually, insurance companies don’t want to pay for any and all claims, legitimate or otherwise that they can skip out on. In the case of woo-ly treatments, they have a legitimate excuse to latch onto. But there also exist people who die of cancer or organ failure because their insurance company denies them treatment, or better yet, sits on their file waiting for them to drop dead.

    Further, given the current incentive structure, once a patient acquires an illness requiring expensive and long term treatment, it would be much more loss limiting for the insurance company if the patient were to die quickly. So, I’m sure they would prefer to pay for say coffee enemas over chemo or radiation therapy (if given a choice), simply because a) it would be much cheaper and b) the patient is likely to die sooner, saving them the cost of subsequent years of treatments.

  10. #10 Citizen Deux
    July 2, 2008

    The error in Stagyar’s post is simple. Insurers want to pay out the least possible amount of claims, while still taking in premiums. If a risk becomes uninsurable (like hurricane insurance in Florida) they either raise their premiums accordingly or leave the state. Thus the government steps in to fill the gap. Health insurance is no different. Paying for WOO will increase premiums, force private insurers out of the state and/or require the state to step in – and that’s rarely a good thing.

    Our ND advocate friend from Canada has demonstrated the failure of a national health scheme. Canada has too few doctors, reimbursements are too low and people are seeking help from unlicensed practicioners. There is no argument about the efficacy of ND’s. They have never proven themselves in ANY clinical setting and their licensure to practice usually comes with severe restrictions.

  11. #11 Interrobang
    July 2, 2008

    Canada has too few doctors, reimbursements are too low and people are seeking help from unlicensed practicioners.

    That’s not a failure of the provincial healthcare systems; that’s a failure of the provincial government(s). If the neocon Premier of the largest province (mine) hadn’t deregulated medical school tuition ten years ago, making it impossible to afford without coming from a wealthy family, we wouldn’t be having this problem now. It never used to be a problem. Nobody sane wants to go $200K into debt before even starting to work, especially since you can go into pretty much any other field and start off debt-free or with less than a tenth that amount in debt. That goes about fiftyfold if you don’t have a family with money that can help you out.

    Also, if you think Canadian doctors make too little money, I don’t know what your idea of “enough” is. According to the annual “Wealthiest People in…” survey published by my local paper, the head of the clinic I go to makes around $300K a year. That puts him making about ten times the local median, and easily in the top 1% of income earners. He’s not even a specialist; some of them make far more than that.

    Also, in terms of our ND-advocating friend, I don’t for a moment think s/he’s telling the truth about the number of Canadians who see naturopaths, for the simple reason that going to the actual doctor is paid for beforehand, and going to the naturopath costs you out of pocket. Also, it’s obviously in hir best interests to inflate the figures.

  12. #12 Stagyar zil Doggo
    July 2, 2008

    Citizen Deux:
    The error in Stagyar’s post appears to be that it is somewhat tangential to PalMD’s remarks and that he does not mention this explicitly. For the record, I agree with PalMD’s criticisms of the law forcing insurers to support WOO, both on general principle and also because of the distributed harm caused to other users of the system.

    Instead, I addressed the broader issue of improving the current system of incentives under which the insurance industry operates.

  13. #13 Blind Watchmaker
    July 2, 2008

    AAAAAAAAAAaaaaaaggghhhh!!!!

    Sorry. Had to vent.

    I am sent a constant barrage of things I, as a legitimate doctor, cannot order due to cost, even if it is the right thing to do. Now they are going to cover S.C.A.M. ???

    They probably will tell the patient that they can go to the woo-meisters as long as their real doctor refers them. They will make us the “bad guy” by forcing doctors into the possition of having to say no. Worse yet, I bet that even if a patient talks the real doctor into a referral to a S.C.A.M. artist, the referral will be rejected because the doctor did not submit the “right code” or a good enough reason for the referral. After all, what “good reason” could there be to justify such a dumb referral.

    These are the same scenarios that we have to deal with now when insurances tell patients that they can see chiropractors.

  14. #14 Bee
    July 3, 2008

    “We don’t accept foreign trained doctors besides the US.” – Delta

    Really? How then to explain that three of the six doctors in my local medical centre in Nova Scotia are from Cuba, India, and Chile?

  15. #15 Reason
    July 5, 2008

    Well for you smugmeisters with your “we practise EBM and are therefore superior to all forms of CAM” – ask yourselves this: why are people leaving this system? If EBM was so superior why are they going to see CAM practitioners in droves? Yes there is a lot of woo-woo nonsense out there but a bit of self-examination is in order. The fact is 80-85% of what constitutes modern medicine was never proven with the gold standard RCT. Many people have been failed by the current system – i.e. they don’t get “better” with what you have to offer. It is easy for you to dismiss anyone eschewing your not-so-EBM as a “loon” or a village idiot – but to me it seems like you are fiddling while Rome burns. You can bemoan what insurance companies do or don’t do all you like – but until you get your own house in order people are obviously voting with their feet. Rather than try and understand why someone would try a coffee enema over what you may have to offer you poke fun, patronize, and generally alienate those you pretend to be concerned about. Not exactly constructive is it?