A Seat at the Table of Health Reform
Lorilee Schoenbeck, ND, AANP Board Member
Wednesday, June 25, 2014
by: Lorilee Schoenbeck, ND, AANP Board Member

Section: State and Federal Advocacy

Vermont is redesigning health care.  Our governor is committed to a single-payor health care system by 2017.  Having test-piloted much of what ultimately got included in Obamacare, Vermont (like OR and WA and other states) is once again pioneering what I believe will ultimately become federal law.  My goal in writing is to give the ND community a glimpse from inside the front lines of health care reform, and inspire more ND warriors to join a common cause.
I believe that naturopathic medicine is critical to the health of our planet.  Our medicine connects people to the earth, and to themselves—key ingredients in changing the way we treat nature.  I believe that the way we will fulfill our highest potential to do good for the planet, is to become accessible to all Americans—which means Americans who rely on insurance, and the current health care delivery structures.  We can no longer remain separate from the mainstream.  They need us too badly. 
The first time I “crashed” a health care reform meeting was around 2004.  An ND showing up at the local hospital’s health reform group raised a few eyebrows.  I felt pretty awkward—and like an outsider.  But as I listened to MDs and administrators discussing “prevention”, “patient-centered care” and “chronic illness”, the lines between us and them began to blur.    I kept showing up.  Ten years later, I now sit at the table, appointed by the governor, to Vermont’s Health Care Workforce Workgroup.  This workgroup is deciding which providers are going to be counted among the health care workforce beyond 2017, and how to recruit them to Vermont.
There are 6 workgroups that are redesigning health care in Vermont.   They are the Workforce group, the Care Models group, the Payment Reform group, the Quality Measures group, the Health Information Exchange group and the Population Health group.  Each group is comprised of about two dozen major stakeholders representing health care:  the deans UVM college of medicine, directors of the Health Department, Labor Department, Education Department, the State Hospital Association, representatives from Community Health Centers and from each of the allied health professions such as RNs, PAs, NPs, dentists and the like.   The charge is to work collaboratively to study and propose a redesign each respective aspect of the care delivery system and advise the governor of these changes.  Pretty big stuff.  Affects every aspect of how we will practice medicine as physicians, and receive it as patients.
Until we added one more complementary/alternative representative to the Workforce group last month, I was the only representative from outside the mainstream medical community on any group.   It sometimes feels lonely, until I realize that I really am part of something bigger, and not alone in sentiment.  Today we heard a fantastic presentation that literally came right out of Paul Starr’s “The Social Transformation of American Medicine”, which was required reading for my NCNM History of Medicine class in 1990.  My conventional colleagues (including the Dean of Primary Care at UVM, sitting next to me), learned that the health cost crisis began when the Flexner Report nearly obliterated the health professions that focused on low force, natural interventions.  The reductionist, biomedical model that favors an MD top-down, intervention-heavy delivery, we were told, needs to be replaced with integrated, team-based, bottom-up care models.  Of course, as an ND, this was music to my ears.  The collective group resonated with these truths.  
Wherever you live, (especially if it’s a Blue state), I bet there’s a health care reform meeting happening near you in the next month.  Go to it.  Listen in on what’s brewing.  It looks and sounds a lot more like naturopathic philosophy than you probably would guess.  Then raise your hand, and let it be known that you are there, and that there’s an emerging profession that is training high quality primary care physicians who utilize low level, cost-effective interventions, and focus on prevention as well as chronic care.  Let them know that NDs are leading primary care medical homes in some states, and carrying significant panels of Medicaid primary care patients.  Ask if they are interested in learning more, or integrating this primary care provider type into the structures they are now creating.  Be there.
It’s almost 100 years post Flexner.  We survived.  We had to huddle for several decades, and keep to our naturopathic enclaves where we supported one another and became a stronger force.  But we made it.  We must now emerge from the comfort of our smaller communities, and brave the round-tables of health reform stakeholders, to let ourselves become a known and respected entity.  We have little now to gain by sitting around talking amongst ourselves about how things should be.  We have everything to gain by stepping out and rolling our sleeves up alongside leaders of health reform, and creating the change we wish to see in the world.  Nobody’s going to do this for you or us.  It’s up to you.
Let’s save this planet, together.
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