The Medicare Bill and the Shape of History

For decades, chiropractic has spent as much energy negotiating with itself as it has negotiating with anyone outside the profession.

That isn’t unique to chiropractic. Every profession develops ideas about what defines it. Over time, those ideas become culture, and culture becomes part of the institution itself. The healthiest professions eventually learn that policy decisions don’t have to resolve every philosophical disagreement. They can pursue a common objective without requiring complete agreement about everything else.

The effort to modernize Medicare feels like one of those moments. Organizations that have often traveled separate paths are now aligned behind the same legislative objective. A bill with bipartisan support is moving through Congress. Leaders from across the profession have invested years building relationships, educating legislators, and assembling a coalition that many would have considered unlikely not very long ago. Whatever ultimately happens to the bill, that level of alignment deserves recognition.

One proposed amendment would define Medicare’s covered chiropractic benefit according to each state’s authorized scope of practice while expressly excluding drugs, surgery, and obstetrics. Some chiropractors immediately recognize that language as an appropriate description of the profession. Others wonder why it needed to be included in legislation that is fundamentally about Medicare reimbursement and access.

The answer depends on what problem the language was intended to solve. If it clarifies the bill, resolves an ambiguity, or prevents a future implementation problem, then it has done exactly what legislative language should do. If the bill already accomplishes those things without the qualifier, then the purpose becomes much less obvious.

That distinction matters because every sentence added to legislation becomes available for future interpretation. Legislators, regulators, agencies, attorneys, and advocacy organizations all return to statutory language when disputes arise, often years after the people who drafted it have moved on. Every additional sentence should accomplish something the legislation cannot accomplish without it. Otherwise, it deserves scrutiny before becoming part of the record.

There is another question that interests me even more. Every amendment exists because someone believed it solved a problem. If this language wasn’t added because the legislation required it, then what need was it addressing? I don’t know, and I’m not going to pretend otherwise. I wasn’t part of those conversations, and there may have been strategic considerations that simply aren’t visible from the outside. Even so, the question deserves to be asked because the answer tells us something about the profession, not just the bill.

Coalitions rarely form without compromise. Organizations with different histories and different constituencies often include language that reassures their members while allowing everyone to move toward the same objective. If that’s what happened here, then these additional words may have been viewed as a reasonable price for presenting a united front. That’s a judgment call, and people of good faith can reasonably disagree about whether it was the right one.

What keeps pulling my attention back is the possibility that the amendment reveals something larger than the amendment itself. After generations of internal philosophical debate, chiropractic may have developed a habit of reaffirming its identity whenever it attempts to accomplish something collectively. If that’s true, the language isn’t simply about Medicare. It reflects a profession that still feels the need to remind itself who it is while pursuing agreement about where it wants to go.

That observation isn’t a criticism. Institutions carry history, and history inevitably shapes behavior. The question is whether identity and mission always need to occupy the same space. The mission behind this legislation appears straightforward: modernize Medicare so beneficiaries can receive chiropractic services already authorized under state law. Whether additional language advances that mission, protects it, or simply accompanies it is worth discussing because each answer says something different about where the profession is today.

I don’t know why this language was included. There may be a legislative explanation that makes perfect sense. There may have been political realities that required it. It may have been an important part of holding together a coalition that otherwise would not have existed.

What I find most interesting isn’t the amendment itself.

It’s the possibility that, after all these years, one of the hardest things for chiropractic is still deciding when agreement on the mission is enough.

Dr. Glenn Jaffe is a practicing chiropractor with more than twenty years in the profession. He served as president of the North Carolina Chiropractic Association and has worked at the national and legislative level on the profession's governance priorities. He is the founder of BoldAzure, a leadership platform for chiropractors. He writes about where the profession is, how it got there, and what maturation actually requires.

Learn more at boldazure.com