WASHINGTON -- Two podiatrists recently visited West Virginia Sen. John D. Rockefeller IV to ask him the burning question among health care practitioners these days: Are we in or out?
They "were terrified," the Democratic senator said, desperate to know whether their services would be covered under the standard benefits package the Clinton administration is expected to offer every American as part of its health care reform proposal.
Health practitioners of every imaginable stripe -- from non-traditional acupuncturists to mainstream physical therapists -- are clamoring to be included in the package, which the administration's health care reform task force is drafting behind closed doors.
Many health insurance plans do not cover nontraditional treatment. For health practitioners, inclusion in the standard benefits package would guarantee them access to the largest possible pool of patients, including the 35 million Americans who have no medical insurance.
Pulling out all the stops, many practitioner groups are meeting with the task force and dispatching lobbyists to Capitol Hill, where a House panel held the first congressional hearing yesterday on what should be included in the benefits package.
In a joking reference to the practitioners' concerns, Fred Grandy, an Iowa Republican and a member of the Ways and Means health subcommittee, said he'd offer a "cash reward" to any group that said it shouldn't be included in the benefits package.
Not everyone is laughing.
"I'm not going to tell you I'm not nervous," said Frederick Somers, an official of the American Occupational Therapy Association, whose members help disabled people learn or relearn the basic skills needed to care for themselves. "This is quite a process: We're talking about reshaping one-tenth of the economy. It's a high-stakes game."
Actually, health care spending accounts for one-seventh of the gross domestic product, and practitioners want to make sure they get their share of the pie. Those whose services aren't reimbursable under the standard package might want to consider another profession.
The stakes are perhaps highest for so-called alternative practitioners and their patients. These include acupuncturists, massage therapists, nurse midwives and osteopaths, who treat illnesses in the context of the entire body.
A study earlier this year found that one-third of all Americans had tried at least one alternative therapy, even though many of the treatments were not covered by health insurance plans.
Disdained by the traditional medical doctors who dominate the present health care system, the alternative specialists see health reform as a golden chance to move up the ladder and, at the same time, transform health care.
They've been given some encouragement by the task force, which invited about two dozen of them to an unpublicized meeting in mid-March. Representatives of massage therapists, acupuncturists, chiropractors, holistic nursing, and other specialties made their pitch inside the large, ornate Indian Treaty Room of the Old Executive Office Building.
Task force officials were sympathetic, but noncommittal.
"They didn't make promises, so to speak," said Elliot Greene, president of the Maryland-based American Massage Therapy Association. "But they indicated they were interested in offering a comprehensive benefit package" that could include alternative therapies.
The head of the new federal office of alternative medicine, Dr. Joseph Jacobs, attended the meeting and was cautious afterward. He said in an interview that the administration would consider only those alternative therapies that are proven effective.
But that's encouragement enough to alternative practitioners such as acupuncturists, who see health reform as a "big window of opportunity," said Anna Bevis, a spokeswoman for the American Association of Acupuncture and Oriental Medicine. The nation's 6,500 acupuncturists are being urged by the association to write to Hillary Rodham Clinton, who heads the task force.
A "sample letter" sent to members advocates legislation "to guarantee insurance coverage of acupuncture as a therapeutic procedure." It emphasizes that the ancient needle therapy from China "is highly effective for relieving pain" and saves money by keeping patients out of the hospital and off expensive prescription drugs.
This is very much in tune with President Clinton's wishes. He wants the standard benefit package, which employers would provide to workers and the poor would receive from the government, to emphasize lower-cost, preventive care.
Not surprisingly, nearly every practitioner group striving to be included in the package has adopted this idea as their own. No matter who they are or how expensive their service, they say it'll save money.
Medical rehabilitation for severely injured trauma victims, which is often extraordinarily expensive, "is one of the few areas that demonstrates proven cost savings," an official of the Medical Rehabilitation Foundation said at a recent news conference.
Unlike the acupuncturists, the foundation could afford to hire Hill and Knowlton, a large public relations firm, to help stage its meeting with journalists. To drive home its point, the group trotted out disabled American League umpire Steve Palermo, a shooting victim who is slowly recovering from spinal injuries.
Chiropractors also plan to push the administration for protection of their prerogatives. Having already won wide acceptance in insurance plans, they fear that the health care system of the future will consist of health maintenance organizations in which their enemies -- traditional medical doctors -- will control which specialists patients see and shut out chiropractors.
In a pre-inauguration meeting with Clinton aides Jan. 5, American Chiropractic Association Vice President Jerome McAndrews warned against allowing medical doctor "wolves" to guard the gate to patient care and recommended legislation barring discrimination against any licensed specialty group.
The chiropractors dream of coming out on top in their war with the medical establishment. In what Mr. McAndrews terms his "blue sky hope" for reform, chiropractors would be the "gatekeepers" at medical facilities instead of the doctors, determining who sees which specialists.