Defining Safe: Working toward accessibility in acupuncture

Aviva Bechky, Assistant City Editor



Some acupuncturists are pushing to get their services insured. Others are working on sliding-scale models. In this episode, Defining Safe takes a look at the history of acupuncture, the changes acupuncturists would like to see and the ways racism impacts the industry.

AVIVA BECHKY: Before we begin, a content warning: this episode contains mentions of anti-Asian racism and slurs.

AVIVA BECHKY: When people talk about how acupuncture spread in the U.S., they often talk about Richard Nixon’s trip to China. A New York Times reporter who traveled with Nixon got acupuncture treatment and wrote about it when he returned. And while many associate that article with acupuncture’s origins in the U.S., traditional East Asian medicine existed here long before Nixon’s trip.

AVIVA BECHKY: In the 1800s, Chinese immigrants used traditional Chinese medicine to treat their communities. And in the 1970s, the Black Panther and Young Lords movements used acupuncture to treat addiction and address disparities in the U.S. health care system.

CHIARA FRANCESCA: My first time getting acupuncture was at the healing justice space, and it was actually the same ear protocol that was used by the Black Panthers and the Young Lords.

AVIVA BECHKY: Acupuncturists use needles at strategic points to lessen pain, help mental health and improve overall wellness. Today, acupuncture is used throughout the United States, but its accessibility varies widely.

AVIVA BECHKY: From The Daily Northwestern, I’m Aviva Bechky. This is Defining Safe, a podcast looking at the intersection of identity and student life at Northwestern and in the Evanston area. In this episode, we’re taking a look at the history of acupuncture in the U.S., as well as present-day efforts to make the treatment more accessible and equitable.

AVIVA BECHKY: The person you heard speaking about their first acupuncture experience is Chiara Francesca, a Chicago-based acupuncturist who works to use acupuncture under a healing justice framework. Acupuncture has long been used to address gaps in the medical system, and Chiara wants to see grassroots efforts to use acupuncture as a form of community health care.

CHIARA FRANCESCA: I think that the solutions are not gonna be cookie cutter, right? Every community’s probably gonna have different ways of showing up for the needs of the people in that community.

AVIVA BECHKY: Not all acupuncturists agree on the route they want to see the medicine take, either.

ELAINE VOZAR: One of the movements is POCA, which is a movement that has to do with having community acupuncture.

AVIVA BECHKY: That was Elaine Vozar, another Chicago acupuncturist. The People’s Organization of Community Acupuncture — or POCA — which Vozar just mentioned, is an organization working to increase affordable group acupuncture options.

ELAINE VOZAR: You’re usually in one room with a bunch of people. Clients are usually in chairs, and you’re trying to see as many patients as possible.

AVIVA BECHKY: Vozar said community acupuncture is just one way acupuncture is being reimagined. Another way is allowing acupuncture to be prescribed in the same way Western medicine is prescribed. This could integrate the practice into already-existing treatment plans, but may exclude uninsured people.

ELAINE VOZAR: So it’s not about, like, “Oh, let’s make sure that people who don’t have access to medicine have it.” But it’s about having people who have lots of access to medicine also partaking in acupuncture.

AVIVA BECHKY: Those pushing for insurance coverage say care by acupuncturists should be covered just like any other medicine. Timothy Suh, also a Chicago-based acupuncturist, is working to improve acupuncture insurance coverage.

TIMOTHY SUH: Right now, there is a grassroots movement to get acupuncturists to become providers under the Social Security Act. An act of Congress has to actually put them in the Social Security Act to become a provider under Medicare.

AVIVA BECHKY: Even though Medicare doesn’t cover all acupuncture procedures, some private insurance companies cover treatments that Medicare doesn’t.

TIMOTHY SUH: I actually started the process of accepting insurance and processing insurance in 2008. And so that took credentialing, it took all the normal process any other health care provider, except there were many other roadblocks, because we’re not considered a provider under Medicare. Which is why, mainly, acupuncture is not covered under other commercial health insurances.

AVIVA BECHKY: Suh said Medicare does cover acupuncture in certain cases, but not if the procedure is performed by an actual acupuncturist.

TIMOTHY SUH: Right now, you can get acupuncture for chronic low back pain, but they will not actually pay an acupuncturist to do it. It has to be done by an M.D., a DO, a PA or nurse or nurse practitioner, which is very unusual, because most of those people generally are not educated in the procedure of acupuncture.

AVIVA BECHKY: However, New York acupuncturist Emily Siy said insurance dictates too much of the way care is received. That’s why she’s trying to make her work more accessible through different routes.

EMILY SIY: I offer certain treatments that are lower-cost. So ear acupuncture, for example, which is just acupuncture on the ears, you can come in for a 30 minute session for $40. So that’s very accessible. I do programs where I have funding to give away some acupuncture treatments, some ear acupuncture treatments for free. And this is for women of color, or people of color who are experiencing things like racial battle fatigue.

AVIVA BECHKY: Similarly, Chiara thinks insurance coverage won’t be the best way to help their clients.

CHIARA FRANCESCA: Ninety-nine percent of my patients don’t have insurance, right? And most people’s insurance doesn’t cover acupuncture anyways. So to me, that’s not a priority, like to have acupuncture covered by insurance, because that’s already a classed reality. Like, who has insurance. I’m more interested in supporting grassroots community health care.

AVIVA BECHKY: Instead of insurance, Chiara uses a sliding scale model. Clients pay what they can, and Chiara doesn’t ask about their finances. That’s a change, they say, from many programs, where low-income people are forced to prove their income status in order to get help.

CHIARA FRANCESCA: To me, the kind of potential of trust — and especially trust for folks who have been systemically untrusted — is actually part of the health care. And that’s part of restoring agency, power, and it’s part of health.

AVIVA BECHKY: Cost and accessibility aren’t the only problems some acupuncturists see in the field. Acupuncture is rooted in East Asian traditions, and some say anti-Asian racism remains a persistent problem for acupuncturists.

EMILY SIY: There is this idea of Orientalism, right? About how the West kind of is able to hold this view, or control the view, of whatever they consider to be East or Eastern.

AVIVA BECHKY: The word “Oriental” is all over acupuncture. Acupuncture schools frequently have it in their names — take the Midwest College of Oriental Medicine in Skokie as an example. A common degree that acupuncturists get is called the master’s of science in acupuncture and oriental medicine. And for some acupuncturists, especially Asian acupuncturists like Siy, this can be alienating.

EMILY SIY: I walked into the doors of the school, and they use the word “Oriental.” I didn’t necessarily want to choose Pacific College, because they use that word. Right away, I did kind of understand, like, I’m walking into an institution where they don’t have this understanding that this word shouldn’t be used.

AVIVA BECHKY: Siy, along with more than 2,000 others, signed a petition created in 2020 by Dr. Tamsin Lee that asked for the word to be removed from institutions and diplomas. Some schools have made that change, like the Pacific College of Health and Science. But on its website, Pacific College’s explanation for the change does not acknowledge the racist origins of the old name. Acupuncturists also told me that many acupuncture schools Westernize the medicine’s history. Chiara, who’s an Italian immigrant and doesn’t have a familial connection to acupuncture, spoke to that.

CHIARA FRANCESCA: It’s learning a medicine that is very divorced from its roots and its context. It’s also the like layers of kind of romanticization, fetishization, white supremacist thinking that are then like overlaid on top of it at school. Also, the schools, most of them are for profit, right? And it’s like $100,000 to get an acupuncture degree? Which, obviously, it’s another huge mechanism of gatekeeping.

AVIVA BECHKY: Some acupuncturists were raised with acupuncture as part of their heritage. Others weren’t. The connection between acupuncture and culture is complicated.

TIMOTHY SUH: I actually grew up with the medicine. I’ve had acupuncture since I was little. It’s been part of my culture and my personal family experience. Herbs and acupuncture has always been part of my life.

AVIVA BECHKY: But Suh added because acupuncture is a traditionally East Asian medicine, some patients make assumptions about their providers.

TIMOTHY SUH: So they assume because you’re East Asian that you’re better. It’s not necessarily true.

AVIVA BECHKY: Siy said she wants to see more acupuncturists of color and more queer acupuncturists in the field. She also wants to hear more discussion about privilege.

EMILY SIY: I hope that there is more discussion and reflection from people who come from more privileged positions about access, oppression, because health care is really, you know, it’s important and it’s, you hear it more and more that it should be a right, but not everybody has access to it.

AVIVA BECHKY: Acupuncture is sometimes termed “alternative medicine,” which often relegates it to a less scientific status than Western medicine. But Siy said that for patients who don’t feel welcomed by dominant health care institutions, receiving care outside the norm can feel more comfortable.

EMILY SIY: You know, it basically is saying that it’s something outside of the system, it’s something that’s othered, it’s something that is an alternative, right? I think there are pros and cons of this. Some people who maybe felt like they were either discriminated against, or they don’t feel comfortable or safe in conventional health care settings, I think that the word alternative could be a little like… it can make people feel a little bit safer? In a larger view, it definitely puts us in an “other” category.

AVIVA BECHKY: Chiara also said accessible acupuncture could be especially beneficial to those who’ve been harmed by dominant systems.

CHIARA FRANCESCA: If anybody hears this, and it’s a health care provider trying to do things outside of the system, I hope that there is a sense that none of this can be done alone. And also that failure and setbacks and hardships are part of it. And I hope that people can find community around it. And if people want to reach out to find community around it, they should.

AVIVA BECHKY: From The Daily Northwestern, I’m Aviva Bechky. Thanks for listening to another episode of Defining Safe. This episode was reported and produced by me. The audio editor of The Daily Northwestern is Will Clark, the digital managing editor is Jordan Mangi, and the editor in chief is Isabelle Sarraf. Make sure to subscribe to The Daily Northwestern’s podcasts on Spotify, Apple Podcasts or SoundCloud to hear more episodes like this.

Correction: A previous version of this story misstated Chiara Francesca’s name and their identity as an immigrant. The Daily regrets this error.

Email: [email protected]
Twitter: @avivabechky

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