How Affordable is the Affordable Care Act? Thoughts on Insurance and Our Options for Health

For thirteen years I was involved in a cash pay practice.  My foray into the medical insurance industry in the last seven months has been an absolute disaster.  Let me start at the beginning.

In 1984, I joined an insurance-based practice as a pediatrician.  While there, HMOs and PPOs and other “Os” (organizations) started forming.  In 1992, a retiring physician asked me to take over his practice, so I made the move to solo practice in a subspecialty of pediatrics called developmental pediatrics—learning disabilities, attention difficulties in children and adults.  A large part of my practice was Medicaid. When the Medicaid ‘rules’ changed in Montana, I could no longer make a living in medicine and stay in Montana.  We left our dream home that we had just built on 23 acres, and explored 7 practices back east that requested we join them.  We made the decision to join a family integrative medicine practice in Cleveland.

Cleveland gave me my first look at a mostly cash-pay practice, and it was extremely busy for me.  I had a waiting list of at least six months before patients could see me.

Four years ago, I started a cash-pay practice in Utah, but I could not get sufficiently busy, quickly enough, through word-of-mouth and lectures.  I decided that cash pay was not going to work in Utah–at least not as quickly as I needed it to– and so eight months ago I joined an insurance practice.  It took 6 months before I was ‘paneled’ (cleared for insurance) by 5 companies.  I was “denied” by a number of other companies who had closed their doors to new physicians.  (Denial is based on a company deciding they have enough doctors enrolled to meet their specifications to cover their patients.)

Here are some observations from the last 8 months:

  • Each insurance company has its own set of rules.
  • Each company has its own maximum allowable paid for each code.
  • Each code must have ‘documentation.’ The documentation is becoming more burdensome and changes regularly, always in favor of providing less and less reimbursement for patient care.
  • There is no monetary value placed on getting a patient well, or in reducing long-term (and short-term) health care costs.
  • Prevention and preventive care are defined by conventional medicine standards, while we in integrative medicine consider many treatments harmful, such as:
  •                Mammograms, which are X-rays of the breast for cancer screening.  This is alarming, considering it is well established that X-rays cause cancer, including contributing to breast cancer.  Thermograms remove all that risk, cause no pain, and are more sensitive than mammograms at picking up potential cancer in the breast–years before mammograms are able to see it.
  • A “preventive” visit (covered by insurance) may turn into a “diagnostic” visit–during the visit.  For example, a colonoscopy is preventive, but it changes when a polyp is found.  Co-pay is received from the patient upon check-in for a diagnostic or maintenance visit, but not necessary if it is preventive—unless the label changes during the visit.
  • Patients go in for their free ‘annual check-up’, but as soon as they talk about their headache, backache, that changes the ‘annual check-up’ to a non-preventive visit, so you are not allowed to bring anything up at that visit.  You must return another day to talk about anything that concerns you. How is that medical “care?”  It represents egregious medical indifference.
  • If medical care is ‘preventing’ diabetes, hypertension or heart disease from getting worse (thereby saving the insurance industry big dollars), it is still not considered preventive care and co-pay is charged.
  • Medications (sometimes very expensive) for treatment of symptoms are a covered service, while treatments (often less expensive) that address the causes of the condition are not covered—to name a few: chelation, intravenous nutrition, hyperbaric oxygen, NAET (allergy desensitization).
  • Out-of-network providers may not be covered at all for ‘preventive’ care.
  • Decisions regarding all of this care are more driven by stockholders and insurance company employees than by patient care.
  • Out of touch, retired practitioners make many of these (arbitrary) ‘decisions.’  But what is even more disgusting to me is that medical decisions, more often than not, are made by the insurance case manager.  Is there something wrong with this picture?  Whatever happened to “practicing medicine without a license?”
  • Some insurance companies refuse to arbitrate (even when promised care options are in their contract) over disputes, thus forcing expensive lawsuits to follow.
  • An insurance-pay practice requires an insurance biller (extra cost for a full time employee).  The doctor is paid a certain percentage of the maximal allowable reimbursement.  Someone must follow-up with the insurance company when errors are made, non-payments are overdue, the company loses billing forms and refuses to deal with incompletely filled out billing forms.  And the rules change on a regular basis.  And there are multiple insurance companies.  And …
  • Insurance companies pay handsomely for a qualified kidney transplant in an individual who is drinking soda pop and eating processed food on a daily basis, but squawks over paying for supplements and healthy eating to prevent serious illness.
  • When Medicare was introduced in the United States, the government made it clear that it would never become the insurance industry standard.  (It reminds me of the government promise that federal taxes would never exceed 1%.)  Because of its reimbursement scale, Medicare restricts care to the elderly.  Overall reimbursement from Medicare is about 60%.  How fiscally viable is a practice when physician offices have a 50 to 60% overhead?

Here is a list of a few things that may work for you in navigating the confusing course of health care:

  1. Carry insurance with a high deductible (which is happening anyway) with a cash slush fund to be used for health care of your choosing (Health Saving Account).  Placing control of health back in the hands of the patient (where it belongs) will maximize health over the long term.
  2. Business initiated Wellness Programs show good statistics in reducing health care costs.  One of the core elements is providing Health Coaches that assist with difficult behavioral changes.  Patients need them and want them, but behavioral changes are difficult to make alone.
  3. Reimburse Alternative Medicine care at the same rate as Conventional Medicine.

The health care system is broken.  Although the free market system has created problems, the only thing that is worse than what we have is a government-run socialized medicine system. And unfortunately, that’s where we are headed (if not there already).

True preventive medicine treatment lies within the realm of the Alternative Medicine field.  Nutrients (real food and supplements) will prevent more disease than anything else.  Counseling around issues of sleep, exercise, water intake, attitude and emotional health take time and do not fit into insurance-based reimbursement patterns.  (For example, a son of mine was sick 3 times in 2 months.  Reason—stress and sleep deprivation.  It did not matter how many antibiotics he used. Until he started getting proper rest and reduced his over-committed life, he continued to get sick.  When he started sleeping and saying “No” to extraneous commitments, his dis-ease disappeared).

To your dynamic health and energy,

Dr. Gardner


On antibiotics and probiotics

Here’s a link to an excellent interview on NPR with Martin J. Blaser the author of “Missing Microbes.” Be sure to listen before you begin a regimen of antibiotics.

If we were to call the good bacteria and micro-organisms in our gut an organ (which would not be fat from the truth), it would be the largest organ in the body. That puts it above the skin and liver as the presently recognized as the two largest organs. The science of how to scientifically solve the problem of microbiome disrupturion is in its infancy. So, in the meantime, find probiotics with the largest number of different organisms and a total of billions and billions of organisms. If you need to take antibiotics, double the dose and take away from antibiotic intake to gain the most protection.

acid reflux antacids stomach stomach ulcers

Gastritis and Other Stomach Issues

A reader writes:

I had an endoscopy 3 days ago (just concentrate on breathing hard and have the throat spray not sedation) the diagnoses was hiatus hernia and gastritis. I’m now awaiting the pathology results (had several biopsies) and will see GP to prescribe medication. In the mean time have researched that I would benefit from taking alginate – the only medication I found off the shelf was Gaviscon. Wow it was amazing took it 2 days after procedure (1st day after was in absolute pain presumably the biopsies done were then open to the acid/bile in my stomach) so I was very happy yesterday to be comfortable 1st time for about 10 months I have also stayed away from tomatoes chocolate and caffeine. Today not so good but had pineapple juice this morning which immediately aggravated it

My response:

Gastritis is inflammation of the stomach lining. The only time anyone looks for stomach inflammation is when there are symptoms like pain in the stomach area just below the sternum (breastbone).

Conventional medicine wants to neutralize the stomach acid or reduce the stomach acid production in order to reduce the gastritis. However, the stomach acid has an important function–it is the major step in the digestive tract to digest proteins. When proteins don’t digest properly, months and years later amino acid deficiencies are noted.

Alginate becomes like viscous gel that coats the stomach lining, thus reducing the inflammatory effects of the acid. Anything that coats the stomach lining, while permitting the acid to remain in the stomach is healthy:

  • DGL
  • aloe vera
  • liquid vitamin E

Unfortunately, Gaviscon has 2 ingredients other than alginate–aluminum hydroxide and magnesium carbonate or magnesium trisilicate, both of which are antacids. Aluminum is a toxic metal and is associated with neurologic disorders–Parkinson’s , Alzheimers.

You may want to try Gaviscon Infant, which has the alginate without the antacids. Inflammation in the stomach is very much tied into your diet, and it is quite different for everyone. Some of the most common triggers include: sugar and sweets, acidic foods, processed foods (with sugar, additives, colorings, flavorings), certain meats. Find what works for you and stay with it until the inflammation is resolved. Then don’t fall back into the same habits which may have caused it in the first place. (Because of conflict of interest with another company I represent, I can’t mention another product that has been very successful in this setting. If you would like more information about it, email Cristie at and mention this topic.)

integrative medicine supplements

Eureka! I Have Found It!

Introducing a New Line of Supplements

 A supplement is a supplement is a supplement, some might say.  However, I can assure you that that is not true!  There are so many grades and qualities of supplements on the market today.  These extend from pharmaceutical grade down to capsules that pass through the body intact (you can read the brand name on the capsule at the bottom of the port-a-potty).  Lower quality supplements may be full of toxic metals (including mercury, lead, arsenic, aluminum) and they may not contain what the label says they have.

For years I have used pharmaceutical grade supplements in my line, but I have been on the lookout or something that in my heart I believed to be possible–a plant-based supplement that energetically feeds our body food.  I am delighted to report that I have finally found it: Eureka!

A relatively new company has plant-based supplements of the highest grade.  In addition to being plant-based, these top quality supplements also have the following amazing benefits to add to their value:

1.These supplements have no fillers, flowing agents or binders.  This means there is no magnesium stearate and silica, ingredients that are present in almost all lines of supplements.  Although there is no evidence that magnesium stearate and silica are unhealthy, they are not native to the body, nor do they come from plant sources.  I am aware of 2 people who have reported having allergic reactions to magnesium stearate.  The compounding pharmacist of this new company contends that items to complement the main ingredient should fill the capsule, rather than “fillers.”

2.Each raw material ingredient is carefully evaluated as to its source and purity. Because this company serves clients worldwide, (including Japan, which has a much more stringent quality control over supplements entering the country compared to the US), their raw materials must be clean.  They do not import anything from China. Previous batches of supplements were not allowed into Japan because of the contaminants from Chinese raw material, so they discontinued the use of Chinese ingredients.

3.Most of the products are thoroughly researched before they are released to the public.

4.They are all gluten-free, non-GMO, and vegetarian (except ‘fish oil’ and a joint product).

5.For the detailed quality in their composition, they are available at competitive pricing.

6.All capsules are comprised of vegetarian cellulose, hypromellose, and do not contain the carcinogen Sodium Lauryl Sulfate.

7.Many of the capsules have a patented Assimilation Enhancing System (AES) that is composed of plant-based digestive enzymes and mineral cofactors that all improve digestion and utilization of the product.

Some of the products add unique components I have not been able to include in any of my other products:

  • ·       Mobility Complex adds pain-relief herbs to the glucosamine and other factors that build the joint.
  • ·       Total Body Detox has at least 2 herbs to purify and detoxify each of the 5 detoxification organs—skin, liver, kidney, lung, colon.
  • ·       Herbal Calming Blend has all 3 calming herbs instead of just 2, and adds lavender to the product.
  • ·       PhytoEstrogen has a nice blend of several products that help with PMS and menopausal symptoms; not just one product that may or may not help.

Another benefit that appeals to me is the energetic ‘fingerprint,’ or the energy that a product imparts to the cells around them.  In supplements, the energetic fingerprint may be stronger in a plant-based extraction than a synthetic made in the laboratory.  It does not make sense to me that the number of cells in a product, whether medication or supplement, actually perform all the functions of the product.  It makes more sense that the energetic frequency of the molecules release energy to the surrounding tissue, which opens the door so the function takes place.

I will continue to offer the other products presently on the supplement site, unless one of these products clearly replaces all of the benefits at a comparable price.  Always remember that your diet is still the most important part of a healthy lifestyle, and taking supplements does not give you permission to eat poorly and expect to get the maximum results from supplements.  Remember to eat right, to focus on healthy vegetables and fruits as your core source of nutrition, and feed your self healthy thoughts to make everything nourish your body and mind.

To your dynamic health and energy,

Dr. Stan


The “Germ Theory” and the “Terrain Theory”

This fascinating article describing new evidence that Black Death was an airborne illness, rather than spread by infected rat fleas, prompted a detailed response, for those of you who want to understand the philosophy behind alternative or preventive medicine.

For years, two schools of thought have governed how we practice medicine:

  • Louis Pasteur was the father of the “Germ Theory,” that says we all get sick because of germs in our bodies and surrounding us.
  • Antoine Bechamp theorized, on the other hand, that people become sick because of a problem with the “terrain,” or immune system.

The germ theory makes a lot of sense on the surface: if you get exposed to germs, you will get sick. This fits very nicely into the philosophy of conventional medicine:

kill the germs (This is often a ‘shotgun’ approach, blasting antibiotics at the enemy germs, even when the illness is a virus and antibiotics won’t kill it anyway]) and prevent the germs from doing damage by giving vaccinations to create ‘immunity.’

Bechamp’s “Building the Terrain” is a more difficult concept to grasp. If the Terrain (immune system) is healthy, then germs do not have the power to make you sick. Germs need an unhealthy or weakened terrain in order to multiply or morph into the more aggressive forms that cause disease.

Becoming healthy is what is preached within the realm of Alternative/Preventive medicine:

nutrient intake with food and supplements,
toxin removal and avoidance,
positive thinking.
These are some of the things that improve the heath of cells, which improve tissue and organ function and leads to a healthy body.

Have you ever wondered why, although we have thousands of ‘germs’ in our mouths and nasal cavities, they do not always cause illness? We are exposed to thousands of ‘germs’ on a daily basis without getting sick. We get sick when our body is stressed, through inadequate sleep, poor food choices, toxin exposure, or emotional stress.

Black Death–if it is an airborne organism as this article indicates–would flourish best in an unhealthy body. The very young, the elderly and the unhealthy were the ones that died during this plague. Even though it took the lives of more than 1/2 the population, the survivors were the more healthy individuals.

It is interesting to note that, in the end, Pasteur agreed with Bechamp. Pasteur’s last words were: “Le microbe n’est rien, le terrain est tout.” (The microbe is nothing, the terrain is everything)

Our best defense against disease is being healthy. Although we may become sick from aggressive organisms (when our body is stressed or weakened), our strong immune system stands a much better chance of resisting sickness, getting over it sooner, and speeding our way to a total recovery.


Beware the “Natural” Label

“Natural” and “Organic” are totally different labels.  This video explains it in a very funny way. (from


YOU and How You View Yourself

A commitment to body-respect is an essential step toward feeling and looking your best.  Women who like themselves are irresistible and fun to be around, regardless of their size.  It’s also important to remember that respecting yourself will actually help you reach your optimal size.  That’s because the feelings associated with self-respect create a metabolic milieu in your body that is conducive to optimal fat burning.  By contrast, the metabolic processes associated with unresolved emotional stress tend to keep excess body fat firmly in place.

Women’s Bodies, Women’s Wisdom

Christiane Northrup, MD

Dr. Gardner’s comments:  Acceptance of where you are is a critical step in moving toward where you want to be.  Self-deprecation will never take you to your lofty aspirations. Today hold your head high and take one step closer to where you want to be. 


The discovery of modern medicine

Discovery of Modern Medicine


What doctors don’t tell you about cholesterol

Ben Kim on cholesterol:

Today, I am grateful to have a better understanding of the relationship between cholesterol and health. How about you? Are you afraid of having high cholesterol? Are you throwing away egg yolks because you think they’re bad for your health? Are you taking cholesterol-lowering medication or considering starting on one?

If you answered yes to any of these questions, I encourage you to consider the work of Uffe Ravnskov, MD, PhD, author of The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease. I consider Dr. Ravnskov to be the world’s leading expert on the relationship between cholesterol and human health.


Your Nutritional Prescription

“Let food be thy medicine, and medicine be thy food.”  Hippocrates

 For years, I have lamented the fact that doctors get very little, if any, nutritional training in their medical school classes.  My own efforts to be current in this very important field of nutrition led me to become a Certified Nutrition Specialist several years ago.  I have felt as though I am swimming upstream, against a strong current filled with tree branches and mud, as I have championed using nutrition as a first choice therapeutic tool.

But I am encouraged!  Why?  On March 15th 2014, an article appeared in the Wall Street Journal, entitled “A Delicious Prescription.”

Doctors and chefs, along with dietitians and nutritionists, health care practitioners and educators are meeting together in Napa Valley, California, to discuss food and its impact on health.  At the present time, this effort is brought about from the allopathic medicine perspective, but it represents a major leap into the world of nutrition, which has largely been ignored in Western medicine.

A large full-page picture spread of good foods and their benefits are part of the article.  Some even go against the grain of prevailing medical philosophy.  Here are some highlights:

 Healthy fats:

  • anchovies with omega 3 fatty acids and selenium; low in mercury;
  • avocados with monounsaturated fat, potassium, vitamins C and K and folate;
  • eggs as a source of iron, protein, vitamins A and B and folate (notice they left out cholesterol and fats!–which caused eggs to be mislabeled as a “bad” food for years);
  • grass-fed beef with vitamins B and iron;
  • wild salmon with protein, vitamins B and D and omega 3s;
  • olive oil with monounsaturated fat.


  • organic chicken with vitamin B6, iron and protein and omega 3;
  • nuts with protein, magnesium and monounsaturated fat;
  • seeds with folate, fiber, protein and zinc.


  • carrots with vitamin A, fiber and beta-carotene;
  • dark leafy greens with vitamins, minerals, phytonutrients, calcium, sulforaphanes and folate;
  • parsley with folate and potassium and vitamins A and C;
  • squash with beta-carotene and other antioxidants and fiber and vitamin A;
  • cruciferous vegetables (broccoli, bok choy, brussels sprouts) with fiber, vitains C, E D and folate;
  • green beans with fiber and regulate blood sugar;
  • onions and garlic with sulfur and folate.


  • berries with polyphenols and fiber, vitamin C and potassium,
  • coconut with calcium, potassium, magnesium and electrolytes;
  • stone fruit (peaches, plums, nectarines cherries, apricots) with vitamins C and K, potassium and beta-carotene.

 Whole grains:

  • barley,
  • buckwheat,
  • oats,
  • quinoa,
  • wheat and
  • wild rice with fiber.

Mushrooms with minerals and vitamins B and D.

You might want to place a copy of this list of magical foods in your kitchen to inspire their use in meals you prepare.

Getting in the Swim of Things

With the Wall Street Journal article, I am seeing conventional allopathic medicine start to catch up to the science of nutritional medicine.  (They now have ‘pharmaceuticals’ for fish oil, vitamin D, eye antioxidants, and folate, which are no better than a high-grade supplement but much more expensive).

 If this nutritional trend continues, I might begin to feel as though I’ve joined a pool party!  No more swimming against the current in a muddy, tricky river.  But even this venture into previously uncharted waters is merely dipping conventional medicine’s toe into the pool.

However, my assessment of this ‘big toe in the swimming pool’ of food and health is guarded.  Dr. Harlan is quoted in the article as saying, “Make no mistake.  I am an allopathic physician.  I do not believe in anything other than evidence-based medicine.  As an internist, I prescribe statins and beta-blockers and ACE inhibitors and aspirin.  I believe in them and they have a role.  Diet alone is very good.  Medication alone is very good.  But diet plus medication is synergistic.  It’s another tool in the box that physicians should have available to them.”

I’m really looking forward to the day when not only the big toe or foot is in the science-based nutritional swimming pool, but allopathic medicine takes a giant leap forward.  Maybe in my lifetime, their whole body will jump in and harness the power of nutrition to address health and disease prevention and treatment.  I certainly hope so.  In the meantime, we can all show them the difference it makes to eat wisely, and healthfully.

To your dynamic health and energy!

Dr. Stan