By Cielo M. Lutino
The average cost of acupuncture really irritates — needles, even — Lisa Rohleder, one of two acupuncturists behind the clinic Working Class Acupuncture.

“A needle costs about 2 cents,” she says, yet calls to 15 randomly selected acupuncturists in the area priced the typical first-time visit at approximately $75. (Follow-up appointments average about $20 less, running about $56.) Reconciling any of the three figures — 2 cents per needle, $56 per follow-up appointment or $75 for an initial visit — doesn’t add up. Why does acupuncture cost so much?

“We’re living in a big city, and rent is a big factor in delivering health care,” says Natalie Arndt, a licensed acupuncturist since 1987 and current board member of the Oregon Acupuncture Association.

Other factors affect the cost of acupuncture, to be sure. The administrative fees that come with untangling insurers’ red tape contribute to its price, as does advertising. So does education: a four-year degree from the Oregon College of Oriental Medicine can run over $40,000. From the cost of delivering acupuncture to its marketing and to receiving a degree in the field, it seems natural medicine increasingly resembles Western medicine in its pricing structure.

That’s worrisome if health care trends continue along their current path. According to Families USA, a national, nonpartisan advocacy group for affordable health care, 6.8 million Americans spend one-third of their income on health care — and that’s for the insured, never mind the 45 million uninsured Americans tracked by the 2003 Census. Perhaps it should come as no surprise then, that medical bills cause approximately half of all personal bankruptcies, as Elizabeth Warren and Amelia Warren Tyagi discovered in their study, “The Two-Income Trap: Why Middle-Class Mothers & Fathers Are Going Broke, published this year.”

Given such numbers, the growing similarity in costs between “alternative,” as natural medicine is sometimes described, and Western medicine may sound alarms, yet there’s seemingly no reason for either medical approach to lower delivery fees. In fact, the rising costs of acupuncture may be a direct result of its practitioners’ desire for their work to be considered “standard,” rather than “alternative,” medicine.

“Charging the same is a by-product of raising our stature within mainstream medicine,” explains Mark Goldby, an acupuncturist whose own clinic, Open Gate, functions in a decidedly non-mainstream fashion. The clinic uses a sliding scale to charge patients, bottoming out at $25 per follow-up session, a fee structure that differs from what most acupuncturists increasingly offer, because insurers demand set prices before adding a clinic or individual acupuncturist to their rolls.

Working Class Acupuncture, the clinic Lisa Rohleder founded with her partner, Skip Van Meter, operates like Open Gate, basing its fees on a client’s income with follow-up visits available for as low as $15.

With workers having to make $15.29 per hour simply to afford a two-bedroom unit at fair market rate in Multnomah County, according to the National Low Income Housing Coalition, Open Gate and Working Class Acupuncture come as close as they can to reaching low- to middle-income populations.

But some acupuncturists are threatened by the services they offer. Explains Arndt, “If a patient can go to someone like Lisa and get treatment for $15 or $20, then it’s gonna make them look bad if their treatments are $70 each. It might [create] pressure from the public that they should lower their rates.”

Rohleder has a firm response to such fears. “It’s a basic business principle that it’s fine to charge what the market will bear. The reality of class is that there is more than one market,” she writes in The Little Red Book of Working Class Acupuncture for Practitioners, which she’s laughingly described as her manifesto of sorts.

The New York Times recently captured the effects of class on health in contrasting profiles of low-, middle-, and high-income Americans who suffered heart attacks in roughly the same period of time, concluding, “Upper-middle-class Americans live longer and in better health than middle-class Americans, who live longer and better than those at the bottom.”

By offering affordable rates, Open Gate and Working Class Acupuncture ensure that more members of the public are able to access acupuncture. Says Gloria Gosnell, who has frequented Working Class Acupuncture for about two years, “I’m not low-income, but I still could not afford to go regularly at the price that most acupuncturists charge.”

Working Class Acupuncture takes the class component beyond costs in the design of its space. Patients take a seat in any of the recliners scattered about the clinic’s cozily lit large room where they receive treatment alongside others who come and go as their appointments dictate. Some take advantage of the worn but clean lap blankets available and settle in for the duration of their treatment, often falling asleep in the process. “Just like going into someone’s basement and hanging out,” says Dave Coultas, a warehouse worker for Toyota who has gone to Working Class Acupuncture for a little over a year.

“The environment is conducive to working class people,” insists Gary Guzman, who has a background in construction and who is now chair of the board for Working Class Acupuncture.

Explains Rohleder of their design choices, “Making this medicine accessible is more than just making it financially accessible. You have to make health care feel like it’s not that far away from the patient’s own world.”

Of course, treating groups of people in a few large spaces benefits Working Class Acupuncture economically, as does their refusal to bill insurers. “Essentially, we are running our business on co-pays,” says Rohleder.

“They don’t have as much overhead so they can charge low prices and still give good quality care,” says Arndt.

Natural medicine providers like Open Gate and Working Class Acupuncture offer alternative business models even for the “alternative” health industry. But, to be fair, acupuncture is only one segment of a burgeoning field that includes chiropractors and naturopaths. To focus on acupuncture’s costs alone doesn’t consider the complex set of factors working on the health industry overall, like the costs of pharmaceutical drugs or fair living wages for acupuncturists themselves. As Arndt says,

Sure, it’s good to have health care be more economical, but [acupuncturists] have certain expenses they have to meet.”
With clinics like Working Class Acupuncture and Open Gate demonstrating affordable and workable models for delivering natural medicine, it’s possible that the “alternative” health industry may yet prove its difference on fiscal terms welcomed by the working class.

Cielo M. Lutino is a local writer and activist.