As health-care providers, one of the most important ways we can show up in this moment is to work toward ending inequity and racism in massage therapy, but this is a concept most of us have yet to fully grasp. Every white provider has played a part in holding up systems that perpetuate inequity (after all, massage therapy is a pretty white profession), and the time has come to set down our proud declarations of “color blindness” or claims that we “treat everyone the same.” We must engage in unflinching self-examination, embrace the truth of unconscious bias, and move straight on through our self-indulgent fragility and defensiveness, so we can directly access the truth of how we got here. This is our work to do. Every single one of us.

Humans see difference. All humans. That’s how we’re wired. Even kind humans who are trained and called to care for other humans. So, we will not untangle this centuries-old mess in one column in one magazine. We can, however, peek at a recent editorial published in the International Journal of Therapeutic Massage & Bodywork titled “Equity, Diversity, and Inclusion in the Massage Therapy Profession,” where the authors offer some key observations and questions. For example, the authors posit that “[since George Floyd’s murder]         . . . people are beginning to wake up to the reality that Black and Brown people are treated differently in the United States.”¹

Health-care disparities in the US are well documented and corroborated by the lived experience of pretty much every person of color in this country. The editorial’s authors invite “the profession—from researchers, to educators, practitioners, and associations—[to work to] improve the landscape.” That’s all of us, and the landscape is in need of much more than improvement. I’m talking brush fire, friends.

The editorial’s authors point to a variety of possible factors for disproportionate representation among consumers as well as providers, including white-centric media representation, economics, access, and education. We can’t tackle all of those here, so let’s look at one in particular: access.

The Insurance Discussion

Massage therapy can no longer exist solely as a “luxury,” available to those with disposable income or who can find a program where massage therapists are serving “the underserved” by working for free. We have to get on board with insurance reimbursement—not just philosophically, but actually.

The insurance “discussion” typically devolves quickly into a slippery slope. The slippery slope is a common default, but it’s a fallacy. It suggests that a certain course of action is undesirable because it leads to an unwanted conclusion. It is based on a series of tenuously connected, unproven, and unsubstantiated premises. And, in this case, there is no consideration of our privilege as mostly white providers or the likelihood of desirable outcomes for others.

Therapists say, “I don’t want the insurance companies telling me what to do,” or “If I take insurance, I’m going to spend my life on paperwork and get paid $30 per session.” And the unintentionally classist claim that, “My whole practice will become workers’ comp cases, and people who ‘don’t really get massage,’ but who have been told they have to.” These fears are bolstered by horror stories we have heard from providers in other disciplines who work within the insurance system, and they are not entirely unfounded but are also not well-researched. Additionally, they fail to account for the possibilities that lie in a future that includes the broad accessibility of massage therapy to all people who could benefit. (Note: Nobody will ever “make” you take insurance.)

According to the Virtual Mentor (from the AMA Journal of Ethics), “In a population-based survey, 27 percent of African-Americans and 28 percent of Hispanics over the age of 50 reported having severe pain most of the time; only 17 percent of non-Hispanic whites did.” In addition, “There is overwhelming evidence that the management of pain in the United States is inequitable.”³ The lack of access to massage therapy is part of this inequity.

Massage therapy must become a standard Medicare- and Medicaid-reimbursable intervention. If we are not compelled to do this solely for the benefit of others, we can look to civil rights leader Derrick Bell’s “Interest Convergence Theory.” Bell theorized that “The interest of [B]lacks in achieving racial equality will be accommodated only when it converges with the interest of whites.”⁴ Black, Indigenous, people of color (BIPOC) in the US have a long history of undiagnosed, misdiagnosed, and untreated or undertreated pain and chronic illness.

We can continue to think about this as “their problem,” or we can recognize the opportunity that exists for all of us in turning to face it head on. We stand to gain lower health-care costs for all people, a healthier population overall, and more opportunity to thrive for clients and practitioners alike. Imagine adding more than 300,000 massage practitioners to the health-care workforce. Now that’s some impact.

Insurance is a place where massage therapy could make a big dent in the equity fight. We will have to relinquish some of the “power” that lies in continuing to work outside the system, but when we clear this hurdle, we will gain much more than we will lose, and when I say “we,” I mean humans. 

Notes

1. Oluwakemi Balogun and Ann Blair Kennedy, “Equity, Diversity, and Inclusion in the Massage Therapy Profession,” International Journal of Therapeutic Massage & Bodywork 13, no. 3 (September 2020): 1–5, https://doi.org/10.3822/ijtmb.v13i3.571.

2. Oluwakemi Balogun and Ann Blair Kennedy, “Equity, Diversity, and Inclusion in the Massage Therapy Profession.”

3. Ronald Wyatt, “Pain and Ethnicity,” Virtual Mentor 15, no. 5 (May 2013): 449–54,  https://doi.org/10.1001/virtualmentor.2013.15.5.pfor1-1305.

4. Derrick A. Bell, Jr., “Brown v. Board of Education and the Interest-Convergence Dilemma,” Harvard Law Review 93, no. 3 (January 1980): 518–33, https://doi.org/10.2307/1340546.