Everybody has a budget and has to live within that budget to stay in business. This is no different between any of the delivery models. When the money runs low in a socialized system, income is increased by raising taxes while the private sector raises prices. Either way, the poor bastard working paycheck to paycheck winds up being the only one really affected.

So which one is better?

It’s no secret that I’m not a huge fan of government-ran healthcare, but that doesn’t mean I think the private-sector is without fault. My issue with government being in control of healthcare is their lack of ability to balance a budget. It just seems like healthcare would be yet another thing on the chopping block when it comes time to reduce the deficit. Instead of the sob stories telling us that “we will have to lay off police officers, firefighters and teachers if we don’t raise these taxes”, we will have the pleasure of having nurses and doctors added to that list. Plus, there is just too much red-tape and BS that goes into getting anything done.

Now I meant it when I said the private-sector isn’t perfect. As a matter of fact, they are far from it. Profit margins and favors to share-holders certainly do their share to affect patient care. Now let me set the record straight. I’m OK with someone making a profit off healthcare. That’s what drives growth and creates jobs. What’s troubling is some of the measures that are often taken to increase those profits.

Throughout my experience in healthcare, I would have to say that non-profit is my favorite delivery model. Like I said, there is still a budget but not so much of a profit margin to compete with. You tend to see things actually being done to benefit the patients that we serve. It’s just a different mentality. I currently work for 2 non-profit entities and I can say that we do a lot of things to benefit our patients that aren’t covered by medicare or probably any insurance agency. It’s just done because it’s the right thing to do.

Of course, there are always exceptions. For example, my last employer was a for-profit ambulance service. While we were in business to turn a profit, we did a ton of things to improve patient comfort, safety, crew comfort, etc. None of which was required. I know that there are a lot of government-based services that do the same as well, it’s just not the norm.

That’s just my opinion, ableit a biased one.

The real problems

The issues around our healthcare problems in the U.S. aren’t a matter of delivery methods. It’s a matter of reimbursement, abuse and lawsuits and all 3 are directly related to each other. It’s like that movie “Human Centipede” with lawsuits being on the front of the of the chain, abuse right behind and reimbursement on the tail end.

Side note – If you haven’t seen Human Centipede, consider yourself lucky. Whatever you do, DON’T watch that movie, it will scar you for life. If you have seen it – god forbid – then you should get the humor in the reference. 

Lawsuits by themselves aren’t necessarily raising the cost of healthcare, but what they do is encourage defensive medicine. Doctors start ordering tests that they know aren’t necessary only to be “safe” just in case it’s actually something serious. So the 19-year-old with a headache and no other symptoms gets a CT scan and the frequent flyer who comes with the same complaint of chest pain every week gets a full cardiac workup. Those are just a couple examples of what the ER’s see on a regular basis.

A system that encourages defensive medicine also encourages abuse. The frequent-flyer previously mentioned will continue to come in on a regular basis, because he knows that nobody is going to just do a medical screening exam and send him away. Whether it’s food or attention he’s after, he knows he’s going to get it and so he continues to come back. Once again, that’s just one example.

So now comes the problem of reimbursement. Every time our frequent-flyer uses emergency services generates a bill. A bill that’s not going to get paid. Even if he is covered by Medicaid / Medicare, they are only going to cover a fraction of the cost. So what happens to the uncovered portion of the bill? Well, prices for these services just continue to increase in order to make up for the lost revenue. See: COST SHIFTING

Solutions, anyone?

Throwing money at the problem or changing our delivery model does nothing without addressing the core issues that got us here in the first place. As it currently stands, the people who pay for their insurance are essentially paying for those that don’t. Switching to a single-payer system or socialized system doesn’t change that. That problem with never go away.

What we need is better access to primary care providers and incentives for seeking appropriate levels of care. There isn’t much incentive for a primary-care physician to see Medicaid or Medicare patients because the reimbursement is terrible. Something has to be done about that. But not in the way that you might think. A trip to the family doctor or urgent care is going to be far less than a full-blown work-up at the ER. If more people were seeing their doctors instead of using emergency services to address their problems, then our insurance providers – both private and public – would have more money to spend on things like reimbursement.

Now this sounds fine and dandy, but getting people to seek appropriate levels of care isn’t going to happen by asking them nicely. There has to be serious incentives. For me, such incentives already exist. For me or my family to visit the ER, we pay a $100 co-pay unless we are admitted. In that case, the co-pay is waived. So every time me or a member of my family gets sick, we have to decide what will be the best way to seek medical attention. Obviously I’m not going to pay $100 for a sore throat, I’m going to pay $25 to see a PCP. Why can’t we use a similar system for Medicaid?

Like I said, asking nicely isn’t going to do the trick and neither will sending a bill. I think most would agree that people that habitually abuse emergency services aren’t going to willingly fork over the cash for a co-pay. And nobody is going to turn them away for lack of ability to pay, and that’s perfectly OK. But what we can do is deduct that co-pay from other benefits, like welfare. I would even go as far as saying that a $30 ER co-pay would substantially reduce the abuse.

If you set out a box of free donuts, people will naturally over-consume. If you charge even 50 cents people will most likely only take one, if even any. When people are visiting ER’s because they don’t have enough money for Tylenol, then we know we have a huge problem. Nobody is held accountable, so why would they act any different?

People abuse the system because it’s not only allowed, it’s encouraged. Until we actually get serious about addressing the high cost of healthcare, nothing is going to change. It doesn’t matter how much money we throw at it or who’s running the show.

Most of you know where I stand with my beliefs. I tend to be very conservative on most things, sometimes moderate with others. I respect other people’s opinions and beliefs and I can only wish for the same in return. Obviously we don’t always get what we wish for.

Unfortunately I’m going to have to go “Hannibal” on some of my fellow conservatives and “eat my own” for a post. I’m sure as a result, the hate-mail folder will probably get a few extra hits this time around.

I have come to a crossroads with my beliefs and I find myself having to choose between values that I stand for. I have realized that many of my beliefs contradict each other, and I feel that it is a direct result from the problems that the 2-party system has created. I hate having to choose sides because frankly, I don’t believe in everything either party stands for. Yes, I consider my beliefs to be conservative, but that doesn’t mean I think the Republicans are always right.

A wise man once told me that the constitution protects not only the rights that I like, but it also protects your rights that I don’t. For the most part, I have accepted that. I may firmly believe in my right to keep and bear arms, but I would never support forcing people to own and carry firearms. I certainly disagree with just about everything that comes out of Michael Moore’s mouth, but I would stand side-by-side with him to defend his right to free speech.

So why haven’t I done the same with things like gay marriage and abortion?

I asked myself this recently and I had a really hard time answering it. The truth is, neither issue really affects me. I’m not homosexual and I wouldn’t consider having an abortion (not that it’s physically possible, but you get the point). If the federal government decided to allow gay marriage nation-wide, it really wouldn’t affect me. Nobody is forcing me to marry another man and nobody is demanding that my wife and I have an abortion next time she gets pregnant.

So I guess where I am going with this, is that I have had to figure out what’s important to me. We can’t sit here and say that we don’t want our rights taken away, but then turn around and hack away at the rights of the people we don’t agree with. Yes, I still believe that abortion is wrong, but I still have the choice not to get one. The same goes for drinking and driving. I think it’s wrong to get plowed and then get behind the wheel of a car, but I’m not about to rally to outlaw bars or alcohol.

My political beliefs are actually quite simple. I don’t want government telling me that I have to or can’t do anything. As long as it doesn’t affect anyone else, let me make the decision on what’s right or wrong.

Where the Republican Party has gone wrong is they seem to spend all their time addressing the issues that don’t really affect anyone. What DOES matter are things like the economy, taxes, war, and defending our god-given rights…..all of them. The beauty of this country is that we don’t have to follow a single belief system. We are still free to practice the religion of our choice. We can work any job we want, live anywhere we want, talk anyway we want, and most importantly, we still have the right and the means to protect it all.

What we need to do, is worry about the issues that really matter right now so that we still have the ability to debate over the little things that we don’t agree with.

I can say that I feel Homer’s pain on this one:

Click here to view the video on YouTube.

Now on to the good news! In just 4 short days, I’ll be picking up this bad boy

I have always wanted a .22 pistol and I just never brought myself to get one. This Walther P22 looks promising. It’s comfortable, has a good reputation and has tons of accessories available. A range report will be available once I pick it up.

http://www.kansascity.com/2011/04/23/2821080/the-stars-editorial-kcs-ambulance.html#storylink=misearch

I was hard pressed to find a single good reason for the change when Kansas City Fire took over MAST. Granted, this is coming from someone who never worked there, but I saw this coming from a mile away. I knew that they would try and run the ambulance division just like the fire department, and there was no way they could do it without compromising something.

The Fire Department has failed in every three-month period since the takeover to meet the council’s response requirement citywide. In fact, the department hasn’t yet reached the mandated response time citywide in any single month. The times have been slowest north of the river, and often not much better in the city’s southern parts.

That’s because you can’t make your times when you house the ambulances in a fire station rather than a street corner without drastically increasing the number of units. That is why system status was created. It’s efficient and effective. Why do you think we don’t have cops sitting in police stations all around the city? There is simply too much work to do.

The city has put Fire Chief Smokey Dyer’s proposed move of more ambulance crews to 24-hour shifts on hold because of legal concerns. Meanwhile, emergency medical providers nationally are having new discussions about the quality of medical care provided by crews that work for 24-hour periods. Kansas City should have this kind of debate too before this notion advances.

There is a reason ambulance services around the nation quit running 24 hour shifts in busy metropolitan systems. It’s too dangerous. My service dropped the long-hour cars in our metro areas a long time ago. We run too many calls for that to be safe. I can’t imagine trying to do the same thing in much bigger city like KC. To make that work, they would have to add a bunch of units to the system, which would cost a ton of money. I thought this takeover was supposed to save the city money.

…. in an interview last week, Dyer dismissed the importance of meeting standards for ambulances, saying: “We just do the best we can each month.” He said “it’s not possible” to meet the council-mandated times with current resources.

Hmm, MAST didn’t seem to have a problem doing it. I think what he meant to say is: “It’s impossible to meet to the council-mandated times while running the service like a fire-department with the current resources”. It’s no surprise to me that he doesn’t understand the importance of response-time requirements, because up until a year ago, his department never had to meet them.

That’s EMS man, you meet the requirements or they find someone else who will.

http://www.bakersfield.com/news/local/x529881103/Officers-rescue-teen-girl-from-Kern-River

It was very refreshing to finally see a positive article in regards to local law enforcement in my area. Of course this was long overdue. Unfortunately the local paper has been too busy criticizing the police for shootings, excessive traffic tickets and various other forms of doing their job. What they don’t seem to report on is all of the officers that are involved in DARE programs, and activity leagues. No news there. They also don’t seem to pay attention to the officer that offered his large sandwich that he just purchased to a homeless woman that was denied entry at the over-crowded homeless shelter. Nope, nothing to report.

The Police Department in my town has taken quite the beating from the local rag and the general public for some time now. Granted, there have been a few bad apples from within the department. But as quickly as they discover wrong-doing on the part of an officer, they are just as quick to make things right. The departments around here will stand up to the screaming liberal, local media who choses to side with the mom of the 18 year old gang-banger who thought that pointing a gun at the cops was a good idea. But at the same time, they will eat their own when an officer abuses the badge.

Unfortunately, cops help out the public by “being the bad guys”. What I mean by that, is they are the ones who pull you over for speeding, arrest you for a DUI, or shoot you when you try to rob a bank. An unfortunate side-effect from this is a negative public perception.

What people don’t see is the positive effects that their work has on society. They don’t realize that traffic officers are the reason people pay attention to speed-limit signs and think twice before driving like an asshole through your child’s school zone. Most people that “tie one on” at the local bar aren’t worried that they might kill someone by driving home. They are worried about getting pulled over and losing their license. What’s the first thing a bank robber does before he enters the building? Check for cops.

When things are good and crime is low, nobody thinks to appreciate the hard work that law enforcement does. But they damn sure notice when things are bad. What’s the first thing someone says when a spree of car jackings or robbers happens?

Where are the cops?

As most of you know, I am a huge proponent of allowing law abiding citizens to carry concealed weapons. For the most part, I support any bill that allows more of the good guys to carry…..except this one. This is just another example of politicians not wanting to live by the rules that they made. The double standard here in California is ridiculous.

What really pisses me off, is the fact that the writers and supporters of this bill have done everything they can to block any attempt that we have made to allow concealed carry in this state. They have blocked all of our efforts and voted against anything expands concealed carry rights. But now the rules they made aren’t good enough to protect them, so they want a new set of rules that applies ONLY TO THEM.

In California a citizen has to show “good cause” in order to obtain a CCW. It is then up to the local Sheriff or Police Chief to decide whether or not you are worthy of one. I am fortunate enough to live in a county where our local sheriff is very conservative and has made it easy for law abiding citizens to carry weapons. Despite what the media and anti-gunners will have you believe, there isn’t a wave of violence or blood and guts in the streets around here. As a matter of fact, in the 30-or-so years that we have been issuing the licences, not one person has ever committed a crime with a legally carried gun. It’s almost as if only the criminals do that…interesting.

Anyway, back to my point. The legislators here in the golden state have for a long time supported stricter gun laws and have opposed carrying weapons. But now that they feel that their job is dangerous, they want to be able to protect themselves. Yet they still don’t understand why the public wants the same protection. Well, they probably understand, they just don’t care.

I thought this was supposed to be a government of the people. But what do I know, I’m just a dumb-ass paramedic.

As I was doing my daily read of the most recent EMS-related news headlines, I stumbled across this interesting article. To be honest I was taken back at first, because I have always wondered why all of the cities around the OC / LA area insist on responding so many paramedics to every call. The fact that they run ALS engines isn’t what gets me, it’s the fact they use private ambulances for transport and FORBID them from providing any ALS care. This of course requires a fire-medic to ride in to the hospital and have the engine or squad follow them to pick them up at the ER. Maybe I’m just ignorant, but it seems like they are doubling their work.

To me it seems that it would make more sense for the fire department to just provide the ambulance transport themselves. Staff a paramedic who doesn’t split his/her role with any other function on the ambulance and an EMT to drive. I will never be convinced that having 4 paramedics treating 1 patient is a good idea.

This particular article is intriguing because for the first time (that I have seen), they actually want to get away from their current system and let a private ambulance staffed with a single paramedic and EMT handle the patient care. While I typically endorse this kind of change, I think the city and county need to be fair to the tax-payers. Chances are, the citizens pay some form of tax to pay for the paramedic service that is currently in place. While such a move will certainly save money, it kinda screws the tax payers. If they go ahead with a switch to private-level service, then they either need to remove that tax, or reduce it accordingly. The whole purpose of contracting to a private pay-for-service model, is the savings in tax dollars to the public, not the general fund.

I thought that this was actually a viable option until I read that the city doesn’t attempt to collect on uninsured parties, and they would expect the private service to do the same. I can say with 100% certainty that this kind of policy WILL NOT WORK without government subsidies. If they are expecting that some private company is going to come in and willingly operate at a loss, then they have another thing coming.

I personally don’t think that such a change is going to happen without some fierce resistance. I applaud their ability to think outside of the box, but I have my doubts that they will actually make this happen.

http://www.jems.com/article/news/more-worries-over-florida-coun

If you haven’t been following this story, you should. The North Naples Fire District had their ability to provide ALS on-scene care revoked by the local medical director because of poor performance and their training not meeting his standards. OK, maybe there is more to the story then what the media tells us, but this sounds pretty simple to me. It’s his license. Either provide care and train to his standards, or don’t provide care.

I would think that the department would have taken this message and headed straight for the classroom. Instead, they spent their time raising their voices and eventually found a way to provide ALS service by bypassing the local medical-control system. Nope, let’s not fix the problem, we’ll just find a medical director who will let us do what we want.

I would be interested to hear what the people of that community have to say.

After watching the video I turned on my stop watch to count the amount of time it takes for a privacy law suite to be filled for an obvious HIPAA violation. By going on national TV and talking about details surrounding the call, he not only put himself but the entire Detroit EMS service in harms way. That was a HUGE, HUGE, HUGE, no no. Being that the call itself made national headlines makes it extremely easy to reference the call, and the individual involved with his comments. I get the frustration, and I understand why he did it, but it was a bad move.

As medical professionals, we really have to watch ourselves when it comes to talking in front of a camera. This is why services like the one I work for prohibit us from speaking to the media at all. Just because he isn’t employed anymore, doesn’t mean he won’t get nailed with a hefty fine. If nothing else, he now has less protection then he did before the termination.

I’m keeping my fingers crossed that nothing happens to this EMT as a result of his statements, but I’m not exactly holding my breath.

Bringing in more money.

It’s not about patient care, or a deficiency on the part of the current provider. It’s about saving the city money. Of course, just like healthcare reform, they want to use the old tactic of spending money to save money.

I get that it’s a tough argument when the current provider is a for-profit entity. But I find it hard to side with the government agency that is just trying to expand their budget at the expense of private enterprise. You can’t tell me that you plan to create jobs and put someone out of business in the same breath.

I have seen this time after time and end result is never saving money. There just isn’t any money in emergency transport. Private ambulance usually survives on transfers and standbys. But hey, I guess if you cranked up the tax rate to provide the same service that the people are already receiving, you could pull in a couple bucks.

The article claims that Sunstar receives $218.40 per transport after paying the county. Of course, this is assuming that they actually get paid for every transport. I wouldn’t be the least bit surprised if the county takes their cut whether or not the patient pays. The article also doesn’t mention that Medicare and Medicaid don’t pay crap.

It always amazes me when cities decide that expanding their services will save money. I wonder how many paramedics currently provide care on the engines? Ever thought about leaving that job to the transport medics? There’s a money saver.

Here is a link to the article on EMS1: http://www.ems1.com/fire-ems/articles/914642-Fire-EMS-policy-could-save-money-for-Fla-city/