I have spoken on this topic a few times before and it usually sparks a lot of heated debate, as it should. So many of us are just sitting here wondering what will happen to the healthcare industry and what it means for our jobs. For me, there are just too many unknowns. I know that our system is broken, but I’m not so sure we went about the right way of fixing it. I don’t claim to have all the answers, but I think I have a pretty good idea of what works and what doesn’t. What bothers me is that people like you and me are continually left out of the decision making process. Instead we have people writing bills that have probably never seen a patient, tried to collect an insurance payment, or tried to run a private medical practice.

The talking heads continue to tell us that we need to cram trillions of federal dollars into the healthcare system in order to keep it afloat. But they never tell you why the system got to where it’s at in the first place. Medical care in the US is so expensive that most people simply can’t afford it without insurance. And many people can’t afford insurance. But have you ever sat down and looked at why it’s so damned expensive? Granted I’m no “expert” economist. I’m just a dumb-ass paramedic. But even I can see that the service I provide is expensive because nobody pays their bill.

Ambulance services can’t survive with half of their customers skipping out on the bill. We also can’t refuse service based on one’s ability to pay. I’m not saying I think we should, but it is a huge factor in the cost. Any other business in the world would call the cops if they saw someone return to their store who took something without paying. Not us. We just give them what they want and expect that they won’t pay. So how do we stay in business?

Someone has to pick up the tab for those that eat and run, and that usually falls on the insurance companies. And no, I don’t mean Medicare and Medicaid, I mean private insurance. Medicare and Medicaid walk into the restaurant and pay what they feel is fair market value and ignore the listed price on the menu. But wait, isn’t that illegal? Well, normally yes. But they’re the government and they’re here to help. The business is forced to raise their prices, which means that the people that do pay are not only paying their tab, but all the tabs of the people that didn’t pay. This nifty little technique is called “cost shifting”. It’s basically a narrowing scale that will eventually spike to the point that nobody is able to afford the cost. Think of it this way, every time the price goes up, less people will be able to afford it.

It’s arguable whether or not expanding Medicare and Medicaid benefits would help this issue. On one hand, ideally, more people would be covered by some kind of insurance which is better than nothing. But the big question is, are more people going to utilize medical services because they are now covered by government aid? If so, then it actually makes the problem worse (refer back to the restaurant analogy). Not to mention that doing so increases the national debt, which usually leads to increased taxes, which usually leads to people with less money, which then leads to less money being spent, which leads to layoffs and more people without insurance. It can make your head hurt thinking about it.

Forcing people to purchase health insurance could help solve this problem, or it could have the reverse affect. The theory behind this soon-t0-be mandate is that more people will be able to pay their medical bills, which would in return cut down on the cost of doing business. But let’s look at this from a different angle. If health insurance was affordable, most people would buy it. So do you think that some 27 year old guy working paycheck to paycheck at a dead-end job is going to be able to take a $500.00 a month hit? Probably not, so instead we hit him with a large penalty? That’s like telling me to buy an expensive sports car to avoid being charged $50,000. You would probably have to throw me in jail because you’re not getting either out of me.

So what’s the next option, forcing employers to provide health insurance? You could do that, but then the business owner would have to offset that loss somehow. And I think we both know that it would end up falling on payroll, which is usually the largest business expense. They would either have to cut wages to make up for the loss or lay off people. That doesn’t help much at all. Instead that just adds more people the uninsured pit.

This of course brings us to our next up-coming “solution”. Now we want to force health insurance companies to take all applicants regardless of their past medical history. I get the reasoning behind this, but are we really looking at the overall picture here? Health insurance companies make money by collecting your monthly premiums and hoping that you either never make a claim or do so as little as possible. They don’t want to take people with serious conditions because they know it’s a money loser from the start. It’s the same reason why auto-insurance companies don’t want drivers with bad records. It’s a losing deal. Do you think it would be fair to get in a car accident without insurance, then apply for coverage and expect them to cover your accident? What do you think a move like this is going to do your monthly premiums? Now the 27 year old guy REALLY can’t afford his coverage. I get that there is not as much of an emotional argument that goes with auto coverage, but it doesn’t change the fact that insurance companies have to stay in business in order to pay for your medical problems. Now before you come at me with torches and pitchforks, I still think that there needs to be a way for people with pre-existing conditions to get insurance. I think a good starting point would be to get more people on private insurance plans so that these companies can afford to lessen their standards. I’ll get to a broader explanation of fixing this problem later.

The next option, and in my option, the worst, is raising taxes to expand government coverage. Taking money from one person to pay for another doesn’t help the problem. Instead you take money from the people that are supposed to be supporting the economy. If you take $200.00 a month from me, you have just taken $200.00 that I would have normally spent elsewhere. This means that the movie theater, grocery store, auto shop, etc now get that much less of my money every month. Multiply by this by millions and you get a recession. Now let’s look at the opposite end of the spectrum. Lowering my taxes would not only let me keep my $200.00, but would give me more money to spend. This means that all those business now get more of my money. Multiply that by millions and you get increased demand and cash flow. This means that businesses have to hire more people in order to keep up with the demand for their product. This then translates to more jobs, which means more people with insurance benefits, paying taxes and being able to pay their medical bills. See where I’m going with this?

Now we may not be considered to be as “intelligent” as the decision makers, but even the simplest of minds can see that if a problem is caused by people not having enough money, we solve it by either getting more money to the people or making the service affordable. Now I know this doesn’t solve all our problems, but it’s a good start. We have already seen how putting money into the hands of the consumer can help, so let’s talk about how to get the cost of doing business down. Many hospitals and ambulance services operate on 40-60% of their patients actually paying their bills. So by using cost shifting, they are forced to increase their prices by that much in order to stay in business. Now imagine if everyone paid their bills. I know that’s unrealistic, but bear with me for a second. If everyone paid their bill, then the service operating with a 50% collection rate could essentially lower their prices by 50%. Sure, that’s a very simplified example, but you get the point. You might notice how I referred to the economy several times. This is because I firmly believe that fixing the economy is more than half the battle of fixing healthcare. It’s rather simple. Get more people back to working, then you will get more people being able to pay their bills.

There are of course plenty of other issues that need to be addressed like the ability to route patients to proper forms of treatment other than just the ER and the lawsuits that lead doctors to practicing defensive medicine. But for the purpose of this article, I’ll leave it here and touch on those subjects later. Like I said before, I don’t have all the answers. I could very well be dead wrong. And to be honest, I hope I am.

November 2nd is going to be a day that we as EMS providers and as American citizens need to have our voice heard. Many of us are unhappy with our elected officals – both Democrat and Republican – and the only way to change this is to elect people that represent you the best.

Politicians use various forms of media to bash their opponents with the hopes of winning your vote. They never offer up any plans or discuss real issues. It isn’t until they are in office that we find out what kind of representative they really are. It’s very important that we ignore the negative ads and ridiculous allegations. Do a little research on the candidates and find out who really represents your best interest. You can do this by looking at their campaign contributors, voting records, and debates.

Don’t be afraid to cross party lines or vote for 3rd party candidates. Many people argue that voting for a 3rd party is a “wasted vote”, but this couldn’t be further from the truth. Every time you vote against someone, as opposed to for someone, you have wasted your vote. The truth is, if everyone actually did the research and picked the best candidate, then all of this campaign spending would be worthless. This would also be the end of the 2-party system. Remember, the lesser of the 2 evils is still evil.

As EMS professionals, we need to pick candidates that will represent our industry. If you work in public safety, then you might want to find out what the candidates plan to do with pensions, benefits, and funding for your organization. If you work in private EMS, or even public-based EMS, then find out where the candidate stands on Medicare and Medicaid reimbursement. Everyone claims to want to “cut spending”, so find out exactly what they plan to cut. Are they planning to cut back on beautification projects or public safety jobs?

While it is extremely important that you get out to vote, it is just as important you know what you are voting for. Don’t be fooled by rhetoric, negative ads and smear campaigns. Remember that voting is your way to have your voice heard.

The ambulance company that I work for is currently under some heavy fire due to a recent rate increase request. Now I’ll be honest, it’s no small increase. I can understand peoples frustration when they hear that expensive ambulance rides are about to become more expensive. What they don’t understand, is that’s healthcare in America. At least until we come up with some real solutions.

EMS and the entire healthcare industry have been taking hits from non-payers and government programs for quite some time now. In many cases healthcare providers are getting paid by Medicare and Medicaid a measly 14 cents on the dollar. That’s insane, but it’s reality. No other industry in the world operates like that. Ford isn’t going to give you a free car if you cant pay and Chevron isn’t going to give you free gas.

Unfortunately, the people that end up paying for lost revenue are the ones that actually do pay their bills. This is usually the private insurance companies. So as the number of non-payers and government-payers goes up, so does the price. This is called cost-shifting and it sucks. But do we blame the ambulance services or the broken system? The old saying “Don’t hate the playa hate the game” couldn’t be more true in this case.

The EMS industry is in a fight for survival. It’s a losing battle and unless some serious change is made, the services we provide will become so expensive that nobody will be able to pay. So do I think services like the one I work for should be granted rate increases? Hell yes I do. I want to keep my job and I want us to keep providing the best service we possibly can. However, I also want to see we the people start working towards a permanent solution.

No single person or service can tackle this issue alone. And I’m sorry but Obamacare isn’t the answer. We need to elect people that truly understand the issues surrounding our healthcare system. Abuse, litigation, non-payers and broken government programs are killing the industry. We as EMS professionals need to be able to route patients to the most appropriate care. Hospitals shouldn’t have to treat a cut finger or deal with a sore throat. There are appropriate care facilities for those types of complaints, yet we still continue to use our resources transporting and treating them in an emergency setting.

We need to get people working so that they can pay their bills. If you fix the economy, then you are halfway to fixing healthcare. They really do go hand in hand. More people working = more people with money and insurance. More people paying their bills = lower healthcare costs. Fixing this should be #1 on the priority list.

Before I get too off track here, I need to get back to my point. Don’t get all hot and heavy when you hear about ambulance services requesting rate increases. The only difference between them and every other healthcare provider is that they have to ask to raise their prices. We are all playing the same survival game and if my predictions are correct, we will be playing it for a long time.

It’s that time of year again for the county hospitals to start complaining about budget cuts and threatening to close their doors. I get that times are tough and the amount of people paying taxes decreases every day. What I don’t understand, is how organizations that bill for their services, in addition to receiving subsidies can be doing so bad?

The first complaint I typically hear is; “We get all the bums, drunks and non-paying patients”. I absolutely agree. However, there is no reason why they should be the place that all the people with no insurance go. They are fully functional and capable hospitals just like the private-based hospitals in the same area, who don’t receive subsidies.

Why don’t these hospitals adopt specialties, advertise, secure HMO contracts, and expand, just like every other hospital? The mentality that only people without insurance go to county hospitals is ridiculous. They need to be in competition to increase their revenue. Start convincing the 58 year-old with chest pain and insurance that the county hospital is the best place to go.

Perhaps I’m just a dumbass, narrow-minded, paramedic who has no idea what he’s talking about, but doesn’t it seem reasonable that if these hospitals ran themselves like a business, that they might succeed like a business? Couldn’t this make a difference in the cost of healthcare all together? Any insight to this matter would be much appreciated.

Abuse and law suites are like siblings when it comes to health care. Massive amounts of people abuse our emergency rooms, ambulance services and even clinics. This is allowed to happen because these people can’t be denied medical care as the medical providers will find themselves in legal trouble.

Of course the people abusing our medical system typically have government aid, or don’t pay at all. Medicaid and Medicare programs are only reimbursing 20-30 cents on the dollar right now. That’s pretty bad considering what it costs to do business in healthcare. So what do the providers do to make up this lost revenue? They raise their prices! Which ultimately means that the private insurance companies get shafted with the high rates. When people abuse the system and don’t pay their bills, the healthcare providers lose money on supplies, wages, procedures, etc. It’s no wonder that the majority of private doctors offices and clinics don’t accept government insurance programs. Why would they?

Law suites closely follow abuse on the “rising healthcare costs” scale. Excessive medical malpractice suites have driven malpractice insurance through the roof. Once again, the doctors have to make up this loss somewhere. It is actually rare to find a doctor who has yet to have a malpractice suite filled against them. Whether the suit is legit or not, it is typically easier and cheaper for the insurance companies to just settle and pay up rather than fight it out in court. Excessive malpractice suites then lead to “defensive medicine”. Ordering expensive unnecessary tests to “cover their asses”. Once again, only contributing to rising medical bills. Doctors wont follow their training and instincts in fear of legal repercussions.

Does this mean that a doctor who shows gross negligence shouldn’t be held liable for their actions? Absolutely not. But suing your OB/GYN because your baby came out with 6 fingers isn’t what I would call reasonable.

Throwing more money at the problem doesn’t fix anything. We need to attack this problem from the ground up. Hospitals need to be able to deny treatment to non-urgent patients. They crowd our emergency rooms and eat up useful resources. Perhaps some public education and readily available low-cost clinics and urgent cares would tackle a good portion of this problem. The other thing that needs to be addressed is the idea that being transported by ambulance will get you seen faster. One of the big ideas behind EMS 2.0 is that EMS professionals could offer other solutions, rather than just transport to an emergency room. These are just a couple things that could significantly reduce the cost of healthcare.

Let’s quit covering up these problems and attack the real issues. Think of it like treating an illness. You can treat the symptoms and give some temporary relief. Or you can correct the core of the problem and fix it all together.

What kind of paramedic would Barack Obama be?

Shifts

Barack Obama would most likely be on a part-time schedule as he is far to busy traveling outside of the country to be tied town to a regular shift.

Scene Safety

We all know the president has the luxury of the Secret Service. When Barack Obama is dispatched to a call, it would be hours before he could safely arrive on scene as the area would have to be secured by snipers, road blocks, check points, etc.

Response

Barack Obama would only respond to calls that he has been prepped to handle. The patients would be carefully selected prior to dispatch to ensure that they didn’t present with an illness or injury that he wasn’t prepared to care for.

Vehicle

Air Force One would most likely be retrofitted to act as a mobile hospital. This might sound expensive and you might wonder how he would fit in into his operating budget. This would simply be achieved by placing a “you call we haul” tax on all ambulance rides around the nation.

Radio Reports

The radio is old and out of date. Barack Obama would hand off his patient care information in the form of town hall meetings and addressing the public via TV and Twitter.

Partner

Obviously Joe Biden would be Barry’s right hand man. Only he would be “that partner” that says dumb things on scene and gets you into trouble with your supervisor. This wouldn’t matter as they really don’t have to answer to anyone. My guess is Joe would be an EMT-Basic.

Billing

Patients treated and transported by Barack Obama wouldn’t have to worry about payment as only those who don’t use or want his service would be billed.

Equipment

Barack Obama wouldn’t carry much equipment as his practice is based on hope rather than experience, training and expertise.

• Microphone – For addressing his patients and for use during his radio reports.
• Teleprompter – Used to scroll pertinent questions for his patient assessments.
• “The Briefcase” – Instead of being using to launch nuclear weapons, it will now be used to summon the real medical professionals behind his operation in the event of a real medical emergency.

Comments are welcomed and encouraged! Have a great week.

Once upon a time lived a boy named Sue. He was well known as the bully around town. Sue was quite the perfectionist. It was understood that when you are in Sue’s territory you play by his rules. One wrong look and you better hold on to your lunch money for dear life, because Sue would have you roughed up and broke before you even knew what hit you.

On the other side of the neighborhood lived a boy named Doc. Now Doc was quite the opposite. He spent his days helping people with their various issues. A problem solver if you will. As a matter of fact, other kids were willing to pay Doc to help them with their problems. He was good at what he did and had a heart of gold. Unfortunately Doc wasn’t perfect. Sometimes he made mistakes, and that often made the other kids mad.

One day came and a kid named Pat had a problem that Doc just couldn’t solve. Pat became very upset as he paid Doc all of his lunch money and didn’t get what he wanted. Pat decided to track down Sue and see what he could do to help. Sue assured him that he would get his money back, as long as he got to keep half. Pat couldn’t resist the offer and decided to take him up on the deal. So Sue tracked down Doc, roughed him up and took all his money. As a matter of fact he took more money than Pat gave him to begin with. Pat ended up getting all of his money back and Sue kept the rest.

Now Doc eventually recovered and went back to his business of helping people. That is until one day Pat returned and requested his services again. Not really sure what to do, Doc agreed to help him. Once again Pat wasn’t very happy with the service he received. Pat once again called upon Sue to get him his money back. Only this time Doc called upon his friend Sharky to defend him in his time of need.

Sharky stood up to Sue and saved Doc from losing all of his money again. This continued until one day Sharky realized that he was providing a valuable service for Doc. A service this good was worth some form of reimbursement. After all, if Doc didn’t have Sharky to help, then he would lose all of his money every time Sue came around. Eventually it got to the point where it cost more money to have Sharky help, then to just give Sue what he wanted. This of course made for hard times with Doc.

More and more kids were getting the idea that they could just call Sue to get what they wanted out of Doc. Of course Doc couldn’t stand to lose all of his money as he had to have something to buy his lunch with. So Doc decided to ask for more money in exchange for solving peoples problems. As the cycle continued, many people couldn’t afford to pay Sue anymore and therefore would not seek his services. Even with the small number of kids that were actually paying Doc for his services, his high prices still provided for enough money to buy lunch.

Times were tough, but Doc managed to eat everyday. That is until the kids that didn’t have enough money to pay Doc called upon Sue to help them with their problems. Sue then told Doc that whether or not the kids had money, he was going to help them unless he wanted to get roughed up and robbed again. Unfortunately it got to the point where Doc was helping every kid in the neighborhood and only a couple kids were actually willing to pay him for his service.

Eventually Doc just couldn’t keep helping people. The constant fear of Sue coming around finally got the best of him. He had no choice but to quit trying to help people and find another way to earn his lunch money.