# What I Hate the most about EMS



## Ridryder911 (Dec 28, 2008)

I actually thought of this before reading the opposite thread. We can all come up with the goodies but really what is the real bad of things. Maybe just venting, but after three decades, I can truthfully say I am really discouraged with EMS and not my employer. The lack of desire to perform excellent patient care, the lack of motivation of wanting to improve the system for the future. 

I was asked about becoming a Paramedic in a coffee shop... I was about to give my standard declaration of how heart warming, self fulfilling in nature, yes to save a life.. yadda.. yaddaa.. then I thought to myself

Should I really recommend this profession to anyone? 

Hmm.. I now have my doubts. Why would I (a nice and thoughtful person) recommend such a profession to someone? When this job is usually composed of non-professionals or those that choose not to be professionals? Seriously, as a civil person should I suggest a profession that continually to refuse to grow, continue to pay such low salaries that many of its members are on government supplements to get food? Now, instead of going forward many much rather take an easy or alternative route to correct or worse do nothing? 

Would you recommend a job to a friend that would require them to work more than 40 hours a week? Almost every Holiday, extreme hours? Would you recommend them to take this job knowing they would have to have another job. No? How many of you have just one job, or how many other medics you know work only one EMS job? 

Should we really recommend a so called profession that its members love to whine and gripe about the profession, yet many choose not to participate in changes (such as legislation, law changes). What would you honestly advise the future of EMS to be? 

In review of quality standards, EMS is usually a joke. How many EMS you know of have a formal TQI program and truly require in service education and accountability? Now, in comparison; what is the percentages of those with and those without? How many in Supervisory roles have a formal education or can write a formal letter? now let's look at administration. How many Directors where hired on the "good ole boy" system? Did they "work" their way up or was it strictly a "business" position? Now, compare that with other health professional management positions... again EMS as a profession presents itself as a joke. That it is. Now let's be truthful.  

Education? Really, do we have education or rather do we promote training? If you don't know the difference, you are trained. Would it not be nice if EMS Instructors were required to have at least the same level education as a Kindergarten teacher?  Wow! One can teach how to do tracheotomies with a 40 hour class & GED but one cannot teach little Johnny to color within the lines... Do we not see something very wrong here? Even more strange, many in this profession does not even know the difference between being licensed and being certified or even know which one they are. Yeah, a real knowledgeable profession. 

Let's look at the majority of the persons now entering most EMS don't give a **** (you can place your favorite foul word) about EMS or health care. Majority only care enough to pass the test to get the patch to get onto a Fire Service EMS. The reason for this is not really providing medical care, it is for the benefits and lower call volume. Again alike oil and vinegar does not mix, neither doe Fire Service and EMS. Sorry, both are respected profession but are NOT nor will ever be the same. 

Unfortunately, Fire Service assumes they will "save" EMS but compare and really look at he systems and what their intent are, and one will see they will probably be the demise of EMS. Only requiring minimal standards, pursuing lower testing requirements and lower interest in true medical care, rather focusing on Public Safety which EMS is NOT. Now here is a bet.. the majority of you will not be in EMS within the next 3-5 years. So what can we expect with a continuous turnover, when the Senior medic has two  to five years service?

Do you know of another profession that would be against accrediting educational institutions? Seriously, does this not make one wonder of those that are in it? Would you imagine reading about engineers protesting that  their educational systems was required to be accredited. That such educational systems would be too hard or worse they may not be able to pass the test? What would you think the next time you drove over a bridge or stand in a tower building?
Now, we wonder why the public thinks of us as a joke?  

How many other professions have to defend and beg for their existence? Do you see PD being absorbed into another division... i.e Sanitation/Law Enforcement. Yet, many EMS has to justify their positions, even though they are making three to four times the number of responses and bringing in money to support themselves. Yeah, this makes a lot of sense?

How many of you know of three or more Paramedics that have been in field  EMS (not education, management or fire related) more than 10-15 years? Is this a profession, you would recommend someone to? 


So in the real world, should we truly recommend such a profession to a person seeking a new career or profession. Would this be fair? We all know how infectious the EMS bug is. It's alike a virus that infects many but we know the outcome of viruses, don't we?

Not to be totally negative, but how are you going to change things and make this profession to be better? 

R/r 911


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## Veneficus (Dec 28, 2008)

Ridryder911 said:


> I actually thought of this before reading the opposite thread. We can all come up with the goodies but really what is the real bad of things. Maybe just venting, but after three decades, I can truthfully say I am really discouraged with EMS and not my employer. The lack of desire to perform excellent patient care, the lack of motivation of wanting to improve the system for the future.
> 
> I was asked about becoming a Paramedic in a coffee shop... I was about to give my standard declaration of how heart warming, self fulfilling in nature, yes to save a life.. yadda.. yaddaa.. then I thought to myself
> 
> ...



This needs to be printed on the first page of every EMS textbook in print.

I like to think EMS is like a crack additction, you know it's bad for you, but you just can't pull yourself away 

The funny thing is the more I try to help the EMS profession, the more the "professionals" tell me I don't get it.


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## boingo (Dec 28, 2008)

Interesting thread.  I was working a shift last evening in a different station from my usual with a new EMT on the BLS truck who was reading an introduction to EKG text.  We started talking, she is thinking about starting medic school soon.  My partner was having trouble with the whole idea of this young and impressionable girl spending time and money on medic school when there are so many other opportunities for a medical career, or profesion.  I can't say I blame him, as a whole, education is a joke, and unless you work for system such as mine, the job is kissing *** to some fire department, or working for them.  I have two kids, and if either of them where considering EMS, I'd probably kick them in the *** and send them off to college.  Now, don't get me wrong, I've committed my life to EMS, its my profession, I've spent years continuing my education, and have had the opportunity to work and learn from some of the best medics and doctors in the nation (my opinion).  Its just that overall, EMS is broken in the U.S., and I'm not sure if its ever going to get better in my lifetime.  If I could guarantee this girl an ALS job in my system, I'd tell her to enroll tomorrow, but, like life, there are no guarantees, and I'm afraid the money could be invested better elsewhere.


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## csly27 (Dec 28, 2008)

Wow, I am not even sure what to make of all that. It could be because I am still a student. Have yet to do my ride along even. I am so excited to become a member of ems that i cant wait. I tryed the whole medical assistant thing now that was a joke if ever there was one, but that could be because i dont like drs offices would rather go to the er. I know kinda twisted but what can I say.

My father was a combat medic in nam, then an emt when he got out So I guess I got the medical gene. But it is all I have wanted to do. I have finally gotten a chance to go back to school and take the class And I am doing well have maintained a b average not great but well. My husband is inthe army, and we are being relocated in feb. When we get to where we are going I want to join the fire acadamy and then medic school. People say that these are supposed to be diffrent professions,but the way I see it is... Everyone, leo, fire, and, ems should all work together as a team to ensure that everyone gets the treastment that they need right? 

Leo's are supposed to help keep our scene safe, fire puts out the fire and we treat any pt that we come into contact with right? So why does everyone talk down about the other feilds. I want to be a ff/medic so that I am able to do both and help that many more people. Sounds like a good plan to me. Or it could be that I am not jaded yet in this feild. I do not have the experience or the knowledge in this feild yet. I love to learn new things and to help people I feel that is what I was put here to do.

I am sure people will critize me for wanting to do both. I also think that by being in this feild My children will gain the knowledge to help because it is something that they  want to do, not something They have to. My 10 year old is falling in love with this feild as well he reads along with me in my book and he helps me study as does my husband. all of my kids have been my pt to help me in my assesments. Both in mock and in life lol. I like knowing that if something does happen to my family I can help them instead of being a bonehead and freaking out. 

I know ridryder911 had mentioned that coming to a scene of a family member or friend would be one of the worst possable situations. I beleive that is true. However with that being said I would rather have myself show up on scene to a family member because I know that I could be there for them and know that I am or rather will be trained  to do what needs to be done, and can be there for the entire thing instead of getting "that" call. Call it controlling if you want and mabey it is to a point but that is just my opinion on that situation. Would it be hard? would it suck? Hell yeah but at least I would be there right from the start.

I guess what I am trying to say is that from what I have heard the ems system is not in the best shape. And the question was would I recommend this job to someone I know? well I cant answer that because I have not been there yet. How can I make a diffrence well all I can say to that is I can go out there and do my best to make people better to the best of my abilitys. I do plan to further my education because without it I cant do what I need to do. Or what I want to do. Who knows mabey in 3-5 years I will feel diffrently than I do right now. But then again mabey not. Wow I think this is my longest post yet lol. 

I have gotten checked off on part of my skills already, My final is on Jan 12th, My ride a long is coming up after the first. I am truly excited and terrified at the same time. Sometimes I think what if I am not good enough. That scares the hell out of because in my heart that is all I want. But I have a great instructor and family and they all have faith in me. so wish me luck.


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## Laur68EMT (Dec 28, 2008)

Ridryder911 said:


> Not to be totally negative, but how are you going to change things and make this profession to be better? R/r 911



Very interesting.  What do you feel would be the best approach to making change?  Do you suggest small steps in our own backyards?


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## Ridryder911 (Dec 28, 2008)

csly27 said:


> Wow, I am not even sure what to make of all that. It could be because I am still a student. Have yet to do my ride along even. I am so excited to become a member of ems that i cant wait.



This is not a jaded conversation and not being rude, truthfully you are correct. You do not what to say; because you cannot say anything yet. How do you really know what is best in EMS or both worlds. How much do you really know about EMS? Did you study what is in the challenged EMS profession before entering the profession or just want to enter the public service arena because of the benefits? Remember, your in a class just above First Aid level, and has this really prepared you for a health care profession? Alike the CMA it is just a crude entry level. 

I challenge you to remember this post in 10 years (if you are still in EMS or Firefighting) and think of this. 

Hence, part of the problem in EMS. Most do not really study, investigate the profession before entering. Alas if I was to ask the basic components of an EMS system, majority would fail. Yet, most feel they are an expert within it. Again, pre-enrollment screening should be performed before entry. A good discussion of what EMS involves and what it does NOT involve.... the truth. 

R/r 911


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## Epi-do (Dec 28, 2008)

I wish I knew where to even go to begin to change things!  Is the answer writing letters to Senators and Congressmen?  Is it better to do this at the state or federal level?  Should letters be written to the state office that controls EMS?  _WHO_ do I approach?

At the simplest level, we need to practice what we preach.  I am planning on picking up the two college level A&P classes I need to complete my Associates degree for paramedicine.  I have also found several additional classes I would like to take - some at the college level, some through continuing education.

We need to stop fighting amongst ourselves and pull together if we ever hope to truly see anything change.  Medic vs. basic, paid vs. volly, green people vs. purple people - it doesn't really matter.  Being a professional is about educating yourself, and putting your best foot forward in all situations.

We need to start by addressing the dismal education required to enter EMS.  Require all programs to be accreditted.  Mandate college level A&P for ALL LEVELS of providers.  Stop training people and increase the amount of education required to even enter the profession.  Plenty of people say they want to see changes, but most of them never act upon those desires.  Change takes time, and the sooner we can band together and demand that change, the sooner it can begin to happen.

Granted, some things will take time to change, but others can be accomplished more readily.  Make the screening process for entering classes more stringent.  Ask applicants why they want to enter the program, and when the answer includes "so I can get a job as a firefighter" or "because I eventually want to be a (enter any other medical profession you can think of here)" think long and hard about whether or not that individual is the best choice for EMS.  How often do you hear someone say, "I am going to med school so I can be an attorney,"?  It doesn't happen.  People go to med school because they want to be doctors.  It should be the same for EMS.  Canidates should be applying to classes because they want to work in EMS.  Decreasing turnover and those leaving the profession is a big step in presenting ourselves as professional, as well as increasing the knowledge base out there for newbies to turn to when they need help.  Encourage those that have been around the block multiple times to gain the neccessary education to be effective managers, leaders, and instructors.  Encourage them to develop research studies that can help further EMS as it's own branch of medicine and improve the care we can provide to our patients.  Other healthcare professionals have gotten to where they are by being educated, having strong leadership within the ranks, and developing their own voice to demand changes and specify what they want those changes to be.

Increasing education does several things.  First and foremost, it makes us better providers.  It will weed out all of the Ricky Rescues that are only doing it for the t-shirt.  It will make people begin to take us seriously as a profession.  Then, and only then, will we be able to move forward and make other changes - move away from certification and demand liscensure, improve pay and benefits.  Wouldn't it be nice to be able to only have to work one job and be able to live reasonably, instead of having to work 2, 3 or even more jobs just to make ends meet?

Along with improving (beginning to???) education, we need to standardize our levels of care.  Whether we have only EMT and Paramedic, or some other variation, it needs to be the same across the board.  Naturally, different areas of the country are going to have different needs, so supplement with additional appropriate training and local protocols.  However, there is no need for state A to have 3 levels of care providers and state B to have 5 different levels.  Then there is state C, which like state A, has only 3 levels of care but they are completely different that those of state A.  Regardless of where you are, if you walk into a hospital you know that a cardiologist is going to take care of your heart, an oncologist deals with cancer, etc.

Ultimately, we are responsible for the future of EMS.  Only we can shape that future to be a success or a failure and the best way to do that is to lead by example.  Accept nothing but the best from those around you, and demand that they do the same.


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## pumper12fireman (Dec 28, 2008)

Having worked in systems WITH fire response and currently in a system WITHOUT fire response, I'd have to agree  that we (EMS and fire) are NOT the same. A little background- started out of a combined Fire Academy/EMT class, started at a fire department that did not transport. Training was always focused on fire. EMS calls were bad things. We were "firemen" not EMT's. I no longer work there. I do now work for a different fire department, however, we transport and have no fire response. So, you work on the ambulance. I had to be taught how to be an EMT and not a stretcher jockey.You are an EMT/Medic FIRST. Yeah, most guys like fire calls, but I feel that the care level provided at my current department is much, much better than at my previous department. But, in my area, most systems are like mentioned above. The guys are "firemen" and riding the ambulance is for a rookie or it's a punishment. But, with the lack of funds/fires, how are fire departments supposed to remain "professional"?? EMS seems to be the loser here in funding our "fun" on the fire department...


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## daedalus (Dec 28, 2008)

Epi-do said:


> I wish I knew where to even go to begin to change things!  Is the answer writing letters to Senators and Congressmen?  Is it better to do this at the state or federal level?  Should letters be written to the state office that controls EMS?  _WHO_ do I approach?
> 
> At the simplest level, we need to practice what we preach.  I am planning on picking up the two college level A&P classes I need to complete my Associates degree for paramedicine.  I have also found several additional classes I would like to take - some at the college level, some through continuing education.
> 
> ...


Post of the year!

I know that Rid 911 is upset and tired of preaching and preaching and no one ever getting it. But I do see him changing minds, just as he and ventmedic changed my mind. I truly believe in the power of people. Lets start local and ask our local programs to up the interview process and the pre-reqs. As more and more programs start this, we can write to legislator to abolish the two week EMT schools. Small steps.


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## Veneficus (Dec 28, 2008)

Epi-do said:


> At the simplest level, we need to practice what we preach.  I am planning on picking up the two college level A&P classes I need to complete my Associates degree for paramedicine.  I have also found several additional classes I would like to take - some at the college level, some through continuing education..



You sound motivated, but many in the EMS profession are not. They prefer 16hour certs to  academic education.



Epi-do said:


> We need to stop fighting amongst ourselves and pull together if we ever hope to truly see anything change.  Medic vs. basic, paid vs. volly, green people vs. purple people - it doesn't really matter.  Being a professional is about educating yourself, and putting your best foot forward in all situations..



here is the first problem, certain agencies do not want to put forth the time or money to inccrease standards. I have struggled for more than a decade to try and convince them.




Epi-do said:


> We need to start by addressing the dismal education required to enter EMS.  Require all programs to be accreditted.  Mandate college level A&P for ALL LEVELS of providers.  Stop training people and increase the amount of education required to even enter the profession.  Plenty of people say they want to see changes, but most of them never act upon those desires.  Change takes time, and the sooner we can band together and demand that change, the sooner it can begin to happen..



You seem to underestimate the efforts of people who tried. Not just myself, but people who worked far longer and harder than I. We are a small minority.



Epi-do said:


> Granted, some things will take time to change, but others can be accomplished more readily.  Make the screening process for entering classes more stringent.  Ask applicants why they want to enter the program, and when the answer includes "so I can get a job as a firefighter" or "because I eventually want to be a (enter any other medical profession you can think of here)" think long and hard about whether or not that individual is the best choice for EMS.  How often do you hear someone say, "I am going to med school so I can be an attorney,"?  It doesn't happen.  People go to med school because they want to be doctors.  It should be the same for EMS.  Canidates should be applying to classes because they want to work in EMS.  Decreasing turnover and those leaving the profession is a big step in presenting ourselves as professional, as well as increasing the knowledge base out there for newbies to turn to when they need help.  Encourage those that have been around the block multiple times to gain the neccessary education to be effective managers, leaders, and instructors.  Encourage them to develop research studies that can help further EMS as it's own branch of medicine and improve the care we can provide to our patients.  Other healthcare professionals have gotten to where they are by being educated, having strong leadership within the ranks, and developing their own voice to demand changes and specify what they want those changes to be..



many people leave EMS for other healthcare professions because of the lack of support, education, opportunity, and respect. I didn't start my career with the idea of becomming a physician, but that is where the path has led.Many nurses I know were medics first. But again, for the same reasons as I, they moved on.



Epi-do said:


> Increasing education does several things.  First and foremost, it makes us better providers.  It will weed out all of the Ricky Rescues that are only doing it for the t-shirt.  It will make people begin to take us seriously as a profession.  Then, and only then, will we be able to move forward and make other changes - move away from certification and demand liscensure, improve pay and benefits.  Wouldn't it be nice to be able to only have to work one job and be able to live reasonably, instead of having to work 2, 3 or even more jobs just to make ends meet?.



I agree, many don't.



Epi-do said:


> Along with improving (beginning to???) education, we need to standardize our levels of care.  Whether we have only EMT and Paramedic, or some other variation, it needs to be the same across the board.  Naturally, different areas of the country are going to have different needs, so supplement with additional appropriate training and local protocols.  However, there is no need for state A to have 3 levels of care providers and state B to have 5 different levels.  Then there is state C, which like state A, has only 3 levels of care but they are completely different that those of state A.  Regardless of where you are, if you walk into a hospital you know that a cardiologist is going to take care of your heart, an oncologist deals with cancer, etc..



this was suggested, but the attempt at implementation is so poor that many EMS advocates including physicians who are former medics oppose the attempt because it promotes skill training over education and puts a cap on the functions of medics based on skills performed, not educational credentials. If I remember correctly you needed a 4 year education for 3-4 more skills, all of which are becomming more common in EMS. That would be one year per skill. Not a smart idea. 



Epi-do said:


> Ultimately, we are responsible for the future of EMS.  Only we can shape that future to be a success or a failure and the best way to do that is to lead by example.  Accept nothing but the best from those around you, and demand that they do the same.



best of luck.


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## Shishkabob (Dec 28, 2008)

People who think that since they have more education then someone else in the same profession, they are well within their rights to talk down to others.

But that's every profession.


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## Veneficus (Dec 28, 2008)

daedalus said:


> Post of the year!
> 
> I know that Rid 911 is upset and tired of preaching and preaching and no one ever getting it. But I do see him changing minds, just as he and ventmedic changed my mind. I truly believe in the power of people. Lets start local and ask our local programs to up the interview process and the pre-reqs. As more and more programs start this, we can write to legislator to abolish the two week EMT schools. Small steps.




I taught at a program that almost went under because they increased standards and everyone went to the medic mills. (several good instructors with vision lost their positions to this) In my area in the US, if you eliminate volunteers and firefighters from class, you'd have 1-2 students a semester. Colleges would not support that.


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## Epi-do (Dec 28, 2008)

Veneficus said:


> here is the first problem, certain agencies do not want to put forth the time or money to inccrease standards. I have struggled for more than a decade to try and convince them.



I am not going to assume you are referring to FDs here, but I know that locally that is who this statement would best apply to.  It is just one of many reasons why we need to really evaluate the marriage of fire/EMS.  I know there are plenty out there who are against it, and we can only hope that someday someone will listen to those voices.




Veneficus said:


> You seem to underestimate the efforts of people who tried. Not just myself, but people who worked far longer and harder than I. *We are a small minority.*



It isn't a matter of underestimating the efforts of those who have tried/are trying.  It is the fact that it is a minority.  More people need to care and put forth some effort to assist those already involved in the fight.



Veneficus said:


> many people leave EMS for other healthcare professions because of the lack of support, education, opportunity, and respect. I didn't start my career with the idea of becomming a physician, but that is where the path has led.Many nurses I know were medics first. But again, for the same reasons as I, they moved on.



These are not the people I am referring to.  Over time, people, their lives, wants, and desires change.  Furthering your education, and continuing to grow as a person are completely normal.  Whether moving on for reasons similar to those you have stated, or being forced to do so due to injury or some other unforeseen circumstance, is one thing.  Entering an EMT class because it will "look good on my application for XXX school" is something different entirely.


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## daedalus (Dec 28, 2008)

Veneficus said:


> I taught at a program that almost went under because they increased standards and everyone went to the medic mills. (several good instructors with vision lost their positions to this) In my area in the US, if you eliminate volunteers and firefighters from class, you'd have 1-2 students a semester. Colleges would not support that.



Not around here. My EMT program was taught by a MSN/NP and a B.S. in paramedicine, and education was held over "training". The folks in my class and area take EMS pretty seriously. Take a look at Ventura County EMSA is you wish.

If the area program where you lived went under because of increased educational standards, legislate to shut down the medic mills and soon a shortage of EMS personal will force the public and politicians to embrace the new standard of EMS education that will be born at both the local and national levels. 

If your not part of the solution than you are a part of the problem. You may be able to sit here and cut down EMS now there the end of med school is in sight but do not think for one second that we are broken beyond repair, because if thats the case you need to match into a nice Derm residency and leave us alone.


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## mycrofft (Dec 28, 2008)

*There are three prerequisites for positive change in EMS:*

1. A finite talent pool, or one which cannot be inflated by pumping half-trainees into service.
2. Legislation which sets realistic and care-oriented standards.
3. The ability to say "No, Sir!", even to the point of denying the employer your labor or refusing certain practices.

There are side issues, such as how to serve areas not able to support a 
full-time, paid, all the bells and whistles EMS; how to ensure that the EMS services actually make enough money to survive the backbreaking costs of insurance/medical supplies/vehicle and other infrastructure; how to provide service at a cost which people can afford.

I personally feel some events need to occur:
1. A union or professional association with a recognized registered bargaining arm. It may seem counterintuitive, but being in cahoots with AFFF is not the worst thing to be doing as long as EMS is not subsumed; you need as much muscle as possible.
2. Government-provided EMS at the EMT-Basic and Paramedic levels, with transport. If this is done using the FD as the "scaffolding" through which to dispatch and station it, firefighters must stop cross-manning except and unless they are fully  and voluntarily qualified, then never dual-tasked (to corrupt staffing figures). An independent medical chain of authority must exist, with a medical person at the top, not a fire chief, as good-intentioned as the chief may be. Perhaps firefighters on firefighting assingment may practice EMT-B, but only if they are there and EMS cannot be awaited due to pending loss of life.
3. Private EMS to carry out wheelchair van, interfacility transfer, and other calls not requiring the extension of _*EMERGENCY*_ care. (Mobile ICU's, etc., would be private and paid through insurance etc. unless a government entity chose to go into it). Hold private EMS to the same standards as government agencies.
4. Cut the frilly categories, go back to EMT-A and EMT-P, then let individuals earn seperately accredited certificates in such specialties as first responder, wilderness, "intensivism", SAR, disaster, and other categories. If you want to give drugs, start IV's,. etc., then you need to become a Paramedic, period, no "EMT-IV" or other "hamburger helper" approaches to allow people to practice outside their scope.
5. Make it illegal for any employers to independently certify then utilize people in certain skills instead of hiring or training them in recognized categories. Bundle skills into coherent categories (start with EMT-A and EMT-P) and require techs to train and certify into a category, not in particular skills. (Currently many states allow employers to do this with LVN's, but that is evaporating).
6. Make EMT-A and -P training profitable for private and public educational insitutions and have educational requirements for them to meet just as they do for other medical professions.
7. Discipline individuals and agencies skirting these requirements.

For areas not able to field their own EMS, how about the military? Currently medics and med techs are not given much practicum outside a hospital, and Reservists are deployed without any sometimes. Who has plenty of airevac aircraft and people with them needing practical experience? (Why do fisherman and boaters get better service, through the mighty Coasties, than citizens of rural Nebraska or Alaska?).

Personally, start here and now. Before you shut off youir computer, write letters and emails to your representatives in Congress, to the President, to your County and state representatives. Identify yourself, then calmly write to them that the system is broken, and it can be fixed without bankrupting the nation or the citizens. When someone decides to "go union", you find out who is behind it; if it makes sense, then do it. And personally get the highest training and follow the most ethical and patient-centered practices you can!


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## mycrofft (Dec 28, 2008)

*But I digress...*

I hate being required to suffer abusive patients because it might make them mad, when they are consciously seeking drugs or other goodies from me.<_<


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## csly27 (Dec 28, 2008)

Ridryder911 said:


> This is not a jaded conversation and not being rude, truthfully you are correct. You do not what to say; because you cannot say anything yet. How do you really know what is best in EMS or both worlds. How much do you really know about EMS? Did you study what is in the challenged EMS profession before entering the profession or just want to enter the public service arena because of the benefits? Remember, your in a class just above First Aid level, and has this really prepared you for a health care profession? Alike the CMA it is just a crude entry level.
> 
> I challenge you to remember this post in 10 years (if you are still in EMS or Firefighting) and think of this.
> 
> ...



Benefits? yeah right. that must be it, or it could be the cool uniform. I may not have a lot to say about it yet but I will. do you honestly think that everyone goes into this profession just for those reasons? Well if you do you just met someone who is not enering this profession for that reason. I am going into ems because that is where I want and need to to be. 

I could be a stay at home mom if I wantd to to, But I need and want to be out there making a diffrence in the world.Even if it is just a small diffrence that no one even really notices. I realize That I will be called every name in the book, me kicked at, spit on, vomited on and even worse. I get that I am ok with that. 

I have done research, I do know the basic components of ems. I also realize that the emt-b class is just a step above first aid. Do I think that makes me 100% prepared? Not a chance, there is no book, or story that an instructor can tell or a video that I can watch that will prepare me for what is out there. All I can do is study hard and go out there and do what I was taught, learn from the mistakes that I know I will make. As long as I learn from them and continue my education I will do great. I am not going to become an experienced emt overnight, I would be an *** to think that. 

I agree that they should pre-screen people before taking these kinds of classes. There are only a few in my class that actually want to enter into this profession why they are there in the first place is beyond me, they will never make it. I also agree that cma and such is a crude entry level, been there done that, with that being said everyone has to start somewhere right?

I will look back in ten years and remember reading a post that made me want to work that much harder to prove that there are people out there that want to go into this profession for the right reasons not the wrong ones.


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## marineman (Dec 29, 2008)

The problem that many people here see as far as being a firefighter/medic or firefighter/emt is that they *should* both be full-time careers requiring 100% dedication of education to truely be competent at either one. You say you could be a stay at home mom if you wanted implying that you have kids which we all know are another full time job. Do you truely think you're ready and able to put 100% dedication into 3 full time jobs and still stay out of the padded room? 

Others may have different opinions about fire services having medics but here's my view. I think it's great that in urban areas firefighters are required to be EMT-B's and I also think it's great that an engine responds to all of our EMS calls as first responders. My problem is when a fire service operates the ambulance itself and their thought process behind assigning people to the ambulance. It was mentioned that in most fire services that operate an ambulance it is used as a punishment or it is for rookies to prove themselves. That leads to people that want nothing to do with EMS operating an ambulance and requires people that want nothing to do with EMS to become paramedics. If a fire service wants to operate an ambulance that's great but they need to be completely independant. They need to hire Medics (or EMT's) for the ambulance and only for the ambulance, these medics shouldn't need to have any fire education as they're not in that job to be firefighters, they're there to be medics and operate the ambulance. They should hire firefighters to be firefighters only and not require that they're medics because they will not have the option of working on the ambulance unless they have applied for that position. That will be the biggest step forward as far as preventing people from entering this profession for the wrong reasons. You look around any paramedic class and you will see that 75% of the students are there because they want to be career firefighters but they can't get a job as a firefighter unless they have their medic certification. After class how much effort do you expect these people to put into furthering their medical education when all they want to do is put the wet stuff on the hot stuff? 

As for the topic at hand, I think a good push to make would be to talk to the boss of our respective companies and start a push to get them to only hire medics with an associates degree or higher. If we can get enough companies on board with that line of logic we can mediate the education requirements ourselves without requiring congress or any other government body. The benefit to the company is better bargaining power against the fire departments by proving that we now have more educated and better trained medics and will be able to provide a better service to the community. With that fire departments will be forced to either give up their service area or upgrade their training requirements. I know in some areas where medics are hard to come by in the first place this could be a tough push but well worth the effort as it will benefit everyone in the end. Even if it's just a smaller step like requiring 2 semesters of college A&P in order to be hired we are still mediating entry level education requirements at our level and we can continuously push until we are satisfied with the requirements. 

Outside of that I think the NREMT is doing us a big favor by only certifying medics from accredited schools, the problem being that the requirements to be accredited still do not provide an adequate education. 

In conclusion for those that read this far or for those that are too lazy to read it and want something brief, I feel there are too many problems coming from too many levels within the current EMS system to be addressed all at once. Those of us pushing for higher education and training standards are the minority so I think at least amongst ourselves we need to dedicate ourselves to all fighting the same issue at the same level until it is corrected and use a systematic approach to solving problems one at a time. Our efforts will go un-noticed with few of us hitting things at all levels for different reasons but if we make a unified effort at a single level we may have more push. If you read all of that you deserve a prize.


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## boingo (Dec 29, 2008)

I have no idea why you would think its good to send a $500,000 truck full of water to every EMS call.  Do  you send an ambulance to every alarm, dumpster fire, water leak or lock out?


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## Veneficus (Dec 29, 2008)

daedalus said:


> Not around here. My EMT program was taught by a MSN/NP and a B.S. in paramedicine, and education was held over "training". The folks in my class and area take EMS pretty seriously. Take a look at Ventura County EMSA is you wish.
> 
> If the area program where you lived went under because of increased educational standards, legislate to shut down the medic mills and soon a shortage of EMS personal will force the public and politicians to embrace the new standard of EMS education that will be born at both the local and national levels.
> 
> If your not part of the solution than you are a part of the problem. You may be able to sit here and cut down EMS now there the end of med school is in sight but do not think for one second that we are broken beyond repair, because if thats the case you need to match into a nice Derm residency and leave us alone.



My point was that it is one thing to sit and talk about lofty goals, but yet another to bring them to reality. The low standards and medic mills have been legislated into effect by powerful lobbies. You may have been fortunate, just like I was, to be educated at a very outstanding paramedic program in your area, but it is not common. Medic mills are opening in states they never existed in before. It's not that I don't want higher standards and a respectable EMS profession, its that we need details on how to actually do it. EMS will be repaired, but I am hoping it will not have to crash before it can be, for the benefit of those still involved.

What do you propose as a step in getting current EMS providers to embrace education over training?


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## FF894 (Dec 29, 2008)

Ridryder911 said:


> I was asked about becoming a Paramedic in a coffee shop... I was about to give my standard declaration of how heart warming, self fulfilling in nature, yes to save a life.. yadda.. yaddaa.. then I thought to myself



Always have coffee first, _then_ reflect...    


just kidding


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## BossyCow (Dec 29, 2008)

Wow.. where to start?  

Okay.. first.. marineman.. would you ask the same question about parenting being a full time job of a male entering the fire service? My husband is a parent that was able to juggle parenting our two boys while being a full time career ff/paramedic. Assuming that the mom bears the full brunt of the parenting burden is not realistic in today's society.

Second, if we assume that EMS is becoming an essential service, the current economic climate is going to see that we make best use of our infrastructure. To have one system that is set up to respond 24/7 to emergencies screams for a sharing of resources. I have heard of fire departments that devalue their EMS response, but I have had no direct contact with one aside from one old fire captain when my husband first entered the field, who was fond of complaining that they were 'turning us into a G.D hospital' 

In my experience the fire based systems are setting a much higher standard of training and education for their employees than the private systems are. Probably because of the lack of a profit motive and the increased competition for fire service jobs.

My own personal experience with the non-fire related EMS systems are with either hospital based or privately owned EMS systems. Of the two, the hospital seems to be the one invested in a higher level of education while the private companies seem to be the life support system for the EMT Mills. 

We need to determine if EMS is an essential service or a business and then proceed from there. Otherwise we will continue to have a very diverse set of goals and an equally diverse set of paths to get there. As long as there is inconsistancy in the definition of EMS, the types of agencies providing it, the funding to pay for it, the methods of billing for it and the expectations of the public, how can we expect to find any resolution in the inconsistancies in our training, certifications and protocols?


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## JPINFV (Dec 29, 2008)

Ridryder911 said:


> [long post]



Sounds like a lot of reasons why I've pretty much ruled out becoming a paramedic even if I don't get into medical school.


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## JPINFV (Dec 29, 2008)

csly27 said:


> Benefits? yeah right. that must be it, or it could be the cool uniform. I may not have a lot to say about it yet but I will. do you honestly think that everyone goes into this profession just for those reasons? Well if you do you just met someone who is not enering this profession for that reason. I am going into ems because that is where I want and need to to be.



A good will doesn't pay my bills or protect me.  Per the JEMS 2007 salary survey the average EMT-P gets paid about 40k/year (based off the 50th percentile on the salary per call volume chart. This corresponds with the salary by region except for the Northwest and Southwest regions, but I imagine that there are some outliers for Alaska and Hawaii that push those averages up). FTOs don't get paid much more, so I would end up essentially fighting for education and administration jobs. In the mean time I'd still have to make enough money to actually pay back my student loans for undergrad and grad school.

It also doesn't provide professional satisfaction. EMS, unfortunately, is a race to the bottom in terms of training, responsibility, and oversight. Too many people want to play with all the toys without a proper education while relying on medical control if their patient doesn't meet some nice predefined boxes on their algorithm. Too many companies are more than happy to comply since punting to medical control limits their liability and it's cheaper to buy a few toys for their crews than to pay a decent wage. Of course the average education level isn't high enough to justify higher pay anyways. Furthermore, too many companies are more than happy with having a QI program that consists of only reviewing calls that billing throws back. I'm sorry, but if I'm doing something wrong, I want to hear about it before it gets used as a lame reason to write me up over a call that didn't go how management thought it should. I also want to know what I'm doing wrong so I can fix it anyways and provide better service to my patients and my company.


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## marineman (Dec 29, 2008)

Bossy, Yes I would hope that any parent entering any profession would be able to devote 100% to their children, that comment however was case specific as the poster mentioned her husband is in the military which is a very honorable and respectable career however it tends to cut into the home life quite a bit. I guess much like our training and protocols many of the problems within EMS vary depending on where you're from and what your experiences have been. From my experience there is an area just south of me where the fire department operates the ambulance, your first two years on the department are spent on the ambulance (like I said for rookies). Older guys only get on the ambulance if they request it or upset the chief. The service I have the most experience with is a sort of hybrid being a private NPO that is co-owned by 4 local hospitals (is that hospital based or private?). They have very high standards for care and education/training as Medics aren't in as high of demand in my area as some others they can be a little picky. Some of the high standards are passed down by the medical director who actually interviews each candidate himself to test for critical thinking skills and common sense because he demands both out of us. 

I see this thread as many people expressing what's wrong with EMS but few suggestions on where us greenhorns can start working to fix it. Lets at least make this a productive thread to push for better medicine.


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## Veneficus (Dec 29, 2008)

As many of the grand ideas and efforts of many of us old guys haven't been able to do more than start p****** contests and get into education to try and convince younger generations to demand what we think will help. 

I can tell you what has been tried, what doesn't seem to help. But I think the answer is going to come from some of the newer members of EMS.


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## VentMedic (Dec 29, 2008)

BossyCow said:


> In my experience the fire based systems are setting a much higher standard of training and education for their employees than the private systems are. Probably because of the lack of a profit motive and the increased competition for fire service jobs.


 
Your area may still have a lot of very small community FDs. Other areas are the result of many mergers and consolidations. In one county for 1 FD, we have 65 stations and over 1000 Paramedics. And, we are just one of several counties like this in Florida. Besides being a Paramedic, they must also concentrate on Fire Fighting. That has to be just as important as the medical side. Just as I wouldn't want a half-arsed medic taking care of a patient, I wouldn't want a FF who has no interest in Fire Fighting watching my back or the back of my loved ones in the profession. 

When you start to see you have only X amount of resources for training, what should get the priority? Patient care or the safety of FFs? Not all will be given equal time in larger departments. Many smaller departments are also unable to accomplish perfection for either specialty due to lack of adequate tax base to support it. They, too, may just scrimp by. 

The benefits at the FDs also bring out everyone, interest or no interest in either Fire or EMS, to apply. Oakland, CA FD dropped their EMT requirement and got 10,000 applicants. It was such a circus there were national film crews watching the hysterical events unfold. 

Right now Miami Dade FD has announced it will again be accepting applications this spring. There is not an opening left in many of the medic mills. Some are even opening more classes to cash in on this spectacular event. The last hiring announcement got 6000 applications with many of them having a Paramedic cert. Quality education or desperate show of training to get a county job?


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## el Murpharino (Dec 29, 2008)

Veneficus said:


> I think the answer is going to come from some of the newer members of EMS.



I find that hard to believe when more and more students attend medic mills and online paramedic courses. They view EMS as a stepping stone and leave once they get their desired job or realize that there is absolutely no career progression in EMS.  I could probably get a job with a police or fire dept, work half the hours I do now and make the same amount I do with better benefits.


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## Veneficus (Dec 29, 2008)

el Murpharino said:


> I find that hard to believe when more and more students attend medic mills and online paramedic courses. They view EMS as a stepping stone and leave once they get their desired job or realize that there is absolutely no career progression in EMS.  I could probably get a job with a police or fire dept, work half the hours I do now and make the same amount I do with better benefits.



I have high hopes this financial crisis and medicare insolvency is going to come down hard on EMS providers that only think they are going to do emergencies, drive to the hospital or whatever. Those that do not commit to more of a healthcare role will find they are hiring less new people, and even laying off some older ones. All the medic mill graduates without the drive for medicine will not be able to compete in this new climate. Agencies that do not embrace an expanded role towards public health or primary care will likely find their budgets diminish as their dollar value to society fades. 

As emergency professionals we have become quite arrogant about how much we feel we are worth. Maybe I am just getting old, but many of the people in emergency roles today seem to have an ignorant entitlement attitude from being called hero once too often.


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## BossyCow (Dec 29, 2008)

marineman said:


> I see this thread as many people expressing what's wrong with EMS but few suggestions on where us greenhorns can start working to fix it. Lets at least make this a productive thread to push for better medicine.



you might try looking at this thread: http://www.emtlife.com/showthread.php?t=10422


VentMedic


> Your area may still have a lot of very small community FDs.



I think it has less to do with that and more to do with my location in the Pacific NW. We took an existing infrastructure and applied it to EMS response rather than duplicating services. 

As to the training issue, there is a required amount of training for a medic, and a required amount of training for a firefighter. Being able to meet those requirements in an age where the fire calls are diminishing due to better building codes and fire prevention doesn't have to make crappy medics who are good firefighters or crappy firefighters who are good medics. If that's happening in your area, I'd suggest its due to the standards being set by the administration.


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## JPINFV (Dec 29, 2008)

Veneficus said:


> I have high hopes this financial crisis and medicare insolvency is going to come down hard on EMS providers that only think they are going to do emergencies, drive to the hospital or whatever. Those that do not commit to more of a healthcare role will find they are hiring less new people, and even laying off some older ones. All the medic mill graduates without the drive for medicine will not be able to compete in this new climate. Agencies that do not embrace an expanded role towards public health or primary care will likely find their budgets diminish as their dollar value to society fades.
> 
> As emergency professionals we have become quite arrogant about how much we feel we are worth. Maybe I am just getting old, but many of the people in emergency roles today seem to have an ignorant entitlement attitude from being called hero once too often.




Ironically enough, an article I just downloaded deals with this to an extent (I was bored yesterday and started flipping through an old JEMS magizine. As I read it, I felt myself getting dumber so I downloaded some articles from Emergency Medicine Journal to keep me entertained tomorrow).


> *
> Effectiveness of emergency care practitioners working within existing emergency service models of care*
> Suzanne Mason1, Colin O’Keeffe1, Patricia Coleman1, Richard Edlin2, Jon Nicholl1
> 
> ...



http://emj.bmj.com/cgi/content/abstract/24/4/239


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## csly27 (Dec 29, 2008)

BossyCow said:


> Wow.. where to start?
> 
> Okay.. first.. marineman.. would you ask the same question about parenting being a full time job of a male entering the fire service? My husband is a parent that was able to juggle parenting our two boys while being a full time career ff/paramedic. Assuming that the mom bears the full brunt of the parenting burden is not realistic in today's society.
> 
> ...



ok, yes being a parent is a full time job, I have been doing it for almost 13 years. It is not realistic to stay home and raise kids as it once was. With my husband being in the military it helps finacally, but I have never been one to stay at home I have to be able to have adult interaction and parents know what I mean by that. Any job that I have ever had I have always givin 100% of myself I can find a balance in everything.

I know that this job will be hard I never said it was not. I feel that by me going into this feild not only is it something I want to do It runs in my family. I feel that it will teach my kids the importance of working and having a jcarrer that is worth something. education is very mportant to me, and I plan to continue it I plan on staying in ems not just using it as a stepping stone as some call it. I may skip around with in the ems system but this is where I want to be.

as of next month I am not sure where we will end up. I suppose some people dont understand my reasoning for wanting to go into ff then medic school, there are a couple of reasons. first of all knowledge is power correct? well I feel the more I know The better I can be. Another reason is that if I can be come a ff then medic I will have a better oppertunity to be able to get on with a fire station opposed to a private company. Realize I am still just a student but as of this point I have not heard many good things about private companys.

Someone had mentioned about being able to give 100% to 3 diffrent I beleive the answer to be yes. as a mother first and always I realize that I may not at home as much as I am now. But I beleive that I will be doing more for children than I am now. thats is why we have familys to help support one another right? and as a ff/medic. you bet. nobody seems very supportive of that, it seems to me like people want you to be either one or the other but I seem to beleive that by being both your gonna be available and knowledgable to help more than just med or trauma pts. How could you not want that? 

As rid911 had mentioned earlier I cant say alot about this subject because i have not been there done t hat yet. But what I can say is that there is nothing that can discourge me from entering this feild and doing the best I can,  plain and simple. As for the problems between wether it should be ff/ medic and education, I dont know how it all works yet but I think that pre sreening is a good first step to try and weed out the people who are in this because it seems like a cool job.


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## FutureFlightMedic (Dec 29, 2008)

_*Wow. Having just spent the last 2 years to obtain my Associates Degree in Paramedicine, graduating with Honors at the Top of my class and just getting my Paramedic cert this week, I am deeply disturbed by this post. I truly understand where you all are coming from, and all of your points are vaild; I agree big changes need to come to EMS for the better. This won't happen if those willing and able to do the job are discouraged to ever enter into it. ALL healthcare has it's drawbacks; I have worked in several busy ER's and volunteer at my local Fire Department. Why do I want to be a Paramedic? Because my brother nearly died of cancer, and he inspired me to do my best, because someday I WILL be caring for someone's brother. Yes, it is what I want to the very depths of my soul. I did not kill myself for a year of pre-reqs and 2 of medic school to be told it is not important. Please know I mean NO disrespect to any of you, I am in agreement with you all. Let's work together to change this! We need to be PROUD of this career we've chosen and work to make it the PROFESSION that it is...*_*[/I]*[/I]


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## JPINFV (Dec 29, 2008)

FutureFlightMedic said:


> _*Wow. Having just spent the last 2 years to obtain my Associates Degree in Paramedicine, graduating with Honors at the Top of my class and just getting my Paramedic cert this week, I am deeply disturbed by this post. *_


_

To be honest, though, I can say something similar. I didn't work hard for 4 years for a BS and 2 years for a MS to be lumped in with people who think that a 800 clock hour course with no prereqs besides a 2 week A/P course and a year as an EMT-B makes them all that and a bag of potato chips (/me makes note that this isn't directed at you)._


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## el Murpharino (Dec 29, 2008)

Veneficus said:


> All the medic mill graduates without the drive for medicine will not be able to compete in this new climate. Agencies that do not embrace an expanded role towards public health or primary care will likely find their budgets diminish as their dollar value to society fades.



You're absolutely right, but what "new climate".  Right now, it's the same ol' same ol'.  I'm sure many medics out there would like to expand their knowledge base and provide care similar to those in Europe and other countries, which will in turn alleviate the congestion in ER's.  But the truth remains that there are just as many medics who don't view EMS in the same way and continue to hold our profession back.  But what would it take for EMS to perform in that capacity in our healthcare system?  In this political climate....an act of God, I'm afraid.


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## Veneficus (Dec 29, 2008)

el Murpharino said:


> You're absolutely right, but what "new climate".  Right now, it's the same ol' same ol'.  I'm sure many medics out there would like to expand their knowledge base and provide care similar to those in Europe and other countries, which will in turn alleviate the congestion in ER's.  But the truth remains that there are just as many medics who don't view EMS in the same way and continue to hold our profession back.  But what would it take for EMS to perform in that capacity in our healthcare system?  In this political climate....an act of God, I'm afraid.



according the the christian bible, a rather large flood was an act of God. I think climate will change because of economic hardship. In order to keep all of US healthcare afloat, medics will have to become something more in order for the public to continue to be able to justifyably fund EMS. This idea of medics acting as public health agents is not new in the US. but I think it is economics that will force the change, not the desire of the people in the profession.


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## daedalus (Dec 29, 2008)

FutureFlightMedic said:


> _*Wow. Having just spent the last 2 years to obtain my Associates Degree in Paramedicine, graduating with Honors at the Top of my class and just getting my Paramedic cert this week, I am deeply disturbed by this post. I truly understand where you all are coming from, and all of your points are vaild; I agree big changes need to come to EMS for the better. This won't happen if those willing and able to do the job are discouraged to ever enter into it. ALL healthcare has it's drawbacks; I have worked in several busy ER's and volunteer at my local Fire Department. Why do I want to be a Paramedic? Because my brother nearly died of cancer, and he inspired me to do my best, because someday I WILL be caring for someone's brother. Yes, it is what I want to the very depths of my soul. I did not kill myself for a year of pre-reqs and 2 of medic school to be told it is not important. Please know I mean NO disrespect to any of you, I am in agreement with you all. Let's work together to change this! We need to be PROUD of this career we've chosen and work to make it the PROFESSION that it is...*_*[/I]*[/I]


You do us all well by holding a degree. Congratulations on this accomplishment.


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## Outbac1 (Dec 29, 2008)

Well Rid from what I have read here and other people I've talked to in the past year, EMS in the USA certainly has a boatload of problems as you have described. Fortunatly here on Canadas east coast much of what concerns you has been addressed. Not that we don't have our problems. We do. There is still an old boys club in management.  We are slowly moving from training to education. Our pay has gone up and is more respectable. We are not mixed in with fire. We are both stand alone entities. We have national standards and reciprocity accross the country is just around the corner.

  This didn't happen overnight. It took a lot of hard work from a relatively small number of people over several years to achieve. 

  The point is if we can do it, you can too. I doubt very much if you are alone in your fight for a better system. Every person whose attitude you change  or instill to be better will have reaching effects. For they will instill new and better ideas in others and change will come. You and other like minded individuals are making a difference. Keep up the good work you are doing. Change will come, slowly, but it will come.


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## lightsandsirens5 (Dec 29, 2008)

Veneficus said:


> I like to think EMS is like a crack additction, you know it's bad for you, but you just can't pull yourself away



Hey! Dont you dare compare me to all those druggies I get to pick up.

Well....you know, come to think of it, veneficus is right! AHHHHHHHHHHHHHHH!!!!!!!!!!!!!


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## Anu (Dec 30, 2008)

Since becoming a part of this forum, I realize the essence of this subject comes up rather frequently..  

In a nutshell, I truly believe what holds emergency medicine back is the integration of Fire Services into the practice of emergency care.  It is impossible to have a clear vision of what the the educational or accreditation requirements for an emergency care provider ought to be when there exists such a lack of _definition_ for the role in itself.  You have FF's and Police personnel getting certified as EMT's and Paramedics only to enhance their roles as public officers, but in reality such practices contribute little to the field of emergency care as public safety becomes enmeshed with clinical care practice.  What is more disastrous is that EMS personnel and the public alike cannot seem to distinguish between these roles, providing a false pretense for what the role of an emergency care provider (and an emergency medical system) should be.

Many of you have become eager to take action on behalf of the profession.  I suggest what EMS needs is to lobby for is for its separation from all kinds of Fire Based Services.  Realistically, this might not be possible, but I firmly believe emergency medical services needs to find its place within the medical community and not with public safety organizations.  Canada should serve as an example of what a true EMS ought to be.


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## Meursault (Dec 30, 2008)

Well, forum's done. Rid wins. Everyone go home.

I'm not in EMS as a career, and he pretty much outlined why. 
I'm young, have attempted and still occasionally attempt to actually change things, and have almost no experience to speak of, but even I'm not quite as upbeat and gung-ho as some of the posters in here. What are you people on and where can I get some? 

It doesn't look like EMS reform is going to be an internal effort. Like most things (our healthcare payment system, for example), it has to get seriously and visibly broken before people start talking about fixing it. So far, I don't see any evidence that people outside of healthcare (the people who for some reason make all the decisions) have noticed that the entire American model of prehospital care is deficient.


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## mycrofft (Dec 30, 2008)

*Start now...email your elected representatives;.*

 Mentor a newbie. Teach a class.
How about a thread about "What you can do personally, in the next year, to positively affect EMS where you stand"?.


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## marineman (Dec 30, 2008)

mycrofft said:


> Mentor a newbie. Teach a class.
> How about a thread about "What you can do personally, in the next year, to positively affect EMS where you stand"?.



Go for it, that's what I was getting at earlier but bossy cow gut upset that she couldn't complain so I gave up.


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## BossyCow (Dec 30, 2008)

marineman said:


> Go for it, that's what I was getting at earlier but bossy cow gut upset that she couldn't complain so I gave up.




This wasn't my thread.. and the point of the thread was to vent and complain.. just trying to maintain the integrity of the thread..


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## suziquzi99 (Dec 30, 2008)

> [Benefits? yeah right. that must be it, or it could be the cool uniform. I may not have a lot to say about it yet but I will. do you honestly think that everyone goes into this profession just for those reasons? Well if you do you just met someone who is not enering this profession for that reason. I am going into ems because that is where I want and need to to be.
> 
> I could be a stay at home mom if I wantd to to, But I need and want to be out there making a diffrence in the world.Even if it is just a small diffrence that no one even really notices. I realize That I will be called every name in the book, me kicked at, spit on, vomited on and even worse. I get that I am ok with that.
> 
> I have done research, I do know the basic components of ems. I also realize that the emt-b class is just a step above first aid. Do I think that makes me 100% prepared? Not a chance, there is no book, or story that an instructor can tell or a video that I can watch that will prepare me for what is out there. All I can do is study hard and go out there and do what I was taught, learn from the mistakes that I know I will make. As long as I learn from them and continue my education I will do great. I am not going to become an experienced emt overnight, I would be an *** to think that.



agreed

Rider, I didn't read this before I posted my other thread, guess you're one of those. lol. Every job has newbie gung ho people who are ready to do what needs to be done. Not all but many and that is where change happens and the profession continues. There are many medics who have over 15 years where I am at and still going strong. I don't know if I will be one of the ones still going in 15 but I'm guessing right now, yes. If you're going to include politics, what could and should be done, there would be not many professions to go in. 
And benefits?? Really! You'd do better to get a degree in education and have holidays and summers off!


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## Bosco578 (Dec 30, 2008)

*Fire Rocks!*

The system sucks, too many wankers and losers. Rid is right. It's just a job. At the end of the day the hose monkey's are the heros in the public's eye,they can do no wrong. A.s.s. Holes. We get in this field for whatever reason,yet it attracts some of this biggest jerk off's. The clowns that have more flashing lights on their POV's,that carry trauma bags and whatever else "just in case". Life sucks! This job is going down hill. Nurses treat us like s.h.i.t.,hospital waits,those dill holes that call us for stupid crap. People suck. This job sucks! F**k it.

And look at some of the posts. People asking or afraid of getting AID's or Hep, or whatever by having their clothes touched by someone infected. Are you really a retard? Yes you are. Some of the stupid questions posted. No matter what site you go on, these kind of lame stupid posts exist. 
But hey, the Mods will come in and say, oh it's inflammitory, or whatever. No it's the cold hard truth, posting stupid questions = you are a retard. Simple educational questions you should have learned or could look up or ask.  But WTF, just lock a post or ban someone, ya that helps.


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## Shishkabob (Dec 30, 2008)

Ok, who stole Bosco's blankey?


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## FFMedic1911 (Dec 31, 2008)

After reading the posts I think I will chime in.Our biggest problem is right here in the posts.We all know there is a problem.We just can't agree what it is.That is where I fell we are getting into trouble.How can we lobby for change when we can't agree among ourselves what needs to be changed.We could have a union with 3/4 the population of the U.S. as card carrying members and we still couldn't get anything done in ems.Until we can pick our battles as a group and fight for that we are a lost cause.I would also like to add that I am a career FF/Medic.I do take my job serious.I challenge anyone from private,third service or hospital base to prove that I do not.With that being said I will not sit here and say that fire based is worse or best than any other way to provide ems.So to start for change lets figure out what we are as a profession.Than we can go from there.Rid I would also like to add that your first post was wonderful and really sheads light to many problems in ems.


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## Bosco578 (Dec 31, 2008)

Linuss said:


> Ok, who stole Bosco's blankey?



Really bad day.


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## Medic (Dec 31, 2008)

This post makes me look at becoming an EMT twice, the reason I want to get into this system/profession/career is to help people in there darkest hour. I’m willing to earn peanuts to help and have little to no sleep. Never have time to be with family or friends. 
In SA emt-b earn half of what you guys do. Plus all the added dangers of working in a 3rd world country. Where medics have to wear bullet proof vests and helmets and have armoured ambulances and armed guards from the police and army with them when they set foot into a township.(not saying we are worse of than you, I don’t know EMS system in US)

When you signed up to a program/degree/course. You should be aware of the factors of this system and the problems you might face. So if you knew this why did you look for a job in this system?

If there is an issue address it. Don’t sit here in a forum and moan. Vote or file complaints about the lack of education in the system. Express your views. 
Do it for the love of helping, because after all EMS is a calling, not a profession


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## Shishkabob (Dec 31, 2008)

One possible reason why EMS doesn't get the recognition of being a profession from other medical professions;



Medical Control.


In some of the on-line services, it can be a babysitter making sure everything is done right.  How many other medical professions have to ask for permission before administering a drug in an emergency?   While the idea is good, albeit sometimes great, it makes the service viewed as not being able to make our own decision.


Granted, civilians don't know about medical control, so that doesn't taint their view.



(Now here's a legit question... do nurses practice using a doctors license like we do?)


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## Ridryder911 (Dec 31, 2008)

Linuss said:


> One possible reason why EMS doesn't get the recognition of being a profession from other medical professions;
> 
> 
> 
> ...



Most systems use standing orders and do NOT have to call medical control. Actually, I am surprised Medical Control will allow so many Paramedics to perform as many procedures as they do. 

Let's look at it this way. Beauticians usually have double the number of hours of training than a Paramedic and thy cut dead cells. Now would trust most Paramedics or EMT's?

Now, I agree they could support us by being more concerned and stricter. Publicize and endorse better medical education.

But again.. the real culprit is ourselves. 

R/r 911


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## VentMedic (Dec 31, 2008)

Linuss said:


> (Now here's a legit question... do nurses practice using a doctors license like we do?)


 
A lot will depend on their work environment, job description, state board and medical director for their unit. Nursing is a very broad field with many different opportunities to grow or coast through one's career. 

Nurses, RRTs, Radiology and a lot of other medical professionals practice under quidelines and protocols written by the medical directors of their unit or department as well as the nationally accepted clinical practice guidelines. There are also many nurse initiated protocols established by national standardizing organization the filter down to state and local regions as well as each hospital's RN initiated protocols. RNs who work in the ED, ICU or on code and rapid response teams may have a very elaborate set of protocols to follow. RNs that work med-surg also have various standing orders and protocols for emergencies or daily care. 

The various member of the medical board (physicians) and medical directors of each unit will also dictate what the scope of practice will be for RNs (or RRTs) in each unit provided it is allowed by the state. That can include A-line or central line insertions, PICCs, intubations and conscious sedation procedures or various meds that once required a physician to give. One would be surprised by the equipment and procedures they do besides just the ones that are commonly used by Paramedics. Many are not aware of them because it is just part of a day in some ICUs. Healthcare professionals in the hospitals don't constantly count the number of procedures they do. Some could care less if they are the ones intubating because there is so many other things to do and patients they also are responsible for at the same time. 

As an RRT, my medical directors, of both my direct overall practice and for whatever specialty unit I am working in, have also written many protocols and guidelines for RTs to follow for many different situations. I do work directly under the license of my medical director(s). The same on CCT, Flight and Specialty transprort. RNs are also included under the medical director of those teams. 

Here is the part that many Paramedics don't get a chance to see about medicine in a hospital or critical care setting. There is so much going on for the long term that a physician must act as a team leader to cordinate the patient care. It is not that he/she much write or direct every order some one does. Emergencies are sometimes the easiest if they are just with the ACLS guidelines or for a very short term stabilization. HEMS or Flight from a prehospital scene can sometimes be easier than picking up a disaster in the making at a hospital for interfacility. 

The long term stabilization and diagnostics require much more effort. It is when you have a patient for the long haul and resuscitation may go on for hours or days. There can be an overwhelming amount of information that may need to be processed. It is sometimes nice to have a physician around to make that decision before giving a medication that you know will put the patient on dialysis for the rest of their life even if it may save their life at the moment. There could be alternatives but would they work or should you really mess with a study drug or break protocol and go with plan C or D? 

Autonomy is good for some things, but when total patient care is expected to increase the patient's chance for survival and recovery to function somewhat normally, a multidisciplinary approach is the most successful. It also reduces medical errors if everyone is watching out for the patient's best interest.


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## mycrofft (Jan 1, 2009)

*Who needs a doctor's oversight?*

Nurses, PA's. Sometimes FNP's. It can be as loose as them signing off on the protocols annually with some review, it can be as tight as every case has to be signed off, but somewhere a MD has medical control, not a "Master PAramedic" or "Great Cachina Nurse In The Sky" or whatever.
I used to see upwards of 150 patient visits a week and every one either involved use of a standardized procedure requiring countersignature (handed him/her a STACk at the end of each day), or review of a case which did not fall into my SP's, or a straight referral to see the MD at the next Dr sick call. There were a few where I could just say "no" (e.g. "Pt reassured, advised seek sick call as needed in future") but not very many. Now I see fewer but more serious pt's and I make sure the doc's and I are on the same page through daily interaction.


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## Maya (Jul 10, 2009)

Wow, hmmmm..  this is all starting to make sense.  I knew I didn't have all of the facts.

Okay this is obviously a big problem and I would like to give it the thought and the respect that it deserves, as people obviously feel very strongly about the subject.  I hope you'll forgive me for bringing this thread up again, but I think that the subject is relevant now, even more-so than it was at the time it was written -- given the current state of our economy, the fact that we now have a new president who actually cares about and listens to the people, and that we are facing a massive re-structuring of a failing Healthcare System...  Not to mention the fact that the Baby Boom generation is now aging, the health of Americans is rapidly declining, more than 1/3 of people born after the year 2000 will develop Diabetes, etc...  EMS is *vital* to the Healthcare System, to the health of Americans, and to the Economy as a whole.

If you want to make a change, we need to Unionize.  We need to write to Senators.  We need to write to Congress.  People have said this before, but I think that our leaders and the people are more willing to listen now than they were before.  We've reached the Tipping-Point.  We've seen the greatest Economic Collapse since the Great Depression.

Times have changed and it’s a BIG deal that Obama is president now.  Obama is a Keynesian Economist – that means Demand-Side Economics.

In the Seventies, 1 out of 3 workers was a member of a Union.  Now, after Bush, it is only 1 in 10.  Standards of living have dropped dramatically.  The distribution of wealth has changed drastically to favor the top 5% of the population, comparable only to the 1920’s when the top 10% of the population owned 72% of the nation’s wealth – Robber Baron’s, the top 1%, owning 26% of the nation’s wealth.  The 1920’s was dominated by Republican presidents – Laissez-faire Capitalism – Supply-Side Economics.

Following the Great Depression, the ideas of John Maynard Keynes were put into practice by President Roosevelt and the economy began to stabilize.  … skipping along… We then gradually moved back towards the ideas of Milton Friedman – laissez-faire Capitalism – this reached a peak in the Eighties with the Trickle-Down Economics of President Reagan.  Fast-forward to modern-day and the likes of Alan Greenspan, Ben Bernanke, and Henry Paulson – Republicans – having absolutely no oversight and doing crazy-*** things like repealing the Uptick-Rule, causing the stock-market to crash, and all this other crap with mortgages and the housing-bust...

Anyway, I could go on about this forever and it’s very difficult to be clear and concise about a topic as complicated as this.  Maybe someone with a stronger grasp of Economics than I have could explain it better.

The point is, Obama, more than any president since Carter (who got a bad rap, so let’s just say ROOSEVELT instead) will be willing to listen to the people.  What he’s trying to do with the Green Initiative and with Healthcare Reform – these are HUGE undertakings that no-one has been willing to face before him.

To be quite honest, I can't even fully comprehend what the impact will be on EMS.  However, I believe that whatever direction it takes, it is imperative that we work together to make sure that working conditions and wages are sufficient to meet living standards and for us to be able to support our families.

Take what you will from it.  Maybe you agree with me, maybe you don’t.  That’s just politics.  But if you feel strongly enough about it, I think it’s worth discussing and I think it’s worth taking action to support a cause – the way they did in the Sixties and Seventies, when people actually cared about what happened in the world and about what happened to the common man – people in EMS should understand that more than anyone else.  There are few professions that are more selfless than EMS.


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## Ridryder911 (Jul 10, 2009)

There are still areas of medicine you are naive on. 

First, NO president is going to change any health care reform. Sorry, it can't be done. AMA, Pharmaceutical Corporations will ensure that their special interest will always come first. I don't care if they are Democrat or Republican, and as well the citizens acclaim that they want change..... as long as it does not affect them. 

Start informing patients that frequent the ED for minor or chronic problems that they will have to start waiting and be seen in a scheduled clinic setting and see the outcry. As well as the difference in medical care of those that have the financial means and the ones that do not. CABG?.... take a number. 

Your faith in Obama is much more than mine. I personally think he is the road of destruction but that is for another post and debate. Just remember, he was a former attorney for a major pharmaceutical chain. 

Again, someone will have to pay for it. Yes, it will be those that are working as in per taxes (middle income). 

The other thought is unions are not well liked among many health care professionals. Even speaking the word union in some of the hospitals I have worked in was a sure way to get fired for some other reason. Their effectiveness is only based upon how good that union is. I know the larger EMS in my area is union and they have not helped any. The major problem is it is a branch of the same union that represents firefighters, and they definitely would never interfere with their demands. So they only thing I see from that is medics paying dues and thus reducing their "normal competitive" salaries. 

I lived during the sixties. Let's not dive into a heated debate about LBJ and the initial reasons how our economy started diving. Having assisted programs are fine as long as it is a hand up and not a hand out. Unfortunately, majority most liberals like developing programs but fail to recognize that there is no such thing as a money tree. Again, somewhere someone will have to pay for it. 

I suggest you study the Carter administration and his inability to function. I met the man. His discussion and policies are the reason I went from a very active Democrat to a Republican. 

R/r 911


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## Maya (Jul 10, 2009)

Regardless of whether or not we agree on politics, I do think you made an excellent point on implementing and enforcing a higher degree of education.  It makes absolute sense.  Wouldn't it be worth lobbying for that?

You can't deny that people acting together for a common cause DOES have an impact.


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## 46Young (Jul 10, 2009)

Ridryder911 said:


> There are still areas of medicine you are naive on.
> 
> First, NO president is going to change any health care reform. Sorry, it can't be done. AMA, Pharmaceutical Corporations will ensure that their special interest will always come first. I don't care if they are Democrat or Republican, and as well the citizens acclaim that they want change..... as long as it does not affect them.
> 
> ...



What are your thoughts on the 1199 organization?


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## atropine (Jul 11, 2009)

Well, lets look and see where ems is a profesion, back east maybe I know where I work and live private emt's and paramedics are paid almost nothing, and firemedics make a ton of cash, so where in the nation is ems a profesion and how is it delivered.

The truth is ems will be delivered differently until the world ends. This is stepping stone job and as long as the privates and third servies can keep wages down things will not change.


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## WolfmanHarris (Jul 11, 2009)

atropine said:


> Well, lets look and see where ems is a profesion, back east maybe I know where I work and live private emt's and paramedics are paid almost nothing, and firemedics make a ton of cash, so where in the nation is ems a profesion and how is it delivered.
> 
> The truth is ems will be delivered differently until the world ends. This is stepping stone job and as long as the privates and third servies can keep wages down things will not change.



How many time does someone have to counter with the relative cost of living between CA and the rest of the US before we can call that horse? Unless it's in it's own thread can we just agree to disagree on your mantra?


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## Maya (Jul 11, 2009)

Okay.  RidRyder --  I was really trying not to take the bait, but this kind-of bothers me.  You have different political beliefs -- I can respect that, although I don't agree with you.  It's unlikely that we'll be able to change one another's minds, although I am mystified as to how anyone could possibly still be Republican after what has just happened in the economy -- having heard such things as Alan Greenspan, himself, admitting that the ideology of unbridled free-market economics he blindly followed for the last 40 years was based on a "fundamental misunderstanding of how the world works."

Not to mention Cheney -- Halliburton.  And..  Bush?!  Thanks, but I'll take my chances with Obama.

That said, I do respect your medical background.  I don't agree with you about the healthcare system.  It is fundamentally flawed and it is not sustainable.  We cannot afford to NOT fix it.  Whether or not anyone agrees with the plan, there has to be a plan.  If it doesn't work perfectly, we'll have to keep trying, but there simply is no way we can keep printing money.. and more money... and more money.  And keep paying for Medicare/ Medicaid and Social Security.  The underlying problem itself has to be fixed.

There is a very big divide between rich and poor.  I don't believe in hand-outs, but you seem to be pretty insensitive to the fact that poverty is an issue that can't be addressed by simply ignoring it and saying that if someone's born into poverty, gets no education, lives in filth and infestation, hungry.. surrounded by drugs, gangs, and violence, has few choices for earning an honest and survivable income, because they don't have that very basic education and few chances to escape from poverty -- too bad.  That's their fault, it's not my problem.

I'm sorry, but I don't think you have a real understanding of what, exactly, is poverty and despair.  Try talking to a kid who doesn't think they'll live past 20 years old.  How can that possibly not break your heart.  It sucks, that is the way it is.  It does seem like there's nothing you can do to change things, but I don't personally believe that's an excuse to do nothing.  Even if you think that what you're doing is futile and you think that you'll fail, how can you accept doing nothing as an alternative?

It is ugly and it's inconvenient, but it's still there even if you turn your back to it.  I'm not trying to be condescending saying that you've never seen things like that.  In EMS, I'm sure you have.  But I can't say that I can really sympathize with Trickle-Down Economics, giving money and tax-breaks to the wealthiest 1%, when everyone else is starving.  And the statistics do not lie.  The divide between rich and poor has only gotten bigger and bigger.

Okay, dammit.  I wasn't going to go back onto the politics.  I can't help myself!  

But what is bothering me -- that I don't understand about what you're saying -- what is your solution to the EMS problem?  Are you saying that there's nothing to be done?  I don't really understand that attitude.  How can you see a problem that affects you directly and just accept it?  Why is this even a topic if you don't even think there's a solution worth considering or discussing?  Even a small possibility of a minor concession would be something.


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## daedalus (Jul 11, 2009)

Maya, many here have to show us the cold, hard truth so that the rest of us may learn. Each and every time one EMT or Paramedic sees the light, we gain a small victory. Every time education is discovered by a new EMT as the key to our future as a profession, we gain a small victory. Once a good number of us recognize education as our saving grace, we can continue on to better pay, more career options, etc. 

What can you do to help? Do not become one of the mindless sheep. Take some classes at a community college. Treat your patients well. Follow evidence based practices and inform your employer and system medical director of the latest research on oxygen, c-spine, and what have you. They will be impressed. Become a paramedic and do not settle for mediocracy in your knowledge base or incompetence in your peers. Advocate for your profession by writing letters to those who hold political office. Teach your younger partners.


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## Shishkabob (Jul 11, 2009)

Maya said:


> although I am mystified as to how anyone could possibly still be Republican after what has just happened in the economy



1) Political affiliation doesn't just have to do with economic views.  Also has to do with gov't views, personal views, etc etc.

2) You DO (or atleast should) know that the economy lags by quite a few years on upswings, correct?  

3) Last I checked, democrats spent more money on this recent recession then Republicans did, and to no avail. 



This recession isn't a red vs blue thing, so don't try to make it one.


(PS, I may live in Texas, but was raised in very liberal Michigan, so don't think I'm a republican just because I'm in Texas)


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## Maya (Jul 11, 2009)

You guys do understand why the Stock Market crashed, right?  Have you been reading about the Credit Crisis, mortgage-backed securities, the Housing Bubble...  This all happened because there was NO oversight by the SEC.  The Uptick-Rule, which was instated by FDR after the Great Depression -- to make sure that a Stock Market Crash on the scale of the Wallstreet Crash of 1929 NEVER happened again.  The Uptick-Rule was repealed in 2007, allowing Hedge Funds to obliterate the market with aggressive short-selling.  Ben Bernanke, Henry Paulson, Christopher Cox -- all of these guys in charge went on the stand shame-faced and ADMITTED that they were wrong!  It's not a simple Red vs. Blue issue.  Alan Greenspan, the poster-boy for unbridled free-market Capitalism, took responsibility for the crash!  He admitted that what he believed to be true for the last 40 years -- based on the economics of Milton Friedman -- was wrong.  Fundamentally flawed.  They have now advocated for a reinstatement of the Uptick-Rule.  The views that are opposite to Milton Friedman's -- those of John Maynard Keynes.

Not to mention all this other crap you see in the news -- Madoff, Stanford...  almost every day there's another scam-artist pulling yet another an *unbelievable* scam.  How did Madoff get away with this?  Because there was NO OVERSIGHT by the SEC.

What we're seeing now is a repeat of history.  You're right in that I'm biased towards to Blue side because of personal beliefs, but the basis of what I believe is the fundamental underlying economics.


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## Maya (Jul 11, 2009)

Daedalus, thank you for the excellent advice, which I will definitely follow!  You can be sure that I will write letters!  But, is there an affiliation of EMS workers trying to achieve this same goal, together?  It doesn't have to even be a 'Union,' as such, but it seems like we would achieve more by acting as some kind of organized group.

As I understand it, the way it more or less works is that the person in charge of the organization writes a standardized letter.  It is sent to all members of the organization via email.  You sign your name at the bottom of the document and it is automatically forwarded on to your Senator and will eventually move on to the House of Representatives when enough letters have been received.  The leaders of the organization hold meetings to educate people and continue to advocate for their cause in Congress and in the Senate...  But none of that actually happens if the Senate doesn't receive enough letters -- it has to be *organized* so that your Senator is forced to address the issue.

That isn't very likely to happen if it is left to individual people to write their own letters, find the information on where to send the letter, actually send the letter.  And keep going through this whole process over and over again.  Very few people will actually bother to send letters, unless it is organized for them and made very simple for them to follow simple steps.  People are generally complacent about taking action on things that they may even feel very passionate about.  It's just human nature.

I know that I'm ranting and raving, but the reason I think that it's so important is that I think that many people don't realize how much of an impact every letter makes.  They assume it's just one letter and it doesn't make a difference whether they send it or not... So why bother if nothing's going to happen anyway?

But, for every letter that is sent to Congress, that letter is weighed as a constituent of 200 votes -- because they know that for every ONE person who feels strongly enough to write to their Senator, another TWO HUNDRED people feel the same way, but are too complacent to send letters themselves.  No kidding, you think people are lazy about voting.  We're pretty lazy overall, however vital it may be to our own health and wellbeing.

http://www.mindpeacecincinnati.org/advocacy.shtml

I really do think that we can do something -- however small that something might even turn out to be.  But, I don't think that *anything* can happen if we are not organized.


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## Maya (Jul 11, 2009)

By the way,  I hope nobody takes anything I say personally.  I'm pretty passionate about my views, and I think that everyone should be -- whether or not they agree with my opinions.  As long as you have opinions and are not complacent, and you're willing to fight for your beliefs, I consider you to be a valuable and active member of society.  

Sorry, I shouldn't even be bringing politics into this discussion.  Maybe we can work together for a common cause, no matter what politics we happen to follow.

Here's another good link for how to address letters:

http://www.ieeeusa.org/policy/guide/letters.html


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## Ridryder911 (Jul 11, 2009)

I never discourage anyone to be politically active, in fact most here know I am one of the few that actually hits the legislatures and State Senators every year. Enough, most of my representatives know my name and definitely are aware of my agenda... I also know that unless you have a representation of at least 30-40% of your workforce legislatures and other politicians will generally ignore your pleas. Letters and faxes are great, but truthfully are usually ignored as they get flooded with them daily. 

We have been working hard at all levels for a change within EMS. Yes, Atropine is correct in one aspect that Fire Service has definitely made some compensation. Unfortunately, many fire services have "hood winked" and sucked monies into grants and programs using the "what if" unrealistically. The reason such pay can be given is because programs can be funded & operated where purchases and revenue used to be spent on salaries; but alas all good things will have to come to an end. As many are now recognizing that "Hero" syndrome is a myth and when the general public is unemployed tax revenue dies. When tax revenue dies, cuts and furloughs are made. The general public will feel if a firefighter makes a ton of cash, then they are over paid. 

One thing fire service does have is a strong PAC and they do use the "bleeding heart" theory, something we could learn off them. Unfortunate that they do not have to justify their failures. I do agree the majority of EMT's are definitely lazy within the profession. They whine and moan about the pay but to take action is a whole different story. Even nursing has a strong PAC and organization that makes a difference, at least their main focus is on patient care, patient safety and protecting those within their profession. 

How many here are even involved with Advocates for EMS (http://www.advocatesforems.org/ )or even involved in NAEMT, State EMS Associations? All have representatives fighting for "our" piece of the pie. Again, as I have said before if you are not part of the solution, then you are part of the problem.

R/r 911


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## Melclin (Jul 11, 2009)

Something I will never understand about Americans is their aversion to reasonable social justice and equity of health care. Anytime the idea of socialized medicine, higher taxes, welfare or state run organisations comes up, out come the naysayers. "It can't work", "It will destroy the economy", "it will break down capitolism", "we won't be able to chose our doctors", "why should I pay for everyone else", "I already pay to much tax", wah wah wah. (Don't anybody get on my back about racism, I'm not being racist, I'm critiquing American society).

All of this completely ignoring the fact that IN EVERY OTHER DEVELOPED COUNTRY IN THE WORLD, IT DOES WORK, IT HAS WORKED FOR A LONG TIME, AND EVERYONE CLEARLY BENEFITS FROM THE OBVIOUSLY BETTER SYSTEM.

This may seem off topic, but I don't think it is. The problems you have with EMS seem endemic in many other areas of American society and I feel that it has something to do with a fundamentally selfish, ignorant and mindlessly competitive ethos. 

An example of how a civilized system works:

- I went to a satisfactory state school, received a good education for free, went to a catholic private school (We were by no means wealthy, but catholic private schools are not beyond the means of alot of people because *most people live in a comfortable middle class)*. I suffered a number of health conditions, for which the FREE public system was able to treat me for (and in two cases save my life), that we would not have been able to afford otherwise. The same is true of most of my family at one point or another. 

-I never worried much about stabbings, gun violence, gangs etc, because relative to America, it doesn't exist - poverty is not so wide spread or serious that people _need_ to adopt that way of life, and guns ownership is strictly controlled (the government and the King of England has yet to take advantage of it and crush my human rights).

-I attended the the university of my choice through academic achievement, not through money, decided against my BSci degree and dropped out. It didn't cripple me financially, because the government pays for the education (then you pay them back, with no interest, when you can).  I finally decided I would go for my original first choice: A Paramedic Bachelors Degree (FYI- there is no other form of Paramedic education now available, and we don't have EMTs). *It's a highly competitive course to get into, taught at the fourth best university in Australia. There were approx 700 applicants and 80 places, I got in because I did well academically at school and I wrote a good essay on why I will make a good medic, not because I watched ER and wrote a cheque. *

-When I graduate, I will be paid around $10,000 a year above the average wage (not the minimum wage) and that will raise significantly more after I finish my internship. WHY? *Because the role that EMS fulfills in our society is respected and acknowledged by everyone as being a self evidently important third service (as it is in Britain, France, Germany etc).* I will work for a state wide, state run service, get paid more than any equivalent American could ever hope too (as do most Australians, in similarly important but non-commercial roles), even after the +30% of my wage goes to taxes. I will enjoy the benefits of those taxes: free health care, good public education, excellent professional Police, Fire and EMS departments, welfare for the poor and disadvantaged, all of which I'm happy and proud to contribute too because contributing to the community makes _mine_ and everyone else's lives better. 


It is the same in every other developed nation.* We are happy to contribute to the common wealth of society because we are part of that society and improving it makes our own lives better*. It's not communism, its just how an enlightened, well educated, wealthy country improves the lives of it citizens.  

When you talk about the resistance you face to professionalism in EMS, to the rampant commercialism at the expense of safety, the lack of important regulation of education and accreditation, the million private providers, which as I said could be a description of many American fields, not just EMS, it makes me think that it is indicative of a deeper underlying problem in your society. It's not to say that it never happens here, but here, and in other developed nations, it faces widespread disapproval as being a self evidently bad thing and for the most part, is even legislated against. In America, its seems to be an accepted norm, if not encouraged as a shinning example of pure capitalism.

I have no idea how you could fix your problems, of if it's even possible, but I admire people like Rid and Vent who are trying.


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## Shishkabob (Jul 11, 2009)

Melcin, quite a few things you and other people that critique America tend to ignore;

Australia has a population of 28,000,000.  
America?  300,000,000+. 

You have less than 10% of our population.  Don't you think that would make it slightly easier to pay for everyones healthcare?  

I don't know if you trust Wikipedia.  I tend not to, but they put everything in one little area, so I'll quote it.



			
				Wiki said:
			
		

> U.S. cancer survival rates are the highest in the world.
> 
> *The U.S. health care system far outspends any other nation's, measured in both per capita spending and percentage of GDP.*
> 
> In 2004, the nonindustrial sector spent three times as much as Europe per capita on biomedical research.



Sorry, but capitalism drives innovation, there is no argument to that.  America is at the forefront of most medical innovations in the past, present, and foreseeable future. 








> Something I will never understand about Americans is their aversion to reasonable social justice and equity of health care. Anytime the idea of socialized medicine, higher taxes, welfare or state run organisations comes up, out come the naysayers.



You're mistaking hating an idea for having no compassion. 

Americans who hate helping people are few and far between.  I hope you realize that America contributes more to humanitarian efforts around the world then ANY OTHER COUNTRY.  So don't call us selfish.  You're dead wrong.


What most Americans DO believe is that you should earn your help, not expect it for nothing.  I'm not against helping those who need it.  I, along with many others, am against helping those who expect it for nothing in return and make no effort to better themselves.


If I work my butt of to make some money, why should 20% of MY WORK AND MY TIME go to help some person in the ghetto who sits on their porch all day not contributing or even attempting to contribute?  Sound extreme?  It's not, because it happens.  Take a drive in inner city LA, Detroit or Dallas and look.





> and guns ownership is strictly controlled (the government and the King of England has yet to take advantage of it and crush my human rights



Sorry this comment just irked me becuase you're being ignorant to history.  The 2nd Amendment (From the Constitution, our founding document)  gives us the right because we WERE being oppressed by the King of England at the time. And as for the gov't part, I guess you never heard about the "Articles of Confederation" before the Constitution, or the American Civil War?


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## Maya (Jul 11, 2009)

Ridryder, thank you for the information.  I'll definitely be getting involved!  I'll do my best to tell other EMTs about it too, because I really had no idea, myself, that these issues even existed until recently.  I think it's fantastic that you're involved in advocating for EMS issues.  That sets you apart as one of a very select few.


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## Melclin (Jul 11, 2009)

Linuss said:


> You have less than 10% of our population.



And almost exactly 10 times the annual budget. So no, I think you could pay for everyone's health care. As I was going to point out untill I read more of your post and saw that you already had, you already spend more per capita than any other developed nation, yet you have the worst health care. If u can stop a problem before it happens, with easy access to health services before people get sick, it costs less. It's a commonly accepted fact by all health health academics and experts everywhere else in the world. 

Yes I know capitalism drives innovation. I'm not at all against it. But, its a cruel beast and needs to be tempered from time to time. The odd bit of government regulation here, a charity there.  

On the cancer survival rates, I cannot comment on without some extensive research that I can't be bothered doing. But I suspect there are some qualifying factors to the blanket state, like, "higher survival rates _out of the people that can get treatment_". 

On the topic of welfare, you're quite right, earning your keep if you can is perfectly reasonable. I disagree with some of the recent welfare policies here, as I feel it aims to much money at young people who are perfectly capable of working, and not enough at the people who can't help themselves (disabled, pentioners), which is the point of welfare. 

On the topic of what America gives to the world monetarily, mostly it does not give the most in absolute terms. More importantly, in relative terms, as a percentage of American GDP you rank 22nd in the world behind a host of developed nations, and most of what you do give goes to the middle east..I wonder why. If you were referring to common charity, internally, then perhaps you're right. I couldn't say. 

As far as those ghettos you refer to ... thats kind of my point. Do you think its a coincidence that countries with excellent social justice and welfare programs don't have the problems you just mentioned? As you just said in America, nobody "wants to give their hard earned cash to some welfare cheat". Point proven really. Locked in a cycle of thinking the poor should just work their way out of poverty. It's probably not possible, and if it is, its definitely not probable. By that I mean, should they work harder? Probably. But ignoring the problem until everyone magics a better work ethic or leaving them to wallow in poverty certainly will not help - cycle of poverty (inextricably linked to the cycle of crime and drugs which become everyone else's problem). Regardless of ideology, regardless of what those nasty poor people _deserve_, you would probably find that those problems you mentioned would clear up after a few generations with similar programs as the rest of the developed world.


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## Ridryder911 (Jul 11, 2009)

Maya said:


> Ridryder, thank you for the information.  I'll definitely be getting involved!  I'll do my best to tell other EMTs about it too, because I really had no idea, myself, that these issues even existed until recently.  I think it's fantastic that you're involved in advocating for EMS issues.  That sets you apart as one of a very select few.



No problem, I am conservative in nature but realize there is not really such as thing as a Democrat or even Republican. All politicians are crooked until proven otherwise. Obama would had traded sides immediately if the deal was great enough as well as Republican leaders. One thing in common, they are all in for it for themselves. 

I have attended the formal dinners and balls. I've seen the smoochin on both sides of the lobbyist and the politicians. It's totally disgusting to think the common person is fooled and actually pays for their amusement. Meanwhile, rural areas have no EMS, middle class cannot afford cancer treatments and the elderly get to choose either food or medicine. Just think if  both  parties, placed the monies spent on one day of campaigning how much funding that would go to. 

EMS is too meek and mild when it comes to standing up for themselves. Unfortunately, everyone else is informing them that EMS is really a part of them... thus dilution occurs. 
If there is funding it is shifted into special projects such as for WMD for rural USA or similar idiotic projects to feed bureaucrats. 

I don't how many Fire Service grants I have seen wasted money. Fortunately, they were able to shift their budgets and purchase routine equipment with grants and hire more FTE. Even though, the rest of the business world would have to reduce if production was down. EMS received very little grant monies. Meanwhile granny that has an AMI cannot receive ALS and maybe not even BLS. 

How much professional development does student's get? We instituted in two programs that I consult at "A day at the Capital". All EMT students are required to go to the Capital and meet their representative. They have the option to discuss EMS and health care bills or not, but they have to meet them. Definitely, an eye opener on both parts. EMS bills as well are now being noticed more and especially after our little fiasco with the trooper; no legislature does not know about EMS and Paramedics.

Again, for those not involved then don't complain. You are worse than those than those are against funding EMS. At least they take a stand. 

R/r 911


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## Ridryder911 (Jul 11, 2009)

Melclin said:


> And almost exactly 10 times the annual budget. So no, I think you could pay for everyone's health care. As I was going to point out untill I read more of your post and saw that you already had, you already spend more per capita than any other developed nation, yet you have the worst health care. If u can stop a problem before it happens, with easy access to health services before people get sick, it costs less. It's a commonly accepted fact by all health health academics and experts everywhere else in the world.
> 
> Yes I know capitalism drives innovation. I'm not at all against it. But, its a cruel beast and needs to be tempered from time to time. The odd bit of government regulation here, a charity there.
> 
> ...



What you and others fail to recognize is the laziness. Sorry, but I have known medics return back to medicaid and welfare because it was easier and they received almost $20,000 worth of benefits my FTE did not receive. 

Yes, you can work yourself out of poverty. It has demonstrated numerous times, but again.. "Why?". Part of the problem of the bleeding heart liberalism methodology is that we have made many socially retarded. That it is much easier not to be productive. Why would anyone not want disability, food stamp type programs, free medical/dental and not only tuition but to get paid while attending school? 

I am all for helping those that need it. Especially the ill and the elderly but that it is not what has happened. It has stopped being a hand up and now is a hand out. 

I have students that attend EMT classes because they recieve funding not only for the tution but get paid being there. As of yet, out of the 70 or so; have ever have one take the final or get a job within EMS. Why should they? They just go to another program and do it again.... They don't even have to pass the tests. 

ER's are full here because it has became a clinic. It is not that they don't have primary care physicians it is because they don't want to have to wait or schedule to be seen. 
This type of abuse takes funding away from those that desperately need it. Families with members that have seriously ill or chronic diseases. 

I am now all in favor for Socialized medicine. I am ready for the rest of the world to start paying for the research and development of medicines and procedures. As well, let them make up the profit margin to pharmaceutical corporations. 

I can assure you when other countries have to pay an increase of 10-15% more for medications and medical devices, they will have wished we would have stayed our same capitalistic selves. The let's stop all foreign aid. Truthfully, we could fund all citizens with health care on what we spend on other countries, and while we are at it... collect on what other countries owes us. France and Japan could not afford what they owe us from rebuilding from WWII.

There is one common denominator .. there is no easy answer. One person will never change it alone and doubtful I or my children will ever see the change.

R/r 911


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## Melclin (Jul 11, 2009)

How much money do you think you give to other countries? Withdrawing you foreign aid wouldn't be enough to foot our health bill let alone yours. 

Ideological rubbish aside, the government already spends enough on health to provide similar systems as are in place in other countries. If that money way redirected in subtle ways, you probably could sustain a socialised healthcare system without to much trouble. Americas current financial woes not withstanding. 

Yes I know people are selfish. That's my point about expecting the problem to fix itself. You can't sit there and say well they can just stay in poverty and if they'd just work harder it will all be better, because their poverty becomes your problem (crime, ER, police, jails costing money). Like I said that might be true but its not ganna happen. Injecting money into fixing the problem will ultimately save money once the problems are fixed and improve society for everyone. 

I might add that when I say welfare, I don't mean free money. We have a program here called _work for the doll_ where people work for the government/community (cleaning public places, planting tree etc, similar to the idea of community service), while they receive counseling on employment issues and must show a number of genuine attempts at seeking employment every week to receive their welfare. It's not perfect, but just because the government tried food stamps and cheques and it doesn't work, doesn't mean the idea of government social support systems is a write off. There are other ways of doing things. 

I don't quite understand your point about the extra cost involved with socialised medicine. I suppose you are suggesting that if America had government funded health care they would be paying pharm companies less and other countries would have to pick up the tab? *Why? They still get the money. Johnny still pays $250 a pill for Megasupersol, but the government helps johnny pay it. Big pharma gets their money anyway*. We went through all this in 'health systems' last year. In fact pharm companies actually have to be more competitive in places with socialised systems because it acts as a consumer advocacy group. The government picks up the bill so the government watches the pharma companies more carefully for unethical and unfair practice. The competition still happens, only the companies have some regulations by which to play and so instead of making money unfairly they are left with producing a good product to satisfy demand - capitalism. Capitalism is a great game, but people aren't going to play fair, unless there is a rule book and an umpire.

In any reply on the topic of things like free tuition, free health care, including your's Rid, the fact that it works in every other country, and works quite well, is never addressed. You say things like "it wouldn't work" or "people would just take advantage and the whole thing would fall in a heap". Sometimes it needs to be approached creatively and somethings don't work the first time around, some things need to be adjusted or reevaluated, _but it does work_. There are many many examples all over the world of it working. Why is this never a factor in American justifications for being anti social justice/welfare/socialhealth/state run services.


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## PapaBear434 (Jul 11, 2009)

I have many arguments for Universal Health Care.  But I'll leave this main one:

Two months worth of tax money we were spending in Iraq could pay for the health care of every person in this country for a year.  Why aren't we?

People like to cite other countries wasting tax money and spending so much more in taxes.  They don't pay THAT much more than us.  They just choose to "waste" their money on health care for all of their people, while we choose to "waste" it blowing up brown people in a sand box because they had the misfortune of being born with oil under them.


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## Shishkabob (Jul 11, 2009)

Better things to spend the money on than healthcare that would actually have a positive effect on the country in the future...

Education.



I'd much rather have smart people that pay for their own healthcare than idiots that demand that it gets provided to them when they are of no contribution to the country.


Harsh?  You bet ya!  But true.  

When you can answer this question, you will have changed my mind:

Why punish those who can help, and reward those who choose not to better themselves?


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## Melclin (Jul 11, 2009)

Linuss said:


> This country was founded off of hard work--- why change that?  Why punish those that contribute, and reward those that do not?  When you can answer that question in a logical manner, then you will have changed my mind.



Exactly the kind of attitude I was talking about in my original post, and shows a clear lack of understanding of complexity of the issues at hand. In any other developed nation in the world this sort of thinking is considered laughably ignorant by the majority of people let alone people involved in health care. However, you make an excellent point about education. I agree that it is more important to publicly fund that (but its easy to do both). If the world run by Melcin was having financial difficulties, which it undoubtedly would be if I were running it, education would be the last thing to lose funding.

I'll say it again: It's not doing away with hard work, its not going to tear apart the fabic of society, its not replacing capitalism with communism, its simply a matter of reallocating money that is being poorly spent and putting into a system that is fairer, more efficient and that provides much better care for everyone. The wealthy can still get better care, it just provides a baseline level of care. Just like public vs private schools. A socialized system does not necessarily exclude a private system, they co-exist, just as with education.

If I can't afford a medication, or a procedure that I need that month because I'm trying to get my business off the ground, or I'm studying at university, or my insurance doesn't cover it for some reason, that does not mean I am not contributing. *You cannot possibly think that society is drawn perfectly down the line of those that do contribute and those that don't, where all the 'DOs' have enough money for health, and all the 'DON'Ts' are too poor to afford health care. *This seems to be a common idea in America, you believe in a meritocracy (and why shouldn't you, that's fair enough) but many of you seem to think that money automatically follows merit. It does not and as poorly paid EMTs and Paramedics, you of all people should know that isn't true. Besides, even quite wealthy people who contribute significantly can be completely financially crippled by, say, a chronically ill elderly parent.

*More Importantly*: As I have said before, aside from the ideology of whether or not you think people _deserve_ it, comparatively, societies work better with it than without it.

There are many fantastically logical and very important arguments out there, articulated far better than any of us are capable of, for your consumption if you choose to look for them, and look for them with a mind to appreciate them rationally, not to prove how wrong and liberal they are. *Of the people that properly understand all the issues involved in health systems, the vast majority of them around the world agree with some form socialized health model.* Putting some trust in those experts instead of our own half baked ideas that we got from google and our own limited experience, would be wise. Some of these arguments I've made are those of my professor that took me for 'Health Systems' last year.


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## Shishkabob (Jul 11, 2009)

I don't know how much of Obamas plan gets siphoned overseas, but obviously not enough.  As of the current plan that's in Congress right now, employers, and not just big corporations but small mom and pop shops too, would be fined for not offering health insurance to their employees.

It would also fine the individual for opting to not have insurance.  They are making it a CRIME to choose not do cover yourself!  That's absurd!    Many people, mainly in the early 20's, opt to not have insurance even though they can afford it, because they are healthy.  Screw them, right?



Shelter is a necessity, yet I don't see any plans or people demanding we provide houses to all people free of cost and to take it out of our paychecks.

Water is a necessity, yet I don't see any laws being passed to allow any and everyone to get free water when they demand it.

Food is a necessity, yet I see no laws pertaining to giving it to any and all people.



What makes healthcare a right?  What makes healthcare more important then shelter, food, and water?


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## Maya (Jul 11, 2009)

I can only tell you about what it was like when I was living in a building in LA run by a Slumlord.  It opened my eyes to what it actually feels like to have to live in poverty.  I don't mean it to sound like a whiny 'poor-me' type of story.  It's just that I had not been aware of the reality of what it's like to live in this type of situation until I was in it.

44-unit building.  The building was pretty dirty, not a great part of town, but I'm not a snob.  The apartment itself looked like it was fixed-up to a somewhat liveable standard.  The neighbors are nice.  The lady in the apartment below me doesn't speak English, but she sells homemade pupusas and tamales out of her apartment, so I stop by after work sometimes.  There's a taco truck that comes by outside everyday and lots of people from the building go outside, chat, and eat tacos.  My Spanish isn't great, so they're nice to me, but sometimes it's difficult to communicate.

Couple weeks go by and I'm seeing a lot of bugs in the apartment.  A couple months pass and my apartment is now completely infested with cockroaches.  They're living in the microwave and toaster, underneath the fridge, dropping from the ceiling out of the light fixtures.  And I start getting these bites, but I don't know where they're coming from, because I don't think that cockroaches bite.  The bites turn into these really itchy and painful welts an inch across in diameter.  I'm fighting with the landlord at this point and he does nothing.  Has a guy come by with a bug bomb.  I have to clean my apartment whenever he comes by and put EVERYTHING I own in bags, so that it's not contaminated by chemicals.  This happens about six or seven times, is completely exhausting, and does NOTHING.  He refuses to pay for a real exterminator.  I turn into a cleaning maniac.  Clean out the radiator and get sick for two weeks, not realizing that there was probably asbestos in the ducts.  I soon find out from one of the neighbors that the welts I have are from bedbugs, which the building is infested with -- they are nearly impossible to get rid of.  Find out that the building is also infested with mice and termites.  At this point, I feel like I am starting to go slightly crazy.  I am not talking to or visiting my friends and won't let them come over to my place, because I don't want them to pick-up the bedbugs and infest their homes.  I have no friends and no one to talk to and I'm starting to get depressed.

I go to sleep at night hearing the baby next door crying, every night.  I later find out that it's because the baby is also covered with 20-30 of these large, painful, and itchy bedbug bites all over it's body and the baby has respiratory and other health problems.  His parents are fighting, sometimes throwing things and the cops are called a few times for domestic dispute.  I later find out that the dad is a drug-addict.  He's a little crazy, stole knives from one of my neighbors, and a few months later jumped out of my neighbor's window (4th floor) when he was high, and somehow miraculously survived.

The neighbor on the 4th floor I made friends with, a gay guy, I later find out is a male prostitute.  I also have people propositioning me for sex, trying to get me into high-class prostitution elsewhere in LA (that's LA), and while I would never do this, it starts to occur to me that I have no money and am quickly going into debt.  Despite the fact that I would never do this, I start to wonder, 'at what point do you really become that desperate, that you could actually justify it?  How much more has to go wrong for me to become that desperate?'  I've always been an optimist, but despite my optimism, I have to admit, that things have only gotten worse for me and could continue to get worse.

The guy on the fourth floor was my best friend in the building and was the one person who fought the landlord with me, more than anyone else.  We called the Health Department many, many times.  When the landlord started harassing people and threatening to evict people who had been living there for 12+ years, we went to court as witnesses to try to fight him.

The people he was trying to evict were paying low rent, $400-500, because they had been there so long.  It used to be a much worse neighborhood, so he kept the rent low and let the building fall into disrepair.  Most of these tenants did not speak English and were illegal.  When they get evicted, they are forced to pay double to triple the rent, while still working for less than minimum wage.  Now that the neighborhood was becoming more trendy, the landlord would find any reason whatsoever to evict tenants and raise the rent to $800-1200/ mo.

I start hearing stories about what had happened to other tenants in the building and I can hardly even believe some of these stories.  I hear a story about woman on the fourth floor who had been living there for 35 years, with another lady friend.  The two ladies were in their eighties, and the lady friend is now dead, but I am told that when she was alive, she had arthritis and had trouble walking down the stairs (elevator was broken every day).  There are no railings on the stairs and she is afraid to walk down the stairs, so it takes her an hour each time she walks up or down the stairs.  The landlord REFUSES to pay to put railings on the stairs (violation of building codes), and she falls down the stairs, breaking her hip and suffering other injuries.  The two ladies pay $600 out of pocket to have a railing put in.  She dies soon after that.  I finally meet the lady who lives on the fourth floor and visit her apartment.  The ceiling and walls are falling in in certain places and one of the windows is about to fall out of its frame.

A ten year old girl comes to my door one night and she's crying.  She knows that me and the guy on the fourth floor are the one's who fight the landlord and she thinks that I can help her.  I, somewhat naively, believe that I can, because at this point I still believe in the justice system.  Her mom doesn't speak English, works two jobs and still has no money.  The landlord is trying to evict them.  They have no money to move.   She shows me pictures of how the ceiling fell in when she was eight.  The landlord wouldn't fix it for SIX MONTHS and she got sick from the dust, mold, and particles.  They've gone through six mattresses and three sofas, because they have to keep throwing them out when they're infested with bedbugs and the landlord refuses to reimburse them.

We go to court to fight the landlord, but he brings five guys along with him and they LIE in court, despite our testimonies and evidence against him.  He provides a FAKE lease agreement, with a FRAUDULENT social security number for the mother.  We have a second date to go back to court.

The landlord is now serving eviction notices to the guy on the 4th floor and several other people.  He is harassing people.  I go to a lawyer, and he tells me that it's almost impossible to win a case against a slumlord -- "throw a rock out of the window and you can hit any one of another 100 buildings just like it."  He does tell me that you can fight the evictions, however.  I try to get people together to form a tenant's association.  It's difficult though, because I don't speak Spanish, and many of the people are afraid of getting reported to immigration, or getting harassed by the landlord and being served an eviction notice themselves.  The landlord is, at this point, going into my apartment and my neighbor's apartment when we're not home and several times actually STOLE the evidence we had against him to take to court!  A few times, they let themselves in when I was there, thinking that I wasn't, which was disturbing enough in itself.

The young girl, her mother and her sister, moved out before the eviction proceedings had finished.  They didn't want to deal with the harassment anymore, although they would've won the case.  The guy on the 4th floor moved out and is STILL, 1 1/2 years later, being harassed by the landlord and is still going through court proceedings.  I was broke and gave up.  I knew that we couldn't do anything if all of the tenant's weren't willing to get involved.  (He owned 7 other buildings that I knew of, but when I went to the records department of the court house, I found in the least 20 properties under various names -- a tactic that slumlords often use, so they are not discovered by the authorities.  I stopped looking, there could have been more).

I left the building.  I lost EVERYTHING I had, because everything was infested and I didn't want to bring the bugs with me.  I was extremely depressed and had nightmares for a year-and-a-half.  Felt responsible for the girl and her family getting evicted.  I really thought that I could help her.

Don't get me wrong, I don't feel in the least bit sorry for myself.  I don't want to sound whiny.  I am the lucky one, because I had the OPTION to move out.  I have the education to move on and to recover from that experience.  Most people do not have those options, and they have no one to advocate for them, because the majority of people don't care.  I'm sure most people who even read this will find it wearisome and boring.

There are people who take advantage of the system, which is terrible.  But for each one who does, there are many more who desperately need help to survive.  Nobody would ever CHOOSE to live in poverty.  It's an entirely different world that most of us could never understand.  Even if you work in that environment, you can probably go home and sleep comfortably in your house in the suburbs.  It's nothing like going to sleep hearing gunshots, living in filth, and wondering if you'll be able to feed or clothe your kids next month.

Okay, sorry about the long rant.  I just don't like to accept that we can't do anything to change things.


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## Maya (Jul 11, 2009)

On the subject of the Healthcare System, I know what you're talking about repeat visits to the ER.  There's an article here for people who don't know:
http://www.nj.com/news/index.ssf/2008/07/repeat_super_users_are_swampin.html

Maybe the solution would be to redirect these repeat users to Medical Facilities equipped to deal with them.

Another aspect of technology that may revolutionize EMS and the Healthcare System, although it will be costly, may the implementation of better computer systems, allowing remote access and sharing of files and medical histories.  It would allow for better patient care.  Just imagine if you showed up on-scene and had all of the past pertinent medical history of your patient on file.  Not to mention, if you had information about the address in question, to know if there has been a long history of violent domestic disputes -- you would already know right away to call for back-up and to be on guard.  Imagine how much more efficiently and safely we could operate and how much we could improve the treatment that we provide.  I know it will take a lot of money and time to implement, but it looks like they are just starting now to use this technology.

I know I'm an Idealist, so be patient with me!


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## PapaBear434 (Jul 11, 2009)

Linuss said:


> Harsh?  You bet ya!  But true.
> 
> When you can answer this question, you will have changed my mind:
> 
> Why punish those who can help, and reward those who choose not to better themselves?



Ok, true.  But what about the kids that were stupid enough to be born to folks in the lower classes of society?  What if they get sick?  What if, even after all their hard work in getting scholarships, they need to quit college to work so they can help their poor cancer ridden mother with no insurance?  

What about the folks that HAVE health insurance, but have a chronic illness like diabetes or COPD?  Their insurance usually goes up every year, often to the point where they have to choose between food and house and the medication that keeps them alive.  They can't shop around for insurance, because the insurance companies won't cover preexisting conditions without demanding a blood sacrifice.  

This "screw them, they didn't work hard enough" attitude is driving me nuts.  Yes, some lazy jerks will get covered.  But there are lots folks out there that don't make enough to get insurance, but too much to qualify for government programs.  There are a lot of folks that THINK they're covered, until a major illness comes along in their family that convinces their insurance that they are too costly and they try to price them out of their service.  

Our health should not be up for sale by mega-corporations.  Yeah, there will be government bureaucrats involved.  At least that bureaucrat isn't worried about making a profit, as opposed to the thousands of privately employed bureaucrats that currently infest insurance companies and HMO's, who's only job is to try to find a way NOT to pay out.

We're America.  We are supposed to help out the tired, poor, and huddled masses.  How does that NOT include helping them when they are most vulnerable, when they are sick and hurt?  How do we pride ourselves on being so compassionate, caring, and plentiful when we can't even provide basic health care for 50 million of our own citizens?  Especially considering that every other industrialized nation in the world has figured out how to make it work and has overwhelmingly positive ratings from it's people?

We aren't nearly as compassionate as we think we are.  We are much more concerned with our selfish endeavors.  People don't vote for what's good for the country, or other people.  They vote for what's best for #1.  We are advocating a perverse form of non-religious Calvinism.  A social Darwinism of sorts.  The people with money will survive, the rest should die because they're dead weight.


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## Shishkabob (Jul 11, 2009)

PapaBear434 said:


> Ok, true.  But what about the kids that were stupid enough to be born to folks in the lower classes of society?  What if they get sick?  What if, even after all their hard work in getting scholarships, they need to quit college to work so they can help their poor cancer ridden mother with no insurance?



They are working, so they are contributing to society, are they not?  They are attempting to better themselves, no?   You missed the mark completely in my argument.  



> What about the folks that HAVE health insurance, but have a chronic illness like diabetes or COPD?  Their insurance usually goes up every year,



One of those tricky areas.  They cost more to treat, which means the insurance company will have to spend more on them.  Someone has to get screwed with cost... the person with the illness, or the rest of us healthy ones that have to pay higher premiums.  Someone, somewhere, has to make up for the money that is spent.





> But there are lots folks out there that don't make enough to get insurance, but too much to qualify for government programs.


  My sister and her husband are going through this right now.  Both middle twenties, he with a Bach degree, she close to having one.  Both white, raised in middle class families, her upper, he lower.  Both have jobs.  Both work 40 minimum at said job.

They just had a baby, not eligible for gov't assistance, but can't afford insurance. 

The baby was jaundice, and my sister and the baby had to spend extra time in the hospital because of such.



STILL doesn't change my view on the matter, nor theirs.  We are all in agreement that it's not the governments job, right, or responsibility to give everyone health care.  




> Our health should not be up for sale by mega-corporations.  Yeah, there will be government bureaucrats involved.


  Companies find ways to save money to make a profit, while still offering a service that people will pay for, and keep paying for.

The government is losing money in the Postal Service.

I choose the former. 

Plus, what happens when you force said insurance companies out of business?  To think no one will lose their jobs from this is foolish.  Thanks for adding to the recession.




> How do we pride ourselves on being so compassionate, caring, and plentiful when we can't even provide basic health care for 50 million of our own citizens?


   I'm tired of this statisic.  It has no factual basis and is false.  It's just a statistic.

How many of that "50 million" CHOOSE not to be covered?  He's a hint, it's a helluva lot more then you would believe, or the pro-NHC group is willing to admit.





*I ask you again, why the push for free healthcare?  Why not the push for free food, water and/or shelter?  Those are the necessities for life.*


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## Melclin (Jul 11, 2009)

Good article Maya, interesting and good example of how problems that could be fixed or managed with good social support and universal health care, end up actually costing more in long run. Diabetes, Hypertension, Cancer, heart failure - the problems that are swamping ERs, could easily be managed with good primary care, if it was easily available, cheap enough to regularly visit and the medications for all those conditions were affordable enough (through government subsidy). *In the long run its cheaper that your current system and has the added benefit of providing everyone with good health care.* On a side note, a lot of those problems like drug abuse, homelessness and violence that put pressure on the health system can be tempered with good social support systems. It also mentioned someone wasting their social security cheque - welfare doesn't have to be and shouldn't be free money. 

I've been a googling and I have this to show for it. 

As it turns out in 2005, on average American's actually paid slightly more income tax that Australians - this is what I mean, its about the redirection of money already being spent, you really don't actually have to tax much more, if at all, than you do now.

In the same year, the US government was responsible for 45.1% of health spending, while the Australia government covered 67.5% - its not that different yet we haven't got EDs being completely swamped by people 

15% percent of US GDP was spent on health, while Australia spends 8.7%. It has been predicted that with the current US system, that will grow to 20% in ten years.


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## Shishkabob (Jul 11, 2009)

Melclin said:


> welfare doesn't have to be and shouldn't be free money.



But that's what it has turned out to be for many people. 

This needs to be corrected, and until it is, I will forever be against any form of social welfare.  It's there to help the needy, not promote the lazy.


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## Melclin (Jul 11, 2009)

Linuss said:


> *I ask you again, why the push for free healthcare?  Why not the push for free food, water and/or shelter?  Those are the necessities for life.*



Subsidising healthy food is probably not a bad idea. This would fall under the banner of public health. 

Rights, responsibilities and entitlements aside, if your sister lived in Canada or Australia, she would live exactly the same life with the exception of fact that her child's health woes would not be an issue. This would be same for millions of Americans. How would it be punishing those that contribute to take some of the tax money they already pay and put it towards helping people like your sister?


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## Melclin (Jul 11, 2009)

Linuss said:


> This needs to be corrected, and until it is, I will forever be against any form of social welfare.  It's there to help the needy, not promote the lazy.



Couldn't agree more. So what you should really be doing is speaking out against the way welfare is administered, trying to fix a system that could (and does in other countries) work, not speaking out against the basic idea of social support.

EDIT: "thats the way it has turned out for many people" - that's the fault of the way it is applied, not the basic idea of welfare. Germany elected Hitler democratically...doesn't make democracy a bad thing.


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## Shishkabob (Jul 11, 2009)

Hold on here, we're not talking about subsidizing.  We're talking about making it free for all.  No qualifiers.  Free food, house, and water for everyone, for life.


Let's say you were a bullied as a kid.  If a teacher caught the bully in the act and told the kid to say sorry, would that forced sorry make you feel any better?  Or would a sorry from him that was true and sincere feel better?


Charity should be a choice, not a legal and forced requirement. 



PS-- You obviously don't know enough about Canada to think they are equal


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## Shishkabob (Jul 11, 2009)

Melclin said:


> Couldn't agree more. So what you should really be doing is speaking out against the way welfare is administered, trying to fix a system that could (and does in other countries) work, not speaking out against the basic idea of social support.



And here's where we keep dropping off with eachother.  I'm not against helping people.

I'm against stupid ideas of helping people.





Fining and employer for not offering insurance, even if that move would put the business out of, well-- business, is stupid.

Fining people for choosing not to have insurance is stupid.

The way the government manages that vast majority of things it does, is stupid.


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## Melclin (Jul 11, 2009)

Linuss said:


> Hold on here, we're not talking about subsidizing.  We're talking about making it free for all.  No qualifiers.  Free food, house, and water for everyone, for life.
> 
> 
> Let's say you were a bullied as a kid.  If a teacher caught the bully in the act and told the kid to say sorry, would that forced sorry make you feel any better?  Or would a sorry from him that was true and sincere feel better?
> ...



Well in a sense all of those things are free, if you need them (food stamps, government housing, rent assist programs). But providing people with any house they want for free, is not equivalent to basic universal health care. Basic universal health care is equivalent to the food stamps and the housing commission flats. *It looks after your basic health needs that you require to get through life. No bells and whistles, just the basics. If you want more, you pay, just like the house and the food.  *

Health funding is not the same as an apology, I take your point about the questionable ethics of forced charity, but its not the same. Money is money. If my taxes go towards a road, they build the same road whether or not I was sincere about wanting it built.

And I might add that you already pay for health in your taxes, its just that the money isn't spent well. If it was you could easily have a system like ours, while paying the same taxes you do now.  



Linuss said:


> Fining and employer for not offering insurance, even if that move would put the business out of, well-- business, is stupid.
> 
> Fining people for choosing not to have insurance is stupid.
> 
> The way the government manages that vast majority of things it does, is stupid.



Yes my point exactly, those things you mentioned are one of the many ridiculous aspects of your system. Your system is buggered.


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## Shishkabob (Jul 11, 2009)

Yes, I know taxes are taxes, but difference is the increase that will have to be done to fund such a thing.  There will be an increase in taxes, no doubt about it.



The reason I brought up food/house/water is becuase people claim that medicine is a right (which it's not), but keep forgetting the actual necessities.


Again, not talking about subsidizing.  Subsidizing is to make people like me feel like we're kind of getting it our way.  I'm talking about straight up free.  Free as in the Canadian healthcare where they pay for their citizens, non citizens, and illegals without a penny coming out of pockets.



Why can healthcare be free, but not food?  Why is healthcare more important?


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## Melclin (Jul 11, 2009)

Linuss said:


> Yes, I know taxes are taxes, but difference is the increase that will have to be done to fund such a thing.  There will be an increase in taxes, no doubt about it.
> 
> 
> 
> ...



Well we pay about the same taxes as you and manage alright. 

I wasn't talking about subsidizing either. Housing commision, food stamps, and rent assist, are effectively free food, water and housing. Healthcare here is not strictly free. It is subsidized, we pay for doctors visits, and medication and scans and so on. But the government subsidises it a very great deal more affordable. I'm not sure exactly how it works in Canada, but the point is universal health care comes in many shapes and sizes, not all of them prohibitively expensive.

*Which brings me to the reason why health care needs to be socialised: it costs more (that's why you have insurance for health but not for food or water)*. It costs more than housing and food and water. You can get by week to week, pay you rent, pay the utilities bill, work hard, but when all of a sudden you end up in an ED and Dr tells you that you need a 150,000 dollar operation or else you will never be able work again, or talk, or die or whatever. That you can't afford. Or maybe its the $750 a month for your diabetes medications, so maybe you don't take it much and end up getting carted to ED three times a month for all kinds of preventable problems. The point is the health is ridiculously expensive and still relatively essential. That's why it should be socialised.

EDIT: Yes I don't think medicine is a right either, but many of the things our governments provide us with are not rights. They are privileges. Privileges of living in wealthy countries. I don't believe I have a right to medication, but seeing as though it would be better if I had it, and a good system has been worked out where _we all contribute a little, so no one pays alot_ has been worked out, I'll argue for that.


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## Maya (Jul 11, 2009)

Even the CEOs of Insurance Companies have admitted that they don't think that the current system is sustainable.  I watched a documentary.  The CEO of the company said that she, herself, was not considered insurable by that company's standards, were she not already working there!  Basically, she can't leave that job.

I was denied private health insurance because of a cervical fusion in my spine.  I currently don't have health insurance.  I wish I did!

The thing about extending health insurance to ALL citizens, is that the cost would be much lower, so WHY would anyone NOT get insurance?!  Also, why would parents ever choose NOT to get insurance for their children?  It's just criminal -- unless they simply can't afford it.  Currently they can't afford it.  If healthcare were to be universalized, they just might be able to.  And if they CAN afford it -- all of a sudden -- it should be mandatory, for the children's sake.

By the way, if Health Insurance were universalized, it would be cheaper for EVERYONE than it is now.  So why is that a problem?  I WANT to be covered by health insurance.  It's not even a CHOICE for me!  Shouldn't that be illegal?!  Where are my rights?


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## Shishkabob (Jul 11, 2009)

[youtube]http://www.youtube.com/watch?v=c7d85T4OfqA[/youtube]


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## Maya (Jul 11, 2009)

Also, for those who say that implementing mandatory health insurance for all employees would put small businesses out of business -- I think you may be judging by TODAY'S very high cost of health insurance.

If insurance were made mandatory for everyone, costs would suddenly drop precipitously.  In the documentary that I watched, the CEO of the insurance company said that they would actually prefer to have it that way.  They still make money, because they have a much larger consumer group, even though they are dropping prices.  It works out for the employer, because costs are less and employees are healthier and happier.  It works out for the employees.  Everybody's happy.


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## Maya (Jul 11, 2009)

bwahahahahaha!  I don't know if I want to buy ANYTHING from an infomercial!

If I buy now, do I get a free Slap Chop?  ..oh wait, that was the ShamWow guy.


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## Sasha (Jul 11, 2009)

> By the way, if Health Insurance were universalized, it would be cheaper for EVERYONE than it is now. So why is that a problem? I WANT to be covered by health insurance. It's not even a CHOICE for me! Shouldn't that be illegal?! Where are my rights?



I don't think universal health care is the answer, but neither is the current health care system.

I don't have an answer for how it should be, (There are people much smarter than I to figure out that answer) but I do know the system desperately needs reform.


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## reaper (Jul 11, 2009)

I am all for it. Free health care for everyone.

First, we need to pull US troops back to our country and protect our borders only. No more helping other countries. They are on their own now. All that money saved right there, could fund insurance for every American for their lifetime.

Then wait 5 years for the rest of the world to tear itself apart, all the while wondering why America is not saving them!

We could take care of every American, if we stopped worrying about the rest of the world!


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## Sasha (Jul 11, 2009)

reaper said:


> I am all for it. Free health care for everyone.
> 
> First, we need to pull US troops back to our country and protect our borders only. No more helping other countries. They are on their own now. All that money saved right there, could fund insurance for every American for their lifetime.
> 
> ...




You, reaper, are a political genius.  Except for the fact when WE get attacked, we wont have any allys when it becomes self centered, and I do not believe America is the superpower it builds itself up to be.


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## reaper (Jul 11, 2009)

We do not have many Allies now! I am not worried about the rest, America can hold it's own against anyone.

Some just do not realize how much of our taxes are spent, defending the rest of the world!


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## Shishkabob (Jul 11, 2009)

reaper said:


> We do not have many Allies now! I am not worried about the rest, America can hold it's own against anyone.



I'll have to correct this.

As long as we're allied with the UK, we can hold our own against anyone.  We share much too much military tech. with England ^_^


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## Sasha (Jul 11, 2009)

reaper said:


> We do not have many Allies now! I am not worried about the rest, America can hold it's own against anyone.
> 
> Some just do not realize how much of our taxes are spent, defending the rest of the world!



I highly doubt that America can hold it's own against anyone. We do not have many allys, but the ones we have are very valuable! America is really good at promoting itself as the best when in fact it's not! 

I am ok with taxes being spent on foreign aid, not everyone is fortunate enough to live in the US. Perhaps I am just a bleeding heart!


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## Shishkabob (Jul 11, 2009)

Sasha said:


> America is really good at promoting itself as the best when in fact it's not!



How so????


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## Maya (Jul 11, 2009)

China's gonna own us soon enough.  As soon as they decide to stop lending us money, we're gonna be SOL.


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## reaper (Jul 11, 2009)

Nope, because we can just call in all the IOU's from every other country that owes us money!


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## Shishkabob (Jul 11, 2009)

Retracted..


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## Sasha (Jul 11, 2009)

reaper said:


> Nope, because we can just call in all the IOU's from every other country that owes us money!



But you cannot force them to comply!


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## reaper (Jul 11, 2009)

Dude,

 We did not win in Korea!


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## Shishkabob (Jul 11, 2009)

reaper said:


> Dude,
> 
> We did not win in Korea!



Did I say we did?  Nope.  

I said China had surprise and numbers, but we still kicked their butt.  


I'm sorry, but if >1million people charge at you, push you across a whole country, and you hold out the Pusan Perimeter and push them back a half a country with less people, that's a butt kicking.


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## reaper (Jul 11, 2009)

But, we would have lost, if it continued.

Now fighting on our own soil, would be different.


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## Shishkabob (Jul 11, 2009)

Naw, after the initial shock they were losing it, which is why the cease-fire was made.  If they thought they could have won, they would have kept going.  They knew they lost.  ^_^





I'm not even worried about our soil.  Good luck getting that amount of troops and technology across the Pacific, in any organized fashion, without us noticing.  Their years of sending millions of $1 toys across won't help them there.


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## Maya (Jul 11, 2009)

huh, I'm lost.  Are we talking about military?  I meant economically.  We are so much in debt and going further in debt.  If they decide to stop lending us money, we're gonna have problems nationwide like California is having right now.

Um, we've gone really far off-track  <_<


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## Shishkabob (Jul 11, 2009)

Every single 1st/2nd world country is in debt.  Nothing new.



If China ever called in the debt (which they won't) it would cause the US to call in ours, which would cause other countries to call in theirs, which would put the world in such economic turmoil it would make no sense to China.


As long as we keep buying their $.30 lead painted toys, they will be content.


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## Maya (Jul 11, 2009)

Hmmm, I like your logic.  I'm off to Saks to max out my CC. ttyl.


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## usafmedic45 (Jul 11, 2009)

> Um, we've gone really far off-track



I was about to say that myself.  I can't believe this thread has not been locked yet.


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## Chimpie (Jul 11, 2009)

usafmedic45 said:


> I was about to say that myself.  I can't believe this thread has not been locked yet.


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