# Why Obamacare is the Best Thing To Happen To EMS Since Johnny and Roy



## RocketMedic (Jun 4, 2013)

Motivated by insomnia, Paramedics on Facebook, and a sincere eagerness to professionalize.



> Why Obamacare Is the Best Thing to Happen to Emergency Medical Services Since Johnny and Roy
> 
> Obamacare (The Affordable Care Act of 2010) is one of the most controversial, hotly-contested and broken laws to ever stagger out of Washington, D.C. By most measures, it is a brutish, clumsy effort at a national mandate to insure every American by subsidizing private health care plans and applying a hefty dose of Stick Therapy to incentivize participation- but not so much as to be effective. In practice, Obamacare will likely not survive in its current form for a significant length of time without major changes, but that is expected by practically everyone. To put it in terms familiar to anyone from the Midwest (Obamacare's hottest resistance), Obamacare is that wet, humid feeling you wake up to on tornado-emergency days. The storm is ahead and will leave things changed to a degree we probably don't comprehend yet (even if we can make some guesses).
> 
> ...


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## ExpatMedic0 (Jun 4, 2013)

Great read. Can you site the source? A url or something? 
Ill reply to the post later when my homework is done lol


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## RocketMedic (Jun 4, 2013)

Typed it myself, I am the source.


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## Carlos Danger (Jun 4, 2013)

> We already know what the health care of the future is going to look like- a single-payer (read: government-funded) system



There is no way we can possibly afford such a system in the US. We can’t even come close to funding what we have now. 

Canada is starting to privatize part of their system, since they just can't afford the status quo.

To my knowledge there is no language within the ACA that addresses funding for EMS systems. EMS system design and funding should be a state issue.


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## Amberlamps916 (Jun 4, 2013)

http://www.emtlife.com/showthread.php?t=35721

I brought up fire-based EMS and Obamacare a few days ago and all I got were crickets chirping, glad to see a an insightful and passionate approach to the whole spectrum of Obamacare and EMS, kudos.


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## RocketMedic (Jun 4, 2013)

Halothane said:


> There is no way we can possibly afford such a system in the US. We can’t even come close to funding what we have now.
> 
> Canada is starting to privatize part of their system, since they just can't afford the status quo.
> 
> To my knowledge there is no language within the ACA that addresses funding for EMS systems. EMS system design and funding should be a state issue.



Although I agree that funding will be an issue, we can indeed afford a national payer. Look at what we spend on private insurance.


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## Carlos Danger (Jun 4, 2013)

Rocketmedic40 said:


> Although I agree that funding will be an issue, *we can indeed afford a national payer*. Look at what we spend on private insurance.



We can't even afford the system we currently have. At 21% of the federal budget covering less than 1/3 of the population, CMS is already bankrupting the country. How could we possibly afford to triple or quadruple that expense?  

The only places where you find successful and solvent publicly provided healthcare are rich nations with small, healthy populations.


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## Bullets (Jun 4, 2013)

Halothane said:


> We can't even afford the system we currently have. At 21% of the federal budget covering less than 1/3 of the population, CMS is already bankrupting the country. How could we possibly afford to triple or quadruple that expense?
> 
> The only places where you find successful and solvent publicly provided healthcare are rich nations with small, healthy populations.



And have income taxes that are double ours....Sweden, Belgium, Portugal, Spain, Denmark and the Netherlands all have personal income tax over 50% and sales tax over 20%.

So if we wanted to pay half our paycheck to the government then we could afford it. Most EMS agencies around here believe its going to slaughter us


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## RocketMedic (Jun 4, 2013)

If we continue as we have been, depending on fees for transport and operations as we have been, Obamacare will indeed drive us out of business. We as a profession need to change.


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## NYMedic828 (Jun 4, 2013)

I don't doubt there will be chaos before change. What came up must come down before it can be rebuilt from the ground up. Buckle up.


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## Arovetli (Jun 4, 2013)

While I appreciate your long discourse, you fell short of making a case for Obamacare being great for EMS. 

It is projected that Obamacare will exceed 40 percent of GDP. That is utterly unsustainable and quite F'ing nuts. For those who don't know, GDP is the aggregate of our economy's production.

Nearly half of our economy would be taking care of our health needs. Should everyone spend 40 percent of their income on healthcare? Would you spend 40 percent of your paycheck on my healthcare?

In other countries and more liberal thinkers in the US, there is this idea if we all pool our resources and work together, kittens and moonbeams will rain from the sky.

Hogwash. It is just not our nature.

We live in an economy and society founded upon the individual, rebellion, distrust of authority, capitalism, greed, etc. Making the entire country to put that aside and subscribe to a collective is unlikely to occur, and for me, fundamentally wrong.

There are 2 sources of wealth (and funding for the government) in the country. A large amount concentrated in a small percentage of upperclass and a small amount spread around a large middle class. Presently we are facing a shrinking middle class, and business and upperclass tax increases are easily passed on to middle class consumers and increasing benefits and entitlements for lower classes is sucking  resources from the middle class.

Middle class America is taking it hard and rough on both sides.

A good number of our businesses have relocated overseas or funnel their cash offshore to avoid taxation. You and I cannot afford an army of tax lawyers to concoct schemes to protect our money, so we get hit hard.

As for Obamacare, presently it depends on (among other things) the success of the health exchanges, which have not been built yet despite them supposed to be in operation next year. There is no real plan to build then nor the funding to build them. Once they are built, the MASS participation of the young and healthy is needed to even attempt to fund care for the poor and old and sick. That is a big challenge, hoping to get kids on board.

There are several governors and state legislatures who reject and refuse to comply. The mid term elections are approaching and you can bet if the republicans take a majority, the ACA will be attacked and at least partially dismantled.

Besides, the bill barely addresses EMS. 

We can theorize about the impact, but largely there is no way to know the outcome. Assuming that a minimally insured patient will provide increased revenue for ALS EMS is a long step on an uncertain direction. It may be possible to surmise that there be some revenue generated for transporting these patients instead of always going at a loss or subsidy, but this revenue is likely to be minimal and potentially subject to satisfaction scoring and ACO-type management.

I would encourage everyone to look at 2 things: 1). The economic notion of the tragedy of the commons, and 2). The governments currently disgraceful mismanagement and multiyear backlog of providing healthcare benefits to our wounded and disabled troops as evidence of the ability to manage healthcare.



tl;dr there is no way to fund obamacare and there is no plan to manage it even remotely well. Also, the impact on EMS is far from certain and no indication that there will be any major positive impact.


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## Arovetli (Jun 4, 2013)

I would also note that it is quite embarrassing for EMS...because as a profession we played zero role in advocating for ourselves in the largest health care reform bill of our time.

Standing ovation NAEMT and EMS, standing ovation.


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## Amberlamps916 (Jun 4, 2013)

Arovetli said:


> I would also note that it is quite embarrassing for EMS...because as a profession we played zero role in advocating for ourselves in the largest health care reform bill of our time.
> 
> Standing ovation NAEMT and EMS, standing ovation.



I share the same sentiments, well put.


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## Arovetli (Jun 5, 2013)

Rocket medic, I mean no personal attack at all, I hope you don't take it that way...but...

I just have to point out the irony of you having kool aid as your avatar and your sentiment that Obamacare will save the world.


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## Bullets (Jun 5, 2013)

Getting the massive buy in of younger Americans is suspect at best. Little proof exists that those who have insurance will abandon what they have for government funded healthcare. What will happen is smaller buisnesses will dump the insurance they currently offer and make their employees go on the government plan. It doesnt  make sense for these buisnesses to pay twice for health care.

One only needs to look at the way the government currently manages Medicare and Social Security, and the fact that at 25, i have no illusion that i will ever collect the money I currently pay into the system. These programs are existing in spite of their monstrosity and will fail as more people attempt to retire. 

Depending on how the next election cycle goes, if the republicans can take control of the Senate, it would not be difficult for them to repeal ACA now that SCOTUS has ruled that it is in fact a tax. Many were disappointed in the ruling, but CJ Roberts knew what he was doing.

With the way EMS is fragmented between the states, and even within states, this will not change much. Home rule will still prevail and advancement will occur locally or regionally


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## ghost02 (Jun 5, 2013)

Bullets said:


> Depending on how the next election cycle goes, if the republicans can take control of the Senate, it would not be difficult for them to repeal ACA now that SCOTUS has ruled that it is in fact a tax. Many were disappointed in the ruling, but CJ Roberts knew what he was doing.y



Now that is something interesting. Thanks for pointing that out, didn't think of it that way.


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## 46Young (Jun 6, 2013)

In the face of decreased billing revenue, or decreased funding in general, I don't see fire departments getting out of EMS. 

The privates won't do it if it's not profitable. The required subsidy may be too much for a municipality to provide. A fire department can get away with staffing and deploying less ambulances than a third service or private since they have the ALS engines to bridge that coverage gap, and "stop the clock" regarding response times. A fire department will wat to old on to EMS, so that they can remain relevant, to remain a vital service, and keep their allotted positions (avoid a RIF). As far as labor costs, we're already seeing the move to hybrid DC/DB programs, reduced benefit multipliers to future employees, pay cuts and step increase freezes in many places. 

The fire department may not necessarily pay more than EMS. In the Southeast, particularly in Charleston County/Charleston City, the medics make much more than the firefighters. A CCEMS medic makes as much as a City of Charleston fire Captain, as a rookie. Here, check this out:

http://www.charleston-sc.gov/Search/Results?searchPhrase=fire department pay scale&page=1&perPage=10

Click on the "Fire Pay Plan" link for their pay scales. A CCEMS medic comes in at a little over $38k/yr, and gets into the mid 40's after clearing as crew chief, after about a year. A Captain with no college makes less than $39k/yr. This is actually more in line with the EMS workload vs the fire workload in the area.


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## epipusher (Jun 6, 2013)

IMO, it is great for EMS in that it improves our job security. EMS and er's are already being used as a primary helthcare source. This will only increase under obamacare for reasons listed in the article as well as the potential for people to be dropped as it will be cheaper for companies to pay the penalty versus providing it themselves.


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## 46Young (Jun 6, 2013)

epipusher said:


> IMO, it is great for EMS in that it improves our job security. EMS and er's are already being used as a primary helthcare source. This will only increase under obamacare for reasons listed in the article as well as the potential for people to be dropped as it will be cheaper for companies to pay the penalty versus providing it themselves.



I wonder if there will be an uptick of ED to ED transfers, or ED to the floor transfers in reaction to the "three week re-admission" rule. Hospitals won't get paid if a patient gets re-admitted for the same issue within three weeks of discharge. I could see the sending facility making the pt a GOMER, claiming that they have no beds available on the floor, to validate the transport. If they're not getting paid for the admission, the next hospital can bill.


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## Bullets (Jun 6, 2013)

ghost02 said:


> Now that is something interesting. Thanks for pointing that out, didn't think of it that way.



Yeah, after their ruling many saw it as a victory for Obama and his plan, but of you know your constitutional law, the procedure for repealing a tax is much easier than anything else. 

Im interested to see how NJ handles this. With the ALS projects being run out of hospitals, there shouldnt be a loss in service, i expect to see more regional or county based EMS. We already have 1 primary service and one county provides backup BLS to all town, has a contract to do primary BLS with some


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## DPM (Jun 6, 2013)

In the UK you pay approximately $2,500 per person per year on healthcare, and you are treated in a system that ranks better than the US in most Healthcare measurements, where you pay on average $6,000 per person per year. 

The UK may pay more in tax, but the overall net cost is much less. This is something that many in the US are surprised by.

Yes, in the UK there are people that weigh the cost of treatment against the benefit of doing it... but this happens in the US already when insurance companies refuse to pay for more expensive treatment options. In the UK there is the National Institute of Clinical Excellence (NICE) and they decide which drugs and treatments the NHS will cover. They consider the finite budget that is available and decide the best ways to make this money do the most.These are not the dreaded death panels that we have heard about, merely a system that already exists in this country.

The NHS is not without it's pitfalls, but there are few instances where the US system is better than those found in the UK and the rest of Europe. 

David Cameron, the current British Prime Minister and leader of the right-wing conservative party said of the NHS "One of the wonderful things about living in this country is that the moment you're inured or fall ill, no matter who you are, where you are from or how much money you've got, you know that the NHS will look after you." This cannot be said for the 45 million people in this country that cannot afford insurance.


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## Arovetli (Jun 6, 2013)

DPM said:


> In the UK you pay approximately $2,500 per person per year on healthcare, and you are treated in a system that ranks better than the US in most Healthcare measurements, where you pay on average $6,000 per person per year.
> 
> The UK may pay more in tax, but the overall net cost is much less. This is something that many in the US are surprised by.
> 
> ...



Hush child.

American Exceptionalism.


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## Bullets (Jun 8, 2013)

DPM said:


> In the UK you pay approximately $2,500 per person per year on healthcare, and you are treated in a system that ranks better than the US in most Healthcare measurements, where you pay on average $6,000 per person per year.
> 
> The UK may pay more in tax, but the overall net cost is much less. This is something that many in the US are surprised by.
> 
> ...



And if you have no problem being put on a bed in a line of a dozen other patients, moved from one room to another, waiting for the overworked staff to get around to you once a day then by all means move to the UK. 

The NHS is not without its problems, their staff is overworked even by our standards, Doctors see a patient once a day, there have been problems with disease running rampant through hospitals and overcrowding on all floors. 

Ultimately, it comes down to ideology. Until you can change the American attitude regarding self-determination you wont change the healthcare system. There is a significant portion of the country who believe that not everyone is entitled to the maximum level of care or that healthcare is a business the government should be in. They cant even manage what they control now, why would it be a good idea to let them take on an EXPANDED role in healthcare.  You get what you pay for.


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## DPM (Jun 8, 2013)

Bullets said:


> And if you have no problem being put on a bed in a line of a dozen other patients, moved from one room to another, waiting for the overworked staff to get around to you once a day then by all means move to the UK.
> 
> The NHS is not without its problems, their staff is overworked even by our standards, Doctors see a patient once a day, there have been problems with disease running rampant through hospitals and overcrowding on all floors.
> 
> Ultimately, it comes down to ideology. Until you can change the American attitude regarding self-determination you wont change the healthcare system. There is a significant portion of the country who believe that not everyone is entitled to the maximum level of care or that healthcare is a business the government should be in. They cant even manage what they control now, why would it be a good idea to let them take on an EXPANDED role in healthcare.  You get what you pay for.



Have you ever been to a Hospital in Oakland? Because that sounds like the situation you provided. I don't want to put your nose out of joint, but on what are you basing this opinion? I have first had experience in both systems, can you say the same? 

As some of you know, I was a soldier before I got into EMS and I spent quite some time recovering from wounds received overseas in these dirty, over crowded hospitals... and that was not the impression that I got. And IF these hospitals are as disease-ridden and disorganized as you described, why are people healthier in the UK? They must be doing something right. I would rather see my Dr once a day and change rooms if it meant I recovered sooner, it cost me less money and I lived longer.

What you described is not how the NHS operates, and that's besides the point. The NHS is one of many examples worldwide of a nationally funded healthcare system. I didn't say the US needs to mirror the British system, or the Spanish or German systems, I was using the NHS as one example where universal healthcare exists and works well. 

Why do we feel that it is un-American to try and improve our current system? We can all agree that it isn't perfect, yet we violently resist the idea of changing it.


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## Bullets (Jun 8, 2013)

DPM said:


> Have you ever been to a Hospital in Oakland? Because that sounds like the situation you provided. I don't want to put your nose out of joint, but on what are you basing this opinion? I have first had experience in both systems, can you say the same?
> 
> As some of you know, I was a soldier before I got into EMS and I spent quite some time recovering from wounds received overseas in these dirty, over crowded hospitals... and that was not the impression that I got. And IF these hospitals are as disease-ridden and disorganized as you described, why are people healthier in the UK? They must be doing something right. I would rather see my Dr once a day and change rooms if it meant I recovered sooner, it cost me less money and I lived longer.
> 
> ...



4 Days in a london hospital

And various news agencies and articles from the UK, who hardly sing the NHS's praises. Seems a lot like a case of the grass being greener on the other side of the Atlantic, for both countries

Americans are resistant to change because some people believe they shouldn't be forced to pay for anything they dont want, nor should they have to pay for someone else.


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## fortsmithman (Jun 8, 2013)

I am curious why it is called Obama care when wasn't it Bill and Hillary's idea when they were in the Whitehouse.


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## Carlos Danger (Jun 8, 2013)

DPM said:


> Why do we feel that it is un-American to try and improve our current system? We can all agree that it isn't perfect, yet we violently resist the idea of changing it.



Can you provide an example of when someone used violence to resist the idea of changing the American healthcare system? I call BS.

I think the reason there is so much resistance to change in the US is because the American people already feel fleeced. The government is out of F'ing control already. A huge proportion of the federal budget already goes to fund entitlements and wars that few support. And we are going on 17 TRILLION dollars in debt, on a trajectory that will absolutely bankrupt us before long.

And after all that, now you have the same people who brought us the VA, Medicaid, Medicare, SS, TSA, DEA, Eric Holder, NCLB, the Patriot Act, the NDAA, and countless trillions of other wasted dollars on various boondoggles and rights violations telling us "if you just give us more federal control over healthcare, we can fix it" when it is already the most highly regulated and most BROKEN industry we have.

And you actually question WHY people might resist that? Seriously?

It is a fatal mistake to assume that resistance to more federal control equals resistance to change. Come up with proposals that don't involve more federal control and spending and maybe people wouldn't resist so much.


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## Arovetli (Jun 9, 2013)

Halothane said:


> Can you provide an example of when someone used violence to resist the idea of changing the American healthcare system? I call BS.
> 
> I think the reason there is so much resistance to change in the US is because the American people already feel fleeced. The government is out of F'ing control already. A huge proportion of the federal budget already goes to fund entitlements and wars that few support. And we are going on 17 TRILLION dollars in debt, on a trajectory that will absolutely bankrupt us before long.
> 
> ...



That's so good I just wanted to post it again.


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## Arovetli (Jun 9, 2013)

fortsmithman said:


> I am curious why it is called Obama care when wasn't it Bill and Hillary's idea when they were in the Whitehouse.



Because if we called it was it was:

:censored::censored::censored::censored:ing mother:censored::censored::censored::censored:ing care

It would get censored. See above.


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## Clipper1 (Jun 9, 2013)

DPM said:


> Have you ever been to a Hospital in Oakland? .



May I suggest getting a copy of the "Waiting Room" (Highland) for those who haven't?

http://www.itvs.org/films/waiting-room


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## Niesje (Jun 9, 2013)

I dont resist change. I resist change in this direction. The US government has shown us incompitance at the best and corruption at the worst. These things should be left up to individuals and state legislation. There should be more freedom. We don't want or need more legislation. I wish everyone could get free health coverage, but I also wish wars didn't exist, we didn't have to pay taxes, that I could make banker salary in EMS, and I could eat a steady diet of donuts without getting fat. It would be nice, but it's just not happening.


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## Aidey (Jun 9, 2013)

Let's keep this about EMS and the ACA, and not a debate about personal opinions on the act overall.


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## Clipper1 (Jun 9, 2013)

Aidey said:


> Let's keep this about EMS and the ACA, and not a debate about personal opinions on the act overall.



Niesje makes a good point and it is probably what is on many American's minds when they read through this Act.

The CA invokes personal opinion by limiting choice since it is merely a government controlled HMO by design.  Do you honestly think it will change much for EMS when people are told they can only go to certain doctors and have only x amount of treatment?   Anyone here who has ever been covered by a limiting HMO knows the frustration with just dealing with one company.  The small businesses will be scrambling for the cheapest plan to meet the mandates.  This will affect the employees and their coverage of some ambulance companies.


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## Hunter (Jun 9, 2013)

Seems to like me people are ignoring the fact that the original post stated that Obama care can't survive in it's current State and that it will be changed, because it needs to be. I feel like as a whole it's a good idea and a great concept, but execution is always the problem, as with everything.

Someone mentioned hospitals transferring more patients to other hospitals to fix the billing issue, but what happens when a patient gets discharged within a week and decides to go back to the hospital within days? Transfer them again? There's patients who go to hospitals every week, more than once. The key to fixing our founding problem and the whole thing with "cost of healthcare is too high" is prevention. With that we end back at the community paramedicine idea. (Regardless if your opinion of nurses, or other healthcare professionals being involved in this.) This is the (best) future for EMS and smart hospitals will be glad when it happens; it's not only gonna minimize visits where hospitals won't be able to bill but it'll mean that the patients they get from EMS will be true emergencies and allow them to get paid at s higher %. Whatever changes are made to obamacare or it's predecessor will need a provision not just for traditional 911 EMS but for preventative community paramedicine.

None of these changes would be possible with Medicare/Medicaid. EMS needs change. Changing/instituting national health care "insurance" is going to snowball change in every aspect of American medicine.


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## Medic Tim (Jun 9, 2013)

I am not lookin to get into a political debate and I understand there is much more to the bill than what my following post comments on. 

I have worked and lived in the USA and Canada. Both systems are far from perfect but what it comes down to for me is quality of life. Yes I pay more taxes in Canada  but I also make a higher wage, have an excellent pension and have additional insurance ( life, medical, dental) provided by my employer. EMS up here is a career and not just a job. We also have higher education standards. People are always complaining about making more money or getting more education and furthering ems then resist the Changes that could make that happen.


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## Aidey (Jun 9, 2013)

This is just for clarification purposes, almost everyone has stayed on topic. 

This thread is for the discussion of how the ACA is going to affect EMS. Including things like reimbursement, the type of care EMS provides and the future of volunteers, as laid out in the OP. It is not the place to discuss your general opinion about the act as a whole. Discussing what benefits EMS employers may or may not offer really isn't relevant to the OP.


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## phideux (Jun 9, 2013)

I don't think it will affect EMS much, if at all. The same emergencies will happen, the same system abusers will still call, and the same people who think they are "entitled" to their free ride to the hospital, for every little minor complaint, while being followed by a family member in one of their 3 cars will still happen.
Reimbursements to EMS from the abusers and the entitled will probably get smaller, and the country will probably bleed green until it is out of green to bleed.
If this plan is so great, why did all the people that are implementing it, exempting themselves from it?????


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## Arovetli (Jun 9, 2013)

phideux said:


> If this plan is so great, why did all the people that are implementing it, exempting themselves from it?????



I think this is something we have seen for awhile and will continue to see, and I think it will show itself too in EMS.

We, (American society) are dividing up increasingly into economic segments. While the has always been a notion of economic "class" in the US, it generally hasn't been very pronounced, the very wealthy were a small segment, and the poorer classes were generally comprised of minority races. We segmented much more on the basis of race (wrongly), and now the divides are much more of the economic nature.

I think "community para-crazy-medicine" will be alot more pronounced in the lower income communities, and you'll probably see the same type of response in the wealthier communities that we already have.

Alot, not all, but the parts which we generally discuss, of the ACA is geared to uninsured care. Other than jacking up taxes, I don't think and mid-middle class and up will change much. 

You can have all the nurse practitioners and community paramedics, but I'll get my care from a physician and I'm willing to pay for it. There's alot that share this sentiment.

This next statement is going to make me sound cold, and like an ***, but the majority of healthcare reform is geared to a segment of the population I'm not hyper concerned about. I have compassion and human decency that I wish them care, but I'm not going to allow an entitlement program to break my bank. My family was poor nothing immigrants like everyone else a few generations ago, and they built a life for themselves. There's something to be said for the fact that if you don't work, you don't eat.

If that bothers you, then realize the clothes you wear we're likely made by poor for pennies, the low prices we pay at the store are because of abusive working conditions for foreign producers, and the amount of resources we waste daily could save lives around the globe. The world is a harsh place and to an extent we are all selfish, and well, it is what it is.

I have compassion for the poor. But you know what, I need my grass cut as well. And id be glad to pay them to do it, and they can use that money to tend to their affairs.

So, by explaining that, I mean to reinforce that there are people not willing to pay through the nose to provide care to the poor, and that does effect EMS already, since alot if our EMTALA mandated resources are tied up with them. 

In my big city home town, we had the "white flight" epidemic decades ago, but now we see "black flight" too, which as people of all colors and creeds improve their economic standing, they break out from the lower income areas, form communities of like minded folks. And, they start breaking off politically from the poor sections. 

That's a big deal. 

It leaves EMS and hospitals in the poorer areas severely strapped for cash. I know there will be some income for transporting the poor under the ACA, but I really doubt that it will be worth it if the poor become increasingly isolated from the others, and we really separate by economic classes.

It's frightening.

In my town, the city cops are either rookies who get 2 years experience then bail to the suburbs, or they are crooked or useless or both. Same effect has happened in fire. I would hate to see our emergency providers continue to bail out of the cities and into the suburbs where the pay and conditions are better.

DC and Detroit and NO look more like Dresden then true world class cities, and this decay has plunged the EMS into an abyss there. I don't want to see that trend continue, but it may.


Mods, I hope that was on topic enough to be relevant.

Edit: nothing racial or offensive was meant at all by this, just pointing out the nature of humans and the history we have had. And you know, alot of the problems and disparities we are faced with today are effects of terrible things that happened previously. To clarify, I support hard work and self determination and charity, but never grinding someone under the heel of my own progress.


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## rescue1 (Jun 10, 2013)

I just want to jump in and mention that it's important to know that while it's likely single payer health will increase taxes in the short run, the US government currently pays more per capita (in medicare and medicaid) than any other country pays for it's single payer system per capita.

I'm not suggesting any specific solutions, but it's important for people to realize that we pay more of our taxes towards healthcare than Canadians do, and get less health care for it.


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## Arovetli (Jun 10, 2013)

rescue1 said:


> I just want to jump in and mention that it's important to know that while it's likely single payer health will increase taxes in the short run, the US government currently pays more per capita (in medicare and medicaid) than any other country pays for it's single payer system per capita.
> 
> I'm not suggesting any specific solutions, but it's important for people to realize that we pay more of our taxes towards healthcare than Canadians do, and get less health care for it.



Right, and we have much different socioeconomic and political conditions and history to deal with than those countries.

Rewrite the economic and political philosophy of America and undo the effects of the poor decisions we have made previously, and maybe things could be different.


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## RocketMedic (Jun 10, 2013)

For the money (public and private) spent on health care, what sort of a health-care system could be built?


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## Achilles (Jun 10, 2013)

Rocketmedic40 said:


> For the money (public and private) spent on health care, what sort of a health-care system could be built?



What have other countries done?


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## Bullets (Jun 10, 2013)

Arovetli said:


> I think this is something we have seen for awhile and will continue to see, and I think it will show itself too in EMS.
> 
> We, (American society) are dividing up increasingly into economic segments. While the has always been a notion of economic "class" in the US, it generally hasn't been very pronounced, the very wealthy were a small segment, and the poorer classes were generally comprised of minority races. We segmented much more on the basis of race (wrongly), and now the divides are much more of the economic nature.



I think 1900s America was far more economically stratified then current society

I really dont think this will affect us as an industry. Those with insurance arent going to lose it, and they will always be reliable payers, those with BCBS and such. 

Those on the public dole will still be on the public dole

and those that slip through the crack will slip through the cracks

As long as insurance providers cant compete across state lines the system will be expensive and cumbersome. I dont see the government system standing as a sole provider who can span state line with a legal challenge. Larger payer base results in decreased individual cost and hope fully more easy coverage, as more companies compete for the same pool of payers


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## Arovetli (Jun 10, 2013)

Bullets said:


> I think 1900s America was far more economically stratified then current society



Indeed. This is known as the Great Economic Arc. 

Also, what I meant by 'notion of economic classes' wasn't in terms of absolute numerical income inequality but rather the notion of upward mobility in our modern history.

In reference to the arc, early 20th century, when data was first available, income inequality was great. During the progressive New Deal era it converged and income distribution narrowed. Presently it is arcing back the other way, and all progressive federal attempts to narrow it seem to be furthering the divide and inequality is increasingly growing.

The more homogenized the middle class becomes with the poor, and the further away the upper class gets. This is a big deal for us when we are presently depending on taxing the rich and increasing corporate taxes to fund Obamacare.

There's no positive benefit to EMS with no viable funding and a side effect of dragging down the backbone of the country.


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## Carlos Danger (Jun 10, 2013)

Rocketmedic40 said:


> For the money (public and private) spent on health care, what sort of a health-care system could be built?



I don't think we need to "build" a new healthcare system. We have a pretty solid one. Not perfect, not nearly as efficient as it should be, but I don't think there there are many countries I'd rather get badly injured in.

Look, we have a large population who is simultaneously aging rapidly and suffering from more and more chronic diseases, yet we are constantly living longer and more productive lives. Is that not the very definition of an effective healthcare system?

First of all, I think we all need to simply accept the fact that quality healthcare is damn expensive. Period. You don't get care in comfortable facilities with short wait times from top physicians using state of the art technology for nothing. Of all the things that people do that confuse me, probably the one thing I have the hardest time wrapping my brain around is the notion that we should be able spend years and years making poor lifestyle choices and taking no responsibility at all for our own health, and then receive prompt, expert, flawless healthcare at no or very little cost to us, as often as want.

We wouldn't expect to be able to buy a new car, beat the crap out of it and never maintain it for 20 years, and then take it back to the dealer and have them restore it to new condition again, at no cost to us. Why do people think that is how medicine should work?

As far as how to improve what we have? I honestly think that's quite simple. Many of the inefficiencies and problems with our system have to do with the tens of thousands of absolutely oppressive federal regulations which completely stifle competition and innovation. 

Do away with federal insurance regulations. Let people buy whatever insurance they want. Get rid of CMS. Get rid of the VA. Limit the ability of the AMA and other interests to enact protectionist regulations. Let the states each develop their own programs for dealing with those who can't afford healthcare.


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## RocketMedic (Jun 10, 2013)

Get rid of the VA? Great, now America's veterans get to trust Humana and United Healthcare to approve them for new prosthetics. Throw those who cannot afford healthcare to state-based programs? Welcome back to 1960.

In many cases, those "oppressive federal regulations" are the only thing keeping insurance companies and hospitals from simply abandoning public health at anything even approaching affordability.


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## Carlos Danger (Jun 11, 2013)

Rocketmedic40 said:


> Get rid of the VA? Great, now America's veterans get to trust Humana and United Healthcare to approve them for new prosthetics. Throw those who cannot afford healthcare to state-based programs? Welcome back to 1960.



There is nothing at all special about the VA. It is just another hospital system, and they turn vets away all the time, ESPECIALLY for prosthetics. 

The VA does nothing that civilian systems don't do, better and more efficiently in many cases. The VA is a bureaucracy on an unmatched scale, and a duplication of effort that is just nonsense.

Is there any reason the military can't simply pay for care in civilian hospitals? 



Rocketmedic40 said:


> In many cases, those "oppressive federal regulations" are the only thing keeping insurance companies and hospitals from simply abandoning public health at anything even approaching affordability.



That "the only thing saving us from being taken advantage of is the federal government" is a _complete_ fallacy. 

The idea that businesses (the insurance companies) actually WANT to turn away business is absolutely illogical.

Do insurance companies sometimes do crappy things to people? Yes. So does the government.

Am I saying the healthcare industry needs no regulation whatsoever? No. I'm saying the states would do a far better job of it.


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