American Healthcare, the next house of cards

[abckidsmom]

I don't really see the definitive march towards socialism that seems to be part of popular politics today.

What I do see is a system that doesn't inherently work that nobody seems to have the will to fix. I think orchestrating such a collapse is a very risky gamble. In America's two party system, the party in power when it happens will pay a rather extreme price.

A total collapse of roughly 1/4 of the nations economy, coupled with a pay to play medical system I think is more likely to motivate people to ropes and torches and pitchforks than passively accepting whatever crumbs are thrown their way.

As is often the case for me, I see this pointing directly back at the entitlement mentality that people have in our country. Don't want to make an appointment and head over to the dr at 8:30 am on Thursday? No big, just take care of it at the ER anytime you want.

To answer your earlier question, to save money in my department I'd:

-cut spending on uniforms, and eliminate the class As

-get all the vehicles on a routine maintenance plan which may help with needing loaner trucks and emergency towing

-get the supervisors out of the office, out spending time in the stations and tasking the motivated people with the low-level admin tasks

-have a supply officer, and track who is removing supplies from storage, associate supply usage with the patients for whom they were used (limit employee theft of supplies)

-Track unnecessary milage, turn vehicles off instead of idling

-OT is not something we can eliminate completely in our small system, but I can see going back to something like comp time, which would allow us to schedule the coverage with part timers instead of automatically going to OT

-Lower drop times at hospitals by 50-75%. There is absolutely no need for 1 hour to be the standard drop time. In an all-911 system, it's not like we can immediately put the crews to work making money, but any time of low levels of availability within the system give the illusion that hundreds of thousands of dollars need to be spent staffing another ambulance

-Educate people about when is an appropriate time to activate a helicoptor. Not our system directly, but overuse of helicopters is a collossal waste of money, and eventually a patient is going to come back on us for an obvious bad call (close EOT being the one that comes to mind)


Those are my thoughts, from an EMS provider's POV. I think one of the keys to improving EMS and the ER systems is improving the primary care systems, and I'm stumped as to how we can overhaul the primary care systems.

 

[abckidsmom]

Doing a blog is about drawing attention to yourself, it seems to me, if you have a philosophy or approach or product that you think will stir up some stuff. Chimpie's right; I see a lot more discussion here than there, though here is somewhat a converted audience (laced with differing opinions as well as detractors!) and there the views could be viewed as revolutionary with application to the public at large.

I think it depends on how large of a sounding-board you want/need. Also, I think a Blog is best geared toward mobilizing a targeted population, while Forum's like these are really about conversation.

According to this site, http://www.emsemployment.net/index.html EMS prospects for employment will be increasing, and that's largely because my generation, the Baby Boomers will be circling the drain.

IMHO the next few years, to soon be overdosed with the decrepit like myself, will probably be the straw that breaks the camel's back, as so clearly articulated by Vene.

I totally agree with the bolded. If we think we're drowning in people now, just wait. It's a good thing that 50 is the new 30, but only if the powers that be use those gap years (I think there are about 10 left till the boomer generation peaks at 70, right?)

Vene's post actually caused some true anxiety in me. I like thinking that our plan for life is just peachy and that we've got an in-demand career path. My husband works in the metro DC area, one that's got a seemingly infinite supply of tax dollars, but even they have cut deep to save money to avoid RIFing. I'm not sure how many years it's been since he got a step increase in pay, and the OT is not happening anymore. Fortunately, the part time jobs are pretty free with the hours, and he is able to work as much as we like him to.

 

[abckidsmom]

I don't really see the definitive march towards socialism that seems to be part of popular politics today.

What I do see is a system that doesn't inherently work that nobody seems to have the will to fix. I think orchestrating such a collapse is a very risky gamble. In America's two party system, the party in power when it happens will pay a rather extreme price.

A total collapse of roughly 1/4 of the nations economy, coupled with a pay to play medical system I think is more likely to motivate people to ropes and torches and pitchforks than passively accepting whatever crumbs are thrown their way.

America's two party system is eroding. The Tea Party, for all its drama and disorganization, has thrown a wrench into things and broken a few cogs off the wheels. Depending on who's in power when the collapse happens, IMO, we'll either have something much closer to true socialism, or step back 30 years and have a dramatically reduced healthcare economy, with pitchforks, people holding sick children outside the hospital, and pay-to-play.

In the middle is where we need to be, but first the pharmaceutical industry needs to collapse and burn, and people need to realize that partying today and counting on a pill to fix the damage tomorrow is stupid. I think that leg of the industry is a key one that will fail and fail hard.

Perhaps when medication is not readily available, people will be more motivated to do the next thing in system overhaul.

 

[46Young]

I don't really see the definitive march towards socialism that seems to be part of popular politics today.
I do. I've seen a growing trend towards more and more entitlement programs. I'm seeing the gov't destroy small businesses. The gov't is looking to penalize the wealthy and redistribute those additional taxes to fund their entitlements. You know, spread the wealth. I'm seeing the gov't drive business overseas due to undesireable regulations and such.

What I do see is a system that doesn't inherently work that nobody seems to have the will to fix. I think orchestrating such a collapse is a very risky gamble. In America's two party system, the party in power when it happens will pay a rather extreme price.
Not really risky for the extreme leftists. When the economy collapses, the citizens will be looking for handouts, to be taken care of. It'll work out well for the liberals.

A total collapse of roughly 1/4 of the nations economy, coupled with a pay to play medical system I think is more likely to motivate people to ropes and torches and pitchforks than passively accepting whatever crumbs are thrown their way.

Unless we do something soon, the U.S. dollar will see hyperinflation. Weimar Germany comes to mind. The Federal Government is already illiquid. QE2 just enables the gov't to keep on with their deficit spending. It's not like money's expensive to borrow. Businesses are sitting on massive amounts of cash, rather than investing, due to the uncertainty of the upcoming govt regulations, the economy in general, and such. Some estimates have the dollar inflating up to 20% with QE2. I can't wait to se QE3, QE4, etc. Weimar Germany.

At least I'll have an affordable fixed rate mortgage. I'll build a greenhouse in my backyard. I'm going to stock non perishable commodities in the basement, and rotate the stock. Bullets and hard liquor are good to have as well. TIPS could be a good investment. I've also read that for every ten dollars in a bond fund, you take out one and invest it in gold. That's supposed to pace inflation pretty well. 90% short term bond fund, 10% gold.

 

[abckidsmom]

At least I'll have an affordable fixed rate mortgage. I'll build a greenhouse in my backyard. I'm going to stock non perishable commodities in the basement, and rotate the stock. Bullets and hard liquor are good to have as well. TIPS could be a good investment. I've also read that for every ten dollars in a bond fund, you take out one and invest it in gold. That's supposed to pace inflation pretty well. 90% short term bond fund, 10% gold.

What is TIPS?

I agree with your entire post. My 6 and 7 yos could run a garden themselves. They love working in the dirt.

 

[46Young]

-Lower drop times at hospitals by 50-75%. There is absolutely no need for 1 hour to be the standard drop time. In an all-911 system, it's not like we can immediately put the crews to work making money, but any time of low levels of availability within the system give the illusion that hundreds of thousands of dollars need to be spent staffing another ambulance.

Be careful what you wish for. At the last service I worked for, we were inservice at the very instant we arrivat at the ED. Oftentimes, we would get another call within a few minutes after arriving. Sometimes, it would be on my screen before I could even turn off the engine! They also had ePCR's. Try filling out five or six reports in various stages of completion at 0200, or even worse, after shift's end!

That was the county's answer to poor staffing and deployment - keep units inservice at the hospital. You'll receive punitive measures if you refuse the call to clean your cot, etc. It's taboo there. Low levels of availability can be a good thing - it shows that the dept legitimately needs more funds for staffing and deployment. The taxpayers may agree to a property tax hike, or you may be able to secure funding from the state or federal gov't. If you artificially narrow your response times (SSM!), you're showing no need for additional funds.[SIZE]

 

[46Young]

What is TIPS?

I agree with your entire post. My 6 and 7 yos could run a garden themselves. They love working in the dirt.

Treasury Inflation Protected Securities

http://www.treasurydirect.gov/indiv/products/prod_tips_glance.htm

 

[Veneficus]

At least I'll have an affordable fixed rate mortgage. I'll build a greenhouse in my backyard. I'm going to stock non perishable commodities in the basement, and rotate the stock. Bullets and hard liquor are good to have as well. TIPS could be a good investment. I've also read that for every ten dollars in a bond fund, you take out one and invest it in gold. That's supposed to pace inflation pretty well. 90% short term bond fund, 10% gold.

Is this post serious? Because it really looks off the wall to me?

 

[firetender]

Is this post serious? Because it really looks off the wall to me?

Methinks he's planning on there being a little bit more than a recession. He didn't mention the underground bomb shelter, nor the full arsenal.

During the Y2K scare, I knew a guy who did research and found out that the best commodities he could stock up on and sell at a tidy profit later were WOODEN MATCHES and CIGARETTE PAPERS!

 

[abckidsmom]

Methinks he's planning on there being a little bit more than a recession. He didn't mention the underground bomb shelter, nor the full arsenal.

And the cabin in the woods.

We're not to full-out prepper status, but I don't want any economic downturn or government bank issue to make me have to look at hungry, cold children. We strive for self-sufficiency, and live carefully.

Vene, you should read the blogs of some of the true prepper zealots out there...fascinating stuff.

 

[Veneficus]

Vene, you should read the blogs of some of the true prepper zealots out there...fascinating stuff.

I don't even want to imagine the kind of conspiracy and doomsday theories going around.

I rate it up there right along with watching TV as the surest way to lose IQ points.

I never argue with or try to convince psych patients to see reality.

Apparently there is considerable anxiety caused in this economic downturn that people are starting to believe all kinds of wild and crazy stuff in order to give themselves some semblance of control or understanding. It seems to work almost like a religion for getting people to believe things that have no basis in fact or even evidence of.

It's a funny thing about wealthy people. They have the ability to take their money and move. I don't see a lot of that happeniing yet. Actually, I don't see it happening at all. More benzos for the masses please.

 

[46Young]

Is this post serious? Because it really looks off the wall to me?

Half serious, I'm afraid. I'm not exactly barricading myself in my home and stockpiling arms and such, but hyperinflation is a real concern in these times. Like I said, the gov't is currently illiquid, and the Fed's answer is QE2. It's like being broke, getting another credit card, and paying the minimums with the new card. We're getting real close to the end of the cliff. Before long, we as a nation won't be able to make the interest payments on our debt, let alone reduce it. Either we'll be taxed to oblivion, or we'll see QE3, QE4, QE5, etc. That will cause massive inflation. Either way, I won't be able to feed my family, not with milk being $10/gal, maybe the same for gas, $15/lb for ground beef, etc. The only thing that will get relatively cheaper is my mortgage, if my salary at least keeps up somewhat with inflation.

Anyway, investors have been seriously considering TIPS, especially those preparing to retire, so that inflation doesn't significantly erode their purchasing power. The 10 to 1 thing with bonds and gold is something I've actually read about. I'm not expecting much to happen in the next year or so, but I've been actively researching ways to hedge hyperinflation.

I have a good investment plan at the present. I plan to buy several firearms both to hunt the abundant amount of deer in the area, and also to protect my family and home, should civil unrest and general crime become a concern. We have castle doctrine in VA. It's a good idea to buy whatever you can in today's dollars. Need some dental work? A new pair of glasses? Car repair? Do it now. I plan to store non perishables, and canned food products that we use on a regular basis. These things last years. Just stock up to an acceptable level, and then rotate your stock. The greenhouse thing will happen if the price of fruits, vegetables, and legumes become unreasonable. I know several people with farms that I can buy from, or put in work in exchange for meat, eggs, and produce. Regarding hard liquor and bullets, if the nation were to become bankrupt, I would needs goods with which to barter. I'm not doing all this right now, but I'm prepared to do all of the above if I things going to Hell in a handbasket, so to speak. If I'm just overreacting, I'm still going to use those non-perishables, I'll certainly drink the liquor, and I'll definitely hunt as well. Gardening is fun and relaxing to me. It's cool to eat stuff that you grow yourself. I've read about how Big Pharma would like to get fruits and vegetables classified as drugs, so they can regulate them, and drive up the prices. If we eat less F&V, we'll be sicker, and be more dependent on drugs and surgery, which is most of what modern Western medicine is good for. Treating signs and symptoms, prescribing meds and surgery, not so much for prevention and cure.


Throughout my life, I've always been one to have contingency plans. Again, I was only half joking in my earlier post. If things are looking to go poorly, it'll be no laughing matter. Hopefully, inflation will only rise moderately, my salary in step, and my mortgage will steadily become a smaller and smaller percentage of my income. We'll see how it goes.

 

[abckidsmom]

I don't even want to imagine the kind of conspiracy and doomsday theories going around.

But your OP in this thread was a complete doomsday theory, IMO. If the house of cards collapses, it's the end of the world as we know it for our family. This is a Big Deal, and we don't even have a family member with particularly special medical needs.

Everyday on the internet I keep seeing adverts for hot healthcare jobs. Transcriptionists, med techs, you name it.

Many EMTs here are finding the market quite saturated right now. Agencies from municiple to hospitals are freezing hiring or cutting back. Back in the day of wooden ships and iron men, my EMT cert all but allowed me to write my own ticket. Now even Medics are having trouble.

All of this growth is unsustainable and will be followed by contraction.

What is yor backup career when you can't make money in medicine?

This is a completely valid summation of the situation. Assuming that the unsustainable growth is followed by a contraction, services rendered will contract too. Supply and demand principles will kick in, and health care will become a prized commodity.

Bad time for your 4 yo to be diagnosed with leukemia, huh? Especially if it's accompanied by a lack of employment options.

The backup plan for us is a lot more like hard labor, boarders, and <gasp> child care. If health care is a bubble, and that bubble bursts in a similar way to the dot com bubble, it's a serious problem that I don't really want to completely imagine.

 

[46Young]

And the cabin in the woods.

We're not to full-out prepper status, but I don't want any economic downturn or government bank issue to make me have to look at hungry, cold children. We strive for self-sufficiency, and live carefully.

Vene, you should read the blogs of some of the true prepper zealots out there...fascinating stuff.

Pretty much.

 

[46Young]

Methinks he's planning on there being a little bit more than a recession. He didn't mention the underground bomb shelter, nor the full arsenal.

During the Y2K scare, I knew a guy who did research and found out that the best commodities he could stock up on and sell at a tidy profit later were WOODEN MATCHES and CIGARETTE PAPERS!

No bomb shelter or rocket launchers. I'm not actively seeking out any backwoods militias to join, either.

Funny story about Y2K. I was working as a bartender on the Upper East Side in Manhattan for New Year's Eve. The owner brings down a loaded gun, places it behind the counter behind the well drinks, and told me to shoot anyone that tried to rob the place. He was high on either blow or weed much of the time. Long story. He was all business about the gun, though.

 

[46Young]

We should have never went off the Gold Standard. Damn you FDR and Nixon!

I read an article about Social Security a couple of weeks ago. It basically said you could take any thirty year period in the U.S. Stock Market, invest what you paid in SS taxes into the Total Stock Market Index, and you would have well over a million in today's dollars, adjusted for inflation. BTW, it's not hard to choose a balanced fund, see a moderate long term appreciation of that principal, and also live off of 5% yearly distrubutions off of that million or so. That's about 50k annually. And you still have over a million in principal. SS, what a scam!

We should instead follow what Chile has done with their privatized Social Security:

http://www.cato.org/pub_display.php?pub_id=5981

 

[Veneficus]

But your OP in this thread was a complete doomsday theory, IMO..

Sorry, I didn't really see it as doomsday, more like a review of what has been known about the system for a long time from a perspective of basic economics and the push towards using healthcare as a new sustainable career to volumes of people who have lost out in other jobs.

If the house of cards collapses, it's the end of the world as we know it for our family. This is a Big Deal, and we don't even have a family member with particularly special medical needs...

I don't think that is possible to accurately predict. If you had $100K in student loans and were seeing a reduction in salary from $80K a year to $30K maybe. As well as if sudddenly there were no positions for your particular position.

Maybe I wasn't clear, but when contracture finally comes, which at current spending is inevitable, the people to be hit hardest are likely the mid level providers and the lower end techs. While physicians and nurses will almost assuredly take a pay cut, it won't be the end of the world unless you are living considerably beyond your current means.

For EMS I imagine a considerable reduction if not elimination of transport revenue. But it will have to be replaced by a different form of payment, people aren't going to stop needing transport.

For mniciple employees, the depth of cut will be decided by what the local tax base will accept. That is location dependant. In places like my hometown, they couldn't raise taxes if they wanted to, the money just doesn't exist. That means a bunch of union guys are going to find themselves with a major pay cut or on the outside looking in. The weak economic tax based copled with a medicare//medicade reduction will certainly be a devastating blow to them as that is how their unrealistic budgets have been sustained for sometime.

Even in a complete healthcare collapse, where it becomes pay to play only, it will force lower prices not only to hospitals but to medical suppliers of all types. Basically everything will get cheaper or everyone from insurance companies to pharm will go out of business. I can't see those interests accepting that scenario.

Anyone is business will tell you it is better to own a percentage of something small rather than 100% of nothing.

This is a completely valid summation of the situation. Assuming that the unsustainable growth is followed by a contraction, services rendered will contract too. Supply and demand principles will kick in, and health care will become a prized commodity.

For certain.

Bad time for your 4 yo to be diagnosed with leukemia, huh? Especially if it's accompanied by a lack of employment options..

Anytime is a bad time, but lack of options is better than no options, and medical tourism is a booming business elsewhere. I can assure you that cancer treatment on this side of the pond is as good as anywhere, and at a fraction of the cost. Which means it is possible to be sustainable at a lower fee schedule. However as I pointed out, the only providers here are physicians and nurses. Though PT is making a really strong increase and the techs are limited to radiology and in the wealthier places, orderlies.

The backup plan for us is a lot more like hard labor, boarders, and <gasp> child care. If health care is a bubble, and that bubble bursts in a similar way to the dot com bubble, it's a serious problem that I don't really want to completely imagine.

I suspect it is just a matter of time before it does. But I don't think it will be soup kitchens for the employees. Begging for service by the un/under insured, almost certain.

 

[Veneficus]

We should have never went off the Gold Standard. Damn you FDR and Nixon!]

Gold standard included a government controlled price on gold by fixing its rate. No matter what proponents say on TV, if they have a substantial gold investment, gold standard is not what they want.

It seems kind of ironic to argue for a government price control in the same breath as complaining about government regulation.

 

[JPINFV]

I have a good investment plan at the present. I plan to buy several firearms both to hunt the abundant amount of deer in the area, and also to protect my family and home, should civil unrest and general crime become a concern. We have castle doctrine in VA.

To be honest, if it becomes that bad I highly doubt it would matter whether you have castle doctrine or not. There comes a point where some laws, and eventually all laws, become irrelevant, and that can be short term or long term.

 

[MrBrown]

Educate people about when is an appropriate time to activate a helicoptor. Not our system directly, but overuse of helicopters is a collossal waste of money, and eventually a patient is going to come back on us for an obvious bad call (close EOT being the one that comes to mind)

Thats it Oz the gig is up, time to go hang our orange jumpsuits out to dry.

American healthcare will always be flawed and broken until you people realise healthcare is a right and not a user-pays privilege