Different angle: why basic level technicians?

[rescue1]

Local taxes=Local services

I would gladly pay more local taxes than I do now if I could be assured that my money was being spent to fund my local services in an efficent manner.

What about municipalities that are in financial trouble or are just very poor? Detroit, Camden...even Philadelphia's EMS system is about 30 ambulances understaffed.

These areas, whether due to economically depressed conditions or financial mishandling by the government, are unable to provide effective emergency services to their citizens. Would it really require punishing taxes to try and support (but not supplant) the fire/EMS/Police forces of these areas? I don't really think so. SAFER grants are such a tiny drop in the bucket for the federal government budget it isn't even funny.

 

[Tigger]

Local taxes=Local services

I would gladly pay more local taxes than I do now if I could be assured that my money was being spent to fund my local services in an efficent manner.

Having spent six years working in the ER of an inner city level one trauma center I can tell you we have the best healthcare system in the world. No waiting for weeks for procedures like you have in the UK and Canada. Why do you think the wealthy and politicaly connected flee to the US from these countries for their more complicated procedures. Yes everyone gets healthcare at some point but not the way we do here in the US. Places that practice socialistic medicine are at present just a small step above the third world toilets they will become once they collapse in on themselves.

Have you ever actually experienced or even studied healthcare systems in developed nations outside the US?

 

[Level1pedstech]

Have you ever actually experienced or even studied healthcare systems in developed nations outside the US?

Good friends with a fireman and his wife whos a nurse they live in Manchester UK,family friend whos a Canadian citizen that regularly travels south for medical treatment. Not sure if that counts but combined with stories I have heard over the years I can say we are with out a doubt the best.

Honestly Im not real interested in what the rest of the world does. I have been knee deep in this countrys health care system and can tell you its not perfect but I would gladly take it any day over the systems in the UK or Canada.

Now let me ask you,have you ever spent an extended period of time in one of our inner city level one trauma centers? If you have did you focus on what came thru the back door like most people do, these would be your A typical emergent health care recipients. Or did you take the time to observe the very large number of people that came in the front door,these would be your not so sick health care recipients. For those that might not know, its the not so sick health care recipients that are dragging us into the hole.

A majority of the not so sick health care recipients are at least in the inner city level one truma scenario going to fall into two groups. Group one is made up of those that could pay but they know if they work the system they can get their care for free or at a deeply discounted rate. Group two is the indigents,illegals and just plain losers in life. They have no resources and after recieving the best care available will walk out knowing they will never have to pay. Then of course there are the rest of us who have to absorb the cost of providing that first class care to every one in need.

Moral of the story is everyone gets first rate care regardless of thier ability to pay. It might be a level one full system trauma patient or your run of the mill tummy ache regardless they both recieve the same care. This care is rendered in sterile state of the art facilities by some of the brightest most educated providers the world has to offer. Funny how the best and brightest are drawn to the US when there are so many other places they could go.

 

[Level1pedstech]

What about municipalities that are in financial trouble or are just very poor? Detroit, Camden...even Philadelphia's EMS system is about 30 ambulances understaffed.

These areas, whether due to economically depressed conditions or financial mishandling by the government, are unable to provide effective emergency services to their citizens. Would it really require punishing taxes to try and support (but not supplant) the fire/EMS/Police forces of these areas? I don't really think so. SAFER grants are such a tiny drop in the bucket for the federal government budget it isn't even funny.

Why are these municipalities in financial trouble,could it be that they have no fiscal accountability or maybe its that they couldnt run a lemonade stand without screwing it up?

I have over the years used the same arguement when tying to convince people that some areas have no choice but to rely on volunteers. Where there is no money there is no paid service but there will always be people willing to volunteer.

A tiny drop in the bucket....you truly dont get the big picture,its okay at least you have something in common with the feds.

 

[the_negro_puppy]

Local taxes=Local services

I would gladly pay more local taxes than I do now if I could be assured that my money was being spent to fund my local services in an efficent manner.

Having spent six years working in the ER of an inner city level one trauma centre I can tell you we have the best healthcare system in the world. No waiting for weeks for procedures like you have in the UK and Canada. Why do you think the wealthy and politically connected flee to the US from these countries for their more complicated procedures. Yes everyone gets healthcare at some point but not the way we do here in the US. Places that practice socialistic medicine are at present just a small step above the third world toilets they will become once they collapse in on themselves.

Baloney. We have been practising Socialised medicine in Australia for decades. It's not without its problems but any citizen or permanent resident can receive primary or emergency care without having to worry about paying a $10,000 for a bed for 12 hours, a CT scan and a few blood tests.

We also have the option of having private health insurance like in the states to attend private hospitals for both emergencies or procedures. No waiting for weeks if you are insured.

I agree that we probably pay higher taxes than US residents, and yes, many dollars are wasted by an inefficient bureaucracy. Without health, what do you really have though?

 

[rescue1]

Why are these municipalities in financial trouble,could it be that they have no fiscal accountability or maybe its that they couldnt run a lemonade stand without screwing it up?

I have over the years used the same arguement when tying to convince people that some areas have no choice but to rely on volunteers. Where there is no money there is no paid service but there will always be people willing to volunteer.

A tiny drop in the bucket....you truly dont get the big picture,its okay at least you have something in common with the feds.

Bro...I get the big picture. I have a college degree in the big picture. So please don't talk condescendingly to me about public finance and tax spending, I just spent four years studying it.

There are municipalities that have been run like absolute crap, no question. But there's no reason to punish the citizens inside for the actions of a few incompetent politicians. And you can't expect Detroit to be protected effectively by volunteers.

Look, we clearly disagree on this, and I don't think either of us is going to convince the other that we're right, so let's get back to talking about basic technicians as opposed to government healthcare and taxes.

 

[sir.shocksalot]

Moral of the story is everyone gets first rate care regardless of thier ability to pay. It might be a level one full system trauma patient or your run of the mill tummy ache regardless they both recieve the same care. This care is rendered in sterile state of the art facilities by some of the brightest most educated providers the world has to offer. Funny how the best and brightest are drawn to the US when there are so many other places they could go.

By every measure the US has one of the worst health care systems in the world. http://www.who.int/countries/en/ Compare Canada and the US, life expectancy is greater, and your chances of dying are smaller in Canada than the US, they also spend less of their GDP caring for themselves.
I will agree that the US probably has some of the greatest physicians in the world. Unfortunately we are measured on averages, and on average we provide poor primary health care, poor public access health, poor preventative medicine.
I also agree that if you show up sicker than :censored::censored::censored::censored: on a US hospitals door step that we probably have a better chance of saving you than maybe the UK or Canada. However the UK or Canada may have prevented that illness from occurring, or follow up care will probably be better should the pt recover.
I have worked in an inner city area with a lvl 1 safety net hospital, and yes these homeless pt's get the care they need to survive, but that's it. Also their care (while cheap compared to a non-homeless person) is still financially devastating, which is an issue that neither the US or the UK has.
Politics aside, believing that our current system is working is simply an exercise in ignorance.

Now that we have gotten sufficiently off topic I will add my 2 cents on EMTs. I think all BLS care in the US system, while not ideal, would be adequate for an urban setting. ER's are often so close that BLS skills will sustain a patient until they get to the ER. However I think ALS should be the minimum for any community, if they can afford to have cops they should also be able to pay for a paramedic.

 

[Level1pedstech]

Baloney. We have been practising Socialised medicine in Australia for decades. It's not without its problems but any citizen or permanent resident can receive primary or emergency care without having to worry about paying a $10,000 for a bed for 12 hours, a CT scan and a few blood tests.

We also have the option of having private health insurance like in the states to attend private hospitals for both emergencies or procedures. No waiting for weeks if you are insured.

I agree that we probably pay higher taxes than US residents, and yes, many dollars are wasted by an inefficient bureaucracy. Without health, what do you really have though?

The majority of us want nothing to do with socialised or government run health care. The majority of my fellow americans were against the passing of Obama care but it was forced on us,had there been a chance to vote on a national level it would have been defeated. Many of those backing the plan are not sure what it really offers,they openly admitted to never reading the complete 2700 page bill. The house speaker stood before the american people and with a straight face(no pun intended) said "we need to pass it to see whats in it". The majority of us are of the mind that "if it aint broke dont fix it". Our system pre Obama care is not perfect but I have yet to see people fleeing to Australia,Canada or the UK to recieve quality healthcare. Glad it works for you but you can keep it.

I laid out my arguement based on years of observing people receiving high quality health care in a privately run system that served a wide demographic. One thing that I will agree with you on and that is the importance of general over all good health. Sadly we have a lack of it here in the US,this is an area where we could learn from other countries.

By far the biggest drain on my former system were those who suffered the health complications related to poor life style choices. Behind that is the tremendous strain the illegal immigrant population continues to put on almost every facility on the west coast. Facilities that should be open and available to all have been closed because their resources to operate have been pissed away in large part on people who are here illegaly or who for whatever reason could just not make good choices.

But because we turn away no one and because we treat all equally those of us that maintain good health and lifetyle choices are forced to live with what remains. Once again its not without problems but I still believe it is the best in the world.

 

[mycrofft]

Is this because of America's health culture is aimed at rescue, and many Americans abuse drugs and live in poverty and have rejected any sort of regulated diet and/or do not engage in anything much more strenuous than lifting the remote and rocking back their recliner?
And to sound a more sinister, eugenic but pragmatic note, we also support, accept and recuse many with lethal genes or lifestyle that pass on to their children ( and may even pass on to their neighbors).

Also, don't some countries fudge their statistics? (Such as the USSR/Eastern Bloc and many Muslim countries OFFICIALLY reporting for years there was no HIV, alcoholism, suicide, etc).

 

[Level1pedstech]

Bro...I get the big picture. I have a college degree in the big picture. So please don't talk condescendingly to me about public finance and tax spending, I just spent four years studying it.

There are municipalities that have been run like absolute crap, no question. But there's no reason to punish the citizens inside for the actions of a few incompetent politicians. And you can't expect Detroit to be protected effectively by volunteers.

Look, we clearly disagree on this, and I don't think either of us is going to convince the other that we're right, so let's get back to talking about basic technicians as opposed to government healthcare and taxes.

Never meant to adress you in a condescending manner,I assume we all have mutual professional respect even if we share different views. My time is valuable and I would not take the time to participate in these discussions if thought I would easily win all the battles.

Good to see you have taken the time to become educated but your four years of higher education cant touch my real life experience. In thirty years we can have a few beers and I can almost guarantee we will be closer in agreement,it just happens.

 

[mycrofft]

Edit to comment above" RESCUE not "recuse".

I want my Windows XP back. Wah.:angry:

 

[Level1pedstech]

Is this because of America's health culture is aimed at rescue, and many Americans abuse drugs and live in poverty and have rejected any sort of regulated diet and/or do not engage in anything much more strenuous than lifting the remote and rocking back their recliner?
And to sound a more sinister, eugenic but pragmatic note, we also support, accept and recuse many with lethal genes or lifestyle that pass on to their children ( and may even pass on to their neighbors).

Also, don't some countries fudge their statistics? (Such as the USSR/Eastern Bloc and many Muslim countries OFFICIALLY reporting for years there was no HIV, alcoholism, suicide, etc).

Most of us who are involved in health care know that people will often wait until the last minute to seek treatment even when early treatment is readily available. This of course is why our ER's are bulging at the seams with people that would have been better treated at a doc in the box or a community clinic a few days earlier.

The patient whos common cold or flu that could have been handeled at home with fluids,rest and some OTC meds is now leaving the ER with a big fat bill and a set of simple instructions for rest,plenty of fluids and treat the symptoms with some OTC meds ( generic motrin will be fine). I have seen this scenario play out in the pediatric emergency room on a regular basis. These simple cough,colds and sniffles patients once they enter the system usually will get a consult,chest film,fluids (IV or oral) and motrin. Most of this is CYA on the hospitals part.

I have always had a hard time buying the arguement that we offer great critical or emergent care but fall short in the area of preventitive or general care. Its been my experience that especially in the last twenty years we have made a huge effort to offer early education and have put in place safety nets to help those that cant or wont help themselves. Pre natal care,well baby check ups,early childhood immunizations are just a few things that give all new americans a fighting chance. These services are easily found and are available to all.

We have an ever increasing number of our fellow americans that are fat and lazy. Even with the flood of available resources and information people continue to partake in activities that will eventually kill them. Those of us that eat right and exercise regularly are far out numbered by those who dont. Life style related illness and disease are becoming common place and even after we treat and educate these people most continue on with the bad habits.

 

[usalsfyre]

Level1peds,

I could type a couple of pages on the issues with your arguments, but what it essentially boils down to is your far too focused on EM and not accounting the bulk of medicine. Expand your horizons a bit.

 

[Tigger]

Good to see you have taken the time to become educated but your four years of higher education cant touch my real life experience. In thirty years we can have a few beers and I can almost guarantee we will be closer in agreement,it just happens.

I too have about finished my degree in the "big picture," and it does touch your thirty years of life experience because when you study something, you have to go a bit beyond "in my experience" to see if there is a problem. You state that you believe that our healthcare system is the best in the world, yet we fall short of nearly every accepted measurement standard on healthcare performance. It just simply isn't enough to say "I've been in healthcare in thirty years, and I say it's great." That's just not a tenable position, given that you have no evidence to support such a position beyond your personal experiences, which are neither reproducible nor verifiable.

I may not have thirty years of life experience but don't think for a second that I don't know what I am talking about and that eventually will see the error in my ways. There's a lot more to medicine than just EM, and there's a lot more to studying to something than just saying "I know this is true because I have seen it."

 

[Level1pedstech]

I too have about finished my degree in the "big picture," and it does touch your thirty years of life experience because when you study something, you have to go a bit beyond "in my experience" to see if there is a problem. You state that you believe that our healthcare system is the best in the world, yet we fall short of nearly every accepted measurement standard on healthcare performance. It just simply isn't enough to say "I've been in healthcare in thirty years, and I say it's great." That's just not a tenable position, given that you have no evidence to support such a position beyond your personal experiences, which are neither reproducible nor verifiable.

I may not have thirty years of life experience but don't think for a second that I don't know what I am talking about and that eventually will see the error in my ways. There's a lot more to medicine than just EM, and there's a lot more to studying to something than just saying "I know this is true because I have seen it."

My experience has been that as patients pass thru the emergency department its possible to get a snap shot of how our health care system is working. For example are we seeing a larger number of chronically ill patients in our inner city area due to lack of available services or is it that some people no matter how much care is available just will not help themselves and eventually end up in the ER.

Having spent the majority of my time working in pediatric emergeny medicine I have over the years seen huge improvements in the general health of our kids. This I owe to the availability of pre natal and well baby care to those that need it regardless of their ability to pay.

I admit to not having poured over tons of research and cant throw out statistics to back my observations. Because traditional learning has always been a challenge I have tried to use the real world as my course of study. Asking questions of the advanced providers and always being available to learn something new. Maybe I am missing some pieces of the puzzle and should seek a wider perspective?

So help me out, give me the top three issues or problems that you think are negatively affecting our health care system and let me see if I truly am centered on emergency medicine. Remember that I have pointed out in most every post that our system is not perfect and there is always going to be room for some improvement. I just dont see the large scale critical failures I would expect to see if as you say we are falling short in multipile areas.

 

[DPM]

The last few pages are very interesting, but not exactly relevant to the topic... "Why Basic level Technicians?"

Perhaps a new thread for "What's wrong with the US healthcare system?"

 

[rescue1]

So help me out, give me the top three issues or problems that you think are negatively affecting our health care system and let me see if I truly am centered on emergency medicine. Remember that I have pointed out in most every post that our system is not perfect and there is always going to be room for some improvement. I just dont see the large scale critical failures I would expect to see if as you say we are falling short in multipile areas.

The US healthcare system isn't suffering from critical failures (though some to the far left would probably say it is), it's just an inefficient system based around older government programs that have never been changed to reflect advances in preventative care or current laws. Remember, government healthcare makes up 21% of the yearly federal budget (as of 2011), more then any other expenditure (including the military). That's like $750 billion a year. Which is a lot of money for how little coverage it provides.

Basically, my issue with US healthcare is this: We spend the most per-capita on healthcare then any other nation in the world (between insurance and government assistance, I think over $7,000 a person) and have lower life expectancy, high child mortality rates, and higher obesity then all the other western democracies.
This is mainly because of ERs being forced to treat all patients regardless of payment ability. Now, I'm not advocating casting poor people out in the cold to die, but when the government passed the Emergency Care Act in 1986, they failed to provide a revenue stream for hospitals to compensate for all this free care they were giving out. Which drove up prices for you and me, people who have health insurance and pay our bills. So basically, we have free healthcare, funded by you and I through our pants-:censored: ingly high medical bills, in an environment meant to deal with emergencies that instead has to treat people with runny noses and constipation in addition to STEMIs and trauma.

There is also that category of income where you have too much money to qualify for Medicaid or to blow off medical bills, but not enough for insurance. Then you can face bankruptcy very quickly through medical bills if you have a sudden medical issue.

The system could be better optimized if we realized that we're already paying for other people's healthcare, and then took that money and spent it on preventative care, clinics that people could use instead of clogging the ER, and that kind of thing. There will be a trade off--the more people you incorporate into the system the longer lines will be, but there are some fixes for that (private hospitals/insurance, like Australia has).

Keep in mind I'm very tired when I wrote this, so it may be riddled with errors, but I think that basically sums up my problem.


And yeah, this should probably be a new thread...