Do we REALLY save lives?

[rescue1]

Few fires will burn city blocks, even in urban cities. you put the tower up, surround and drown, and the city block is saved. usually the loss is just a house, maybe an exposure if the delay is that great. but it isn't a city block unless there are other factors at play.

Yes...because they have a fire truck to do that. I'm not talking about "oh god, if we brownout an engine company everyone will die". I was talking about not actually having a fire department. Like, at all.

Besides, this is a minor point to the discussion. I'm not advocating cutting EMS funding to fund new fire apparatus, I'm not suggesting that the fire department is somehow better then EMS or "saves more lives". I'm using the fire department as an example of a service that produces, for the most part, easily noticable results. When the fire engine shows up and puts out a fire, it's easy to say "This is what the firefighters did and why it's good that they did that." I can compare two departments and say that one puts out fires faster and more safely than the other. I can do the same with plumbers, electricians, and restaurants too, the example doesn't change.

Here, lets look at it this way. Pretend that you have to sell your paid ambulance service to my town. How do you convince the Big Cheeses that your paid ALS ambulance will be worth the extra tens thousands of dollars to the town compared with an unstaffed BLS volunteer ambulance which we have now.

Forget the fire department and the cops, just answer me that.

 

[Handsome Robb]

This has nothing to do with being a hero...it's about the effectiveness of a well run professional EMS system compared with a poorly managed EMS system in the the current US system, in which EMS exists primarily as a vehicle to transport patients rapidly to a hospital.
How can I justify (mainly in my mind) how a professional, fast, well trained ALS service is significantly better then a volunteer squad with a slow response and minimal training, with chase ALS a ways away? Basically see my second post, where I explain my point a bit better.

I'm not a whacker wanna be who's upset that I can't save people every day like they do on Trauma, trust me.

Also, I'm not saying that fire threatens us on a hourly basis and could destroy cities at any second...I'm just saying there is a real and measurable consequence to not having fire protection.

Sorry I shouldn't have snapped. Working 84 hours a week between clinicals and work has made me a bit ragged.

Agreed many EMS systems are run backasswards in this country, however many run just fine.

People might hate me on here because I always reference my agency but when we are having door to ballon times of 20-25 minutes when we call a STEMI alert we are doing something right. Do we have longer times than that? Absolutely but It is rare to have a time of greater than 45 minutes. Hell often we get Pt contact to ballon times of 45-60 minutes with routine transport rather than lights and sirens. Time is tissue. Is EMS abused, I agree and many systems need a reconstruction on their operations. My point is I don't know many volley agencies who are able to make things like this happen.

 

[Veneficus]

If I could point out...

Everyone, in every industry, has to justify their value everyday.

EMS is not an exception to this.

 

[rescue1]

Sorry I shouldn't have snapped. Working 84 hours a week between clinicals and work has made me a bit ragged.

Hey, don't worry about it. I'm running on little sleep too and I have a medic school entrance test coming up, so I'm in the same boat.

 

[RocketMedic]

*Points at Detroit*
Fire and EMS done correctly do a lot more prevention than response, and without a robust law-enforcement arm...

no its not. I shot all your points full of holes, you just refuse to realize them. and your not alone, the FD and PD unions are great fear mongers. don't fund the FD, and your house will burn down. don't fund the PD, and you will become the victim of a crime. that's the argument.

it's very easy to quantify ambulance service. if you don't have EMS, you have a greater chance of not recovering if you experience a medical emergency or a traumatic injury. the difference is, most people don't think they will ever need EMS. As such, they don't want to pay for EMS, because they don't want to pay for a service that they will never need.

the difference is, FD and PD don't have any confidentiality issues like EMS does. FD or PD delivers a baby, and it's news. EMS does, and it's not. FD saves someone with a defib, and they tell the media. if EMS does, they can't. if someone gets shot 12 times, the PD usually has a statement about what happened.... EMS rarely speaks to the press, and has the misguided notion that no news is good news. no one thinks they will ever need EMS, and few people (outside of those IN EMS) actually know what EMS does.

Few fires will burn city blocks, even in urban cities. you put the tower up, surround and drown, and the city block is saved. usually the loss is just a house, maybe an exposure if the delay is that great. but it isn't a city block unless there are other factors at play.

think of it this way: if EMS doesn't do anything, and should need to justify their existence, why have EMS calls nation wide steadily risen in numbers in the past 40 years? apparently someone keeps calling for EMS and more and more people are calling them.

 

[RocketMedic]

Simply put, ALS saves lives sometimes. What's the mayor going to say when his daughter goes anaphylactic at her school or little Timmy chokes on meat or Mr. Oldrichwhiteguy spends three hours onscene with an MI because no one assesses the possibility of MI? Or Mrs All-American and family linger in horrible pain for an hour because they wrecked 30 minutes from a city at 1700?

When in doubt, copy fire and paint a bleak picture of a world without ALS while we present our best image to the public.

 

[Veneficus]

Simply put, ALS saves lives sometimes. What's the mayor going to say when his daughter goes anaphylactic at her school or little Timmy chokes on meat or Mr. Oldrichwhiteguy spends three hours onscene with an MI because no one assesses the possibility of MI? Or Mrs All-American and family linger in horrible pain for an hour because they wrecked 30 minutes from a city at 1700?

Well, he could say:

"While this may seem like a tragedy, your taxes are the lowwest in the Western World, so the Smith family has made a great sacrifice in the American dream of the government not taking your money."

A flag, a wreath, and a rock with an empassioned speech about being a self sacrificing hero is a lot cheaper than ALS.

Or he could say "Only in socialist countries does the government take your money and give it to your lazy good for nothing neighbor, so if Timmy chokes and dies, his family should have gotten a better job to pay for the concierge doctor to respond like I did when my daughter was having an alergic reaction."

How about?

"If little timmy was working as the school janitor or shining shoes on the corner instead of being at school, he would be able to afford his own healthcare coverage. Since he can't, let him die." (The people at republican debates seem to think this is cool.)

"Maybe Mrs. All American and family should go to church and ask them to pay for their EMS and medical bills like they did back in the 50's. It's not the government's problem"

Will this suffice or do I need to type up a few more?

 

[RocketMedic]

Well, he could say:

"While this may seem like a tragedy, your taxes are the lowwest in the Western World, so the Smith family has made a great sacrifice in the American dream of the government not taking your money."

A flag, a wreath, and a rock with an empassioned speech about being a self sacrificing hero is a lot cheaper than ALS.

Or he could say "Only in socialist countries does the government take your money and give it to your lazy good for nothing neighbor, so if Timmy chokes and dies, his family should have gotten a better job to pay for the concierge doctor to respond like I did when my daughter was having an alergic reaction."

How about?

"If little timmy was working as the school janitor or shining shoes on the corner instead of being at school, he would be able to afford his own healthcare coverage. Since he can't, let him die." (The people at republican debates seem to think this is cool.)

"Maybe Mrs. All American and family should go to church and ask them to pay for their EMS and medical bills like they did back in the 50's. It's not the government's problem"

Will this suffice or do I need to type up a few more?

Remember that for the public the system generally works, and many of us are insured. Cutting ALS service will not be seen as politically possible when fire departments and private ambulance services lobby to keep paramedics. Most American s want care, even if it means a bill. You can't paint a national system like ours that is so fragmented in one stroke.

Not having ALS drops you in the 1950s and prompts ALS.

 

[Veneficus]

Remember that for the public the system generally works, and many of us are insured..

:rofl:

I think you need to do way more research on Americans without insurance and underinsurance.

Additionally, in every nation throughout history, people at the lower end of the economic spectrum are sick/injured more often more severely, and can absorb less loss of production capacity. Which means your poorest people put the largest burdon on the system.

As for that insurance, as soon as you are out of work with an injury or illness for a couple of months, not only will you burn through your entire savings, you will lose your insurance, because the critical flaw in the US medical system is the only people who can afford insurance are the ones working. If you are working, you are generally not sick. (as for if you become sick, see the losing your insurance part.)

Next, when you retire or disabled, you become part of the government insurance, like medicare. Which means all the money you paid in premiums and the profits generated by such (which is how insurance works) is kept by a private company while your healthcare bills at that point get picked up by taxpayers.

In essence, in the civillian world, you pay your premium copay out of your wages, then you pay medicare tax, you are ineligible for medicare until you are disabled/past your productive work years, so you are literally paying twice for something you will only ever get once. (and as I said, never see a return on your insurance investment)

If you haven't noticed, medicare is unsustainable and every year there are new and creative ways required to cut it. Rather soon, it will require a significant reduction in benefits or tax increase. (Want to lay a wager on which it will be?) You will one day depend on those benefits unless you are independantly wealthy enough to absorb the inflation adjusted cost of healthcare out of pocket.

Not sure of your definition of "works" but that certainly doesn't meet mine.

Another "works" is since most people will use EMS once or twice in their life they cannot make an informed decision on whether it works or not. But in my experience, they are definately not getting what they think they are paying for. (like treatments that are harmful or do not work.)

Cutting ALS service will not be seen as politically possible when fire departments and private ambulance services lobby to keep paramedics. Most American s want care, even if it means a bill.

I would like 2 types of steak for dinner along with some Russian black caviar and a bottle of Dom. But I am not getting it even if it means a bill. You know why? Because I cannot afford to pay the bill.

Now if the supplier billed me and I defaulted, then the supplier will go out of business. Which means the next person or time I would like such a fine meal, there will be nobody there to sell it to me. Medicare, private insurance, and private pay all work the same way. If the payer defaults, the supplier (EMS, hospital, Doctor, etc) all go away.

You can't paint a national system like ours that is so fragmented in one stroke.

Yes I can. Very accurately, watch.

The US healthcare system is a private pay system. Money always has to change hands. Sometimes that money comes from tax payers, who share the cost of paying the care. (EMS to hospital) Private insurance companies, who not only need to maintain liquidity but ever increasing investor profit margins in order to stay in business to pay again, or it comes out of the individuals pocket.

Which means, when tax dollars alone will not cover the cost of responsive ALS ambulance, and it becomes so expensive that other payers can't either. ALS ambulance is going away or becomming strictly pay to play. (probably as a subscription service upfront)

Not having ALS drops you in the 1950s and prompts ALS.

I have said it many times, but here it is again.

ALS is not a need, it is a want. It is a higher level of care with fancy bells and whistles. You may need a ride to the hospital, you may want a paramedic. But if you can't afford the later, you will settle for the former.

Starting to see how this works now?

Medicine was created to protect and preserve wealth. When medicine costs more than the loss of a certain level of wealth, it no longer benefits anyone to have it. Think of it like this:

If generation A works hard and passes down a house (shelter) and money generating resources (like investments) and even cash, Generation B does not have to work to reproduce these assets. Which means what Generation B produces increases the family standard of living. (and generation C so on down the line.)

If the good people in generation A wind up with a sickness that costs more to treat they assets they have, they lose all and generation B starts over from 0. (this perpetuates poverty.)

But let's say generation A is now 65-80 years old, and wants to break the poverty cycle. You know what that means when they get sick?

It is more beneficial for the familiy if they die than to pay for medicine.

If generation B decides they will be altruistic and take care of generation A, at some point, the cost of that care will be so high, that thier production does not match their consumption.

Elderly, out of work, working adults, and children are all consumers.

Working adults are the only produces.

When consumptions outpaces production, it leads to defualt and contraction. If you are alive in the modern US, you definately should understand how that works, because it is happening to you.

Imagine that in healthcare.

People can no longer pay for the cost of cardiac bypass, so the hospital stops offering cardiac bypass. Now you need cardiac bypass and you cannot find a supplier. By chance you manage to locate one, but since so few people actually can afford it, he has to charge more for the people who can.(Regardless of outcome) So if he charges more than you can possibly pay, even if you liquidate all of your extended family assets, you can't have it.

Nobody is going to give you a loan, becuase it would be an unacceptable risk to the lender. After 40+ years of messing yourself up, you have to be returned to a level of function that you could continue in a job long enough at a high enough pay to pay back your debt. At 65+ after a CABG, that is an unacceptable gamble for a lender.

You can spout all day about altruism, doing the right thing, etc.

But money talks and BS walks.

Show me the money.

 

[rescue1]

Remember that for the public the system generally works, and many of us are insured. Cutting ALS service will not be seen as politically possible when fire departments and private ambulance services lobby to keep paramedics. Most American s want care, even if it means a bill. You can't paint a national system like ours that is so fragmented in one stroke.

Remember that you are talking about the US healthcare system--the one that spends more money per capita then most other countries while providing less overall care.

 

[RocketMedic]

American health care is not perfect. However, I do not see the entire system collapsing into rubble where only EMT-Basics take their 1997 E350 into the wastelands of abandoned hospitals to see faith healers.

Communities invest in ALS services every day, and those services do save lives. The proliferation of ALS service since the 1960s is proof that our communities do want more care than AEDs, Epi-Pens, and Kerlex.

By Veneficus's standards, it's too expensive to actually have or staff a complete ER when an urgent care clinic will take care of 90% of the patient population. It's not economically effective to go into pediatric oncology when the cost of care far exceeds that child's likely lifetime earnings. You could argue that 3 years of medical school is "enough" for most of what a doctor usually sees and save some money there too.

Cost is important, but some things are not solely cost-governed. As evidenced by the existence of EMS, some things are not cost-effective, but they are morally deemed necessary by their communities.

Medicine in America is expensive because we have a lot of problems, a lot of old people, and a lot of tests/procedures in our treatment pathways. A lot of those are redundant, but a lot are not. Does the average headache in the UK get a CT scan, for instance? Many hospitals here in the US do it, even as a rule-out. Sometimes it catches something, most of the time it doesn't. The only real changes I think need to be made are a massive emphasis on preventive medicine and end-of-lifespan care.

Personally, I'd rather spend a little more and have world-class medical care when I need it than a poorly-run socialized health-care system where I'm not "productive" enough to rate ICU time. To tie care to cash directly is immoral from my perspective.

 

[systemet]

Medicine in America is expensive because we have a lot of problems, a lot of old people, and a lot of tests/procedures in our treatment pathways. A lot of those are redundant, but a lot are not. Does the average headache in the UK get a CT scan, for instance? Many hospitals here in the US do it, even as a rule-out. Sometimes it catches something, most of the time it doesn't. The only real changes I think need to be made are a massive emphasis on preventive medicine and end-of-lifespan care.

* Is the US population significantly older than other first world countries? This is within the realms of possibility, but seems unlikely to be a major contributor to the cost of US health care. I'm sure a quick google around could find any number of industrialised countries with similarly old populations, with lower per capita costs.

* Is the population more sick? I honestly don't know, but a question that needs to be asked at the same time is "Are they more sick due to a lack of timely access to primary care and preventative medicine?". Because if that is the case, it's a fault that's directly related to the distribution of healthcare resources. In that case, the reason the system is expensive, is because it's poorly designed. So this might be a dependent variable.

* A lot of diagnostics? I think this may be true. This is where medical tort law threatens to turn the entire conversation into a side show. If you risk a multi-million dollar settlement for a missed aneurysm, then doing a lot of unnecessary CT scans becomes economically rational. This issue is a little more difficult, because defensive medicine saves people with atypical presentations, but it does it at the cost of injuring a lot of people with typical presentations, and making the entire system much more expensive.

I think if I was arguing your side of this, I'd be focusing on obesity and related diseases as driving the cost up, and on the effects of poverty and drug addiction. But let's be realistic, the reason it's expensive here is that your system is run for profit by a bunch of insurance companies and privately owned hospitals and health centers. Each of these has CEOs, and managers, and a healthy level of bureaucracy. They have shareholders who need to see good numbers.

Personally, I'd rather spend a little more and have world-class medical care when I need it than a poorly-run socialized health-care system where I'm not "productive" enough to rate ICU time. To tie care to cash directly is immoral from my perspective.

Find a socialised health care system where ICU admission is based upon "productivity", in the first world. The only examples I can think of are places like China, which probably isn't a valid comparison. For example, tell me which of the 30+ nations in Europe you feel allot ICU beds based on socioeconmomic status. I'm not saying it doesn't happen somewhere, but if you think the German, French, English, Polish, Spanish, Italian, Czech, Slovakian, Austrian, Irish, Norwegian, Danish, Swedish, Icelandic, etc. systems work like this then you're confused.

I would suggest that the "tying cash to care" is more a characteristic of the US system. How much personal bankruptcy occurs due to healthcare costs? This doesn't happen in most other first world nations. I'm saying most, because I think there must be an example I'm missing somewhere. How much and what quality of care do the uninsured in the US get? This just isn't an issue in most of what the right wing likes to call "socialised medicine". To most people living in other first world countries the idea of getting sick, losing your insurance, and losing your house, savings, vehicles, etc. and descending into poverty, just isn't an issue.

I also want to spend a second asking you what "world class" care means? There's no question that patients are cared for at a high level in the US. But they are in lots of other countries, including many on the list above, and others that are missing, e.g. New Zealand, Australia, Japan, Canada, etc. On the same metric, where does US care for it's uninsured rate on a world scale? Would the average poor uninsured American be better off (from a medical perspective) in Cuba? One thing is defined, if you're planning on delivering a baby, the infant mortality rate is better in Cuba than in the US (marginally), but it's also better in about 40 other countries. What about life expectency? There's a similar argument there, with about 30 countries beating out the US, including the UAE.

It could be argued that many of these differences are due to the effect of a quality system for those who are insured being diluted by poor health amongst the uninsured. It seems likely there'd be a selection bias there anyway, that sicker people tend to become uninsured and would make the insured cohort look healthier. But if you want to talk about the US healthcare system, I think you're compelled to include both.

Please understand I'm interested in discussing this, and happy to be shown wrong on any of the above. None of this is intended in anger, and please don't take any of my opinions about the US healthcare system as being an attack on Americans in general, or on the USA. It's not intended that way. I just have a different perspective on how socialised and privately run healthcare systems work.

 

[RocketMedic]

Definitely pop-up I'm tied to the porcelain throne LOL. Captive audience.

American health care for the uninsured is very dependent on how sick that person is and what sort of help they seek. Acute episodes are managed as well as anywhere else, its prevention that we suffer in. Americans suck at self-preservation medicine-wise.

 

[Veneficus]

By Veneficus's standards, it's too expensive to actually have or staff a complete ER when an urgent care clinic will take care of 90% of the patient population.

Actually, the trend in ER service is to have an attached urgent care, which has a seperate designated staff and billing for the very reason of not requiring the actual ED resources on every patient which reduces the need for more resources and cost of them.

Another idea is the observation units that observe chest pain pts without elevated troponins so they do not tie up monitored beds in the hospital.

You really should look into this stuff, healthcare costs in the US are a very serious issue, as is how the emergency department is going to meet the demands and budgets of modern care. (one more reason I don't want to go into EM, then I would have to deal with this headache as more than an observer)

It's not economically effective to go into pediatric oncology when the cost of care far exceeds that child's likely lifetime earnings..

This statement is absolutely erroneous, pediatric oncology has a remission/cure rate approaching 80%. It is one of the most effective medical specialties anywhere in terms of both quality of life and productivity.

Quit trying to make stuff up to pull heartstrings.

You could argue that 3 years of medical school is "enough" for most of what a doctor usually sees and save some money there too.

You have a pssionate argument, but I don't think you are actually aware of the situation past your feelings. Any health system is required to keep costs under control. The US system has been out of control and on the verge of breakdown for many years.

If you are working in US healthcare I would really suggest you look into the problems faced.

As for mdical school, I think it should be 6 years.

Cost is important, but some things are not solely cost-governed. As evidenced by the existence of EMS, some things are not cost-effective, but they are morally deemed necessary by their communities.

I get what you are trying to say, but you don't seem to get that no matter what your morals, if you can't actually pay, you can't actually have.

Medicine in America is expensive because we have a lot of problems, a lot of old people, and a lot of tests/procedures in our treatment pathways. A lot of those are redundant, but a lot are not. Does the average headache in the UK get a CT scan, for instance? Many hospitals here in the US do it, even as a rule-out. Sometimes it catches something, most of the time it doesn't. The only real changes I think need to be made are a massive emphasis on preventive medicine and end-of-lifespan care..

:rofl:

You should ask some US medical professionals.

In any event, in no country is running every or especially expensive tests to "possibly catch" something, good medicine. Most tests in the US are not done for the patient , they are done for lawyers, it is called "defensive medicine" by trade name.

Personally, I'd rather spend a little more and have world-class medical care when I need it than a poorly-run socialized health-care system where I'm not "productive" enough to rate ICU time. To tie care to cash directly is immoral from my perspective.

But you do not have world class care.

3 examples I can rattle off the top of my head, but I am sure there are many.

In young or active people, biological replacement heart valves are superior as they allow greater activity and do not require life long anticoagulation compared to mechanical replacements. This increases not only quality of life, but also productivity. The draw back is that they have a 5 year life span, which means they have to be replaced.

In the system here (which is insurance based) if you qualify for a biological replacement, you get one, and it gets replaced on schedule and any complications managed.

In the US, largely based on legal fears and cost, most places (including some very reputable cardiac centers) will only put in mechanical valves because it saves money and reduces hospital exposure to liability. It is actually worse for the patient. The systemic anticoagulation makes the patient sicker and reduces the normal level of activity.

Is that what you call "superior" medicine?

Cardiac bypass in the US is most often done "on pump" to say a cardio bypass machine is used during the procedure. It nearly doubles the price of the surgery.

In the rest of the modern world, and even some not so modern places, bypass is done off pump except in special circumstances.

Now to cover the cost increase a US cardio-surg group did a study comparing on pump to off pump bypass. They claimed on pump showed better results, but a flaw in the paper was that since so few US surgeons use off pump bypass operations, they included all surgeons that performed as little as 10 off pump procedures. (the mean I believe was nealry 12)

Use your head, how many times do you think a person needs to perform a specific cardiac surgery to be good at it? (i'll give you a hint, most C/T surgeons do 3-5 operations per day) 10 is nowhere near enough to qualify the effectiveness of a procedure.

I absolutely love the hemodialysis vs. peritoneal dialysis argument. The British proved this point long ago.

Peritoneal dialysis is cheaper (by more than 5 times), leads to a better quality of life, and is effective to maintain that quality of life just as long as hemofiltration.

How often do you see US patients on peritoneal dialysis? (let me help you, almost never, because in the US hemo is the recommended)

Do you think spending your whole life and considerable monetary costs revolving around when you can pee is a moral quality of life? One you would like?

Do you think when the effectiveness of quality sustainment on hemo is over, justifies paying to haul around and cover the complications and cost of making sure Frankenstein can pee is good medicine? Even when these people cannot remain conscious for more than afew hours a day?

No offense man, but you seriously need more time/information of medicine if you want to argue about what is good medicine and the costs relative to it outside of ethnocentric propaganda and passionate moral conviction.

As for a collapse, you don't need to be a healthcar einsider, you ever hear the word "unsustainable" on the news when talking about medicare and prescription drug benefits?

Texas is one of if not the leading state in unreimbursed healthcare costs, ask some of your local hospital administrators how well that works.

As I said, save your convictions, show me the money.

(medical tourism anyone?)

 

[Veneficus]

its prevention that we suffer in. Americans suck at self-preservation medicine-wise.

and rehabilitation, and chronic disease management.

All of which increase the burdon on the system.

This is part of my point.

What you call "world class health" is BS.

Because somebody enacted an unfunded law based on moral conviction. (help the sick in time of urgent need) and neglected to care for these people after the acute crisis, instead of these people being "saved" and returned to life, they get "saved" and sent to disability.

With chronic conditions and rehab unaccessable, they get stuck in an endless loop of acute conditions that are never managed past the emergent event.

I am not against America, but I do have both an inside and outside look at how US healthcare system doesn't work.

 

[Hunter]

After I had been working for a few months I changed my view on what we do. Yes we do save SOME lives, but I don't think that should be our goal, I think our major goal is; to minimize the loss of quality of life.

 

[RocketMedic]

Looks like I got told, but I do know that I don't want to live under a government-socialized medical thing like the military healthcare system. We do deeply stupid things and it's not good for patients.

 

[systemet]

Looks like I got told, but I do know that I don't want to live under a government-socialized medical thing like the military healthcare system. We do deeply stupid things and it's not good for patients.

For what it's worth, I'm not trying to tell anyone how it is. I'm interested in having a discussion.

I'm just surprised at some of the opinions you hold. I don't expect to convince you to my point of view, especially as I think both our opinions are formed by our own life experiences.

It seems that you're assuming that "socialised medicine" in other countries works in a similar manner to the healthcare offered to the US military. I don't think that assumption is valid.

Other countries manage to provide care that's at least equivalent, if not superior, for a much lower per capita cost, using a publicly funded system. Myself, I could not imagine ever not being insured, or losing my insurance because of unemployment, or having this happen to a family member or someone I cared deeply about. That must be a very difficult situation to be placed in.

 

[Veneficus]

Looks like I got told, but I do know that I don't want to live under a government-socialized medical thing like the military healthcare system. We do deeply stupid things and it's not good for patients.

It's not about being told, it's about educating people to what is really going on so they can make rational decisions based on knowledge.

This past Holiday I had the pleasure of dealing with US military medicine. In my not always humble opinion they are not accountable for their care in any way. So if they provide poor care, so what? It is not like they will be punished, or sued, or that most people they "help" know any better.

I also noticed they are more interested in the niceties and ego of being an officer than they are patient care. Too much being called sir and ma'am and not enough earning it.

But I really think if you actually went abroad and looked at other systems from the inside and not from the propaganda that people with special interests want you to hear on tv, you may actually decide it is not so bad.

Then again, you may, but you will have made an informed decision. Not one based on emotion. Especially fear.

It seems to me that your journey in healthcare is rather new. That you have passion and want to do the best you can for the people you serve. There is definately no shame in that.

But many of us want the same thing. The only difference is we realize that doing the very best for as many or all of the patients we see requires us to get involved with where the money comes from and how it is spent.

If you stay in the EMS job for any length of time, you will see first hand the flaws in the system. Especially when you transport the same patient for the same thing the 100 time and find out the hospital did the same thing for him as the other 99 times.

It is about then you realize that these frequent flyers are not abusing the system, the system isn't helping them. But yet we keep spending money on what the system is doing for them.

A few years ago medicare decided it wasn't going to pay for patient care resulting from "preventable" complications. The hospital would have to treat these complications at their own expense.

In defense of the hospitals, what is considered "preventable" is extremely unfair. (some are regular and expected complications of procedures)

If you really want to see change, lobby medicare to stop paying for ED visits if the patient's condition doesn't get the required treatment and they are forced to return.