Reform Healthcare and EMS

[Bloom-IUEMT]

I've been a bit surprised on the lack of debate in this forum about Healtcare reform considering it rages everywhere else and the fact it will effect your job.

I understand the issue was brought up before and the thread was closed due to heated debate (and I don't believe in Godwin's law because sometimes a person warrants a comparison with Hitler, lol). It's really something that needs to be discussed no matter how controversial and how passionate the arguments get.

I am curious though how you think Healthcare Reform will effect EMS specifically, regardless of what your political standing is. It seems as though it's often asked of citizens and politicians how reform should proceed but not often asked of those on Healthcare's frontlines: those employed in healthcare.

I believe Healthcare should be universal and guaranteed regardless of your social class or state of health. I also believe (or rather theorize based on evidence) that universal healthcare will improve patient outcomes and that this has been demonstrated in other countries.

And, in regards to EMS--- my service is hospital based and actually loses money because of Medicare/Caid and the uninsured. The hospital is gracious enough to put up loses because they believe the service is so imperative to the community. I think that with the new reform in place, our service, and many other services that are non-fire based, would see in increase in revenue. However, this reform that is being debated right now would need to be reevaluated every year in terms of its reimbursement rates which is only 9% or Medicare's reimbursement. If the reimbursement stays at the current proposed rate it will eventually destroy any non-FD based EMS services.

I am really curious to know what people working in EMS think about reform AS IT PERTAINS TO EMS regardless of political standing.
Play nice

 

[PapaBear434]

Personally, I want the last thing people have to worry about when they call us is if they can afford the bill or not.

But my opinions on this matter were more than covered in the other thread, so I'm just going to leave it at that. I've been responsible for enough closed threads.

 

[Ridryder911]

I don't believe anyone is against universal healthcare, it is the mannerism of how it is going to get paid that matters. It is a nice theory to believe it is a right (although it is not), and yes would be great if money really did not matter... but; that is a delusion and not reality. Medicine is a business and BIG business.

The OP described his hospital takes a hit by having EMS, which is probably true as Hospital based EMS can only received partial of reimbursement rates in comparison to other EMS agencies. Now, with that saying; would the OP agree to take a cut in pay or work multiple jobs to fund such programs as his current EMS?

Again, it is not the problem that people disagree rather it is the way to fund the correction. One has to live in a fantasy world not to understand that money does not "suddenly appear". I was watching C-Span today on the Senate debate, as one Senator described the proposed health care plan would start taxing immediately next year, but; that no one could start the benefit portion until four years from now. See a little misappropriation?

Very simply, the Government is a poor manager of any programs (look at the simple clunker program) and we would expect any better in health programs (again, prime example is VA hospitals)?

EMS is just a small pimple on the whole picture of healthcare. Truthfully, I would not see any advantages of government programs. The upswing is I would see EMS progressing in providing more holistic care and expanding their role .... without any major additional funding rather to keep in existence or be required to. Regionalization would almost have to be mandatory to ensure everyone access to the system (hey, maybe it would be better after all).

The downsize I believe is that you will see a major shift in financial culture. Those with money will go to private hospitals with specialized physicians (alike now, but more prominent) and such specialities as neuro for trauma would almost be a thing of the past except for teaching institutions (until they can fulfill their fellowship). This is happening and increasing already as exclusively specialized physicians and surgeons refuse to participate in trauma care due to poor funding and reimbursement rates. What do you think will happen, when there is cap placed onto reimbursement?

R/r 911

 

[piranah]

how about reform privatized healthcare so it is affordable to a broader spectrum..i do not think universal healthcare is the answer because i have allot of experience with the VA system. I have to say im not impressed.look at canadas system,why do you think people come down here for critical care.there is an answer besides universal healthcare, just because you wish it will cost nothing doesnt mean it will.....

 

[PapaBear434]

Well, no one is arguing a universal health care. Well... I am. But no one in the government currently is. We are instead rearranging the chairs around this gigantic elephant that is the health insurance industry.

Besides, we aren't trying to nationalize health care. We are trying to make the INSURANCE more affordable. The care itself is not going to be touched.

 

[EMTinNEPA]

Healthcare is not a right, as so many people would like to believe. Sure, lots of us need it to survive. But we all need food, and I bet that if you walked into Burger King right now and said "I'm hungry", they would provide you with a list of their cuisine, with a price next to every item.

 

[PapaBear434]

Healthcare is not a right, as so many people would like to believe. Sure, lots of us need it to survive. But we all need food, and I bet that if you walked into Burger King right now and said "I'm hungry", they would provide you with a list of their cuisine, with a price next to every item.

That's a pretty simple argument. Are you saying that everyone doesn't have the right to food? We have government funded shelters and soup kitchens right now.

Just because you have the right to food doesn't mean you get to go into any restaurant and eat for free. But it does mean that there is food available should you not be able to pay for it, because no one should be allowed to starve to death in a country as rich as America.

Same thing applies to medical care. There is no reason someone should go without care for something like pneumonia because they can't pay, and no one should go bankrupt just because they had the misfortune to get into a car accident or get cancer.

 

[Sasha]

Healthcare is not a right, as so many people would like to believe. Sure, lots of us need it to survive. But we all need food, and I bet that if you walked into Burger King right now and said "I'm hungry", they would provide you with a list of their cuisine, with a price next to every item.

Of course you cannot have the food you want without paying for it, however there are things like food banks and soup kitchens available to help feed the hungry.

 

[eveningsky339]

A brief glance at how much having, say, a simple ultrasound done reveals a big part of the problem. When my wife had hers, it was $600. A vaginal delivery is about $3,000, and looking at the bill, only $1,000 was to cover the room and the equipment. The other $2,000 was to pay a doctor to come in and say "Push".

Let's face it-- most doctors are obscenely overpaid. After four years of college, four years of med school, three years of residency, and heaven knows how much debt, I can see why. ...But, when it costs $600 for a simple procedure, there are problems.

 

[Luno]

Health Care

Ugh, here we go again... Okay, my opinion is a little slanted, but here goes. Health Care (whether you agree or not) is both a right and universal in the US (as decided by law). Anyone in EMS should recognize this already, how many in the US are automatically turned away from Emergency Rooms because of an inability to pay? None. The reason why? They can't. They are obligated to treat. Hence Health Care is already universal and a determined right in the US. Unfortunately, in the model countries that we are trying to emulate, it isn't a right. Prime example is Canada, if you don't have insurance, you die. (an over simplification, but there are citeable examples) The debate while framed to be about "Health Care" has nothing to do with actual health care, it has everything to do with insurance. It also has a lot to do with insurance regulation, not health care. Here's an interesting article if you care to read about what the author believes is wrong with Health Care and Insurance. I think it's worth the read, it's titled "How American Health Care Killed My Father" here's the link... http://www.theatlantic.com/doc/200909/health-care Well, that's just my opinion for whatever it's worth...

 

[EMTinNEPA]

And if you go to a food bank or a soup kitchen, do you get tenderloin steak? Or do you get cheap food? If you want quality, you should have to pay for it. We have free clinics for those who can't afford anything else.

 

[PapaBear434]

And if you go to a food bank or a soup kitchen, do you get tenderloin steak? Or do you get cheap food? If you want quality, you should have to pay for it. We have free clinics for those who can't afford anything else.

Thing is, you can survive just fine off the food bank and soup kitchen fair food. Tenderloin tastes better, sure, but you will get the same life-sustaining nutrients from the beef stew in a can.

The free clinic isn't going to cover dialysis. They aren't going to be able to give you chemo. If you need an MRI, you are probably out of luck. Free clinics are good if you're having simple infections or a boil that needs to be lanced. Not so good for extended or chronic illnesses.

And that's completely ignoring the preventative medicine side of things. Check ups and the like.

 

[Sasha]

And if you go to a food bank or a soup kitchen, do you get tenderloin steak? Or do you get cheap food? If you want quality, you should have to pay for it. We have free clinics for those who can't afford anything else.

Free clinics are not hospitals, they do not fill rxs. There is no icu no cath lab no birthing center no vents. There is an array of expensive procedures they can't do. Appendectomy? LP? Tonsillectomy? Liver biopsy? Radiation? What do those people do if they can't afford insurance? Should we let them die?

 

[daedalus]

Personal responasbility. Two words that can fix American Healthcare.

 

[PapaBear434]

Personal responasbility. Two words that can fix American Healthcare.

Yes. Buzzwords solve everything, despite reality. They should have taken personal responsibility for themselves and not have selfishly went out and got cancer.

 

[daedalus]

Yes. Buzzwords solve everything, despite reality. They should have taken personal responsibility for themselves and not have selfishly went out and got cancer.

Common PapaBear, I think you know that anything I post I can back up.

Did you know that 80% of cancer, stroke, heart disease, and diabetes can be prevented by lifestyle choices?
http://thehappyhospitalist.blogspot.com/2009/08/how-can-you-reduce-your-risk-of-diabets.html

If we became responsible for our own health, we could prevent a large portion of disease and bring the cost of health care down in this country.

Do I think that women who get breast cancer or children with DM type I are responsible for their disease? No. They of course are victims of such terrible pathologies. However, is a 50 year old obese male who has a 40 pack/year smoking history and uncontrolled hypertension an innocent victim when MI strikes him? Is he entitled to treatment? Of course he is, along with all the compassion I can give as his medical provider, however, he is mostly to blame and should pay with his own money because the tax payers did not force him to eat his big mac everyday and wash it down with soda and a smoke. They also did not force him to sit on his couch in the morning instead of going on a jog.

By the way, jogging also equals a 50 % reduction in the risk of dying from cancer.
http://thehappyhospitalist.blogspot.com/2009/08/does-jogging-prevent-cancer.html

It is all about prevention when possible, and the key to a healthier america with less money being spent on healthcare is whole grain sandwiches, exercise, and quitting smoking.

 

[daedalus]

The fact that exercise, not smoking, and healthy eating prevents disease seems intuitive to most of us. However, evidence has very recently been piling up in controlled research that shows these things are more beneficial than we once thought. It seems like everyday I check my email, I have a new message from medscape about the cancer-protective effects of low red meat diets or the reduction of cardiovascular disease from 30 minutes of exercise a day.

By the way, I was born with a ventricular septal defect. At the age of 10, I was in full heart failure. It was not my fault. I had to undergo expensive open heart surgery to repair it. By contrast, if I develop coronary artery disease in the future, I have no one to blame but myself.

 

[PapaBear434]

You're covering a pretty narrow realm of health care. Some people are going to get diabetes no matter what they do, it's just in the genetic cards. Some people are going to get MS. Some people are going to be born into Huntington's. Others will be hit by a bus and be brain damaged for the rest of their lives.

Some people are kids of smokers, who grew up breathing in that crap against their will for their entire adolescence and now as adults have chronic bronchitis, asthma, and other issues.

How about others who have work place accidents? Get a finger cut off with a saw? Accidents happen. Should they go bankrupt just to pay for care? What if a logger's chain comes lose and rips apart his upper thigh?

What about a drywaller who ends up with COPD from breathing in the dust his entire career, even though he wore a mask every day but it can only do so much? We can't just say "Well, you shouldn't have done that job." We need drywall, and we need people to hang it.

This Libertarian fantasy land you live in is quite amazing, but unfortunately it's not real. What you are arguing is social Darwinism. It's new age Calvinism. If you have money, obviously you deserve to survive. If you don't, too bad, get on the ice floe and do us a favor and just die. You are better because you ate nothing but roughage your entire life, while this guy deserves to die and leave his grandkids without a grandpa because he decided to eat as an omnivore, as nature intended.

It's morally reprehensible to me that health care providers, who see people at their very worst and in times where they are most vulnerable and most in need, saying "Sorry, you ain't got the cabbage, you're not worth society's trouble."

 

[daedalus]

A pretty narrow realm of health care? Take a look at where our health care money is being spent dude. well over 70 % is managing COPD, cancer, DM and its complications, and heart disease. 80 percent is not narrow no matter how you cut it. Cancer, stroke, heart disease, and diabetes are by far the costliest and deadliest medical problems facing america excluding trauma. Also, while genetics play a major role in disease, the actual expression of genes that code for increase chance in disease can be prevented by lifestyle choices. Pretty cool actually.

Diseases like MS and huntingtons are very rare and are not costing americans billions of dollars so I do not see how they factor into our conversation. Like I said, no one blames these people for their disease, they are victims. It is also fortunate that they are rare enough to not be causing significant financial stress of the country.

If we teach our children the importance of healthy living, and we all practice it ourselves, we will cut our health care spending. The science says so. We will also live longer and have a better sense of well being. Liberal or conservative, I do not see anyone arguing with that. Ill take an 80 % reduction in the risk of significant disease any day.

This Libertarian fantasy land you live in is quite amazing, but unfortunately it's not real. What you are arguing is social Darwinism. It's new age Calvinism. If you have money, obviously you deserve to survive. If you don't, too bad, get on the ice floe and do us a favor and just die. You are better because you ate nothing but roughage your entire life, while this guy deserves to die and leave his grandkids without a grandpa because he decided to eat as an omnivore, as nature intended.

It's morally reprehensible to me that health care providers, who see people at their very worst and in times where they are most vulnerable and most in need, saying "Sorry, you ain't got the cabbage, you're not worth society's trouble.

This upsets me. I said nor implied any of this. I am afraid you are wrong about quite a few things as well. Man was not designed to be an omnivore, please take a look at Dr. Oz's book (YOU on a diet) for comprehensive discussion on the natural diet of the human. It is a great book written by a surgeon and you come away with a deeper understanding of GI physiology. Humans once were hunter gathers and spent at least 30 minutes a day walking for food, which consisted of nuts and berries with red meat around 3 times a week. This kept us lean and healthy. Fast food on the other hand is a whole different beast and nature never intended it.

Also, every one is entitled to medical care. I never said any one is deserving of anything but the best care including the CABG, and all the compassion I can offer them. However, I would be remiss if I did not educate the patient that future problems could be avoided by eating healthy and quitting smoking. Prevention is better for grandpa that surgery he may not recover from.

 

[JPINFV]

This Libertarian fantasy land you live in is quite amazing, but unfortunately it's not real. What you are arguing is social Darwinism. It's new age Calvinism. If you have money, obviously you deserve to survive. If you don't, too bad, get on the ice floe and do us a favor and just die. You are better because you ate nothing but roughage your entire life, while this guy deserves to die and leave his grandkids without a grandpa because he decided to eat as an omnivore, as nature intended.

It's morally reprehensible to me that health care providers, who see people at their very worst and in times where they are most vulnerable and most in need, saying "Sorry, you ain't got the cabbage, you're not worth society's trouble."

...and the liberal fantasyland where money grows on trees and no one has any personal responsibility is even more amazing. Really, read through the constitution and tell me where you have the right to take everyone elses money to treat your poor choices?