How will Trump effect EMS?

Tigger · Nov 10, 2016

Remi said:
As a pretty staunch libertarian and fiscal grinch, this is a tough pill for me to swallow. But it is true. Many people simply will not do what they need to do to take care of themselves, and unless we are prepared to start taking ICU patients who can't pay their bill outside to be dumped in the street, or refuse to let people who obviously really need care from entering the ED without cash payment in advance, then there has to be government programs to pay for their care.

Even if there aren't government programs to pay, costs will still be passed on to those that do pay.

Our rates are as high as they are because we need to use private insurance payments to make up for the below market reimbursement of Medicaid/care patients. Fair and equitable? Not in the slightest.

Qulevrius · Nov 10, 2016

Remi said:
Repealing the ACA would be a good start, but it has to be more than that. I think there have got to be lots of free-market(ish) ideas that if nothing else, would at least slow the rise of costs for a while.

So, purely theoretical - and this comes off of a conversation with another member of this community - there's a direct quote:

"Basically, it all comes down to subsidizing it => drawing a budget => deciding who's paying for it. A socialist model would be 'hey, lets raise the taxes and pay it from the haul'; this is what we have right now - people pay more and receive less, because the excess goes into paying for those who never paid and never received. A more sensible, conservative approach is to address the situation on a case-by-case basis - without going into specifics, it has to come down to promoting communal awareness, specialized education and have NPOs take care of CP (with very strict regulation and legislation)."

Expanding on the aforesaid:

1) the educational bar and subsequently, professional requirements for EMS professionals need to be raised;
2) EMS/CP budget has to come, at least partially, from municipal authorities. Would be much better to give [deserving] EMS professionals enough incentive to draw them away from private companies and into municipal EMS, but that's day-dreaming;
3) State/Federal approved and regulated NPOs whose leadership promotes health-related awareness and whose rank & file members provide for basic healthcare needs of a target community.

That way, at least, it's a case-by-case and not a shotgun approach. Incidentally, I believe this is nearly the exact model that Harvey Hall is employing right now (barring the NPO part).

CatrionaEMT · Dec 6, 2016

Frankly - nothing but good can come out of it. Socialism is a nice idea, too bad it doesn't work. The ER's are being treated like a doctors office, and health insurance costs have skyrocketed. This leaves us with people who abuse the system and/or are taking away from people that truly need the help.
I don't know a single EMT or Paramedic in my division that didn't vote for Trump. We were all heavy supporters - and know that it will help the economy, therefore helping health insurance, therefore helping ACA - helping people stop abusing. Then we can actually get back to our job and stop running as many "I stubbed my toe" calls... (although those are in number anyway).

EpiEMS · Dec 7, 2016

CatrionaEMT said:
I don't know a single EMT or Paramedic in my division that didn't vote for Trump.

Demography is destiny, as they say.

Aside from the demographics, though, I don't think we can be very confident in politicians fixing health care, one way or the other.

The ACA (with attendant Medicaid expansion) isn't to blame for heavy use, but it sure as heck didn't help - as we know from a piece of a wonderful study/natural experiment. We've committed as a society to pay for care for the indigent forever, and really put it on paper with the EMTALA for some 30 years (as an unfunded mandate). Clearly, insuring people doesn't help. Will the putative economic benefits of Mr. Trump's policy platform make things better? I give it a qualified yes. Yes insofar as that we will have more tax revenue to make good on our unfunded mandates, but no insofar as that the economy being better overall doesn't necessarily reduce overutilization of emergency services.

zzyzx · Dec 12, 2016

The fox has been let into the hen house.
EMS is my least concern.

DrParasite · Dec 12, 2016

CatrionaEMT said:
Socialism is a nice idea, too bad it doesn't work.

You sure about that? did you watch the same movie Sicko as I did? https://en.wikipedia.org/wiki/Sicko

Communism doesn't work, but I, for one, would love to see socialized medicine actually be applied in the US. It works in England, and many countries in Europe. Heck, it even works in Cuba. The ACA is a disaster, which can be blamed on liberals and those who want something for nothing, but that's another topic. But it did provide a means for people to get health insurance, if they wanted it.

I think Trump will be good for domestic businesses, but I don't see him getting re-elected in 4 years, especially if the democrats nominate a decent trustworthy candidate (which they failed to do this time)

EpiEMS · Dec 12, 2016

DrParasite said:
Communism doesn't work, but I, for one, would love to see socialized medicine actually be applied in the US. It works in England, and many countries in Europe. Heck, it even works in Cuba.

For what it's worth, socialized medicine isn't (politically) feasible in the U.S., except for that which we already have: Medicare (arguably), Medicaid (definitely is), and taxpayer subsidization for employer-provided health insurance. However, the fundamental constraint of a socialist system is what we as a society are willing to pay for a (selfish) individual. For example, England (the NHS) has very strict limits on the kind of care (read: cost of care) that is deemed societally acceptable. Can't really do that here, politically speaking.

If you think socialized health care works for everybody in Cuba, you're sadly mistaken: You can have a great ratio of physicians to population, a great ratio of nurses to population, and really well trained staff, but since they don't have the equipment and pharmaceuticals they need, they are basically back in the pre-antibiotic era...except if they resort to the black market. The point is, free health care is not free, and when it's "free", it's often not going to be good.

DrParasite said:
The ACA is a disaster, which can be blamed on liberals and those who want something for nothing, but that's another topic. But it did provide a means for people to get health insurance, if they wanted it.

To give the ACA its due, I will say this: It has improved *financial* security for a subset of people. However, it has done so at too great a cost - and we know that insurance doesn't improve physical health measures or outcomes, nor does it reduce utilization of emergency services (i.e. ambulances, EMS and the ED) for non-emergent conditions. Insurance is not care.

Carlos Danger · Dec 12, 2016

DrParasite said:
You sure about that? did you watch the same movie Sicko as I did? https://en.wikipedia.org/wiki/Sicko

Communism doesn't work, but I, for one, would love to see socialized medicine actually be applied in the US. It works in England, and many countries in Europe. Heck, it even works in Cuba. The ACA is a disaster, which can be blamed on liberals and those who want something for nothing, but that's another topic. But it did provide a means for people to get health insurance, if they wanted it.

I think Trump will be good for domestic businesses, but I don't see him getting re-elected in 4 years, especially if the democrats nominate a decent trustworthy candidate (which they failed to do this time)

How do you know socialized medicine works in Cuba? The accounts I've read all describe long wait times, run down facilities and old equipment, and chronic shortages of both qualified providers and basic medications.

I think socialized medicine appears on the surface to work well, but is fraught with all the problems that accompany any "free" program; namely, demand that outstrips supply. From what I understand, private healthcare is a rapidly growing industry in western Europe for those who can afford it.

EpiEMS · Dec 12, 2016

Remi said:
From what I understand, private healthcare is a rapidly growing industry in western Europe for those who can afford it.

The same holds true in Canada, I'm told. Heck, for what it's worth, in Canada, "Private insurance, held by about two-thirds of Canadians, covers services excluded from public reimbursement, such as vision and dental care, prescription drugs, rehabilitation services, home care, and private rooms in hospitals."

Qulevrius · Dec 12, 2016

People who never experienced socialized medicine, do not understand how it works. Basic healthcare needs are, indeed, freely accessible and if a person has something not particularly complicated (i.e. has to see a general physician), it's on a walk-in, 15-20 min wait time, basis. But once someone needs a specialist, it turns into a horror show, because - as it has been pointed out - the demand is much greater than supply, and people end up waiting months til they can get the service they need. And the only way around it is through the cracks in the system. Corruption, the hallmark of socialism - 'all animals are equal but some are more equal than others'.

Drwlemt · Dec 12, 2016

Qulevrius said:
People who never experienced socialized medicine, do not understand how it works. Basic healthcare needs are, indeed, freely accessible and if a person has something not particularly complicated (i.e. has to see a general physician), it's on a walk-in, 15-20 min wait time, basis. But once someone needs a specialist, it turns into a horror show, because - as it has been pointed out - the demand is much greater than supply, and people end up waiting months til they can get the service they need. And the only way around it is through the cracks in the system. Corruption, the hallmark of socialism - 'all animals are equal but some are more equal than others'.

Can't agree more military healthcare and now VA health care can be a nightmare depending what you need. Plenty of Ibuprofen though.

Qulevrius · Dec 12, 2016

Drwlemt said:
Can't agree more military healthcare and now VA health care can be a nightmare depending what you need. Plenty of Ibuprofen though.

Yep. Break the pill in half, 'this half is for headache, the other one is for stomach pain. Take the wrong one and you die.'

Carlos Danger · Dec 12, 2016

Drwlemt said:
Can't agree more military healthcare and now VA health care can be a nightmare depending what you need. Plenty of Ibuprofen though.

I truly can't believe how people can witness the DMV.....the IRS.....the VA......not to mention all the ways that hyper-regulation already contributes to making our "private" healthcare system such as mess.......and then actually want the government to take even more control.

DrParasite · Dec 13, 2016

Remi said:
How do you know socialized medicine works in Cuba? The accounts I've read all describe long wait times, run down facilities and old equipment, and chronic shortages of both qualified providers and basic medications.

I think socialized medicine appears on the surface to work well, but is fraught with all the problems that accompany any "free" program; namely, demand that outstrips supply. From what I understand, private healthcare is a rapidly growing industry in western Europe for those who can afford it.

Actually, I know very little about Cuba's healthcare system, other than what I have been told by some Cuban friends. Ditto Europe: my little brother lives in England, and every time I suggest he moves back to the US, he said the free healthcare is great for someone who has chronic Kidney stones, and having a baby is much cheaper than the $5000 it's going to cost me in the states with insurance.

DrParasite · Dec 13, 2016

Remi said:
I truly can't believe how people can witness the DMV.....the IRS.....the VA......not to mention all the ways that hyper-regulation already contributes to making our "private" healthcare system such as mess.......and then actually want the government to take even more control.

I don't want the government to take control, per se; but I would love for the government to fund the system via taxes, so everyone contributes to the heathcare system, at least at the basic level. No more needing to go to the ER for routine stuff, you can go to your GP. Or an urgent care. no need to call 911 for the "free ride," at least now the agency will get some reimbursement for it.

Are there going to be system abusers? absolutely. Will private insurance be needed to cover the basics that aren't covered? probably. But our current for profit system is inherently flawed, so something needs to be done. If you have a better idea, I'm sure people would love to hear it.

EpiEMS · Dec 13, 2016

DrParasite said:
Actually, I know very little about Cuba's healthcare system, other than what I have been told by some Cuban friends. Ditto Europe: my little brother lives in England, and every time I suggest he moves back to the US, he said the free healthcare is great for someone who has chronic Kidney stones, and having a baby is much cheaper than the $5000 it's going to cost me in the states with insurance.

Free:

Why-We-Don-t-Like-Fast-Track-It-s-a-Total-Failure_blog_post_fullWidth.jpg

Free isn't free - it's taxes and borrowing (from future people).

DrParasite said:
No more needing to go to the ER for routine stuff, you can go to your GP. Or an urgent care. no need to call 911 for the "free ride," at least now the agency will get some reimbursement for it.

There is no evidence that improved health insurance reduces inappropriate ER use. It does the opposite: "[T]he increase in emergency department use occurred despite Medicaid increasing access to other types and sites of care."

ExpatMedic0 · Dec 13, 2016

I have worked with 20+ UK paramedics from the NHS, not one of them had anything good to say about the NHS. It's also constantly under fire in the media. On the other hand, I have worked with a good number of paramedics from Australia and they all talked positively about their system and working in EMS there. Obviously, these are all strictly subjective and anecdotal experiences but I think it's fair to say not all systems are the same just because health care is government funded. I live in Denmark right now, the healthcare system is 100% government funded, and it has pros and cons. The EMS system also has many pros and cons but is much more stream-lined in someways. I believe the U.S. is the only modern English-speaking nation that, until very recently, had no coverage for millions of citizens. So something had to be put into place. There are pros and cons to every kind of system, but what I am concerned most about for this forum post is the U.S. and its EMS system(s) and how they will change for better or for worse with the new president, and what the rationale is behind those opinions.

Carlos Danger · Dec 13, 2016

DrParasite said:
But our current for profit system is inherently flawed, so something needs to be done. If you have a better idea, I'm sure people would love to hear it.

Our current system is incredibly complex and contains innumerable inefficiencies.....many (if not most) of which are a direct result of or at least partially because of a heavy regulatory burden. It's always easy to blame capitalism, but considering that our current healthcare system is far from a true free market - and hasn't been for decades - that claim just can't be made. So I disagree that the profit motive can be blamed for our systems failure. There's way too much going on besides some greedy people making money.

With all that in mind, I think the best solution is for the federal government to get out of healthcare completely. Let the states run their own programs. Of course that will never happen.

Maybe socialized medicine does work elsewhere, but I think it's pretty clear that our federal government sucks bad at it.

Qulevrius · Dec 13, 2016

ExpatMedic0 said:
I have worked with 20+ UK paramedics from the NHS, not one of them had anything good to say about the NHS. It's also constantly under fire in the media. On the other hand, I have worked with a good number of paramedics from Australia and they all talked positively about their system and working in EMS there. Obviously, these are all strictly subjective and anecdotal experiences but I think it's fair to say not all systems are the same just because health care is government funded. I live in Denmark right now, the healthcare system is 100% government funded, and it has pros and cons. The EMS system also has many pros and cons but is much more stream-lined in someways. I believe the U.S. is the only modern English-speaking nation that, until very recently, had no coverage for millions of citizens. So something had to be put into place. There are pros and cons to every kind of system, but what I am concerned most about for this forum post is the U.S. and its EMS system(s) and how they will change for better or for worse with the new president, and what the rationale is behind those opinions.

There's really no basis for comparison between a small Northern European country with a total population of 5.5 million, with ~10% being immigrants, and a country the size of US, with its annual immigration rates. Not to mention their respective GDP and per capita, defense expenditure and other stuff. It's not a 'what's good for the goose is good for the gander' thing, it is a 'what's good for the goose, isn't always good for the gander'.

Scott33 · Dec 13, 2016

ExpatMedic0 said:
I have worked with 20+ UK paramedics from the NHS, not one of them had anything good to say about the NHS.

My experience is the opposite. Sure, they like to whinge about their jobs (it's a British tradition) but they have suffered increasing demands over the years which are unsustainable. Several trusts have been forced to recruit from abroad (notably Australia and NZ) to fit bums on seats, due to some places losing staff quicker than they can be replaced.

However, most UK paras I know (and I am related to one) are still pretty proud of the NHS. They may be disillusioned with their jobs, hate their management, and wish a swift death upon Jeremy Hunt (Secretary of State for Health), but most of them would be hard pushed to imagine working under a different system...least of all something like we have in the US.

How will Trump effect EMS?

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