How would the Tea Party deal with EMS Calls?

[Asysin2leads]

While I swore off political and religious discussions, watching the Republican debate tonight left me wondering about something. The question about what to do with the 30 year old previously healthy person who has no health insurance and gets a catastrophic illness. Michelle Bachmann's response was "Hurrrk.... Obamacare...bad...hurrrkkk..." but Ron Paul said that it should be about choice, and if you choose to not buy health insurance, and you cannot pay for it when you need it, then you should have service denied. Fair enough. You don't plan ahead, you don't pay the price, you don't enjoy the benefits. But my question is, "So what do you do when that person calls 911?" This is a particularly valid question in that when the uninsured and underinsured stop getting healthcare, it falls on EMS to treat them. Now I fully believe health care in the States is in crisis, and I do agree that a government mandate to purchase a product is unconstitutional, though not without precedent, but the thing is, in a system that denies treatment and care to a population, the roles of primary care shifts to emergency medical services, and I can tell you that paramedics providing primary care is a heck a lot more expensive than providing primary care in just about any other capacity. Add to that the cost of treating a disease before it reaches the catastrophic level where EMS is actually needed, and you're really setting up a recipe for financial disaster. So my question is, if the Tea Party plans on denying service to the uninsured, do they also plan on cutting reimbursements to EMS services? No more Medicare or Medicaid checks to those nice people in billing? I mean, my suggestion is, they'd better, or government floated healthcare costs are going to go through the roof. If they do cut Medicare and Medicaid reimbursement, how would that sit with their supporters with names like AMR, Rural/Metro, Transcare, and the IAFF? This is really just a thought experiment. No ethical discussions. I am just talking dollars and cents.

[Kaisu]

Oh please Asys... intelligent, thoughtful consideration of consequences? This is US health care we are talking about. Wade into this mind field through all the special interests and we really do live in Bizzaroworld, where good things occur only as unintended and unforeseen by-products.

[ERDoc]

Asys, I realize that you are aiming this towards the EMS perspective, but it affects the ER also. We already have an unfunded mandate to care for the uninsured, EMTALA. If we now eliminate medicare and medicaid, leaving a lot more people uninsured, what effect will that have on the system? Are hospitals/ambulances going to screen people and turn away people that can't pay? Are hospitals/EMS agencies expected to bear the financial burden of caring for these people? How long can these agencies be expected to be financially solvent in such a situation? Imagine the PR nightmare when one of these people get turned away and ends up getting worse (as part of the natural disease course) and dies. Is the govt going to protect doctors/paramedics/hospitals/etc from the increased risk of a lawsuit should something like this happen?

There are so many questions and the answers are not encouraging.

[uglyEMT]

I can see the following happening

Operator: "911 What Is Your Emergency?"

Caller: "I am having chest pains!"

Operator: "Do you have insurance?"

Caller: "No."

Operator: "Sorry then Sir, take an asprin."

Caller: "Huh? What?"

Operator: "Thank you for calling 911, Have a nice day."

CLICK

In all reality this will be a quagmire if it happens.

IMPO I don't think anyone should be denied healthcare be it preventive or emergency based on wether or not you can pay. Maybe once we move from profit based to something else (like that will ever happen) things will change. I know my opinion is a pipe dream but it still is the way I feel.

[ERDoc]

To play devil's advocate, Ugly, why shouldn't medicine be allowed to be profit driven? Aren't doctors just small business owners? Aren't small business owners the supposed backbone of the economy? Why are doctors held to such a different standard than any other sector of the economy? Can you imagine if the govt tried to put the restrictions/mandates (socialism?) on the legal field that the medical field (including EMS) has endured?

[Asysin2leads]

<p>ERDoc, sorry, I should have been more specific. When I said EMS I mean the entire system, including the emergency room, not just prehospital care. What you did hit on pretty much my point. If a politician wanted to move to a strict cash on the barrelhead, no pay, no play system, which would be the only alternative to subsidized health insurance, then you'd have to repeal things like EMTALA, and also institute sweeping tort reform for when a person does not get treated or assessed properly by a medical professional and suffers dire consequences. Personally I think if the government basically offered affordable (not free) health insurance to lower and middle class populations, you could do a lot without trampling on the constitution too much.</p>

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[uglyEMT]

ER Doc I guess what I envision (again my personal wishes or dreams) is to see a cost effective system. Why does the surgon have to charge thousands for that opperation sort of thinking. Like say you are an ER Doc you make X amount, the surgon makes X amount, ect. If every doc or nurse or specialist country wide was on the same pay scale my thinking would tell me prices charged wouldn't be so outrageous that hospitals or offices couldn't turn a profit while still being affordable to the masses.

I guess I want to imagine when its doesn't cost 500 a ride for BLS, 1000 more if a medic gets on board, 3000 for that ER visit, another 5000 in lab work and xrays, then 8000 for that specialist that walked in for 5 minutes to do something. (prices for effect only here)

I hope that made sense.

[Just Plain Ruff]

People will still call 911 and they will be treated.

People will still go to the ER and still be treated

Deny deny deny all you want, the people who are falling through the safety net of health insurance will always be treated at the ED. What happens after the ED then that's where it gets sticky.

and yes, the tea party and other parties do indeed think about cutting EMS funding. It's the next logical course, you have cut funding to hospitals, cut funding to doctors, cut funding to nursing homes to where my family paid 7500 per month to a nursing home to take care of my grandmother.

the next logical choice of any party and choosing cuts will be to ambulance services.

the big question I have on this line is this. Will the cuts be so drastic or draconian that it will force those who are currently providing EMS care into the Arms of the Fire department or the couple of conglomerates.

I know that my wife's last bill from a local fire department ambulance service was 1600 bucks. We are insured so insurance covered part of it but not all of it. Thank goodness for insurance.

Does healthcare need reform, YES, but not at the expense of the doctors and hospitals who bear the brunt of the cuts and are already paying for uninsured patients.

I have always argued for fair across the board cuts in services. Seriously, how much does it really cost for you to put in an IV? I can tell you. The ER bill my wife got was that her IV fee's/costs were around 225.00 Doing missed charges for a small ER the bag of IV fluid costs around .45 cents for the bag, the IV supplies cost an additional 12 or so dollars. So how do you justify a 212.50 profit over the cost of supplies? Just an example.

Two darvocet n-100 cost at the hospital is around 2 dollars. The cost to the patient is 47.00 or so. Again a 45 dollar profit.

I'm sure that others have examples. I know hospitals have HUGE operating costs, management costs and such but this is where people get really pissed off.

I know of a CNIO in a florida hospital is paid a high 6 figure salary. The CEO is paid a high 6 figure salary. The director of nursing is paid at one hospital 120K. I know that you have to attract the best talent but a high 6 figure salary is a bit much.

And don't even get me started on my line of work. What I cost the hospitals is amazing and absurd if you ask me. I have an entire list of how to save hospitals and EMS systems lots and lots of money on consulting fees.

[ERDoc]

Ugly, I think I see where the issue is. The system you are talking about is what the govt is trying to move to with organization based care. Everyone becomes an employee of the hospital and gets a salary. I think the thing you are missing is that most doctors work for themselves. As an example, I work for a private group of ER doctors that has contracts with our hospitals. We bill separately from the hospital because we are a separate company. We are paid based on what we collect from the pts, if they don't pay, I don't get paid, my family doesn't eat, etc. The same goes for many physicians such as surgeons, orthopods, dermatologists, even anesthesia and radiology. I like the way it is where I am because I am rewarded for working hard. The more patients I see, the more I get paid. In a system where everyone is salaried, you remove that incentive. Hypothetically, why am I going to bust my ass, increasing my exposure to risk while getting the same pay as the guy who sees as few pts as possible? I don't think we can find an ideal system and I agree something needs to change. I also don't say I have the answers.

How about 2 systems, one that is similar to the current system that is privately run and a new system, similar to the VA that is for people on govt programs? From an EMS standpoint, you go to the closest hospital. If you 'belong' in the other system you are stabilized in the ER and then transferred to the hospital belonging to the system you belong to. Ethical issues abound, but everyone gets what they want. The people that want to keep the system as a free market/profit driven get theirs and the people that want a govt program to help everyone else gets theirs. I think it would be a very interesting social experiment.

Edit: Ruff and I were posting at the same time. To address the high costs of things in the hospital, let's look at an albuterol MDI at one of the hospitals I work at. It costs the pt $12 at WalMart. Get it from the ER and it's going to cost $125. The reason, as Ruff said, is operating costs. You have to pay the pharmacist in the hospital to stock, inventory and dispense the MDI. They also have to confirm it is appropriate for the pt and the script is written properly to make sure the is not a medication error. The pharmacy with all of it's costs including salaries and benefits is a huge expense. You then have to pay the respiratory therapist to teach how to properly use the MDI. More added expense. I'm not sure about the RT, but you cannot charge a person for the pharmacy services so in order to collect those expenses, you have to increase the cost of the meds. We are constantly encouraged not to send people home with meds so that they do not get hit with a huge bill for them as most insurances will not pay for them.

Edited September 13, 2011 by ERDoc

[Just Plain Ruff]

There would be some good lessons learned from your experiment Doc. It might prove one right over the other or might prove that a hybrid plan would be best.

I have the perfect company to do this study. I'll give them a email and see if they might be interested.

It's all about transforming care with the least amount of disruption to patients, doctors, employers and payors/patients as possible.