How would the Tea Party deal with EMS Calls?

[zippyRN]

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?

see that cloud of steam ?

that's respect for you evaporating ...

or do you advocate privatising law enforcement and the judiciary ?

and the USA badly needs tort reform

[Bieber]

I don't claim to know all of the complexities behind the high cost of healthcare, and I won't try to make you think otherwise, but I do think that there is a lot of wasteful spending in medicine especially with regards to unnecessary administrative costs. I know even where I am there is a ton of money just sitting around waiting for someone to free it up by streamlining the system and making it more efficient.

ERDoc, while I do think that the system should maintain a system for rewarding hard work, I'm not sure if it necessarily has to remain the status quo in order to accomplish that. I also think that, from an EMS perspective, we ought to be rewarded for clinical excellence as well--something which does not currently occur at the service I work for. We are rewarded for times, and skill competency as well to a certain degree; and while I do believe that maintaining competency in the psychomotor aspect of our job is important, I also think that we ought to be graded based on the other aspects of our job as well including the affect and the didactic portions as well.

I would agree with you on a two tier system that protects our citizens who do not have the ability to afford private health insurance. I strongly believe that healthcare is something we ought to provide for our people, and that it will in the end be something that benefits everyone else as well--including the insured. We all know that the cost of emergency medical services (including EMS and the ER) practicing general medicine for people without a family doctor is much higher than if those people had a family doctor to begin with. And whether it's right or wrong and whether we like it or not, that cost gets shifted to the rest of us when those people are unable to pay for their medical expenses. It is because of this that I think EMS should expand its role and transition to "mobile health services" and provide (and charge for) more services for people with general non-emergent complaints, because as much as our job ought to be restricted to true emergencies, between the tremendous number of uninsured individuals and the fact that we spent the last forty years telling people to call 911 for any and every reason under the sun, we're not going to soon eliminate the reality that we are being increasingly called on to provide primary care.

Either the government is going to have to provide some sort of safety net for the uninsured and set them up with family practitioners, and/or we in the emergency medical field are going to have to come up with a solution to the problem of people calling on us for problems that could either have been treated with appropriate preventative care or requires only primary care treatment.

One thing is clear, though, "just take them to the ER" is NOT going to be a viable solution if our goal is to decrease the costs of healthcare both in the short and long term. And while I'm not as familiar with other specialties in medicine and the problems they face, I am sure that everyone in gastroenterology, nephrology, anesthesiology, family practice and every other specialty that exists would all say that there are problems within their own realm of medicine that need to be fixed, abolished, or added in order to help streamline medical care and reduce unnecessary spending.

[Asysin2leads]

ERDoc, the only problem with strict fee for service is the studies that show that the amount of medical procedures performed by physicians goes up drastically in fee-for-service systems as opposed to other payment systems. Yes, I know we all want to believe that all physicians everywhere would only perform procedures that are absolutely necessary, but doctors are human and humans are fallible. If medication and procedures were doled out strictly on medical science, there wouldn't be advertisements on TV for medications.

While I believe capitalism is the superior system for finance, in that it promotes competition, I do not believe that free market values should be applied to the medical industry. You can't just say "caveat emptor" to patients. If you sell someone an air conditioner they may not need or the extra upholstery package for their car, that's just good salesmanship. But to have someone get an operation or take a medication because of the profit is morally and ethically wrong.

[ERDoc]

see that cloud of steam ?

that's respect for you evaporating ...

or do you advocate privatising law enforcement and the judiciary ?

and the USA badly needs tort reform

Whatever. Life is not a popularity contest. Show me in the US constitution where it says that healthcare is a right. Don't get me wrong, I believe everyone should have access to proper healthcare (primary care and emergency care) but doctors shouldn't be forced into government service if they don't want to be. This is where I think separate systems could work. To attract people to the govt system, you could recruit those who want to do it but you would also need to attract others into it. Offer them free medical school if they are willing to sign on for X number of years and give them protection from medical malpractice. We already have a system like this, the military (not the VA). It works pretty well for them. This would allow those that still want to be a small business owner to be that and those that want to be government employees to do that. Telling 1 million US citizens that they must now become employees of the state is never going to work, maybe it would happen over the on the other side of the pond, but never here where freedom is important.

Asys, I'm not saying we need a free for all in the medical field. The must be some regulation. The problem is that doctors no longer run healthcare. It is run by the govt, the drug companies and the insurance companies. Doctors are horrible at being politically active. I'd love to see all of the pharmaceutical ads taken off TV. I love the fact that gifts/freebees are no longer allowed. We should be making the best decisions based on the science. The reason HMOs are less expensive than FFS is the fact that they ration care (I'm not saying rationing of care is a bad thing but when HMOs are turning out huge profits, you have to admit there might be a little conflict of interest). Under a FFS service model it is the doctor who decides what tests you need. I agree that there is room for doing more than needed but I don't believe it happens as much as people try to make the public believe. The govt has even started to move to a system where out reimbursement is going to be based on pt satisfaction. Antibiotics for colds? Absolutely. How many Vicodin would you like me to write your script for? A CT scan for your kid every time he comes to the ER? Let me order his 12th appy scan in the last 12 months. We'll deal with the thyroid cancer in 20 years. Right now my goal is to make you happy so I can feed my family.

Take a look at what is going on in Washington state right now. They have decided that they will not pay for more than 3 non-emergent ER visits per year. Who is the burden being put on? The doctors and the hospitals. EMTALA says we have to see them, take the risk associated with the visit but will not get paid for it. It is not the doctors/hospitals making the decision to go to the ER, so why are they the ones being punished. Now take a look at the "non-emergency conditions."

http://www.wsha.org/files/65/Non-Emergency%20Conditions.pdf

There are several issues with this. How is a layperson supposed to know when they have a non-emergency condition? Are they supposed to know the difference between Bell's Palsy and a stroke? You better believe that an 80y/o with a Bell's Palsy is going to get a big workup for a stroke, but according to the list, this will not be reimbursed. Others that just boggle the mind include acute cholecystitis, septicemia, hypoglycemia and hypoglycemic coma, status asthmaticus, visual loss, tenosynovitis, and dysrhythmia to name a few. This is being discussed on student doctor, here is the link: http://forums.studentdoctor.net/showthread.php?t=856120

[crotchitymedic1986]

Hello ! Obama already solved this problem for you with his Obama=Care Policy. So unless you let the tea party screw it up, you have no worries

[paramedicmike]

Doc,

You lost me with the "telling 1 million citizens they must now become employees of the state" bit. Where is that from?

[ERDoc]

Doc,

You lost me with the "telling 1 million citizens they must now become employees of the state" bit. Where is that from?

There is estimated to be just under 1 million practicing physicians in the US,

[ERDoc]

Defib, I'd like to think that we would never get that bad here. We have many more regulations which should be applied to all healthcare facilities.

[paramedicmike]

There is estimated to be just under 1 million practicing physicians in the US,

I got that part. I missed the jump to where they became state employees. Did I just miss it from earlier in the thread? Or is there something afoot about which I'm not aware?

[ERDoc]

I got that part. I missed the jump to where they became state employees. Did I just miss it from earlier in the thread? Or is there something afoot about which I'm not aware?

OK, I got you. Sorry about that. I had a thought process in my head that didn't quite make it to the keyboard. If we continue to go down the line of becoming a single payer system (ie the govt) then doctors, EMTs, paramedics, nurses have basically become employees of the govt. Our payments will only come from the govt, our regulations come from the govt and our rationing will come from the govt. There will be a third party in between (the hospital or EMS service). That is what I meant by the employee of the state comment.