Today, President Barack Obama discussed the health care industry's promise to cut $2 trillion in costs over 10 years.

According to an Associated Press article on JEMS.com, he "acknowledged that the step announced Monday would be meaningful into the future only if it is not a singular event, but part of a larger and successful effort toward universal health care coverage for Americans. He said the country 'can, will and must' accomplish this goal by the end of the year."

I think this is a huge deal for EMS, not just for care in the field but also for billing.

My question is this: Do you think universal health care coverage would be beneficial to your service overall? What about your patients? How do you think it would change your calls?

Tags: billing, insurance, uninsured patients, universal health care

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It probably would only change things at the margins. The people with insurance and the people who don't have insurance but can't be billed due to poverty aren't going to change their usage patterns much; the people without insurance that make enough to get a bill might take a few extra ambulance trips.
Universal Healthcare? Given the current deficit that probably isn't going anywhere? Quick, someone buy Obama a European history text book and open it to the chapter on the Weimar Republic for him.
I forsee a couple of huge potential problems with this, the first one being a huge increase in call volume for very minor complaints. People who don't feel that someone else is going to pay for the ride are going to be more inclined to call EMS when a lot of local systems are already running to the breaking point.

Cost control also tends to mean "we'll just pay fewer cents on the dollar" for EMS calls on the part of the government cost control folks. There doesn't have to be a rational basis for this, just less reimbursement.
That will tend to reinforce EMS as a trade, not a profession, and will tend to perpetuate the issues with a lot of EMS systems primarily employing a young, disposable work force.

Some EMS problems can be solved with creativity, but others can only be solved with money. When someone says they're going to control costs, that means - at least in part - "We're going to limit your ability to deal with problems for which money is the primary solution."

That may force EMS systems into more triage-by-call-taker and EMS-driven, rather than patient driven refusals.
Both of those have potential huge downsides the first time someone in the EMS system makes a triage or refusal mistake.

On the other hand, we can't go on just being a black hole for public funding as the solution to every problem.
The best way is to get involved, get your community involved, and start using the grass roots to get leverage with your state and local legislative delegations. The squeaky wheel gets the grease.
I don't know, so I'll ask, but what is the experience of EMS systems in Canada and Europe? You know, in those countries where they have universal--or close to it--coverage?

I ask because before all the dire predictions are voiced, they should be considered against the backdrop of industrial Western countries that have such coverage. The tax level/conditions are different, but so is the relative wealth of the states involved. Despite the current economic downturn and concerns about China, the U.S. still has by far the biggest economy in the world. We can't afford in the long term to provide health coverage to every citizen?

And what about the idea that if everyone had coverage, EMS calls expected to be covered by the taxpayer that are made due to a lack of health coverage (in the same sense people go to the ER for everything when they don't have coverage) would decrease? If that is not a realistic notion, why not?

In terms of the Weimer Republic...uh, Joe...the U.S. is still the biggest economy in the world. We didn't lose a catastrophic war and are forced to pay economically strangling reparations. The last time I checked we didn't have a piece of our territory (one heavy in natural resources) taken by a neighboring nation as the result of losing that war. And we aren't yet in a great depression. You may want to visit the library yourself...
Ok, answer this. With a 1.8 trillion dollar deficit predicted for this year, 1.2 trillion dollar deficit predicted for next year and the yearly deficit prediction for 2011 through 2019 being predicted as being between 500 and 800 billion dollars (rounded) (source), how much longer are other countries going to be lending money to us? What's going to happen then? Now we want to throw socialized health care on top of that? The money has to come from somewhere and I don't see Obama cutting a ton of social programs.

Unless, of course, you think that all of those problems are prerequisites for hyperinflation.
We live in a global economy and in a country where the immigration laws are not enforced. The practical effect of those two things is that we hemmorage money outside our country (the trade deficit is still huge) while people who are here illegally and don't pay their fair share of taxes or fees-for-service use those services at someone else's expense.

We might not have crippling reparations to pay to another country, but we have crippling reparations to pay to future generations. We might not have lost a large part of our territory to a foreign country, but we have lost the ability to exploit a lot of the natural resources in other parts of the country because extracting those resources has an unacceptably high environmental cost...a cost that wasn't part of the equation in the Weimar Republic.

"A democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves largesse from the public treasury. From that moment on, the majority always votes for the candidates promising the most benefits from the public treasury with the result that a democracy always collapses over loose fiscal policy, followed always by a dictatorship." Attributed to Alexander Franklin Tytler, late 18th century.

Alexis de Tocqueville had a similar thought "The American Republic will endure, until politicians realize they can bribe the people with their own money."

Government-funded universal health care coverage amounts to the worries that Tytler and de Tocqeville expressed more than two centuries ago.
1: Your "source" isn't exactly an unbiased economic voice. At least try to go with the Wall Street Journal or Financial Times for something close to unbiased...

2: We are the consumer engine that has been driving much of the world's economic growth--they don't lend they hurt.

3: Nobody said anything about "socialized" health care. I brought up states that have such a system for anyone to point out how EMS systems in those countries adapted historically. While a troubled effort, Massachusetts moved toward near universal coverage (under a Republican governor) without going the Canadian/UK route. Health care reform and universal coverage does not equal socialism. There could be other routes.

4. Most of the budget is locked-in non-discretionary spending. Until Social Security/Medicaid is reformed there isn't a lot of wiggle room. Social programs beyond those aren't even a rounding error of the Iraq and Afghanistan deployments (never mind the DOD black budget which is either the 2nd or 3rd biggest defense budget in the world by itself, outside the declared defense budget). So cuts in those discretionary areas aren't the answer.

5: Inflation is more than likely. But the calculus is inflation is not worse than depression. If the banks and major industries collapsed and unemployment reached Great Depression levels, this is all a pointless discussion. This spending started in the last administration (the banks received the first bailout last October) and continued in the current one because the risk of systemic failure would have been a lot worse. This might mean inflation in the near future--but people won't be needing wheelbarrows to haul around money. Again, it is still a lot different situation than 1920s-1930s post-WWI Germany.

Though if you are against these deficits, we could pull out of Iraq and Afghanistan (which helped drive deficits in the first place...remember Bush came into office with a surplus) and not give banks, industry, or state/local governments any sort of stimulus. So the layoffs that all are witnessing/experiencing now would be nothing without the infusion of federal funds. Your local government likely cannot deficit spend. Without rising federal deficits, many public safety systems would be in even worse shape.
If you would have asked me this10 years ago I would have been adamantly against it. Probably even five years ago I would have been as well. However now I am willing to listen and see where they want to go.

Right now we receive compensation from around 69% of our transports, now remember we do not receive 100% payment on the vast majority of those that do pay. Let’s just round it off and say that we receive 70% of the approximately 70% of the people who do pay.
Would we be better off getting paid for 100% of our transports at a lower overall fee? As time goes on I believe I am coming around to thinking that we would.

Taking away my feelings about Ambulance billing I think that right now the system is certainly broken to an extent. Medicare sets their fee schedule and large insurance companies negotiate a fee that they would like to pay. Thus leaving people who have little to no insurance footing the full bill for their health care and they are the ones who can afford it the least.

However I am not willing to jump face first into this on faith, I would want to see how they intend to do this and how they intend to pay for it. Usually anything that the government does comes with a price attached to it in the form of a regulation, so I would want to see what this is going to be.

The one thing though that I feel would help the U.S. health care system almost more than anything is real and honest tort reform. So much of our money goes into defensive medicine, trial lawyers and bloated insurance payments that if we could even cut this in half I believe most insurance carriers could afford to offer drastically lower health insurance policy’s. But that’s not even on the table.
Here our universal model is Medicare.

All major public hospitals and therefore major health care are State run. Care in these hospitals is free essentially. You pay a levy as part of your tax return dependent on income.
Medicare covers 30- 80% of visits to clinics.

A safety net exists for excess medical expenses where the benefit increases.

Pensioners (elderly and unemployed) receive free healht care as do veterans.

Private health insurance covers care in private hospitals and private emergency departments.

Ambulance care is either a fee for service (in my state) that is offset by an annual membership or pts can take their bill to their insurer. Again pensioners and veterans get free ambulance.

Other sates include an ambulance levy into things like motor registration or utility payments making the service free essentially. Reciprocal rights exist between states for ambulance care.

Universal health care isn't that hard. You just have to eliminate the idea of greed........
TheCannulator said:
Here our universal model is Medicare.

All major public hospitals and therefore major health care are State run. Care in these hospitals is free essentially. You pay a levy as part of your tax return dependent on income.
Medicare covers 30- 80% of visits to clinics.

A safety net exists for excess medical expenses where the benefit increases.

Pensioners (elderly and unemployed) receive free healht care as do veterans.

Private health insurance covers care in private hospitals and private emergency departments.

Ambulance care is either a fee for service (in my state) that is offset by an annual membership or pts can take their bill to their insurer. Again pensioners and veterans get free ambulance.

Other sates include an ambulance levy into things like motor registration or utility payments making the service free essentially. Reciprocal rights exist between states for ambulance care.

Universal health care isn't that hard. You just have to eliminate the idea of greed........

Can you define this statement for me? What constitutes greed?
"Greed"...in other words, you just have to eliminate human nature...

TheCannulator said:"Universal health care isn't that hard. You just have to eliminate the idea of greed........"
I think that the devil is in the details.

Although not a "right" guaranteed by the Constitution, health care is a basic element of a decent human condition. So, I'm OK with everybody having access to health care - and I don't think that it should be a commodity only for those who can afford it.

Right now, a huge portion of our health care bill pays for the insurance bureaucracy. Eliminate that and you might reduce current costs by 40%. It's hard to imagine the federal government producing LESS bureaucracy, but what we have is so screwed up I'm willing to give it a try.

But I have no idea what they intend to do with EMS................

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