Healthcare

[bholler]

I have never said that once. All I have said is if you think the government can run healthcare you’re an idiot. Government ran programs have lowered payments so much its impossible to survive and now private insurance is following suit while making billions in profits and screwing over the policy holders with huge balance bills.

Don’t try to put words in my mouth.

Ok I misunderstood. I am just curious what you feel the answer is if it is not govt or privately run?

 

[bholler]

I think I also said “while some actually need it”

There is a need for it but, it is abused too easily.

I agree with that. But the majority on it are working poor. Now I know some intentionally stay below a certain income so they don't get cut off but part of that is a problem with the system. If they could get partial benifits it could help minimise that.

 

[Medic21]

Ok I misunderstood. I am just curious what you feel the answer is if it is not govt or privately run?

the answer for EMS especially, is to raise Medicaid reimbursement rates. They have not been increased Nationwide since 1977.

the service I came from last year has a 3.1 million budget for three trucks. We wrote off 1 million dollars of reimbursement that Medicaid did not pay based on billing. We made 2.1million in revenue after that. That leaves 1 million for tax payers to compensate to just break even. Granted that is just to break even.

my current company is about $500k a quarter in losses based on what we receive vs billing amount to Medicaid. We run 5X the number of runs a year but, that is how government treats healthcare.

Here is a good case. 71 year old cardiac arrest I had. We got her back and to the cath lab. She never stopped in the ER once, from my cot to the cath lab table. She was medicaid and we billed $4200 which was break even for supplies and equipment used. The Medicaid reimbursement was $229.00.

Had she went into arrest in the ER the bill would have been upwards of $30k for the exact care I gave her. They would have recouped the money.

EMS as you know it will cease to exist as long as the abuse of the system and low reimbursements continue. And, it will cease within the next 10 years.

 

[bholler]

the answer for EMS especially, is to raise Medicaid reimbursement rates. They have not been increased Nationwide since 1977.

the service I came from last year has a 3.1 million budget for three trucks. We wrote off 1 million dollars of reimbursement that Medicaid did not pay based on billing. We made 2.1million in revenue after that. That leaves 1 million for tax payers to compensate to just break even. Granted that is just to break even.

my current company is about $500k a quarter in losses based on what we receive vs billing amount to Medicaid. We run 5X the number of runs a year but, that is how government treats healthcare.

Here is a good case. 71 year old cardiac arrest I had. We got her back and to the cath lab. She never stopped in the ER once, from my cot to the cath lab table. She was medicaid and we billed $4200 which was break even for supplies and equipment used. The Medicaid reimbursement was $229.00.

Had she went into arrest in the ER the bill would have been upwards of $30k for the exact care I gave her. They would have recouped the money.

EMS as you know it will cease to exist as long as the abuse of the system and low reimbursements continue. And, it will cease within the next 10 years.

And if that happens it will become a public service as it should be now and profits won't enter into it. The fact that our healthcare system has so many layers of private profit driven companies involved is clearly going to drive prices through the roof.

 

[Medic21]

Oh, and to put a perspective on it. Based on the median income for a Paramedic in Indiana if they have a family of 3 they qualify for Medicaid.

brought to you by the government run healthcare system. When you loose money at the end of the year you can only afford to pay $32,000 a year on average for a 2 year degree job.

 

[Medic21]

And if that happens it will become a public service as it should be now and profits won't enter into it. The fact that our healthcare system has so many layers of private profit driven companies involved is clearly going to drive prices through the roof.

EMS is not listed as an essential service amongst emergency services in our state or many others. State code specifically says communities “may” provide a service not “shall”. That pool of tax money for emergency services is sucked up by PD and FD trying to scrape by.

Your taxes will drastically increase for it to be a tax base rather than a billed user base.

 

[WinterinWI]

We can and should do better. Healthcare should be a national priority and not a profit center.

I'd agree with you that profit off of healthcare is a somewhat morbid practice, however, the motivation for profit is a much larger motivating force for advancement of any industry, healthcare not excluded. Once a single company or entity (Gov't) has control, motivation for excellence and better care is stifled. Unless of course you are a "citizen" of a dictatorship like China, where the fear of gov't retaliation against self/family is an extreme motivating force.

 

[bholler]

EMS is not listed as an essential service amongst emergency services in our state or many others. State code specifically says communities “may” provide a service not “shall”. That pool of tax money for emergency services is sucked up by PD and FD trying to scrape by.

Your taxes will drastically increase for it to be a tax base rather than a billed user base.

It should also dramatically reduce operating expenses. The way we are doing it now is not working for anyone but the insurance companies. So why not change it?

 

[bholler]

I'd agree with you that profit off of healthcare is a somewhat morbid practice, however, the motivation for profit is a much larger motivating force for advancement of any industry, healthcare not excluded. Once a single company or entity (Gov't) has control, motivation for excellence and better care is stifled. Unless of course you are a "citizen" of a dictatorship like China, where the fear of gov't retaliation against self/family is an extreme motivating force.

That is true. But all of that advancement doesn't help if people can no longer afford healthcare.

 

[Medic21]

It should also dramatically reduce operating expenses. The way we are doing it now is not working for anyone but the insurance companies. So why not change it?

We have it running at as lean as it can go now. A fully equipped and staffed Paramedic truck is a half a million dollars running down the road.

$250,000 for the truck
$32,000 monitor
$30,000 Cot system
$25,000 Ventilator
Drugs
A ton of other equipment
Supplies
Personnel.

we run on contracts of around $150,000 a year per truck and the rest comes from user fees. We then write off a bunch because of Medicare and Medicaid each year. The brunt of the payments come from balance billing what the private insurance does not pay So they can make their billions every year.

Fort Wayne Indiana tried to take over their EMS service a couple years ago. They would have doubled operating costs According to their own plans and projections. Indianapolis did for 2 years and lost a ton of money and contracted it back out.

What we need is a combination of public vs user funded that will make it better for all.

 

[bholler]

We have it running at as lean as it can go now. A fully equipped and staffed Paramedic truck is a half a million dollars running down the road.

$250,000 for the truck
$32,000 monitor
$30,000 Cot system
$25,000 Ventilator
Drugs
A ton of other equipment
Supplies
Personnel.

we run on contracts of around $150,000 a year per truck and the rest comes from user fees. We then write off a bunch because of Medicare and Medicaid each year. The brunt of the payments come from balance billing what the private insurance does not pay So they can make their billions every year.

Fort Wayne Indiana tried to take over their EMS service a couple years ago. They would have doubled operating costs According to their own plans and projections. Indianapolis did for 2 years and lost a ton of money and contracted it back out.

What we need is a combination of public vs user funded that will make it better for all.

Most of those prices are drastically inflated as everything in the medical field is. There is absolutely no reason the truck should cost anywhere near that much.

 

[bholler]

And yes publicly run ems will have high operating expenses if nothing else changes. No way around that

 

[WinterinWI]

Most of those prices are drastically inflated as everything in the medical field is. There is absolutely no reason the truck should cost anywhere near that much.

Well, that's the cost of the business. Quarter million dollar truck sounds exorbitant, but are they going to chance it on something cheaper? The "I'll sue you" culture applies here, thus the high insurance costs.

 

[milothecat]

So could you enlighten us that are not in the U.S. about how medicaid and medicare work? I was under the impression that if you received healthcare down there that you or your insurance company received a bill for services rendered. I know that whenever I travel to the good ol' U.S.A that I am scared shirtless of having a car accident or other health emergency. I have good insurance, but you never know how good your insurance is until you need it.

 

[Medic21]

Most of those prices are drastically inflated as everything in the medical field is. There is absolutely no reason the truck should cost anywhere near that much.

$68k just for a chassis and a solid 2 months of labor to build. Onboard Oxygen systems, onboard suction systems, inventor systems, AC and heat systems with hepa and viral filter systems, interior and emergency lighting systems. WiFi and GPS systems. Hell the radios alone will cost $10k-$12k with installation from Motorola. Restraint systems that would rival a fighter jet, the most dangerous place in an accident is in the back treating a pt. the truck is a rolling ER room todayfor a Paramedic truck. Sure you can buy cheaper, but the NFPA and DOT reccomend replacement every 5 years. So remounting every 5 years for $100k-$150k is cheaper over 15-20 years than buying a cheap $150k truck that won’t last you 3 years till the box is wore out and causing you problems. I am the fleet manager for our company.

20 years ago I could get a fire engine for under $200k. Now they are close to a million for the same thing.

I have something like 62 different drugs I can administer in the truck today so it had changed drastically for capabilities each year I have been in this.

 

[milothecat]

I can absolutely see how an ambulance costs 250 000$. I fix agricultural equipment for a living and got a new service truck a few years ago. I was told the price tag was 90 000$. I would hope an ambulance would cost more that a truck to follow roaund tractors and fix them.

 

[bholler]

Well, that's the cost of the business. Quarter million dollar truck sounds exorbitant, but are they going to chance it on something cheaper? The "I'll sue you" culture applies here, thus the high insurance costs.

Yet amazingly in Europe where they have evil socialized healthcare their ambulances cost a fraction of what they do here.

 

[bholler]

I can absolutely see how an ambulance costs 250 000$. I fix agricultural equipment for a living and got a new service truck a few years ago. I was told the price tag was 90 000$. I would hope an ambulance would cost more that a truck to follow roaund tractors and fix them.

Yes more. But why should it be that much more? The answer is because they can charge it.

 

[Medic21]

So could you enlighten us that are not in the U.S. about how medicaid and medicare work? I was under the impression that if you received healthcare down there that you or your insurance company received a bill for services rendered. I know that whenever I travel to the good ol' U.S.A that I am scared shirtless of having a car accident or other health emergency. I have good insurance, but you never know how good your insurance is until you need it.

Yes, private insurance is billed. Here they basically send a check for what they feel is an acceptable amount and the pt is on the hook for the rest.

Medicaid and Medicare use an ICD code for whatever the issue was coded as. They pay a set amount. We are allowed to bill Medicare a very reduced rate but, can not touch Medicaid. Our BLS average bill is $980 dollars for just a ride plus $31 a mile. We receive $169 plus $3 a mile for service. Average bill for ALS is $2600 plus same mileage. We get paid $229 plus the $3 a mile. Medicaid is killing EMS.

 

[bholler]

$68k just for a chassis and a solid 2 months of labor to build. Onboard Oxygen systems, onboard suction systems, inventor systems, AC and heat systems with hepa and viral filter systems, interior and emergency lighting systems. WiFi and GPS systems. Hell the radios alone will cost $10k-$12k with installation from Motorola. Restraint systems that would rival a fighter jet, the most dangerous place in an accident is in the back treating a pt. the truck is a rolling ER room todayfor a Paramedic truck. Sure you can buy cheaper, but the NFPA and DOT reccomend replacement every 5 years. So remounting every 5 years for $100k-$150k is cheaper over 15-20 years than buying a cheap $150k truck that won’t last you 3 years till the box is wore out and causing you problems. I am the fleet manager for our company.

20 years ago I could get a fire engine for under $200k. Now they are close to a million for the same thing.

I have something like 62 different drugs I can administer in the truck today so it had changed drastically for capabilities each year I have been in this.

Again dramatically inflated prices. Because they can charge it here. They can't get close to that in other places.

 

[Medic21]

Yet amazingly in Europe where they have evil socialized healthcare their ambulances cost a fraction of what they do here.

And, the care is a fraction of what we provide. If you happen to get a dr you will get good advanced level care. If you get a Paramedic here I can do way more than a RN and do not have to ask a Dr if I can.

 

[Medic21]

Again dramatically inflated prices. Because they can charge it here. They can't get close to that in other places.

Our trucks are built in Canada

 

[bholler]

And, the care is a fraction of what we provide. If you happen to get a dr you will get good advanced level care. If you get a Paramedic here I can do way more than a RN and do not have to ask a Dr if I can.

Yet their healthcare is consistently rated higher than ours. Funny how that works.

 

[bholler]

Our trucks are built in Canada

Ok and they are selling them here.

 

[WinterinWI]

Again dramatically inflated prices. Because they can charge it here. They can't get close to that in other places.

Please. A lot of people think your quoted prices for chimneys are exorbitant as well. Yet you're not willing to cut your rate or quality of the products/service you provide.