Emergency Medical Services: Last Week Tonight with John Oliver (HBO)

moving on our main story tonight concerns ambulances you know big ouchy trucks that go whoop whoop ambulances can be an annoyance to city dwellers with their shrieking sirens although not if you live in brussels where that siren sounds very different [Applause] okay that is just an objectively better siren it sounds like mickey mouse getting on a washing machine in a good way and i do know that that is hard to picture so please let me help oh boy i mean that's fantastic i'd far rather be woken up by the sound of america's rats getting railed on the spin cycle because i'd immediately laugh then remember that someone was having a medical emergency and feel bad then hear the siren and laugh myself to sleep again what a siren anyway ambulance crews clearly play a critically important role across the country so it is no wonder that during the height of the pandemic last year they were among those who got an outpouring of gratitude and nightly applause with new york's mayor even making this pledge i want to guarantee you one thing that when that day comes that we can restart the vibrant beautiful life of this city again the first thing we will do is we will have a ticker tape parade down the canyon of heroes for our health care workers and our first responders we will honor those who saved us okay first i don't know if a parade is quite the dangling carrot de blasio seems to think it is because parades and this is true suck they are loud crowded and go on approximately four hours too long the only good thing about the thanksgiving day parade is seeing which country singer gets to lip sync next to the jolly green giant's dick but second there was a small irony in all the vocal appreciation that took place last year as this emt that we featured pointed out right now i'm doing all of this with no health insurance the job doesn't offer it and our affordable marketplaces aren't very affordable if i get sick and okay i go get tested positive i can't go to the hospital you know people come out and they show us the support and i love it i love i've eaten so much pizza in the last two weeks it's been great i don't need pizza i need to be able to pay my bills right people clapping and giving pizza in appreciation was very nice but it wasn't a substitute for the things that they actually needed like a living wage and health benefits think about it like this if you had a heart attack and paramedics showed up with a pepperoni pie and some garlic knots you'd be grateful sure but you'd also be justified in pointing out that that's not everything that the situation demanded and that man's story is by no means a one-off ems workers around the country are shockingly underpaid which is kind of amazing especially when you consider how prohibitively expensive taking an ambulance can be so much so you'll often see local news stories like this it was rush hour at the mass avenue station when this passenger stepped off the crowded train surveillance video shows the moment her leg dropped into the gap trapping her between the train and the platform as other commuters rocked the train to dislodge the woman's leg a boston globe reporter tweeted from the scene she begged no one call an ambulance it's three thousand dollars i can't afford that wow it is a pretty strong indictment of our current health care system that that woman's main concern was getting crushed financially even while she was getting crushed physically so given that we have injured people begging bystanders not to call ambulances and the emts who work inside them forced to live off peta donations tonight let's take a look at our emergency medical services specifically how they function why they can be so expensive and what we can do to fix things and the first thing to know is there is absolutely no consistency when it comes to ems in this country when you talk about emergency medical services you're actually talking about 19 000 locally run ems providers with wildly different structures to give you an idea of just how much variant exists in houston ems is provided by firefighters cross-trained as paramedics or emts in new york city it's under the fire department umbrella but it's a separate division and supplemented by private companies in pittsburgh it's a freestanding municipal department of its own and in rural wyoming ems is mostly provided by volunteer-based organizations and frustratingly in no part of the country does ems have ambulances that sound like this the very fact our sirens could sound like a puccini aria performed by a flustered parakeet and yet we choose for that not to be the case makes us a bunch of idiots but all of this is to say if you have seen one ems set up you've seen exactly one ems set up and one reason for this is that there is no single federal agency overseeing and supporting ems in the same way that for instance fire departments have the u.s fire administration and the frustrating thing is it didn't have to be this way back in 1973 congress enacted the ems systems act which created a new program to help develop regional ems systems something that was badly needed prior to that ambulance services were frequently provided by hearses simply because they were long enough to transport a human body now unfortunately under the reagan administration budget cuts eliminated direct federal funding and oversight shifting the responsibility onto the states many of which opted to direct their money away from ems and into other public health services instead which brings us to an absolutely incredible fact unlike other first responders such as police and fire departments right now in all 39 of these states ems is not considered an essential service meaning local governments don't have to provide it to their citizens which as a practical matter means ems generally has much less access to government funding this is a huge deal and if this is surprising news to you you are not alone just listen to this utah state representative i became aware of the fact that that this issue existed when i asked the question to chief brad hennig chief what can i do for you and he said he started explaining to me this issue and i was like really because i thought i thought this was an essential service too i didn't know any better yeah of course he was surprised finding out that ems is not deemed essential it's like finding out that most states don't consider geese to be birds that's what they are they have beaks wings feathers they range shipped from the sky sully sullenberger is their jeffrey dahmer they're birds i didn't realize anyone was even disputing that ems providers can be so strapped for cash especially in rural areas that they have to fundraise for themselves do a quick search on gofundme right now and you will find multiple outfits trying to raise money for equipment gear and updated ambulances and you know our healthcare system is up when patients and providers are relying on the same crowdfunding platform some people even do fundraising stunts for their local ems whether it's this guy doing a polar bear plunge for a thousand bucks or this dj doing a three hour live stream that raise money for ems workers in new york and i have to say my admiration for that man's generosity is almost enough to overcome my horror at the idea of a three-hour livestream dj set it's like someone donating a million dollars to cancer research by writing out a check in turtle blood love the end hate the means and these massive funding deficiencies start to explain why it is that ems workers like that guy you saw earlier are so terribly paid the median annual wage is just over 36 000 well below what police officers and firefighters make and for a dangerous and stressful job emts and paramedics have an injury rate about three times the national average and they're roughly 10 times more likely to have suicidal thoughts or behaviors so it is no wonder that ambulance services can have real trouble finding or retaining workers and volunteers especially in rural communities experts now warn that close to one third of all rural emergency medical services are in immediate danger of closing down in rural marmot north dakota no one remembers the last time the town had a doctor the ambulance is the community safety net we are literally one person away from closing if we lose one of our emts one of our care providers we will have to look at shutting down and closing our doors that is terrible no workplace should be in danger of shutting down because it loses one person unless that is that workplace is the sex and the city reboot what are you thinking it's never going to work without kim control it's not that any of you or bad is that you only work together i can't appreciate my puritan charlotte if i don't have my naughty samantha i know i live for miranda hobbs but if she's not serving side eye while samantha uses penne pasta to describe her new italian lover's dick what is the point and to be clear this isn't just a rural problem some big city services are stretched to breaking point too takes chicago where its ems is operated by the fire department both workers and city officials have complained for years that not enough resources have been allocated to ems leading to an ambulance shortage and while the fire department says its fleet meets the needs of residents a local news investigation found some pretty harrowing stories one analysis of 700 000 medical in nineteen 911 of them it took an ambulance more than seven minutes to get to the scene sometimes there just isn't one wow we are out of ambulances that is just not something you want to hear i think we all know when you call an ambulance you want it to show up like that what's wrong with you oh no i'm sorry george i did it again i'm sorry how hard is it not to snap your fingers you know what it turns out it's surprisingly hard you know i got the power to just clap my hands and summon kermit the frog anytime i want do you think i use it no i do not because i respect kermit yeah yeah i get that but uh hey george do it do it now please this better be good george it's not well i thought that went very well anyway um where were we oh that's right emergency medical services in america are underfunded because in most places they're not supported by federal programs and local dollars the way that police and fire departments are and the fact they are so underfunded starts to explain why they can cost so much because for many the way they recoup their costs is by billing patients although interestingly if they don't physically transport those patients to a hospital they can be out of luck you're reimbursed based on the number of patients that you transport to a hospital so you could get called a thousand times a year and only transport 750 patients those other 250 calls you made no money on yeah it's true and policies like that can not only put ems providers even further into a financial hole it can also incentivize them to take patients to the hospital even if it is not totally necessary which makes no sense it's a practice known throughout the ems industry as you call we hall which i admit is a fun phrase although to be honest nowhere near as fun as the fire department's motto you hurt we squirt and ems's funding structure doesn't just serve providers poorly it serves patients poorly too because right now patients and their insurance reimbursements are most ems outfits primary funding sources which is just not a good situation for either side some patients have medicare and medicaid and by law ems providers are required to accept their reimbursement rates despite many saying that they are set too low but for patients with private insurance the fact is ems's are not required to accept that at all in fact many choose to keep themselves out of network for most insurers meaning that they can generally set their rates wherever they want this situation can often leave patients facing so-called surprise bills some of which can be absolutely ridiculous baby sawyer just couldn't wait to enter the world katie marita's water broke a week before he was due she and husband daniel raced to sutter roseville with the emergency room in sight katie screamed for him to stop the car don't push nathan i have to brush she went like this and i pushed and then popped and he came out roseville pd called the paramedics who cut the umbilical cord and drove katie and sawyer a matter of a few hundred yards to the hospital door the entire time of the paramedics 10 minutes it is such a blur but later it would come into focus when two equal amr ambulance bills showed up one for katie one for baby sawyer totaling more than 3 500 bucks not even a full minute worth of an ambulance ride we had already done the hard part we delivered our child in the front seat of our car well hold on there did we really do the hard part dan because from what i just heard you did some driving and then sat back while your wife in your words popped out a human so i'm not sure you really did the hard part so much as you were just sort of there come on dan be an ally read a tweet and that can be absolutely crazy examples of surprise billing even when ems is run by the city in houston literally all city-run ambulance services are out of network for all insurers and a study of one large national insurance plan found that 71 of ambulance rides had the potential to generate a surprise bill and when you know that is it any wonder that that woman begged people not to call her an ambulance or that this incredibly grim trend has emerged ambulance or uber that's now the choice as more americans are using uber and other car services to get to the emergency room 42 year old tech magazine writer chandra steele did it what were your symptoms i had some emergency room doctor robert glatter of lenox hill hospital in new york says uber er as it's been nicknamed is not a smart idea in a crisis they don't have any kind of oxygen they don't have intravenous fluids or ivs they don't have paramedics that's the main difference they have a driver right they also may not know which local hospital has a trauma stroke cardiac or pediatric unit because they're uber drivers the most they have are tiny water bottles you're afraid to drink from and a charger for samsung phone you do not own so to recap instead of all of us paying a little bit all the time for ambulances we have a system where some of us pay an awful lot all at once when we have a terrible emergency and if you're thinking how could this possibly get any worse well wait it can because for-profit businesses are also involved here in fact currently private companies represent about 25 of all ambulance providers and many of them are owned by private equity firms who've been acquiring distressed local ambulance providers for decades now remember that baby who got a bill for being born that came from a private for-profit company american medical response they are currently the largest ambulance company in the u.s and are owned by one of the country's largest private equity firms and when a private equity firm swoops in to help ring profits out of ambulance services by keeping costs low and revenues high things generally don't change for the better take trans care an ems company acquired out of bankruptcy by private equity firm run by this woman lynn tilton and a few things to note about her aside from serving looks that can only be described as my style icons are wayne newton and a ferrero rocher candy lynn tilton is a self-described poet already one of the biggest red flags imaginable we looked and one of the only things close to poetry we could find from her was this instagram post i am a woman of strength nothing can break my spirit i am wild and free i am a warrior of light i am me which feels less like real poetry more like someone with a concussion trying to remember kesha lyrics lynn tilton was also the star of the sadly cancelled reality series diva of distressed where she portrayed herself as a savior of troubled companies in inspirational moments like this one of the things we do is we all commit so i'm going to ask you all to commit with me that we will not stop until we have achieved our goal i commit thank you commit commit no in my mail she seems great and lin tilton certainly knows how to instill a sense of courage in those around her it reminds me of that famous fdr quote the only thing we have to fear is in my mill and tilton promised to bring that uplifting leadership style to trans care but many who worked there described rough conditions on her watch with one former employee saying they were sent out in a vehicle where the brakes didn't work properly and during the 2014 ebola scare had trouble getting enough sanitary wipes to disinfect their ambulances former staff even said they were pressured by trans care supervisors to go er shopping meaning they would steal medical supplies from the ers to restock their ambulances and when trans care inevitably ended up filing for bankruptcy in 2016 its employees found out that they lost their jobs like this workers were told they had 30 days left on the job they showed up today to find this trans care was shuttered i was in shock we were all in shock it was horrible it's absolutely horrible a work emergency for dozens of paramedics now i have to find another job i have another side job to support me right now currently but that doesn't pay the bills last night we were told see you tomorrow have a good night well that's up there are certain businesses you assume might disappear overnight like a kids lemonade stand or any circuit city in the late 2000s incidentally they all became kingdoms of optical cables and loose batteries governed by rats and that's absolutely fine but it is not great when what's disappearing is a community's life-saving medical service and it is not just the trans-care folded it's that in a bankruptcy court ruling last year a judge recommended finding lynn tilton liable for nearly 42 million dollars for stripping value out of the company which i guess isn't totally shocking from a woman whose employees were encouraged to strip value out of emergency rooms now i have to say tilton denies having done anything wrong and has challenged that recommendation in federal court and the thing is i'm not just mad with lynn tilton here i'm mad that we're operating a system where a vital service is left vulnerable to the lin tilton's of the world so what can we do about this well as i've said before ideally we transition to a medicare for all approach but that doesn't seem to be in the cars right now and in the meantime there are smaller things that we could and should do for patients we need to put an end to surprise billing and the good news is congress passed a bill last year called the no surprises act making it illegal to send patients steep medical bills when an out-of-network provider is unexpectedly involved in their care the bad news is while that applies to air ambulances the bill for some reason explicitly carved out ground ambulances in other words most ambulances as for ems providers we should establish a lead federal agency dedicated to them and they should absolutely be labeled an essential service especially because that's what everyone thinks they are but for that label to mean something it has to come with funding at the local state and federal levels and there is no better time to make these changes than right now when we still remember the absolute hell of what these workers went through last year remember that parade that bill de blasio promised it actually took place last month but you know who notably did not attend emts many of whom boycotted it because of stagnant wages and the fact that they worked during the pandemic without hazard pay look last year everyone was anxious to show just how much they supported emts well now is the time to prove it and make big changes on their behalf and if we do do that maybe we'll collectively be worthy of a siren that sounds like this get yours mickey you filthy mouse you

Channel: LastWeekTonight

Views: 3,493,669

Rating: 4.8746705 out of 5

Keywords:

Id: Ezv8sdTLxKo

Length: 21min 40sec (1300 seconds)

Published: Sun Aug 01 2021

Reddit Comments

[u/zimfroi]

Just finished watching it, came to see if there was discussion. Excellent piece, showcases some financial issues I didn't really know about.

Also shouts-out my former employer/deployment and the hospital I transported to most often.(Not in a good way.)

[u/sarazorz27]

"YOU HURT, WE SQUIRT" 👌

[u/ithinktherefore]

I had no idea AMR was owned by KKR, but that explains a lot.

He didn’t touch on IFTs, but phenomenal piece otherwise.

[u/-malcolm-tucker]

Whilst at university doing my paramedic degree I had to study and contrast another ambulance and health system with our own for an assessment. The unit coordinator forbade any US systems for comparison because "they are too messy."

[u/austinjval]

Every time I hear about all the bullshit EMS providers go through it makes me more grateful that I work at a good company. Excellent pay, unlimited OT, call bonuses, full benefits and retirement, lots of PTO and chill management. Equipment’s kind of garbage, but I’d rather have them invest in the employees than autoloaders.

[u/werealldeadramones]

So now, will this actually go anywhere or will it be forgotten by the next news cycle?

[u/AbominableSnowPickle]

I’m catching the show this morning on Hulu, and this segment is fucking fantastic. I was hoping there’d be a thread about it!

[u/Self-Aware-Bears]

The other crisis that is starting to bloom is that many areas are in the middle of a staffing crisis. Where I’m at we have nobody new coming in the door and a whole lot of people leaving. We simply do not have enough staffing to keep the number of ambulances we need on the streets. As a result the company is leaning ever harder on us to work more and more shifts, enacting multiple forced mandatory shifts, all without offering any incentive, financial or otherwise, to try and retain the workforce. Many are just giving up and leaving for greener pastures. Many are discussing striking, even though we are told that we can’t legally go on strike.

[u/Ificouldstart-over]

I’m sorry EMS workers. No insurance?! Low wages? You should make a lot of money for what you do and who you save. Corporations only worry about their bottom line.

Edit: took out too much info

Edit 2 spelling