Back to the Future or Forth to the Past?

2010.Nov.02 Tuesday · 4 comments

in Life

Ambulance crash

I tend to avoid the political arena on this blog, but here we are on midterm election day, and it’s been a contentious process to get here, to say the least. Who knows what tomorrow will bring – likely, more of the same – the same that has been, more or less in place regardless of which party controls whichever part of the government. Inertia is more powerful than change in general. It doesn’t mean change doesn’t happen, but it takes something that will derail the momentum of what’s already in place.

So I’m going to meander a bit (and the ambulance crash photo may or may not make sense by the end of this) about my own journey to this point, particularly in relation to the healthcare system of our nation.

Now, I never set out to be a chef in my early life. I always wanted to be a cop. A federal one – FBI, Border Patrol, Forest Service, National Park Service, CIA even. Cooking was something I fell into, early on working at a neighbor’s Italian restaurant when I was a teen, and then something to fall back on later. And it was a fall back – I’d gone into ROTC in college, but got tossed out when someone got around to figuring out that I was (and had been upfront) openly gay. The FBI turned me down on the same basis. The CIA did, interestingly, offer me a job, though not in a field position – they wanted me to run their word processing pool. Go figure. I don’t actually know where the whole military/police, interest in public service came from, and obviously I didn’t end up there. Perhaps it was my father being a public health service officer in the early part of his medical career.

(If I were going to make a cynical observation to my friends who have been sniping about the socialist directions of our country, I’d point out that the public health service was turned from a military only service that had been in place since John Adams’ presidency in 1789 to a public welfare program of sorts by two successive Republican presidents – Theodore Roosevelt and William Howard Taft – who decided that a national health service was a necessity….)

I dabbled around the fringes of the law enforcement world – I went to the Michigan State Police training camp for teens, twice. I was a Police Explorer scout with our local police department. I worked as a security guard on the University of Michigan campus. And then, I can’t recall how, I got interested in the world of medics (this was more or less pre-“paramedic” days, back in the basic EMT or even just ambulance jockey times), got myself trained and went to work for one of our local ambulance services, Fontana Taylor.

Now, this was the days of truly capitalistic healthcare. Ambulance services were run by private companies – most of them, like ours, associated at least loosely, with funeral homes. They were pay-for services. We responded to calls, and on arrival, after basic first aid treatment, didn’t provide any additional care, nor transport to hospitals, unless the person paid us. In cash, by credit card, or with an insurance card (not a common thing then) from one of a few select carriers that would cover ambulance service. If they didn’t pay, we walked away. And we billed them for whatever treatment that we’d already provided. There were exceptions, anyone in a life-threatening situation we took care of. We still tried to get paid, and harassing family members at the hospital was simply a part of our job. If they didn’t pay on the spot, they got billed, if they didn’t pay that, it went to collection. Etc. There was a movie from a few years earlier, called Mother, Jugs and Speed, which people watch as an old comedy today (and it was a comedy then too to most people), but to be honest, it was pretty dead on accurate for our day to day routine.

Oh, and by the way, the hospitals were doing the exact same thing. Other than critical life saving treatment, it was pay or go away. Other emergency services were in similar situations – most of our county had tax supported fire departments, but not all of it, and one township had a pay for service – if you hadn’t subscribed with the monthly fee, you didn’t get taken care of if your house caught on fire – they’d respond, but only to protect your neighbors’ homes, assuming that they’d paid. Otherwise, they let things burn to the ground. Some township police operated on a similar basis, though at least there you had the backup of both the county sheriff’s deparment and the state police – they might take longer to get there than your local folk, but at least they came.

And then, somewhere along the line, a couple of years after I started, the county (republican government again) decided to “nationalize” (I don’t think there’s a word like “county-ize”) emergency services, in particular, healthcare. They took over the ambulance services, I assume they bought the owners out, along with one other area service. There were (and maybe still are) private ambulances around, but they were no longer called to scenes by the police or fire departments, essentially killing off that capitalistic competition. Yet, care standards were upgraded (we’d already gone to paramedic service in 1979, a very new thing – in fact, my paramedic national registry number was (is?) 81 – nationwide). Equipment was upgraded. Facilities were upgraded and expanded in number. And now, nearly 30 years later, the county service (now covering multiple counties) is just a fact of life, and far better than anything that was created by a competitive, for-profit model. Tax supported and all. And, I doubt anyone would want to go back to the “capitalistic” system of pre-1981. That’s likely true throughout our country.

So that’s my healthcare and “nationalized” story of sorts – I see a direct application to all the protests about the recently passed national healthcare bill. It’s different in many ways – primarily in that it’s not a nationalization of the system, but the creation of a national system. That’s different in that, unlike my experience back there with the EMS world, the government isn’t taking over the day to day operations of it. Nothing in the bill turns private hospitals or doctors’ offices into government run facilities. It’s just a giant government run HMO. And it’s not flawless by any stretch. There will be lots of changes that need to be made to it – most of them won’t likely become apparent until it goes into practice.

The one part, to which I understand, though don’t agree with, the objection to, is the mandatory part – I really do understand that there are people who want to opt out of the system. The problem is that the majority of them aren’t the wealthy who can afford to pay as they go or seek treatment elsewhere – the majority of them are people who want to protest about government interference, but when the day comes that they get sick or injured, they want to be cared for, on the public dole. They want their Medicare and Medicaid payments. They want their Social Security. They just don’t want anyone new (and often, anyone who isn’t a “good white Christian”) to get those same benefits. Maybe there’s a place to go back to those earlier days – anyone who opts out simply gets left to be sick, injured or dying, wherever they are, and no one steps in to help them. Yeah, that’s what we want. Let ’em rely on the kindness of strangers. Or their families and friends. Kick ’em to the curb.

There’s no socialism in this bill or other administration or congressional proposals going on right now. There’s no communism. There’s no totalitarianism. There’s no fascism. There’s no destruction of American values. Not even of capitalism. There is more government oversight and regulation, and no doubt some of that is questionable – but that too will get adjusted as time goes on. And thirty years from now, likely we’ll look back and wonder how we ever could have allowed the current system to go on as long as we did.

And now, back to food.

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{ 4 comments… read them below or add one }

Nic November 2, 2010 at 16:24

I am always completely shell shocked when I read about the US healthcare system and hear that people often don’t have any insurance and how expensive a hospital stay can get…

Where I come from, everybody must have a health insurance, if you want to drop out of the public system you need to sign up for a private one. And although this system has some flaws (mainly it is expensive), nobody really questions the general idea, as nobody wants to worry about paying the bill when he is really sick.

Evie November 2, 2010 at 18:22

Thanks, Dan, for this post. The health system isn’t perfect, but it’s something better than what I had when I left the States. I lived for about 5 years crossing my fingers that I wouldn’t get sick or hit by a car when I didn’t have health insurance. After, I came here and realized everyone had something–OK, maybe not excellent health care, but SOME basic, decent health care is available for all–I thought, dang…the US sucks in this respect. Hopefully, we’ll make the necessary changes to make it run better so we’re not leaving anyone out in the cold.

Jody November 7, 2010 at 14:08

I’m with you all the way on this one, Dan. Having experienced the best and the worst of our health care “system” I’m appalled that the US did not, long ago, see fit to assure basic health care for all of its citizens. Our infant mortality rate is at the level of some frightening countries. Having spent a lot of time in Canada over the decades, I know it is possible. Our Canadian friends have been scratching their heads at our bizarre discussions over health care during the last year and say, “Death squads??!! What is up with you guys?” Indeed.

I hope it is not inappropriate to mention this here, but how does one get invited to your Puertas Cerradas dinners? I am in BA several times throughout the year and am very intrigued.

dan November 7, 2010 at 20:08

You don’t need an invitation Jody, just go to our website, pick a date that works for you and click on the link to make a reservation.

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