He refused to go in an ambulance the first time. He could have refused the second ride. You can refuse transport or medical care at any time as long as you are able to make rational decisions.
As an EMT if you're A&Ox4, alert to time, place, person and event, you make the choices. You do sign a release so we have proof we didn't abandon you, but you make the choice. If we move you without your approval, it's kidnapping or entrapment (not hit me up law arguers). To do that we either need implied consent (minor no parent, not A&Ox4, or Law Enforcement).
My department, a small rural one with a small tax base which happens to cover a lot of injuries because we have 20 miles of dangerous mountain pass freeway and a ski and mountain bike area, only charge for calls if we transport. I think a transport is around $900. Our minimum transport is 37 miles. We scale it down depending on income and type of event. We're not massive sticklers about it. We're just trying to cover wear and tear on big expensive vehicles for all the non-transports, winter driving, equipment, uniforms, training, etc. Most of our "business" comes from "transients" eg folks who don't live there, eg those skiing, hiking, biking, or driving over the pass.
This is also very much not the norm. But should explain a bit about those who do pay are covering those who don't.
We don't want a chilling effect on calling 911 for precautionary stuff. We'd rather show up 99 times and check people out and let them go than miss the impending cardiac event. And we get those. It's very interesting just how much going over a 4k foot pass stresses people on the edge. Many of our medica calls are people driving to seattle for deeper care and things exacerbating when they get to 4k feet.
I don't think the question is "Should ambulances be a thing?" though. It's a question of "Should someone in a situation where they need an ambulance have to balance the potentially life-threatening impact of saying no versus the potentially financially ruinous impact of saying yes?"
The (fairly obvious) answer to that no one should be in that situation. It's horrible. Society should find a better way to pay for ambulances. Most of the world has accepted that some system to spread the cost among everyone is better than putting people in that situation.
> Society should find a better way to pay for ambulances
Society has this figured out, at least a decent solution that works until we find a perfect one. Only the US society seems to be unable to find a solution.
> In Tulsa and Oklahoma City, meanwhile, the government buys staffed unit-hours from an ambulance operator, while households can prepay a few dollars a month on their utility bill and owe nothing if the ambulance ever comes.
billed for buying unit-hours from an operator... that's very carefully worded to make it sound like a corporation<>customer relationship and not socialism.
Lots of policy in the US is hacking around the lizard brain idea of "We cannot have nice things because someone who doesn't deserve it might get it."
My favorite example is universal school breakfast and lunch. Without fail, someone will argue that some kids don't deserve it. It doesn't matter that all of the data shows it is more economically efficient and the benefits to kids is overwhelming.
You essentially described the Republican and Libertarian perspectives in the US.
The Republicans seem to see it as immoral to potentially give a few people support they don't need even if that means that most of the people who need the support actually get it. And, instead, they believe that having an inconsistent array of private interests will somehow be more able to service an enormous population than having an organization (like government...) that is large enough to match that population's needs.
The Libertarians seem to either genuinely not care about the rest of the world or, more often than not, seem to be naive about how life can be for the less privileged.
It's the lie of the "rugged individualist" in America. Most "successful" people come from successful families. Social mobility, in the US, is part of that lie. Here, we celebrate the person who rises from poverty to become wealthy as a member of a sports team, or as an actor, or similar, while disregarding that these massive successes are outliers.
It's interesting to note that very often these same Republicans have no issues at all with large tax-based incentives when they help their employers or knock some dollars off they yearly property tax bills.
It just boggles my mind how the poor are supposed to be continually punished just for being poor and should always be denied, almost by rote, any sort of government aid because, you know, did you hear that story about that fentanyl addict who was found with THREE active EBT cards in his wallet?
Yeah for sure...how dare some dirty addict should be able to eat!
> The Libertarians seem to either genuinely not care about the rest of the world or, more often than not, seem to be naive about how life can be for the less privileged
No, they just put boundaries on what services they want handled by the government. Government programs are the least efficient and most wasteful way of getting a job done, and there are endless examples of this.
Churches were historically the places people went to for assistance, and churches held people accountable and would push them to fix their underlying issues.
Government programs have none of this, you can keep making the same bad decisions and nobody will hold you accountable and the benefits will keep coming in.
The government is in a bad position to be that kind of paternal - any sort of large machine is the worst possible judge of the difference between "shit happened" and "I am systemically making incorrect life choices".
I agree that what you need here is someone(s) with leverage and respect in your life to interfere with systemic bad behaviors if they exist, but that takes community, government merely gets leverage, and churches are often not a welcoming place to many people's eyes, rightly or wrongly, around the US.
As I get older, I'm increasingly of the opinion that the best you can do is unconditional support from the government (because it's the only kind you can rely on no humans in the chain acting in bad faith to condition), and well funded local support structures for people to subsist while fucking up their lives and also help them get out of that spiral if they want to.
Not because I believe in some fundamental good in man or something, but because I think that's the only way you can design this that isn't subject to people's bad faith manipulation, and I've personally seen too many cases go wildly differently for "objective" criteria where the main difference seemed to be whether the person reading it went into it assuming you were lying or not.
Christianity died in my country because people got tired of the judgemental, hypocritical cunts. The child abuse scandals that hit later only confirmed it.
You’re attributing to government what is just the overwhelming population of perps in this context: predatory men. Sometimes teachers, very often religious institution participants; positions of power, trust, and/or authority used to control.
I am not.
School teachers are predominantly women (around 90%), single parent homes are primarily run by women, women play the largest roles in the raising of children in genetal, and also make up about 35% of domestic abuse reports (not accounting for all the cases where men are too ashamed to report the abuse).
Women commit just as much sexual abuse as men, it's just not talked about by society.
Sorry 'bub but the Democratic party is as much to blame as republicans. Neoliberalism has infected both parties and let us finally shed this fake reality that the democratic party is the party of labor and not corporations.
Good news is that if you want the democratic party to become the party of labor, now is the absolutely best time to have a real impact in your community.
Come on, across the world we prepay for the use of things regardless if we do or not. As described in the article it's an option, not a political system.
serious, go look at the F500 list and see how many of the largest, meanest companies in the US (and world) world also happen to be healthcare
if you wanna know why it's never gonna happen -- there is the list. they will spend more money than god on social media, bribes, and whatever else they need to keep the system the way it is
Why is Fortune the relevant list? Why not market cap, which also happens to correlate with net income, which means more cash to spend on political influence?
Mostly only pharmaceutical healthcare in the upper tiers of that, but these businesses still have market caps and net incomes literally one or two orders of magnitude separating them. Grouping top 10, 50, and 500 makes no sense.
Unable to be willing.
The combination of not knowing any better, political parties and media that don't care or exert a contrary pressure because they belong to billionaires, and powerful health sector businesses appears to be very effective.
The odds are stacked, but everyone still has free will and can choose to question what they’ve been told (especially what they’ve been told conflicts with what they can see with their own eyes).
And the US also pays a TON of tax dollars to a broken, overregulated system.
IIRC if you look at the cost of Medicaide, Medicare, VA, and other federal and state spending it's the same as most other countries per capita or as a percent of GDP. The US taxpayer pays about as much as Canadians to fund their public system, then pays the same amount again for private cover since it's not universal.
No I'm not making a typo. Medicare, Medicaide, and the US system is such a rip off that per capita Americans are paying similar tax dollars to their joke of a public system.
But no one wants to fix it. US doctors are overpaid. US nurses are over paid. Dug companies. Admin. Lawyers. Everyone who makes the system work, and everyone who makes the system a mess are paid a fortune for it.
McKinsey did a nice analysis of what is driving US healthcare costs. It compares category spending to OECD then compared price and volume.
Turns out the US pays a bit more for drugs (relative to total spend), a little more for inpatient care and a TON more for outpatient care but half of the increase is volume, not price.
As someone who works in healthcare globally, the difference in US care is stark. Americans get much early and more access to new technology than other countries.
If your lymphoma has returned and you have a 20% of living more than a few years the best care is CAR-T with cure rates close to 60%.
Check out CAR-T rates in the US versus Europe, it’s almost 3x. The US started using it in 2014 and Singapore just started paying for last year (11 years later). Even in Europe adopt only ramped up in the last 5 years.
So yes prices are higher, but a big part is more aggressive care with more expensive treatment.
The US healthcare system just upsells on unnessessary crap. It's junk volume or at best it's heroic high tech solutions mostly making up for the fact that people stay away from hospitals until it's too late.
Life expectancy shows that while the US is the best place to have stage 4 cancer, it's probably not the best place overall. Most places do the 80/20 stuff better.
But yeah, you are right that the US does some stuff well. Just not efficiently.
US care is highly aligned with international guidelines. Saying "it's junk volume" just tells me you're not that close to the data.
Life expectancy doesn't measure quality of healthcare, there are far too many confounding variables like genetics, diet, accidental deaths, etc. No serious study of healthcare quality relies on it.
Look at 5-year cancer survival rates. The US is better (significantly better) in many of them than other countries. A big part of that is access to the latest technology.
Now do maternal death rate. Like I said, a good place to have cancer but they aren't good at stuff that matters.
The US leans aggressive on tests and heroic end of life care. I doubt you really disagree (except maybe on whether you think it's the right call). That is where the money is, since the insurance company can be forced to pay. It's kind of good for the rest of the world though if the US wants to pay (in both money and other issues) to be early adoptors.
Read "When doctors die", the US is the total opposite - everything goes to the big ticket aggressive (and yes, modern and cutting edge) treatment where it's hitting diminishing returns. https://pmc.ncbi.nlm.nih.gov/articles/PMC6179868/
Turns out the CDC changed the way it counts maternal deaths, while other countries didn't, so you're comparing different measures.
The old US measure was deaths that occurred during birth or shortly thereafter, now it's within six months and they added a check box only asking if the woman had been pregnant in the last year.
Not "this woman died because of poor maternal care", but rather "this woman who died had been pregnant in the last year".
This change immediately doubled the number. The data was wildly overestimating maternal deaths and in fact the CDC and many states are revising data collection to improve the number.
A good tell that someone is utterly full of shit on Canadian healthcare is that they generalize all of Canada.
“Canadian health care” is not a thing. Each province administers its own completely independent system.
Someone on PEI is in a healthcare system that has as much to do with Alberta’s healthcare system as it does their neighbours in Maine. As a result, anyone referencing Canadian healthcare is talking about a dozen or so unrelated systems that do things very differently. The closest it comes is that there are interprovincial billing systems so you don’t have to do the paperwork to get covered for an urgent visit out of province, and not all provinces are signed on.
You can safely dismiss anyone that has reduced that complexity, or is completely ignorant of it. It’s a great way to tell when a foreigner is spouting talking points they picked up from an unreliable source and did not do even a minimal fact check on. “Canadian health care” as it is talked about in the US media is frequently fiction for propaganda purposes.
Canadians almost always talk about problems within a province. What's happening in the Maritimes has nothing to do with BC.
The feds set a minimum standard for a province to qualify for federal funding, and that's about the limit of their influence.
No idea if the rest of his statement is poorly sourced propaganda as the first sentence.
You’re ignoring the fact that provinces can’t fund technology that the federal government hasn’t reviewed and negotiated a price for.
So yes there may be differences between provinces in terms of when they fund what restrictions are put on it, the overall trend across Canada is pretty consistent.
And as I said Canadians don’t get the same care as Americans so concluding the higher cost is entirely higher prices for the same thing is false.
I lived in Ontario for 20 years then I lived in Seattle for the next 17, I assure you that the healthcare I receive and received is pretty much the same - except in Ontario it's way cheaper.
You're talking about cutting edge technologies available to the tiniest sliver of people - I'm not even able to get access to much of them with my private FAANG insurance - and drawing a false comparison.
Nope. I've not only lived in both countries, I work in healthcare so I'm very close to who gets access to what.
And it's not "the tiniest sliver of people", we're talking about disease like cancer. Check out the CAR-T rates in the US vs. Canada, the difference is stark. And CAR-T is standard of care in some types of lymphoma.
Hell, ask parents with autistic kids what kind of early intervention is available to them in Canada. I had a coworker who moved to the US so he'd have much better access for his kid at a time when it had a big impact.
Look at access to the cystic fibrosis therapy that effectively cures it (e.g. Orkambi). It was paid for by insurance (and Medicaid!) from the day it was launched and avaiable to everyone it could help. In Canada some provinces just started paying for it, but only kids, adults are shit outta luck.
And I don't know the details of your FAANG insurance, but my US insurance (typical corporate insurance) pays for all these new technologies.
Canada is great if you have a routine issue. If you need something specialized you're going to be treated with therapies that are a decade or more old. Hell, even the CBC wrote a whole story about 2 friends with breast cancer and the differences in treatment.
"Then I found out that this other country — which I thought had a healthcare system that was so superior to the U.S. — doesn't test for the tumour marker that saved my life, and doesn't cover this drug that is responsible for pushing my cancer into remission after traditional chemotherapy failed to do that."
Certain specialities probably are overpaid (orthopedics), but others like pediatricians or general practitioners usually aren’t.
And nurses!? From the nurses I know they are underpaid for what they deal with.
The ones making loads of many are willing to travel around the country and uproot their life once or more every year. Not exactly a lifestyle without its drawbacks.
Everyone is gonna say nurses are underpaid. It's a caring, female dominated profession, it's a motherlove sentiment. And they are not paid as well as doctors.
Yeah, most pink / blue collar workers in the US are badly underpaid, but IIRC ones in the health sector are some of the best off, relative to medium salaries.
Compare teachers and nurses. In most countries they make about the same AFAIK (and I'd say nurses do deserve more, telling a parent Billy did badly on a math test has got to be easier than explaining a bad medical test). But in the US it's about 75k vs 95k. There's a huge premium for working in health in the USA, EVEN in the underpaid blue collar end.
Doctors make out even better in the US, and the c suite in health can have salaries that are just insane.
I don’t dispute this, but I also don’t think it matters. An underpaid profession being paid more then a severely underpaid profession doesn’t make the former overpaid.
> US doctors are overpaid. US nurses are over paid.
Median pay for a Nurse Practitioner is $132K/yr [0]. I think that's reasonable.
Average pay for physicians ranges from $220-450K depending on specialty. [1]
Personally, I think doctors should be paid more than software engineers, so I think those numbers are all reasonable, especially when you consider what it takes just to enter the field. Nurses require a Master's degree. Physicians need a Bachelor's degree PLUS another 4 years of med school AND THEN a residency program that lasts 3-9 years depending on specialty before they finally earn their medical license.
IMO, the idea that nurses and doctors are overpaid is quite simply ludicrous.
You might find those salaries reasonable, but they’re probably double what those same occupations pay in many other (first world) countries with lower healthcare costs. Maybe the trade off is worth it, but it’s not something that can be ignored when people complain about how much more expensive healthcare is in the U.S. compared to Europe (for example).
> but they’re probably double what those same occupations pay in many other (first world) countries with lower healthcare costs
You'll find that salaries across the board are lower in other countries. Software developers in Europe make half of what they do in the USA. In exchange, they get far better benefits.
Also, physician salary only makes up about 8% of total healthcare costs [0]. Cutting salaries in half wouldn't significantly lower our healthcare costs.
No, certainly just cutting physician salaries wouldn’t make a big difference. But cutting salaries for everyone involved, including physicians, nurses, and administration would. I’m not saying we should do that, but just that people seem to ignore how much higher salaries are in the U.S. when they compare healthcare costs to other countries.
This is a common claim, but it is a misleading simplification of US politics and European politics. (In simple terms, many of the economic positions taken by the Democratic Party would be considered centrist in Europe, but if you include positions that have been taken on immigration, identity politics, criminal justice, reproductive rights, etc. it would not.)
All nations are nations of immigrants other than maybe the cradle of humankind. They stop being that generally when the state and benefits get so expensive that administrating them and paying for them becomes a huge burden. The original immigrants to America fought the land and many died to tame it. Coming now to take is not the same thing. Particularly when you can fly in, give birth to an American, and fly out again.
Immigrants provide a net economic benefit on average. If they work here, they spend here. They tend to be younger and with our aging demographics it’s really important that we have more young people entering the workforce.
This is just GDP, which isn't that relevant. If you add a million people and only one of them works, GDP will still go up. It doesn't take into account the following:
- no-one's talking about immigration in general. They're talking about mass immigration. So any general "look how immigration can be good" is not addressing the issue.
- mass immigration means that housing becomes scarce, driving up prices. This again makes GDP look good, because stamp duty revenue goes up and so do estate agent fees. But all the many negative externalities, such as everyone is now buying houses 10 years later, and leaning on their parents, and their dwellings are all being subdivided because even a tiny place is now worth renting out or selling, are totally ignored. The housing costs drive every other cost up. Minimum wage / living wage needs to skyrocket just to combat this one thing, both because people need more money to pay for their own accommodation, and people need to afford goods and services that are all also being made more expensive because their salary costs need to increase for the same reason.
- mass immigration spikes up demand for power. Power is often a large capital investment, which means that the country borrows a load of money from Macquarie Group to build it, with lots of interest paid back over decades. Seems to generate GDP as people are being paid to build things; actually a net negative all told over the lifetime of the investment.
- the same as power but for water.
- the same as power but for roads. Traffic and congestion are now being actively managed by computerised systems because there are so many cars on the road.
- the same as power but for pollution. Another negative externality of driving up population for GDP reasons. Every person imported is more pollution generated in and by the local country.
It's important we have young people entering the workforce. But adding more people from external sources is not sustainable. When they all get old do we import more people? Or should we just be repurposing the millions of young people who are doing less important but less icky jobs to do the jobs that we're currently getting immigrants to do. "Who will pick the cotton?" is not a good question.
Net economic benefit is not only GDP, it includes net tax over government spending. Immigrants are younger so they have more regular taxable income (vs capital gains), while spending more of it (vs saving) and drawing less government benefits.
The housing shortage is driven by NIMBY and regulatory capture. You are right that perpetual growth is unsustainable but we are not remotely near the possible carrying capacity of our land and resources. We have had periods of much greater population growth that were accompanied by greater prosperity overall.
Immigrants are not the problem, they are the convenient scapegoat of the business interests that have systematically hollowed out the middle class over the last 50 years.
Since when is the constitution leftist? Birthright citizenship isn’t a left or right question at all in Europe. It’s not a thing there. Neither left nor right wants it.
>But no one wants to fix it. US doctors are overpaid. US nurses are over paid. Dug companies. Admin. Lawyers. Everyone who makes the system work, and everyone who makes the system a mess are paid a fortune for it.
17% of GDP is healthcare. So between 1:10 and 2:10 people in this country are making more than they otherwise would (note I did not say wealthier) because the system is screwed up and hoovers up more of everyone else's wealth than it ought to.
Slavery was 12% and (while obviously geographic concentration of industry plays a lot into it) it took a war for them to take a haircut.
Earnings represented by GDP are not distributed evenly across a given population. That 17% of extra earnings goes to relatively few people in the States (I'm putting this very mildly, the concentration in reality is insanely lopsided).
The US healthcare industry is ~10% of the workforce. More if you include people affected by the supply distortions thereof (all those techbros working for agentic penis pump startups).
The fact that that pie is not sliced evenly does not change the fact that is an integer multiple larger than it ought to be.
I easily see that changing the USA to be more socialist, especially in areas where game theory indicates its the best solution, will likely take a civil war.
That also aligns with Marx's writings, that the capitalists will not acquiesce without a fight, and a big fight at that.
The slavery and Civil War connection is a comparison of similar economic magnitudes.
Canada doesn’t pay for ambulances unless it’s truly an emergency. Think you’re having a heart attack but you’re not? Time to pony up hundreds of dollars
The war in Iran in MAY was reported at 29 billion dollars. It's probably been a bit more since then. Justifying stupid actions because you hate brown people isn't good for any of us.
Surrounded by the barbarian warmonger nations of Canada and Mexico, the US has to increase its military budget to close to a trillion to pay for wars it definitely hasn’t been single-handedly starting since the 1970s while the USAID budget which is 5% of the military’s which tries to eradicate tuberculosis and malaria needs to go. Makes total sense.
I've been there before. I had a high deductible health plan, it was December & I hadn't used any of my premiums... I had a heart attack (I didn't know it at the time). And my mind went to "but my premium! I know, I'll walk myself to urgent care instead of taking an ambulance to the hospital"
I remember this came up during COVID. The government was worried that homeless people and illegals would be afraid to report symptoms. GPs are specifically free and don't have to ask for papers or insurance to combat these health crises.
Is this the common cost or is this an outlier blog story that hit it off. Talk real data to me. I don't get excited about any individual anecdote (unless it's me personally of course).
No people shouldn't be bankrupted for a short cab ride that's not needed. I'm not arguing that.
Well over a decade ago, it was $6500 for a couple mile ride to the nearest hospital, no emergency medical care necessary (just supervision). This was in the Bay Area, in California.
That's wild. According to the website of my local ambulance organisation, a full on ambulance ride with all medical supervision etc runs between 400 and 900 euros. Typically this would be reimbursed by the (mandatory in this country) health insurance. This is in a large city in western Europe, I would expect it's cheaper in places with lower cost of living.
Yeah my mom got billed 9k a few months ago from SFO to one of the south sf hospitals. Neck brace and supervision was all that was needed. Basically an expensive uber ride.
I know that John Oliver is a bit of a “lightning rod,” for many folks, but he (or his staff, really) does his homework. He did a segment on it, some time ago: https://youtube.com/watch?v=Ezv8sdTLxKo
There’s a thin line between satire, which can convince, and sneering, which can only turn off. John Oliver, unfortunately, does end up on the wrong side of it from time to time, and can (together with his core audience) be something of a bully when he does.
I’d also be careful about his facts: they’re usually well-researched, but by the nature of the format he only ever presents those which fit his argument, and that’s just not good epistemology. I can think of a few times when the show made me feel safer about my beliefs than I should have been feeling.
>So why not make fun of them? There's no downside.
...except the populist right backlash, triggered in part by their resentment at coastal "elites" (think yuppies, not people who fly to davos annually) sneering at them.
The "coastal elites" they resent are made up by conservative media. No behavior changes by the yuppies can affect the ever-increasing resentment people feel in response to this sneering bully, because the bully is made up and the tendency of RW media to use ever-more-dire portrayals of supposed societal ills.
As an aside, I think the culture which produces this result is related to people in the US always thinking crime is increasing, regardless of actual crime trends.
Even with insurance all these companies will fight with each other to find excuses to say it’s not their responsibility and send you letters non stop saying things like “oh you paid for the van, I’m just the nurse, it’s separate” or “oh yeah you paid for the hallway in the hospital but the ct scan person is a contractor, you owe them 3k”. System could not be more broken
Well, you don't know how rotten the industry is.
Your moral social-darwinism just enriches a couple of suits, nothing more, instead of spreading the costs you could very well start by making sure the costs are not inflated.
x2..x5 multiplier is always applied to any ambulance bill as far as I'm aware. I worked in that industry.
This shit is exactly the problem with capitalism and capitalists.
I've seen as long as I've been alive, "Communism killed hundreds of millions!!!" breathless claims.
When Capitalism kills, oh wait, it never does! Its always "bad individual choices", and never a review of the terrible for-profit system that caused it to begin with.
> Making poor medical choices that prioritize your own well-being over the financial solvency of those you care for, those around you, is a shitty thing to do.
And there it is. The system is highly predatory as intentioned. But the system is just part of capitalism, so its OK. But 'YOUR CHOICES' are the one that's bad, aka blame redirection.
And guess what? More and more people are seeing behind this facade that capitalism is good. Socialism is better. We're tired of being extracted, used up, and thrown away. Its why I'm also part of DSA. I'm done with this individual blame for systemic shit.
It's not a strawman. Ruining entire countries is literally what the parent comment said would happen if we do something as outrageous as making ambulances free.
> But those same people, through one false rationalization or another, are more than happy to ruin the entire country.
You may not have agued it yourself but your two sentence comment is rather lacking in alternate arguments, so I can only interpret you as supporting said parent comment and now engaging in a motte-and-bailey now that you realise you don't actually like what they said.
The increase in healthcare costs is more a function of an aging population, rather than people (mis)using ambulances too much. However in these countries, although the rates are fairly low, misuse of ambulances is often heavily linked to poor levels of health literacy or lack of transportation options - though the caller often genuinely perceives it as an emergency - both of which can be improved through other programs such as education and public transport provisions. It’s almost as if providing good public education and transportation makes the population more productive and less wasteful.
I refuse to play these games. If you wish to make the argument that universal healthcare (including cheap or free ambulance coverage at point of use) necessarily leads to financial ruin you are free to make that argument, along with all the necessary support such a position requires. If you do not wish to do so, then I have no issues and thus decline to make any argument otherwise.
I am not obligated to make your argument for you, and I am not inclined to calibrate your motte-and-bailey merely because you feel like interjecting your support for a position you would call a strawman when called out.
No, I just don't see any point in debating anything when you presumably agree that nobody is being bankrupted by free ambulance rides given that you called it a strawman. If you wish to defend what you called a strawman, which I didn't think people normally did in good faith but could be convinced otherwise, then I am willing to let you set the definitions you wish and make a case, as is standard for those instigating a discussion, while reserving the right to decline further participation if my disagreement with the position is below a certain threshold and/or any other reason I might find the discussion unproductive.
I'm amazed that in ~450 comments, the word "capitalism" is mentioned in just one - yours - and you've been downvoted for criticizing it!
It seems even a group that purports to be rational critical thinkers don't want to be rational critical thinkers to the extent of looking into the root causes.
The problem with capitalists is that if you wanted, they'd let you go do your little commune thing somewhere. The problem with communists is that if you're not a communist and you can't be reeducated into becoming one, you must die. Or if you're the wrong kind of communist. Or if you're the same kind of communist, but you also want power. Or if you don't want power, but they think you might some day. Or if you're related to someone who might want power some day.
But no, I won't be a communist with you. And if you insist, things could get ugly. Fortunately for me, you're still in your hipster-college-champagne stage of communism, and you're both scared of violence and worried about the PR backlash of being found out to be a bloodthirsty savage.
In November when it becomes apparent that the Democrats won't win back seats, you'll all start to panic. But the real fun will come in 2028 or 2030, when Obamacare will be dismantled. I can hardly wait.
So in your eyes, the population of several western countries is (and has been for decades) dominated by complete morons, resulting in free or almost free ambulance rides?
And what does the Democratic party have to do with all that? Your whole comment just seems like a thinly veiled and insulting political rant. Going by your account name, this seems to be a pattern.
So people should be getting financially ruined to god-forbid prevent some abuse of the system? As long as there is no abuse everything else is hunky-dory?
> Only a complete moron would think the answer to this is no. If there's no personal cost to using an extremely expensive service, every one is going to use it regardless of whether it's actually necessary. It will quickly turn into a free taxi service for anyone who wants to go anywhere near a hospital.
Okay, so why don't we see this behaviour more in other countries?
In my jurisdiction, the incentives are actually weighted towards pushing people to ambulances, as there is a €100 fee for self-referral to ED which is waived if you're transported, but while there are time wasters and frequent flyers, the service is actually less abused than US ambulances under EMTALA.
I had an accident where I had a concussion and other injuries that put me in a lot of, and the people I was with called an ambulance for me, and I wasn't really in a state to decline, but if I had been, and knew how much it would cost, I would have. The ambulance ride was, of course, out of network. As were some of the doctors that treated me once I got to the hospital. It was the first time I dealt with a major medical expense as an adult, and it came as quite a shock when the bills came several months later, that said I was responsible for about $10,000 for the ambulance (plus a lot more for the hospital), and a good chunk of it didn't even count towards my deductible because it was out of network. I later learned I should have contested that since it was an emergency, and insurance is supposed to cover out of network service in an emergency, but I was young and inexperienced with dealing with health insurance companies. Oh, and it was about a 10 minute ambulance ride.
I guess my point is, sometimes you don't have a choice, but you still end up with a massive bill. And also, that experience definitely had a chilling effect on me calling 911.
Treating medical care like this, similar to a racketeering scheme, should not be a thing anywhere.
Instead of punishing people for seeking medical care (or plainly requiring it), it would be preferable to have a robust protocol for rejecting patients that do not require care, whether at the hospital or before the ambulance ride.
For this, people would need to want medical care be a humanitarian right and basic pillar of a functioning society, not a business or a bureaucratic system to perform a selection process decreasing the life expectancy of less-affluent people.
Ironically, when there is free medical care and universal insurance, there are also perverse incentives. For example unneeded expensive procedures, prescribing patented, newer drugs where cheaper ones would work, providing ineffective or even detrimental services, etc.
But humanitarian values are out of fashion, because they were never achieved globally.
So the only right people care about increasingly is their right to own property.
For most nation states "should" in this case also corresponds to a certain treaty they are party to being highly inconsistent with treating health like a racket. Of course, the US is one of the few that never ratified said treaty. Too much like socialism I suppose.
Can't you simply argue: I never agreed to this, so I'm not obliged to pay this?
Americans love to pretend that healthcare can somehow be a free market (it can't), but a free market requires voluntarily entering into a transaction. Costs that can be forced upon you without your agreement need to be tightly regulated and subject to clear caps.
Being concussed should count as not being fully aware. And making someone pay something that he was made to accept while not fully aware should be denounced as a scam.
I can literally buy a nice house with that just outside the city. And we somehow have universal healthcare despite the average salary is not even one-tenth of American.
>> We scale it down depending on income and type of event. We're not massive sticklers about it.
That touches on another very american problem. The injured person now does not know how much the tansport/treatment will cost. And the only persons on the ground cannot quote a price. If they say yes they enter into that zone of having another random health care bill comming in the mail. Is it 900, or 9000? Will my insurance cover this? Is this outside my deductable? ... this is math that no person should have to do while bleeding beside a highway.
My insurance says ambulance rides are covered 100%. Apparently most are out of network though, which the people have no choice of choosing (obviously).
I was sent a post insurance $8000 bill. After months and months of arguing they said it was an error on their side and dropped the charge. Absolutely ridiculous
Under distress, yes. But honestly, I did piloting a little (airplane and various soaring aircrafts), and think that thinking there is also under distress, and that's ok, you still need to make decisions, that's life.
You’re getting in an ambulance, not calling a cab. You’re probably unconscious, maybe at least disoriented, overwhelmed, concerned about what’s happening more than doing math. Also you’re there on the floor bleeding, what’s your alternative? “Nah don’t worry, I’ll figure out this exposed fracture in the uber, I got points with them so it’s cheaper”?
I had fractures several times, and I did think about the costs. In fact, the last one was pretty bad, andy first thought was "good thing I'm in a country with good medical care, even though expensive".
>> He could have refused the second ride. You can refuse transport or medical care at any time as long as you are able to make rational decisions.
Disagreed. Someone who is cogent and not intoxicated and not a stroke victim can't always make the best choices. Your decision making can be compromised by I dunno the fucking pain of a broken toe bone.
Seeking help should not be interpreted as a sign of weakness and made into a maze where only the most rational can escape with minimal bills. The longer we leave this cognitive dissonance where the land of the free roughly translates to land of the free to get fucked we are going to continue to have instability.
Really? Where I live a patient is always able to refuse any medical procedure or treatment, unless they’re unconscious or otherwise mentally unable and the procedure is considered necessary to save their life. They certainly can opt for a non-ambulance transfer, though here it would be free even though a regular ambulance service typically isn’t.
Consent for treatment is a core principle of medical practice.
I think the idea is that if it's mandated, then the ambulance should be covered by some kind of insurance since it was medically necessary and not just Ol' Bob, the hypochondriac, calling because his tin foil hat fell off.
As an EMT if you're A&Ox4, alert to time, place, person and event, you make the choices. You do sign a release so we have proof we didn't abandon you, but you make the choice. If we move you without your approval, it's kidnapping or entrapment (not hit me up law arguers). To do that we either need implied consent (minor no parent, not A&Ox4, or Law Enforcement).
My department, a small rural one with a small tax base which happens to cover a lot of injuries because we have 20 miles of dangerous mountain pass freeway and a ski and mountain bike area, only charge for calls if we transport. I think a transport is around $900. Our minimum transport is 37 miles. We scale it down depending on income and type of event. We're not massive sticklers about it. We're just trying to cover wear and tear on big expensive vehicles for all the non-transports, winter driving, equipment, uniforms, training, etc. Most of our "business" comes from "transients" eg folks who don't live there, eg those skiing, hiking, biking, or driving over the pass.
This is also very much not the norm. But should explain a bit about those who do pay are covering those who don't.
We don't want a chilling effect on calling 911 for precautionary stuff. We'd rather show up 99 times and check people out and let them go than miss the impending cardiac event. And we get those. It's very interesting just how much going over a 4k foot pass stresses people on the edge. Many of our medica calls are people driving to seattle for deeper care and things exacerbating when they get to 4k feet.