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EMS News in Focus
by Arthur Hsieh

Breaking healthcare paradigms: How SCOTUS decision affects EMS

Opportunities for EMS under ACA are large — assuming we can break out of existing healthcare paradigm

By Arthur Hsieh

Editor's note: The Supreme Court upheld the Affordable Care Act last week. Here's Art Hsieh's take on how the new law could impact EMS providers; what's yours? Tell us in the comments!

Unless you've been living under a very big pile of rocks for a very long time, you know that the federal Supreme Court upheld the Affordable Care Act (ACA).

Since then, election-year politics has pushed the anti-Obamacare faction into efforts to repeal the law. No doubt politicians will try to score points with their constituency in demonizing the ACA as another infringement on personal freedoms and liberty and somehow contributing to the downfall of the pursuit of happiness.

What a crock.

Health care is a right, not a privilege. That's not just my opinion; our representatives in Congress legislated that concept in 1986 with the passage of the Emergency Medical Treatment and Labor Act (EMTALA).

A simplistic explanation for EMTALA is its result. If you are in the United States and you are sick or injured, a hospital must provide a minimum of care for your condition, regardless of your ability to pay.

And therein lies the problem: While enacting the legislation might have been the ethical thing to do, little was done to figure out how to pay for that care.

Emergency departments quickly became the primary care clinic for the under- and uninsured, and over time, EMS field providers have responded to an increasing number of non-urgent requests for service. We are under-trained to manage these but are trapped in a system that is unable to respond appropriately and effectively.

Personally, I'd rather have some of my tax dollars (as well as my additional 311 million fellow citizens) share the burden of paying for healthcare than be stuck here, even though it's simply not fair for those of us with health insurance to pay for the 50+ million folks who do not.

But all of these numbers are simply academic to the typical American. As EMS providers, we know this all too well. You probably have had the following conversation with a non-EMS friend or relative:

That Person: "Wow! You're in EMS? That must be so cool. You must see some of the most exciting things, like on TV, right?"
You: "Uh, not really."

You and I know that we act as the safety net for the current U.S. health care system.

We respond to, treat and transport patients with minimal complaints.

We handle the intoxicated, the inebriated and the behaviorally challenged.

We just don't — and can't — do it in a very effective or very efficient way. The current system seems to assume that conditions that existed prior to 1986 continue to exist today. That's just untrue and unfair.

What is the way out of this situation? The first belief is starting to become a reality: Healthcare is a right. The second and more important belief is that the healthcare provided be appropriate, effective and efficient.

The opportunities for EMS are large — assuming we, too, can break out of the existing paradigm. A sea change of healthcare reform is coming, and we need to be riding that wave.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
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