Blowing Up the Ambulance Industry

Medicare for All

Today we’re taking about ambulances and the ambulance industry! We know this topic is important because Michael Bay recently released an action movie called… “Ambulance.” This is the director who brings you about 90% of big-budget Hollywood films where car chases happen and lots of shit blows up. And sometimes robots from outer-space. Like a lot of our healthcare system, the ambulance industry has become increasingly privatized, and taken over by for-profit equity firms. This has a dramatic impact on the patients who need emergency medical services (EMS) - often at their most vulnerable moments - as well as the EMS providers who work in the industry, and are increasingly squeezed by their employers. https://www.youtube.com/watch?v=GI3CUZXlktQ Show Notes Today's guests are: J. Wesley “Wes” Boyd, MD, PhD is a professor of psychiatry and medical ethics at Baylor College of Medicine. He is also a Lecturer on Global Health and Social Medicine at Harvard Medical School. Wes has written about and taught extensively in the humanities, medical ethics, human rights and psychiatry. Aditya Shekhar studies the epidemiology of various emergency medical conditions, including cardiac arrest and traumatic injury. He has contributed to numerous publications in leading medical journals, and his work has been featured by several medical societies. He also has field experience as an emergency medical services (EMS) provider and teaches EMS in the United States and internationally. Wes and Aditya published an article in Slate: “Ambulance Raises an Important Point About Ambulances; The box office flop is basically a commercial for Falck, a for-profit ambulance company with slow response times." As research for this podcast, Gillian watched the movie Ambulance. (Thank you for your service Gillian.) The movie actually realistically depicts the failure of our healthcare system. Our hero, whose insurance company denies coverage for his wife's life-saving treatment, robs a bank and abducts an EMT, using an ambulance as a getaway vehicle. (What? It could happen.) Promotional material for the movie Ambulance, a 2 hour 16 min infomercial for the ambulance corporation Falck. Aditya shares how his experience in EMS is and is not like the movie. For example, unlike the movie, EMS providers don't typically perform surgery in an ambulance. He has also never been kidnapped by Jake Gyllenhaal. But they do provide care in the moment a patient is at their most vulnerable, helping them get to the most appropriate care. Wes describes his experience working in an outpatient psychiatric clinic, about a mile and a half away from a hospital. He crossed paths with EMS whenever a patient was at risk of self-harm, when he would have the patient transported to the Emergency Room. Many patients begged him not to call the ambulance and let them get themselves to the ER, because previous ambulance trips came with a bill of over $2,000. At one point he even drove the patient to the ER himself to avoid that expense. Ambulance services are increasingly becoming privatized. The trend sped up after the 2008 economic crisis because cities struggled to afford these services. Many of these companies are owned by private equity firms, who saw an opportunity to use existing resources to minimize management, while billing the patient’s insurance for high profit. When a city runs an ambulance service, the goal is to break even, and when they don't, the city absorbs the cost because it's a public service the community needs. When a private equity firm runs an ambulance service, the goal is profit, so they cut services, overwork and underpay their staff, and ultimately provide less safe care. We hear a lot about “surprise billing” in the hospital setting, but surprise billing is also rampant in emergency medical services. Congress recently passed “The No Surprises Act” to address surprise billing,