The Problem of Private Ambulance Services

David Anderson, writing about his experience in Current Affairs:

The private ownership model for ambulances is fundamentally at odds with its own purpose. In the beginning they were useful insofar as they were an ad-hoc option in a society that gave no thought to whether or not speed was important in treating an illness or injury. However, this jumble of organizations across the nation creates big problems beyond figuring out billing logs. A key problem is the cost of doing business. A single ambulance can cost somewhere in the $500,000 to $1 million range, so any ambulance company’s first priority is to reduce overhead as much as possible... They want to get the cheapest gear, the cheapest ambulances, and the cheapest workers. You will see EMS personnel make fast-food level wages, for what is ostensibly an extremely important job. Paying people by the hour in addition to having prohibitively expensive equipment means EMS corporations need to maximize the workload for a workforce that they keep as small as is feasible.

The irregularity is just one reason that health problems are rampant in EMS. Overworked EMTs have random meal schedules, eat unhealthy food often, and are too tired to exercise.About 1/3 of EMTs work more than 40 hours a week, and the Bureau of Labor Statistics confirms that they have “one of the highest rates of injuries and illnesses of all occupations.” … No wonder, then, that your average EMT lasts about two years before experiencing “burnout,” the psychological exhaustion that irreversibly damages your performance.

The usual justifications for free markets fail completely when it comes to ambulances, since there’s no practical way for “consumer choice” to improve services. When you’re bleeding to death, it’s hard to comparison shop—not that you’re even offered a choice. As Harvard Law School’s Shailin Thomas wrote, ambulances function as monopolies, because “the patient faces a market with exactly one option.” Thus even though the ambulance industry itself is actually “quite diverse,” consumers have approximately zero power in the market. Moreover, the company that transports you is usually determined by the contract they strike with the town/city government, not you. You take whatever ambulance the dispatcher sends, and they already got the council to agree to what constituted an “acceptable” transportation fee.

If we were to design a good EMS system, it would be fully tax-funded, and each town EMS department would be run by the EMTs themselves. They would either act collectively to optimize the place or elect officers to dictate orders. Ideally, to combat fatigue, they would only ever work 4-6 hours a day, 5 days a week. That would require a lot of manpower for 24/7 coverage, but better pay and reasonable hours would lure many highly capable people to the job. Of course, it would cost far more than the current system. But the current system is disastrous, and getting profit out of emergency services means no more thousand-dollar one-mile rides.

Good emergency medical services are going to be expensive and unprofitable. The sheer cost of operating an emergency response service is why firefighting was ultimately turned into a public utility. In the beginning week of firefighter training, students learn that the Great Chicago Fire was the turning point that led to the extinction of private fire companies and the beginning of fire services as a widespread public utility. Chicago’s fire businesses found it far too expensive to keep and maintain the equipment and people necessary for a massive disaster, which they saw as too rare an occurrence to justify budgeting for it. The same could be said for ambulances…

"50 Million Adults Are Uninsured Every Single Year"

Matt Bruenig, of People’s Policy Project:

Everyone knows the American health care system is a disaster, but surprisingly few realize just how much of a disaster it really is. One reason for this is that the statistics we use to measure it completely miss how much anguish is caused by people constantly cycling in and out of insurance plans. In prior posts, I have tried to produce some figures that help illuminate the immense degree of “churn” in our system (I, II). In this post, I do the same thing, but with a new data source. What this source reveals is that, in a given 12 month period, 1 in 4 adults between the ages of 18 and 64 — 50 million people — face a spell of uninsurance.

That’s right: one in four adults between the ages of 18 and 64 faced a spell of uninsurance in the prior 12 months, meaning that they were either uninsured for the entire 12 months or for some period of time during those 12 months. Based on current population estimates, this is just under 50 million people and that’s not even counting children and elderly people.

And a (ahem) vital point, to understand how inhumane our system is:

What’s important to understand about this figure is that it is a direct result of the way in which our health insurance system constantly causes people to lose their insurance at nearly every critical life moment: loss of job, loss of spouse, loss of parent, loss of Medicaid upon income increase, turning 26, moving states, and so on. Indeed, even those who manage to stay continuously insured are nonetheless forced to switch plans all the time, often losing their doctors and preferred providers in the process.

Only a seamless national health plan that keeps you insured no matter what happens to you, like that envisioned by the Medicare for All proposal, can finally rescue Americans from this nightmare system.

Flint's water's been OK for a couple years

Some good(ish) news on Flint, MI!

Kevin Drum, in Mother Jones:

Marc Edwards and his team at Virginia Tech have published a new paper that uses a clever way of calculating lead levels in the Flint water supply over the past five years. It turns out that sewage sludge is tested for metal content monthly, and it also turns out that the metal content of the sludge is closely correlated with the metal content of the system’s water supply….

…By October 2014 lead contamination in drinking water was back to its normal, pre-switch level, and by mid-2016 had dropped below the EPA “action level” of 15 ppb. By the beginning of 2017, Flint water was probably cleaner than the majority of municipal water systems in the US.

…Flint appears to have suffered a lead crisis in 2011 even worse than the one in 2014—but nobody knew about it. It was only the sludge testing that revealed it…

A cause for celebration, and disgust: "Deepest ever dive finds plastic bag at bottom of Mariana Trench"

Francesca Street, at CNN:

An American undersea explorer has completed what is claimed to be the deepest manned sea dive ever recorded -- returning to the surface with the depressing news that there's plastic trash down there.

Victor Vescovo journeyed 10,927 meters (35,853 feet) to the bottom of the Challenger Deep , the southern end of the Pacific Ocean's Mariana Trench, as part of a mission to chart the world's deepest underwater places. 

Making multiple trips nearly 11 kilometers, or seven miles, to the ocean floor -- one of them four hours in duration -- Vescovo set a record for the deepest solo dive in history, his team said. The previous record was held by "Titanic" director James Cameron in 2012

As well as four new species that could offer clues about the origins of life on Earth, Vescovo observed a plastic bag and candy wrappers at the deepest point on the planet…

Millions of Americans Flood Into Mexico for Health Care — the Human Caravan You Haven’t Heard About

It’s true that Latin and Central Americans are coming to the US fleeing violence and poverty, much of it caused by destructive US trade policy over the course of decades. But there’s another massive “border crossing” phenomenon afoot — and Trump has not said a word about it. We’re talking about thousands of US citizens crossing the border each day in search of affordable health care.

At just one checkpoint in Yuma, Arizona, up to 6,000 Americans cross the border every day and enter the bustling Mexican town of Los Algodones, seeking heath care.

Unlike the Trump administration that seeks to build a wall between the countries, Los Algodones welcomes Americans seeking dental care with open arms.

Los Algodones has to be seen to believed. There are more dentists per capita than anywhere else in the world. It seems like every square foot of public space wall is covered with advertisements promising quality and affordable dental care, vision care and prescription drugs. The community’s economy is built to serve the flood of “dental refugees” — mostly senior citizens from the US and Canada seeking major dental care they cannot afford in their own countries, even with insurance.

On the morality of billionaires...

Democrats' Impeachment Panic is Endangering the Country

Brian Beutler, in Crooked:

At some point soon, Democratic leaders will have to reckon with the fact that the founders created the impeachment power for precisely this moment. That impeachment is their basic obligation. On a practical level, there’s simply too much time between now and the election for them to avoid the confrontation altogether with stalling tactics. But more importantly if they try to run out the clock, or settle on the claim that impeachment just isn’t worth it, they will do incalculable damage to themselves and the country.

This is not principally an argument about what constitutes sound political strategy—about what approach will galvanize whose base more. My biases tell me that impeaching Trump would inspire Democratic voters, and bog Republicans down with endless recitations of their party’s hideous corruption. My biases tells me that running scared from the impeachment question would deflate many Democratic activists, by signaling to them that the party doesn’t really consider Trump’s presidency to be an emergency after all, and will refuse to hold his regime accountable for its crimes even if the next election goes well. But that could be wrong.

The real importance of impeachment at this point is to shelter the country from what Trump and his allies will do if Democrats remain aimless. Democrats aren’t really buying time for themselves. They are buying time for Trump to get the GOP back on its horribly dishonest but unified message that he has been exonerated and that the investigation itself was criminal. If Democrats don’t pull the country into a debate about impeachment, we won’t get a draw. We will get a debate about investigating the investigators and jailing Trump’s critics. Cowardice creates a void that Trump will fill with autocratic ambition, and his crooked attorney general will be there to help.

William Barr has already threatened the FBI officials who launched the Russia investigation with recriminations. Two of Trump’s most clownish but ubiquitous propagandists told the White House counsel in a semi-public forum that they should counteract the Mueller report by charging Hillary Clinton with a crime.

The combination of impunity from prosecution, a faithless attorney general, and a Congress that says impeachment isn’t worth it is a bit like hanging a flashing sign outside Trump’s bedroom window that screams “YOU ARE ABOVE THE LAW.” It tells him that no one with any power will discourage him from colluding with Russia (or the Saudis or his new best friend Kim Jong Un) to win the election just as he did in 2016. The “politically cautious” move is actually an invitation to him—to work in tandem with the next authoritarian regime that’s willing to criminally sabotage the Democrats’ eventual nominee.