In my last two posts I have painted a very bleak picture for paramedics.  The previous entries can be found here and here.  But I don’t want to seal up our coffin yet.  Then I would just be somebody who bitches and moans about the problems in EMS, but never provides any solutions.  I am not like that.  Although the tone of this blog is sometimes dark, I am trying to role up my sleeves and get under the hood.

So what’s the plan?  Its ugly.  You’re not going to like it.  Its a two stage process: We have to nationalize health care and significantly change the scope of practice for paramedics.

I am growing tired of the usual arguments against the nationalization of health care.  So much is misundertood about our current problem.  For starters, we already have a nationalized system to a degree.  Fifty cents of every dollar that is spent on health care in this country comes from Medicare.  Twenty-five cents of every dollar spent comes from Medicaid.  The rest is a twisted pile of wreckage that consists of a bunch of for-profit companies that only insure healthy people because they make money by not paying claims.  What happens if you are poor?  You go on Medicaid.  What happens if you are terminally ill?  You go on Medicare.  What happens when you get old?  You go on Medicare?  So if 75% of all truly ill, indigent, and old people are getting by on this plan, what are we so afraid of?

The fact that this system has limped along as well as it has is really amazing.  The way an insurance company makes money is to take the money from healthy people and use that to shore up the cost of those making claims.  Here in the United States we have made a system by which healthy people pay a small amount for a system they are not allowed to access, while they pay hundreds per month to the greedy privates who have all the weight of failure taken away because the real burden is carried by social programs.  If we took that ridiculous amount of money being spent on the private insurance model and put it where it belongs the system might actually have a chance to straighten up and fly right.  We will never know though because the private companies have lobbyists who make campaign contributions which will ensure this never happens.  We are doomed to limp along with this broken hybrid system until things get so critical that congress passes something overnight that doesn’t make any sense and further wrecks the system.  See bailout bill.

If health care becomes nationalized, the fight is not over.  Nationalizing health care does not immediately equal more money for EMS.  As a matter of fact, the budget will tighten and the EMTs and EMT-Is of the world will look more and more attractive.  There is a slim chance that we could manage to pass a bill that would allow EMS services to be funded more under the model of service coverage rather than service provided.  I am talking about a model similar to police and fire, but do not hold your breath.  If health care goes national, they are going to be all about saving money, not handing more out.

Which brings us to the second part of the survival plan: we need to change our scope of practice.  And unfortunately for adrenaline junkies everywhere, we need to go broader, not up.  I have fought this idea for years.  But more and more I am realizing that this is the only way.  The thing that won me over was the fact that I have seen changes in curriculum, and I have seen a state go from certification to licensure.  Do you know what happened?  Nothing.  That is because the scope of practice did not change.  Think of the management nightmare, “So I now have a staff that does X, and you want me to add a whole bunch of education and expense to this system, but in the end I still get X?  What are you smoking?”  The current push by the EMS Agenda for the Future and the National Registry of EMTs to put a pig in a dress is not going to get us anywhere.  We are increasing expense without getting anything for that investment.  Our one trick pony days are numbered.

So what I am proposing is a new kind of paramedic that provides a lot more than emergency care.  This initiative needs to be funded by the efforts to nationalize health care so that we can deal with the coming Silver Tsunami.  And yes, you are going to be taking care of these baby boomers.  There will be old age, alzheimer’s, cancer, hospice, disease, pestilence, and probably a swarm of locusts.  Health care needs to become more proactive in these times.  We need to stop waiting around for people to get sick, and start helping them with the problems that they have now.

Here is the dark part of this: I am not sure that paramedics are the perfect tool for this.  If you look at what care will be needed in the future, it looks a lot like well care nursing.  Whether or not we change our scope of practice, are we the right tool to fix this problem?  In this role, can we offer anything that a home health nurse in a well stocked van cannot offer?  Can we do anything that a clinic or a nursing home cannot do?  We need to take a long hard look at that problem and everywhere we see an opening we need to pounce and change our scope of practice accordingly.

Otherwise, I am affraid that technology and our lower paid yet almost as functional counterparts are going to be the only affordable option for our one-trick-pony style of care.  On the EMSEduCast we have an interview scheduled in May with Gary Wingrove to talk about his ideas for community paramedic care.  Hopefully he has the answer to this. 

To wrap it up, we need to address the interlopers explained before.  Right now, our profession is in crisis.  The current model won’t hold.  We get what we pay for and the current applicants are the dregs of other professions and other failed economic sectors.  We need to take back our profession from those who don’t care about it by redefining it.  Otherwise I fear the problem will get worse, the system will fail, and paramedics will go the way of the dodo.

What about you?  What do you think?  Leave some comments and save your profession.