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On Last Week Tonight, John Oliver dug into America’s broken front line of Emergency Medical Services – underpaid emergency responders, a fragmented and underfunded patchwork of EMS departments and surprise bills that leave many on the hook for thousands in a medical emergency.
Even as the country celebrated emergency medical technicians as “essential workers” on the frontlines of the coronavirus pandemic, “there was a small irony in all the vocal appreciation that took place last year,” Oliver explained, pointing to one EMT who appeared on PBS to appeal for higher pay: “I don’t need pizza, I need to be able to pay my bills.”
“Right – people clapping and giving appreciation was very nice,” said Oliver, “but it wasn’t a substitute for the things they actually needed, like a living wage and health benefits.”
“Think about it like this,” he added, “if you had a heart attack, and paramedics showed up with some pepperoni pie and some garlic knots, you’d be grateful, sure, but you’d also be justified in pointing out that that’s not everything that the situation demanded.”
EMS workers around the country are “shockingly underpaid,” Oliver continued, “which is kinda amazing, especially when you consider how prohibitively expensive taking an ambulance can be.” Ambulance bills can be so high, often in the thousands of dollars, that many in distress opt not to call them; Oliver cited one case in Boston, where a woman whose leg was wedged between a subway car and the platform begged onlookers not to call an ambulance she couldn’t afford.
“So given that we have injured people begging bystanders not to call ambulances,” Oliver said, “and the EMTs who work inside them forced to live off pizza donations, tonight, let’s take a look at our emergency medical services.”
First, “there is absolutely no consistency when it comes to EMS in this country,” as “EMS” refers to nearly 19,000 locally run providers with different structures. In Houston, for example, EMS is provided by firefighters cross-trained as paramedics or EMTs; New York’s EMS is a separate department under the fire department umbrella. EMS in rural Wyoming is provided by teams of volunteer departments.
There’s no single federal agency overseeing EMS, the way the US Fire Administration oversees local fire departments. “The frustrating thing is, it didn’t have to be this way,” said Oliver. The 1973 EMS Systems Act outlined a grant program for local and regional EMS systems, but budget cuts under the Reagan administration eliminated direct federal funding and oversight for EMS, shifting responsibility onto the states, which sometimes directed the funding elsewhere. As a result, EMS is not considered an “essential service” in 39 states, meaning that local governments don’t have to provide it to their citizens, and EMS thus has trouble accessing federal funding. “Finding out that EMS is not deemed essential is like finding out that most states don’t consider geese to be birds – that’s what they are!” said Oliver.
“EMS providers can be so strapped for cash, especially in rural areas, that they have to fundraise for themselves,” Oliver added, pointing to several GoFundMe pages for ambulance gear and equipment. “You know our healthcare system is fucked up when patients and providers are allying on the same crowdfunding platform.”
Compounding the funding issues, many departments struggle to retain staff and are thus at risk of immediate closure. The median annual wage for EMTs – a demanding job with serious risk – was $36,650 in May last year, well below police and firefighter salaries.
“The fact they are so underfunded starts to explain why they can cost so much,” Oliver continued, “because for many, the way they recoup their costs is by billing patients.”
The risk of surprise bills – Oliver pointed to one case in California in which a woman and her infant were each charged $1,770 for 10 minutes of transport from the car where the baby was delivered to the hospital – has led many Americans to choose “Uber ER,” or ride-sharing apps to the hospital. “Instead of all of us paying a little bit all the time for ambulances, we have a system where some of us pay an awful lot all at once when we have a terrible emergency,” said Oliver.
“And if you’re thinking, how could this possibly get any worse? Well, wait, it can. Because for-profit businesses are also involved here.” In fact, private companies comprise about 25% of all ambulance providers, many of which are owned by private equity firms. “And when a private equity firm swoops in to help wring profits out of ambulance services by keeping costs low and revenues high,” Oliver said, “things generally don’t change for the better.”
Oliver then offered better paths forward: outlawing surprise billing for out-of-network ambulance rides, establishing a lead federal agency to oversee EMS providers and officially labelling EMS an “essential service”.
“For that label to mean something, it has to come with funding at the local, state and federal levels,” he said. “And there is no better time to make these changes than right now, when we still remember the absolute hell of what these workers went through last year.”
“Look, last year, everyone was anxious to show just how much they supported EMTs,” he concluded. “Well, now is the time to fucking prove it and make big changes on their behalf.”