S08.E19: Ambulances and EMS Services

[PrincessPurrsALot]

Main Topic:  Ambulances

Also:  House investigation of January 6th insurrection; US withdrawal from Afghanistan and translators; Jim Cramer loves Chipotle 

Original air date 2021.08.01

[scarynikki12]

Ollie can summon George Clooney by snapping his fingers and George can summon Kermit by clapping his hands. I wonder who Kermit can summon?

I knew EMTs were expensive but I had no idea they weren’t considered essential. Our system gets revealed as more and more fucked up.

[Annber03]

All right, well, now I have the official answer as to why it cost so damn much to take my dad to the hospital via ambulance when he was sick, back when we lived in South Dakota. And that was over a decade ago. I can't even begin to imagine how much the cost has shot up since then (though that story about the woman who gave birth certainly gave us a clue. $3,000 some dollars? And you're charging over a thousand to the newborn baby? Okay...). I could be fine with those costs if I knew they were going to pay the actual workers, but clearly that ain't happening, so...

Seriously, how in the hell is EMS not considered an essential service?!?! And why in God's name do SO MANY STATES not consider it an essential service? Thank goodness my state of Iowa is one of the few that does-nice to see our state on the map for something good for a change. The clip of the guy saying they were out of ambulances was horrifying. Here's to hoping that the person on the other end wasn't suffering some life-threatening situation. 

That is just truly fucked up on so many levels. Just when you think there's aspects of our healthcare system that can't be any more backwards... I was shocked by the revelation that at one time people used hearses to take people to the hospital, but honestly, at this point, really, people probably couldn't do much worse in terms of travel options. Something else to press Congress over and make a much bigger noise about politically. 

On a lighter note, that siren was freaky. It sounded like something out of a horror movie :p. Certainly gets your attention, though, I will give it that. 

As for the topic of Afghan interpreters, that show "United States of Al" actually touched on that topic in an episode a few months back. Good that Biden shows his support, but yes, John's right about the phrasing of his message, and yes, we need to move more urgently on that issue, too. Hopefully there will be some further positive movement on that front. 

Edited August 2, 2021 by Annber03

[letter8358]

Thank you, John Oliver! Now I am I forever horrified to imagine Mickey Mouse being railed by that weird ambulance noise! 

[ahisma]

Really, really glad that John is shining a light on the Afghan interpreters needing to get out. 

And really, really glad that John is shining a light on both EMTs and ambulance patients getting screwed. (And Mickey, apparently…) Of course it was that asshole Reagan and his hardon for destroying public services in the pursuit of privatization that kicked off the current dire situation.

Edited August 2, 2021 by ahisma

[paigow]

1 hour ago, letter8358 said:

Now I am I forever horrified to imagine Mickey Mouse being railed by... 

Was that Goofy or Pluto????

[letter8358]

Just now, paigow said:

Was that Goofy or Pluto????

Looks like Goofy to me....

[JustHereForFood]

I am not from the US, so I guess it's not really my place to criticize, but I can't help noticing that in many segments that highlight some systemic issue, these sentences keep showing up: "... under the Reagan administration... budget cuts..." and "wait, it gets worse... private businesses are also involved here...". Just an observation.

I also don't understand how that surprise billing works. Like, in every other service you buy, you have to be informed beforehand about the price and agree to it, so how can they bill you later some surprising sum? What if you just refuse to pay it? And in that case of the lady that didn't want an ambulance called, what if someone did call it? Why should she pay for it, if she specifically asked not to call it? It just all seems like from some parody dystopian novel to me.

[ahisma]

1 hour ago, JustHereForFood said:

I also don't understand how that surprise billing works. Like, in every other service you buy, you have to be informed beforehand about the price and agree to it, so how can they bill you later some surprising sum?

Welcome to US health care. When the doctor says, “We’re going to need a blood test and an MRI to find out what’s going on,” you just say, “Okay,” because you want to find out what’s going on. Even if you asked the doctor how much that was going to cost, they probably wouldn’t be able to tell you. Same if they tried to ask those EMTs who took mother and baby to the hospital. (And if you were unconscious when the ambulance arrived, of course you won’t find out the cost in advance, or be able to refuse transport.)

Billing is a whole arcane practice that happens elsewhere in the system, and there’s very little similarity across entities. There are people now trying to build services that offer more transparency. If you can check the web for how much an Acer laptop costs at different stores, you should be able to find out that an MRI or a quadruple bypass surgery costs four times as much at hospital X over hospital Y.

The surprise billing legislation that was mentioned at least takes care of the issue people had of finding out on the bill that their approved surgery had an out-of-network anesthesiologist, and you’re completely on the hook for their cost.

[peeayebee]

Nice to see George again. And Kermit! That was a great. A palate cleanser.

I've always been shocked whenever I or someone I knew received the ambulance bill. I had no idea what they were really about.

Did anyone notice the sign language interpreter in the corner when deBlasio was speaking? 

[Annber03]

3 hours ago, JustHereForFood said:

I can't help noticing that in many segments that highlight some systemic issue, these sentences keep showing up: "... under the Reagan administration... budget cuts..."

Amazing how so many of our current issues can be traced back to that time period, huh? 

[swanpride]

You know, if you really want to shock Americans spending time in Germany, just call an ambulance on them. First they get terrified and then they are stunned when they see the bill. Because even if you are uninsured, medical services are simply not as expensive at it is in the US (and if they are with a German insurer, well, then the bill is zero). Hence I was completely aware how expensive ambulances are for those who need them. But I was unaware of all the structural nonsense which has to be in the background to make them the way they are. 

 

[DoctorAtomic]

"Fuck all the way off" is definitely going to be used by me. The best part of the joke was John saying Paul couldn't win a fight against his neighbor. 

[RedbirdNelly]

* I'd like to thank the show for really providing an educational service. Seriously. I knew ambulance services were expensive but really didn't know the background on how they vary by location and why--nor appreciate how crappy the pay and benefits are. Once again the show finds a topic and provides useful information. It reminded me of learning about medical examiners and coroners

* when John mentioned sirens in Belgium, I thought he was going to play one of those European police sirens that to me sound like a WWII movie when the Gestapo shows up. It's always puzzled me that Europe didn't drop that siren (or did movies just make that up as the Nazi siren sound?)

*loved seeing Clooney and Kermit

* there is something lowdown about a separate charge for baby and mom when the service is the birth itself. Insurance does that (or at least mine did with my 2nd child) for delivering in the hospital. It just seemed like a scam--the copay is supposed to encourage appropriate use of services; was I supposed to give birth, then grab the baby before he could be listed as a patient and run for the door? It just felt like double dipping. I was paying a copy for the delivery. . . 

[candall]

Before Covid, I was taking a water aerobics class with some older women and they were talking about ambulance costs.  One woman had gone to the ER about an hour away, and was then helicoptered to a St. Louis hospital, two hours farther north.

I said, "I bet that cost a fortune," and she said, "Yes, it did.  $80,000, to be exact."

I almost slid under the water and drowned.

 

That's eighty-thousand dollars, not a typo.

[peeayebee]

Did she have to pay all of that?

[Hanahope]

11 hours ago, ahisma said:

Welcome to US health care. When the doctor says, “We’re going to need a blood test and an MRI to find out what’s going on,” you just say, “Okay,” because you want to find out what’s going on. Even if you asked the doctor how much that was going to cost, they probably wouldn’t be able to tell you. Same if they tried to ask those EMTs who took mother and baby to the hospital. (And if you were unconscious when the ambulance arrived, of course you won’t find out the cost in advance, or be able to refuse transport.)

Billing is a whole arcane practice that happens elsewhere in the system, and there’s very little similarity across entities. There are people now trying to build services that offer more transparency. If you can check the web for how much an Acer laptop costs at different stores, you should be able to find out that an MRI or a quadruple bypass surgery costs four times as much at hospital X over hospital Y.

The surprise billing legislation that was mentioned at least takes care of the issue people had of finding out on the bill that their approved surgery had an out-of-network anesthesiologist, and you’re completely on the hook for their cost.

Yeah.  I always love the claim that you can shop around for your health care like repairing your car.  As if you can do without your broken body for a couple of days while you get estimates.  
 

 

[paigow]

13 hours ago, Hanahope said:

Yeah.  I always love the claim that you can shop around for your health care like repairing your car.  As if you can do without your broken body for a couple of days while you get estimates.

Companies like Verizon should take over EMS operations so trips can be "bundled" on the next wireless bill... Unlimited data AND miles

[iMonrey]

First of all, how does Disney not sue this show for Mickey getting fucked on the washing machine? I mean, they're pretty litigious.

And yeah, no - that Belgian siren is NOT cool, John. It's eerie as fuck.

Second, I had my own surprise ambulance bill about five years ago.  It was upwards of $500 so I guess I was lucky now that I see these bills of upwards of $3000. Still, I was shocked it wasn't covered by my insurance. The next time I need to go to the emergency room I'm calling a cab. The only thing is that if you're taken to Emergency in an ambulance, you get into an exam room immediately. Whereas if you walk into the Emergency room, you wait in the waiting room for hours. I probably would have passed out from the pain, though, so I guess that would have gotten their attention.

 

[paigow]

1 hour ago, iMonrey said:

The next time I need to go to the emergency room I'm calling a cab. 

the cops

[BrownBear2012]

I've stopped watching Oliver. By Sunday night I'm worn out by the news and all the negative bullshit of the last week and watching him in that  blank void is getting old. I might start watching him again when he goes back to his old format but lately he seems to be very preachy, angry and just can't seem to find anything positive to say about much of anything. His interviews are so good...I miss them. His funny bits like buying the Presidential wax figures and making a "movie" with them was classic. I want to laugh with him again and well, just laugh for thirty minutes instead of getting angry and depressed about the state of the world...I have all week to feel that way. I look forward to him getting back to the studio and streets again and lightening up a little....we all need more of that.

[peeayebee]

I know what you mean, but I still enjoy the show. The other day I got a book from the library "The Cruelty Is The Point," and I've found I just can't handle it anymore.

[swanpride]

I like the show the best when I learn something. 

Though, for the record, I didn't enjoy the Mickey joke. I mean, I get that Disney is kind of triggering people with their "family friendly" image, but I actually like Mickey as a character, especially the Mickey of the old, before he was pushed into the role of the straight man, and the Mickey from the European comics, where he is more a detective character. In fact, he is my favourite of the "main three", which I know is rare. And while I am not a prude, the joke was a little bit too crass for my personal sensibilities. There are some things I really don't want in my childhood memories. 

I appreciated him pointing out who actually did the work in the in-car birth. 

Back to the ambulance thing....it's actually a pretty complicated matter. I am a member of a non-profit organisation over here in Germany, which provides a lot of emergency services. With the right structures, ambulances can be a pretty stable business, which is by far not limited to bringing people to hospitals. Like, if someone wants to have a big event, it is basically part of the deal that an ambulance team has to be around in the case of emergency (and you have ALWAYS emergencies at big event, from alcohol poisoning, to heat strokes, to wounds, there are a lot of reasons why there should be people nearby who know what to do in an emergency, and who can bring people to the hospital with the proper equipment). The various organisations who offer this service DO compete with each other for the contracts. Another job they do fairly regularly is bringing people back who got ill on vacation. Since they usually can stay wherever they are in order to recover, the regular health insurance doesn't pay for the transport but there are additional insurances or organisations which offer the service. And finally they do also things like bringing someone who is deadly ill to a last event or similar, so transports for private matters. It's not cheap, but it is affordable (we used the service to have my grandma transported to a wedding, but we actually don't know exactly how expensive having her transported nearly one hour away, having the MTAs with her for the whole service and then for the beginning of the actual celebration in the restaurant and then having her transported back after she got tired, because the organisation "lost" the bill as a wedding present...but we could have paid for it, even if we had tipped in our savings). 

Anyway, long story short, one can actually combine a non-profit part (the emergency transports) with a pro-profit part in ambulance services.  But the emergency transports, they have to non-profit. And naturally an ambulance should be paid for driving to an emergency, not for bringing someone to the hospital. (in case someone is wondering, the profit which is made within the ambulance service is naturally used for other non-profit projects). 

[peeayebee]

4 hours ago, swanpride said:

And while I am not a prude, the joke was a little bit too crass for my personal sensibilities.

I liked the joke better without the graphics.

[Nialla]

11 hours ago, iMonrey said:

First of all, how does Disney not sue this show for Mickey getting fucked on the washing machine? I mean, they're pretty litigious.

It's parody/satire, which is covered by Fair Use. Disney could sue, but there's little chance of winning, and  it would only draw more attention to the "negative" imagery.

[andromeda331]

Well, that explains why ambulance bills are so high. I knew the system was messed up. I didn't realize most states don't even consider it essential. That's so stupid. Definitely recognized AMR. I hated those people. I remember talking to them about my mother's ambulence bills. They refuse to work with you on a payment plan so you have no choice but to let it go to collections. Because at least they'll work with you. I can see why the woman freaked out about not wanting an ambulence. Its expenisve and you still have to pay the hospital bill, tests and etc from the hospital.  

Great seeing Clooney but even better to see Kermit. 

[Rlb8031]

On 8/2/2021 at 10:06 PM, Hanahope said:

Yeah.  I always love the claim that you can shop around for your health care like repairing your car.  As if you can do without your broken body for a couple of days while you get estimates.  
 

 

I was listening to a episode of Freakonomics where they were talking about this issue. Turns out that while Congress passed a law to require more visibility in healthcare (John referenced it in the episode), researchers found that many hospitals/insurance companies responded by posting their price list on line, BUT didn't provide tags for the pages so that its almost impossible to search using any search engine and actually find the pages (even when searching within the sites themselves). They literally hide the prices from you 😠

[Victor the Crab]

23 hours ago, BrownBear2012 said:

I've stopped watching Oliver. By Sunday night I'm worn out by the news and all the negative bullshit of the last week and watching him in that  blank void is getting old. I might start watching him again when he goes back to his old format but lately he seems to be very preachy, angry and just can't seem to find anything positive to say about much of anything. His interviews are so good...I miss them. His funny bits like buying the Presidential wax figures and making a "movie" with them was classic. I want to laugh with him again and well, just laugh for thirty minutes instead of getting angry and depressed about the state of the world...I have all week to feel that way. I look forward to him getting back to the studio and streets again and lightening up a little....we all need more of that.

One thing I've noticed, this past year or two, is that Ollie really seems to dislike Joe Biden. Even as he shows something positive, Ollie always finds a way to take a humorless shot at him, as he did this past Sunday when discussing the problems facing Afghani interpreters who helped the United States during the Afghan conflict. I know one shouldn't play favorites, but that seems so unnecessary and, if I dare say, petty.

So we're looking at three more weeks of H Jon Benjamin as the voice of the blank void set, eh? I can live with that!

I know ambulance services can be pricy. But YIPE!!! What they're charging users in America is obscene! And in constant danger of being shut down? Absurd!

I really don't want to know what Jim Cramer likes about Chipotle. That may be the most overrated restaurant chain out there, which is saying something!

[Annber03]

1 minute ago, Victor the Crab said:

I really don't want to know what Jim Cramer likes about Chipotle. That may be the most overrated restaurant chain out there, which is saying something!

I loved the last clip in that segment, where he was talking to that guy about the restaurant and the guy kept attempting to end that discussion. I've never been to that restaurant, so I can't comment on its food, but...yeah, time and place, Jim. 

Frankly, I'm amazed the guy's still on TV at all - didn't he get a lot of negative press after the 2008 crash happened, because of the way his show seemed to foster a lot of the elements that led to that crash? 

[Kel Varnsen]

On 8/1/2021 at 11:43 PM, Annber03 said:

And you're charging over a thousand to the newborn baby?

I had to wonder what would happen if the mom paid her bill and the baby didn't.

[letter8358]

21 hours ago, Victor the Crab said:

One thing I've noticed, this past year or two, is that Ollie really seems to dislike Joe Biden. Even as he shows something positive, Ollie always finds a way to take a humorless shot at him, as he did this past Sunday when discussing the problems facing Afghani interpreters who helped the United States during the Afghan conflict. I know one shouldn't play favorites, but that seems so unnecessary and, if I dare say, petty.

So we're looking at three more weeks of H Jon Benjamin as the voice of the blank void set, eh? I can live with that!

I know ambulance services can be pricy. But YIPE!!! What they're charging users in America is obscene! And in constant danger of being shut down? Absurd!

I really don't want to know what Jim Cramer likes about Chipotle. That may be the most overrated restaurant chain out there, which is saying something!

I don't understand why he would do that. Okay, Biden is not perfect, but what president was? If Ollie wants to attack or take humorless shots at someone, start with the other two characters denying him in that razor-thin majority Biden has now. I am not saying Biden is to blame, but Ollie's hair should literally be on fire with those two standing in the way. End of rant. He should spotlight on them everyday and so far I don't see him doing that.

Pheww...that's all I have to say.

Edited August 5, 2021 by letter8358

[candall]

On 8/2/2021 at 7:51 PM, peeayebee said:

Did she have to pay all of that?

Well, she was a little old lady with a bad dowager's hump in a hospital-affiliate pool so she didn't necessarily come across as someone with an extra $80k tucked away.

But the big news, for me, was that nearly everyone immediately bobbed up to say they purchased that helicopter-ambulance insurance.  

I've been receiving those LifeFlight solicitations for years and never paid any attention.  I guess I need to be writing them an annual check.

[paigow]

18 hours ago, Kel Varnsen said:

I had to wonder what would happen if the mom paid her bill and the baby didn't.

Those collection agency phone conversations would be one-sided...

[paigow]

3 hours ago, candall said:

LifeFlight

Sounds like a Liam Neeson film franchise

[Brandi Maxxxx]

On 8/5/2021 at 1:35 PM, Kel Varnsen said:

I had to wonder what would happen if the mom paid her bill and the baby didn't.

More importantly: If neither of them pay, does the baby have to go back inside?

[JustHereForFood]

7 hours ago, Brandi Maxxxx said:

More importantly: If neither of them pay, does the baby have to go back inside?

Well, there certainly are people who are far more interested in protecting its rights when inside the womb, so it might be better off.

[Brandi Maxxxx]

The mother might not see it that way.

[Kel Varnsen]

15 hours ago, paigow said:

Those collection agency phone conversations would be one-sided...

I am just curious what would happen if a baby got sent to collections. Could they destroy the baby's credit?

I was also curious so I looked it up and where I live it is a flat $45 fee for an ambulance ride. That fee seems to be waived if you are on social assistance. And it seems that the reason for the fee is because back when most of the Canadian universal healthcare laws were passed, like John kind of said an ambulance ride wasn't really part of the healthcare system (since it was just a guy driving you to the hospital).

[Ailianna]

A child can definitely have its credit ruined by misuse before they can even walk. I used to deal with a lot of parents who put the cable bill in their child's name and social security number because the parent was blacklisted. The bills wouldn't be paid and would go to collections against the child. The patent would then put cable in the name/SSN of the next child.  Those kids had awful credit before kindergarten because their parents would get credit cards the same way.

[wknt3]

On 8/6/2021 at 9:48 AM, Kel Varnsen said:

I am just curious what would happen if a baby got sent to collections. Could they destroy the baby's credit?

On the bright side it will fall off their credit report after 7 years so by the time they understand money they will basically be all set! Although now you have me picturing the Season 16 episode where they air a clip from this episode while explaining how Alabama is denying kids school lunches because their unpaid ambulance bills as newborns ruined their credit...

Edited August 8, 2021 by wknt3
hit submit by mistake

[SoMuchTV]

I know everyone's having a bit of fun with this hypothetical and I am not a lawyer, but wouldn't the parents obviously be responsible for the medical bills for their children?  Every time I've ever taken a kid to the doctor, there's a form for I have to sign as "guarantor" or "responsible party".  Or are you saying that if they didn't get the new mother to sign a form in time, she's off the hook for the baby's expenses?  To be clear, I'm not in any way saying the amounts she was charged were fair or justified, but in general, parents can't just say "I'm not paying the kid's bills.  You can go after him if you want."

[Lantern7]

Didn't know that EMS wasn't federally-regulated, which lends itself to widely different systems from one place to another.  Once again, John shows us something faulty we didn't know that much about. Also: the slightly-animated scene of Mickey Mouse getting railed. Um . .  . thanks?

On 8/3/2021 at 11:55 PM, Nialla said:

It's parody/satire, which is covered by Fair Use. Disney could sue, but there's little chance of winning, and  it would only draw more attention to the "negative" imagery.

Right, but it's still Disney. I would've thought John would have been found in a woodchipper with a poorly-written suicide note after he told people he can make Disney canon, and that Cogsworth collected Nazi memorabilia. Mickey getting banged on a washing machine? He might not live long long enough to leave The Void.

[Victor the Crab]

9 hours ago, Lantern7 said:

Right, but it's still Disney. I would've thought John would have been found in a woodchipper with a poorly-written suicide note after he told people he can make Disney canon, and that Cogsworth collected Nazi memorabilia. Mickey getting banged on a washing machine? He might not live long long enough to leave The Void.

I'd imagine Ollie went through all that with the HBO lawyers before putting that out there, just like he does with a lot of questionable topics!

[andromeda331]

On 8/8/2021 at 8:24 AM, Victor the Crab said:

I'd imagine Ollie went through all that with the HBO lawyers before putting that out there, just like he does with a lot of questionable topics!

Your probably right. But its funny to think of an HBO lawyer watching the episode and immediately face palm "Dammit John not again!" and another one getting a phone call from a friend telling him what John's done now.