If the promise of “Obamacare” was to bring universal health care to America, we are bound to be disappointed once more. In terms of access to affordable medical services, the future looks as bleak as ever for most Americans.
Employer-based health insurance is quickly becoming a thing of the past, tens of millions are insufficiently or not at all covered, Medicare and Medicaid are under increasing financial and political pressure, more hospitals and emergency rooms are being closed than opened, rural areas and low-income neighborhoods are severely underserved, and there is a fast-growing shortage of general practitioners in the medical profession. These are just a few examples of many alarming issues that continue to make health care a menacing problem in this country.
Many Americans rely on calling 911 as their only option when catastrophe strikes. Catastrophe can mean anything from injuries suffered in an accident, heart attack, stroke, asthma attack, to adverse reactions to foods or medications. 30 to 40 million emergency calls are places every year in the U.S., according to federal record keeping.
The costs for responding to emergency calls are high. Most will never be repaid because the heaviest users of the system are uninsured and too poor to pay out of pocket. So, more and more cash-strapped communities are looking for ways to reduce the number of calls for help.
Especially in rural areas where medical services are harder to come by, local governments have been experimenting with alternatives to the traditional doctor’s office. One idea in particular seems to have gotten some traction. It’s called the “community paramedic.”
As reported in the New York Times (9/19/2011), the town of Eagle in Colorado, for example, has begun to retrain former first-responders to provide preventive care for seniors to keep them out of hospitals and nursing homes for as long as possible. Visits at senior centers to teach classes in nutrition, regular exercise and accident prevention are all part of the job description of this new brand of paramedics, which proponents say will improve the quality of people’s lives and save communities millions of dollars in health care costs.
Big cities like San Francisco, San Diego and Washington, D.C. have also begun to send paramedics pro-actively into low-income neighborhoods and to the homeless population to reduce the amounts of 911 calls.
The federal Health Resources and Services Administration, which collects data on access to health care nationwide, is expected to implement this year a new system for measuring the performance of community paramedics, according to the Times. “What we have had is a patchwork of different cities trying different things, and different paramedics reinventing the wheel each time,” said Niels Tangherlini, a paramedic captain at the fire department of San Francisco who helped create the city’s preventive health care program for homeless people. As a next step he hopes for a much broader implementation of the concept, which he sees as a better approach because it’s “pro-active rather than just reactive.”
Pro-active measures often come down to the most basic and simple things in health care, such as human contact and interaction. Kevin Creek, a community paramedic in Colorado, works primarily with seniors. He makes house calls, organizes medications, checks on blood sugar levels and blood pressure and countless other day-to-day chores. For many of his patients he is nothing less than a lifeline.
No matter how successful and popular programs like these may be, their survival is by no means certain. Under federal law, emergency medical responders get only reimbursed for their services if they transport a patient to a medical facility. Cutting down on 911 calls is not necessarily in their best interest in terms of their bottom line. When the homeless outreach program at the San Francisco Fire Department lead to a 75 percent reduction in emergency calls, which saved the city an estimated $12 million, it was still discontinued because of concerns that resources would be diverted from traditional emergency response funds, which are already dangerously low due to ongoing budget cuts.
Even staunch supporters of preventive health care admit that success is hard to measure. How do you know what exactly is being prevented? If saving money is the only objective, then you may never truly appreciate the benefits of such programs. But if you consider the increase of quality of life for the elderly, the chronically sick and the poor who are given at least a minimum amount of care they otherwise wouldn’t have, then you know it’s worth the effort and the expense.
Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter (http://twitter.com/TimiGustafsonRD) and on Facebook.