Emergency Medical Services: Last Week Tonight with John Oliver (HBO)

Summary

The script discusses the plight of ambulance services in the U.S., highlighting the inconsistent and underfunded nature of Emergency Medical Services (EMS). It points out the irony of high ambulance costs and the low wages of EMS workers, who often lack basic benefits like health insurance. The script also criticizes the lack of federal oversight and the reliance on private companies, which can lead to poor service and financial strain on both providers and patients.

Takeaways

• 🚑 Brussels has a unique and playful ambulance siren sound that is considered objectively better and amusing.
• 🙌 Ambulance crews received an outpouring of gratitude during the pandemic, but many EMTs highlighted the lack of essential benefits like health insurance.
• 📊 Emergency Medical Services (EMS) in the U.S. are inconsistent, with 19,000 locally run providers having different structures and funding models.
• 🔧 There is no single federal agency overseeing EMS, leading to a lack of standardization and support compared to other first responders like police and fire departments.
• 🏥 In many states, EMS is not considered an essential service, which affects government funding and the provision of services to citizens.
• 💰 EMS providers often struggle with funding and may resort to crowdfunding for essential equipment and ambulances.
• 🤔 The median annual wage for EMS workers is significantly lower than that of police officers and firefighters, leading to challenges in recruitment and retention.
• 🚨 Rural areas are particularly at risk, with some EMS services one person away from shutting down, highlighting the fragility of these essential services.
• 🚑 The cost of ambulance services can be prohibitively expensive for patients, leading to situations where individuals avoid calling for help due to financial concerns.
• 💸 Billing practices for EMS are often based on transporting patients to hospitals, which can lead to financial strain on providers and 'surprise bills' for patients.
• 🏛️ There is a call for change, including the establishment of a lead federal agency for EMS, recognizing EMS as an essential service, and providing adequate funding.

Q & A

What is the main topic discussed in the script?

The main topic discussed in the script is the state of Emergency Medical Services (EMS) in the United States, focusing on issues such as underfunding, inconsistent structures, and the challenges faced by EMS workers and patients.

How does the script describe the siren sound in Brussels?

The script humorously describes the siren sound in Brussels as playful and different from typical ambulance sirens, comparing it to Mickey Mouse getting washed in a good way on a washing machine.

What irony did the EMT point out in the script regarding the appreciation received during the pandemic?

The irony pointed out by the EMT is that while they received an outpouring of gratitude and support during the pandemic, they were still working without health insurance and fair wages, highlighting the disparity between public appreciation and actual working conditions.

What is the issue with the current EMS funding structure in the United States?

The issue with the current EMS funding structure is that it is inconsistent and underfunded, with many EMS providers not receiving adequate support from federal or local governments, leading to reliance on patient billing and private fundraising.

Why are ambulance services so expensive for patients in the United States?

Ambulance services are expensive for patients due to the lack of consistent funding for EMS providers, which often have to recoup their costs through billing patients, sometimes resulting in high out-of-pocket costs or 'surprise bills'.

What is the situation with EMS workers' pay and benefits?

EMS workers are shockingly underpaid, with a median annual wage well below what police officers and firefighters make. They also often lack health benefits, leading to situations where workers have to rely on donations or second jobs to make ends meet.

How does the script describe the variability of EMS structures across the United States?

The script describes EMS structures as highly variable, with 19,000 locally run providers having wildly different setups, ranging from being part of fire departments to being standalone municipal departments or volunteer-based organizations.

What was the EMS Systems Act of 1973 intended to do, and what happened to it?

The EMS Systems Act of 1973 was intended to help develop regional EMS systems by creating a new federal program. However, under the Reagan administration, direct federal funding and oversight were eliminated, shifting responsibility to the states, many of which chose to allocate less money to EMS.

Why are EMS providers not considered an essential service in many states?

EMS providers are not considered an essential service in many states due to historical budget cuts and shifts in responsibility. This means that local governments are not required to provide EMS to their citizens, leading to less access to government funding.

What is the impact of private equity firms on EMS providers?

Private equity firms have been acquiring stressed local ambulance providers, often with the goal of increasing profits by keeping costs low and revenues high. This can lead to poor working conditions, inadequate resources, and even bankruptcy for the EMS providers, impacting the quality of service provided to the community.

What is the No Surprises Act, and how does it relate to EMS?

The No Surprises Act is a bill passed by Congress to make it illegal to send patients steep medical bills when an out-of-network provider is unexpectedly involved in their care. However, the bill explicitly excludes ground ambulances, which means that many EMS services can still issue surprise bills to patients.

Outlines

00:00

🚑 Ambulance Sirens and Their Impact on Society

The script opens with a humorous take on the different sounds of ambulance sirens, particularly highlighting the unique and playful siren of Brussels, which contrasts with the typically harsh sirens in the U.S. The narrative then shifts to acknowledge the critical role of ambulance crews, especially during the pandemic, and the public's show of gratitude towards them. However, it points out the irony of the appreciation, as many EMTs lack health insurance and are underpaid, suggesting that material support like wages and benefits is more needed than applause and pizza donations.

05:00

📊 The Fragmented and Underfunded State of EMS in the U.S.

This paragraph delves into the lack of consistency and federal oversight in the U.S. emergency medical services (EMS), which are managed by 19,000 locally run providers with vastly different structures. It discusses the historical context of EMS development and the unfortunate elimination of federal funding under the Reagan administration. The script emphasizes the shocking fact that EMS is not considered an essential service in 39 states, leading to limited government funding and reliance on crowdfunding for equipment and operations. It also touches on the low wages and high stress faced by EMS workers, contributing to staffing challenges, especially in rural areas.

10:02

🚑 The High Cost and Funding Challenges of Ambulance Services

The script addresses the high cost of ambulance services and the funding challenges faced by EMS providers. It explains how the underfunding leads to billing patients as a way to recoup costs, which can result in high out-of-pocket expenses for patients. The narrative discusses the practice of only reimbursing for transported patients and the potential for 'surprise billing' due to out-of-network ambulance services. It also highlights the issue of private equity firms acquiring ambulance services and the negative impacts on service quality and worker conditions.

15:04

🏥 The Impact of For-Profit Ambulance Services and Surprise Billing

This paragraph focuses on the role of for-profit ambulance companies, particularly American Medical Response, and the issues arising from their business practices, such as surprise billing. It recounts specific instances of exorbitant ambulance bills and the trend of people opting for alternative transportation like Uber to avoid high ambulance costs. The script also criticizes the involvement of private equity in essential services and the case of TransCare, which was acquired by a private equity firm and subsequently faced bankruptcy, leaving employees and communities in distress.

20:05

🛑 Solutions for Improving EMS Services and Support for EMTs

The final paragraph suggests potential solutions for the issues within the EMS system. It calls for an end to surprise billing, the establishment of a federal agency dedicated to EMS, and the recognition of EMS as an essential service with appropriate funding. The script also emphasizes the need for public support to translate into tangible improvements for EMTs, referencing the recent parade for healthcare workers that was boycotted by many EMTs due to ongoing concerns about wages and benefits. It concludes with a call to action to make meaningful changes in support of EMS workers.

Keywords

💡Ambulances

Ambulances are emergency vehicles equipped to transport patients to medical facilities quickly and safely. They are central to the video's theme, highlighting the disparities in the Emergency Medical Services (EMS) system, such as the unique siren in Brussels and the financial struggles faced by ambulance crews. The script mentions the public's gratitude towards ambulance services during the pandemic and the irony of underpaid EMTs.

💡Siren

A siren is a loud noise-making device used by emergency vehicles like ambulances to warn other drivers and pedestrians of their approach. The video script humorously describes the siren in Brussels and contrasts it with the typical shrill siren sound in the U.S., using it as a metaphor for the broader discussion on EMS services.

💡EMTs (Emergency Medical Technicians)

EMTs are healthcare professionals who provide immediate response to emergency medical situations. The script discusses the lack of health insurance and low wages for EMTs, despite their critical role during the pandemic and the high-risk nature of their job, emphasizing the need for better compensation and benefits.

💡Pandemic

The pandemic refers to the global outbreak of COVID-19. The video script uses the pandemic as a backdrop to discuss the increased recognition and appreciation for frontline workers like ambulance crews, while also pointing out the systemic issues that existed prior to and during the pandemic.

💡Healthcare System

The healthcare system encompasses all organizations and resources that provide medical services to people. The script criticizes the U.S. healthcare system for its high costs and lack of support for EMS workers, as well as the financial burden placed on patients who require ambulance services.

💡Essential Service

An essential service is a service that is crucial for the functioning of a society and is typically expected to be provided by the government. The video points out that in many U.S. states, EMS is not considered an essential service, which contributes to the lack of funding and support for ambulance services.

💡Funding Deficiencies

Funding deficiencies refer to a lack of sufficient financial resources. The script discusses how EMS providers, particularly in rural areas, struggle with funding, leading to the need for self-funding through donations and crowdfunding platforms, which is indicative of the broader financial challenges within the EMS system.

💡Rural Areas

Rural areas are regions with low population density and limited access to services. The video script highlights the specific challenges faced by EMS providers in rural areas, such as the risk of service shutdowns due to financial constraints and staffing issues.

💡For-Profit Businesses

For-profit businesses are organizations that operate with the primary goal of generating profit. The script criticizes the involvement of for-profit businesses in EMS services, suggesting that their focus on profit can compromise the quality of emergency medical care and contribute to high costs for patients.

💡Surprise Billing

Surprise billing occurs when patients receive unexpected medical bills, often from out-of-network providers. The video script discusses the issue of surprise billing in the context of EMS, where patients can face high costs for ambulance services, especially when the service is out of their insurance network.

💡No Surprises Act

The No Surprises Act is a U.S. legislative act aimed at protecting patients from surprise medical bills. The script mentions this act as a positive step towards addressing surprise billing, but notes its limitation as it does not apply to ground ambulance services.

Highlights

Ambulance sirens in Brussels have a unique and playful sound, unlike typical sirens.

Ambulance crews received public gratitude during the pandemic, but many still lack essential benefits like health insurance.

New York's mayor promised a ticker-tape parade for healthcare workers and first responders, but some see parades as less than ideal rewards.

The reality of underpaid EMS workers contrasts sharply with the high cost of ambulance services for patients.

There is a significant variance in how EMS is structured and funded across different regions in the U.S.

EMS was deprioritized during the Reagan administration, leading to a lack of federal oversight and funding.

In many states, EMS is not considered an essential service, impacting government funding and support.

Some EMS providers have to resort to fundraising to cover basic operational costs, including equipment and ambulances.

The median annual wage for EMS workers is significantly lower than that of police and firefighters, despite the high-risk nature of their jobs.

Rural EMS services are particularly at risk of closure due to funding shortages and staff retention issues.

Ambulance services recoup costs by billing patients, which can lead to high out-of-pocket expenses and 'surprise bills'.

The funding structure of EMS can incentivize unnecessary hospital transports to increase reimbursements.

Patients with private insurance are particularly vulnerable to high ambulance costs due to out-of-network billing practices.

The No Surprises Act aims to protect patients from unexpected medical bills, but it does not cover ground ambulances.

Private equity firms are increasingly involved in EMS, often leading to cost-cutting measures that can compromise service quality.

The bankruptcy of TransCare, a company owned by a private equity firm, left employees and communities without vital EMS services.

Calls to action include recognizing EMS as an essential service with dedicated funding and ending surprise billing for patients.

The New York City parade for healthcare workers was boycotted by EMTs due to ongoing issues with wages and benefits.

The transcript calls for substantial changes in the recognition and support of EMS workers in light of their pandemic contributions.

Transcripts

♪ ("LAST WEEK TONIGHT" THEME PLAYS) ♪

Moving on. Our main story tonight

concerns ambulances. You know, big ouchie trucks

that go woop-woop.

Ambulances can be an annoyance to city dwellers

with their shrieking sirens. Although not if you live

in Brussels, where that siren sounds

very different.

(PLAYFUL SIREN WAILS)

Okay, that is just an objectively better siren.

It sounds like Mickey Mouse getting fucked

on a washing machine, in a good way.

And I do know that that is hard to picture,

so, please, let me help.

(IMITATES SIREN) Oh, boy.

I mean, that's fantastic. I'd far rather

be woken up by the sound of America's rat

getting railed on the spin cycle

because I'd immediately laugh, then,

remember that someone was having a medical emergency

and feel bad. Then, hear the siren,

and laugh myself to sleep again.

What a siren!

Anyway, ambulance crews clearly play

a critically important role across the country.

So it is no wonder that during the height

of the pandemic last year, they were among those

who got an outpouring of gratitude

and nightly applause.

With New York's mayor even making this pledge.

I want to guarantee you one thing.

That when that day comes that we can restart

the vibrant, beautiful life of this city again,

the first thing we will do is we will have

a ticker-tape parade down the Canyon of Heroes

for our healthcare workers and our first responders.

We will honor those who saved us.

Okay, first, I don't know if a parade

is quite the dangling carrot de Blasio seems to think it is.

Because parades, and this is true, suck.

They are loud, crowded, and go on approximately

four hours too long. The only good thing

about the Thanksgiving Day Parade

is seeing which country singer gets to lip-sync

next to the Jolly Green Giant's dick.

But second, there was a small irony

in all the vocal appreciation that took place last year,

as this EMT that we featured pointed out.

Right now, I'm doing all of this

with no health insurance.

The job doesn't offer it and our affordable marketplaces

aren't very affordable. If I get sick,

and okay, I get tested positive, I can't go to the hospital.

You know, people come out and they show us this support

and I love it, I love--

I've eaten so much pizza in the last two weeks,

it's been great. I don't need pizza,

I need to be able to pay my bills.

Right.

People clapping and giving pizza

in appreciation was very nice, but it wasn't a substitute

for the things they actually needed, like,

a living wage and health benefits.

Think about it like this, if you had a heart attack,

a paramedic showed up with a 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.

And that man's story is by no means a one-off.

EMS workers around the country are shockingly underpaid.

Which is kind of amazing, especially when you consider

how prohibitively expensive taking an ambulance can be.

So much so, you'll often see

local news stories like this.

REPORTER: It was rush hour at the Mass Avenue station

when this passenger stepped off the crowded train.

Surveillance video shows the moment

her leg dropped into the gap, trapping her between

the train and the platform.

As other commuters rocked the train to dislodge

the woman's leg, a Boston Globe reporter

tweeted from the scene. She begged,

"No one call an ambulance, it's 3,000 dollars,

I can't afford that."

Wow. It is a pretty strong

indictment of our current healthcare system

that that woman's main concern was getting crushed financially

even while she was getting crushed physically.

So given that, we have injured people

begging bystanders not to call ambulances.

And the EMT's who work inside them

forced to live off pizza donations.

Tonight, let's take a look at our

emergency medical services. Specifically, how they function,

why they can be so expensive,

and what we can do to fix things.

And the first thing to know is, there is absolutely

no consistency when it comes to EMS in this country.

When you talk about Emergency Medical Services,

you're actually talking about 19,000 locally run

EMS providers, with wildly

different structures.

To give you an idea of just how much

variance exists, in Houston,

EMS is provided by firefighters

cross-trained as paramedics or EMT's.

In New York City, it's under the fire department

umbrella, but it's a separate division,

and supplemented by private companies.

In Pittsburgh, it's a freestanding

municipal department of its own.

And in rural Wyoming, EMS is mostly provided

by volunteer-based organizations.

And frustratingly, in no part of the country,

does EMS have ambulances that sound like this.

(PLAYFUL SIREN WAILS)

The very fact our sirens could sound

like a Puccini Aria performed

by a flustered parakeet, and yet we choose

for that not to be the case, makes us a bunch

of fucking idiots. But all of this is to say,

if you have seen one EMS setup,

you've seen exactly one EMS setup.

And one reason for this, is that there is no

single federal agency overseeing and supporting EMS

in the same way that, for instance,

fire departments have the U.S. Fire Administration.

And the frustrating thing is, it didn't have to be this way.

Back in 1973, Congress enacted

the EMS Systems Act, which created

a new program to help develop regional EMS systems.

Something that was badly needed.

Prior to that, ambulance services

were frequently provided by hearses,

simply because they were long enough

to transport a human body.

Now, unfortunately, under the Reagan administration,

budget cuts eliminated direct federal funding

and oversight, shifting responsibility

onto the states, many of which opted

to direct their money away from EMS

and into other public health services instead.

Which brings us to an absolutely incredible fact.

Unlike other first responders such as police

and fire departments, right now,

in all 39 of these states, EMS is not considered

an essential service. Meaning local governments

don't have to provide it to their citizens.

Which, as a practical matter, means EMS, generally,

has much less access to government funding.

This is a huge deal.

And if this is surprising news to you,

you are not alone. Just listen to this

Utah State representative.

I became aware of the fact that this issue existed

when I asked the question to Chief Brad Hanning:

"Chief, what can I do for you?" And he started explaining to me

this issue, and I was like, "Really?"

'Cause I thought-- I thought this was

an essential service too, I didn't know any better.

Yeah. Of course he was surprised.

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. They have beaks, wings,

feathers, they rain shit from the sky.

Sully Sullenberger is their Jeffrey Dahmer.

They're fucking birds!

I didn't realize anyone was even disputing that.

EMS providers can be so strapped for cash,

especially in rural areas, that they have

to fundraise for themselves.

Do a quick search on GoFundMe right now,

and you will find multiple outfits trying

to raise money for equipment, gear, and updated ambulances.

And you know our healthcare system is fucked up

when patients and providers are relying

on the same crowdfunding platform.

Some people even do fundraising stunts

for their local EMS. Whether it's this guy

doing a polar bear plunge for 1,000 bucks.

Or this DJ doing a three-hour livestream

to raise money for EMS workers in New York.

And I have to say, my admiration

for that man's generosity is almost enough

to overcome my horror at the idea

of a three-hour livestreamed DJ set.

It's like someone donating a million dollars

to cancer research by writing out a check

in turtle blood. Love the end, hate the means.

And these massive funding deficiencies

start to explain why it is that EMS workers,

like that guy you saw earlier,

are so terribly paid.

The median annual wage is just over 36,000 dollars.

Well below what police officers

and firefighters make. And, for a dangerous

and stressful job. EMTs and paramedics

have an injury rate about three times

the national average. And they're roughly

ten times more likely to have suicidal thoughts

of behaviors. So it is no wonder

that ambulance services can have real trouble

finding or retaining workers and volunteers.

Especially in rural communities.

REPORTER 2: Experts now warn, close to one-third

of all rural emergency medical services

are in immediate danger of closing down.

In rural Marmarth, North Dakota,

no one remembers the last time the town

had a doctor. The ambulance

is the community safety net.

We're literally one person away from closing

if we lose one of our EMTs,

one of our care providers. We will have to look

at shutting down and closing our doors.

That is terrible.

No workplace should be in danger of shutting down

because it loses one person.

Unless that is, that workplace is

the Sex and the City reboot.

What are you thinking? It's never gonna work

without Kim Cattrall. It's not that any

of you are bad, it's that you only

work together. I can't appreciate

my puritan Charlotte if I don't have

my naughty Samantha. And I live for Miranda Hobbes.

But if she's not serving side-eye

while Samantha uses penne pasta

to describe her new Italian lover's dick,

what is the point?

And to be clear, this isn't just a rural problem.

Some big city services are stretched

to a breaking point, too. Take Chicago,

where its EMS is operated by the fire department.

Both workers and city officials have complained for years

that not enough resources have been allocated to EMS,

leading to an ambulance shortage.

And while the fire department says its fleets...

...a local news investigation found some pretty

harrowing stories.

REPORTER 3: One analysis of 700,000

medical 911 calls found in 19 percent of them,

it took an ambulance more than seven minutes

to get to the scene. Sometimes there just isn't one.

DISPATCH:

Wow. "We are out of ambulances."

That is just not something you want to hear.

I think we all know when you call an ambulance,

you want it to show up like that.

-What's wrong with you? -Oh... no.

I'm sorry, George, I did it again.

-I'm sorry. -How hard is it not to snap

-your fingers? -You know what, it turns out,

it's surprisingly hard.

You know, I got the power to just clap my hands

and summon Kermit the Frog anytime I want.

Do you think I use it? No, I do not.

Because I respect Kermit.

Yeah, yeah, I get that, but, hey, George... do it.

Do it now. Please.

-(CLAPS) -(BANJO NOTE STRUMS)

This better be good, George.

It's not.

-(CLAPS) -(SNAPS)

Well, I thought that went very well.

Anyway, um, where were we? Oh, that's right.

Emergency medical services in America are underfunded

because in most places, they're not supported

by federal programs and local dollars

the way that police and fire departments are.

And the fact they are so underfunded

starts to explain why they can cost so much.

Because for many, the way they recoup their costs

is by billing patients. Although, interestingly,

if they don't physically transport those patients

to a hospital, they can be out of luck.

You're reimbursed based on the number of patients

that you transport to a hospital.

(SIREN WAILS)

So you could be called 1,000 times a year

and only transport 750 patients.

Those other 250 calls, you made no money on them.

Yeah, it's true.

And policies like that can not only put EMS providers

even further into a financial hole,

it can also incentivize them to take patients to the hospital

even if it is not totally necessary,

which makes no sense.

It's a practice known through the EMS industry as...

which I admit is a fun phrase. Although, to be honest,

nowhere near as fun as the fire department's motto...

And EMS' funding structure

doesn't just serve the providers poorly,

it serves patients poorly too.

Because right now, patients and their insurance reimbursements

are most EMS outfits' primary funding sources,

which is just not a good situation for either side.

Some patients have Medicare and Medicaid,

and by law, EMS providers are required to accept

their reimbursement rate

despite many saying that they are set too low.

But for patients with private insurance,

the fact is EMS's are not required to accept that

at all. In fact, many choose to keep themselves out of network

for most insurers, meaning they can generally set

their rates wherever they want.

This situation can often leave patients facing so called

"surprise bills." Some of which can be absolutely ridiculous.

KURTIS MING: Baby Sawyer just couldn't wait to enter the world.

Katie Moraida's water broke a week before he was due.

She and husband Daniel raced to Sutter Roseville.

With the emergency room in sight,

Katie screamed for him to stop the car.

Don't push! And I said, "I have to push!"

She went like this.

-And I push. -And then, pop!

And he came out.

MING: Roseville PD called the paramedics,

who cut the umbilical cord and drove Katie and Sawyer

a matter of a few hundred yards to the hospital door.

The entire time of the paramedics: ten minutes.

It is such a blur.

MING: But later, it would come into focus

when two equal AMR ambulance bills showed up,

one for Katie, one for baby Sawyer,

totaling more than 3,500 bucks.

Not even a full minute worth of an ambulance ride.

We had already done the hard part.

We delivered our child in the front seat of our car.

Well, hold on there.

Did "we" really do the hard part, Dad?

Because from what I just heard, you did some driving

and then sat back while your wife, in your words,

popped out a human.

So I'm not sure you really did the hard part

so much as you were just sort of there.

Come on, Dan. Be an ally. Read a tweet.

And there could be absolutely crazy examples

of surprise billing, even when EMS is run by the city.

In Houston, literally...

And a study of one large national insurance plan found...

And when you know that,

is it any wonder that that woman

begged people not to call her an ambulance.

Or that this incredibly grim trend has emerged.

DEBORAH NORVILLE: Ambulance or Uber?

That's now the choice as more Americans are using Uber

and other car services to get to the emergency room.

Forty-two-year-old tech magazine writer Chandra Steele did it.

What were your symptoms?

-I had some internal bleeding-- -You had internal bleeding

and you took an Uber to the hospital?!

Emergency room doctor Robert Glatter

of Lennox Hill Hospital in New York

says Uber ER, as it's been nicknamed,

is not a smart idea in a crisis.

They don't have any kind of oxygen,

they don't have intravenous fluids or IVs,

they don't have paramedics. That's the main difference.

They have a driver.

Right. They also may not know which local hospital

has a trauma, stroke, cardiac or pediatric unit

because they're Uber drivers.

The most they have are tiny water bottles

you're afraid to drink from and a charger

for a Samsung phone you do not own.

So, to recap, 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.

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, currently...

And many of them are owned by private equity firms

who've been acquiring stressed local ambulance providers

for decades now.

Remember that baby who got a bill for being born?

That came from a private, for-profit company,

American Medical Response.

They are currently the largest ambulance company in the US

and are owned

by one of the country's largest private equity firms.

And when private equity firm swoops in

to help wring profits out of ambulance services

by keeping costs low and revenues high,

things generally don't change for the better.

Take TransCare, an EMS company acquired out of bankruptcy

by a private equity firm run by this woman, Lynn Tilton,

and a few things to note about her.

Aside from serving looks that can only be described

as my style icons are Wayne Newton

and a Ferrero Rocher candy,

Lynn Tilton is a self-described poet,

already one of the biggest red flags imaginable.

We looked and one of the only things

close to poetry we could find from her

was this Instagram post...

...which feels less like real poetry

and more like someone with a concussion

trying to remember Kesha lyrics.

Lynn Tilton was also the star of the sadly canceled

reality series, Diva of Distressed,

where she portrayed herself as a savior of troubled companies

in inspirational moments like this.

One of the things we do is we all commit.

So I'm gonna ask you all to commit with me,

that we will not stop until we have achieved our goal.

I commit.

-ALL: We commit. -Thank you.

Commit! Commit!

No pussies in my mill.

She seems great.

And Lynn Tilton certainly knows how to instill

a sense of courage in those around her.

It reminds me of that famous FDR quote...

And Tilton promised to bring that uplifting leadership style

to TransCare, but many who worked there

described rough conditions on her watch,

with one former employee saying they were sent out

in a vehicle where...

Former staff even said they were pressured

by TransCare supervisors to go...

...to restock their ambulances.

And when TransCare inevitably ended up filing for bankruptcy

in 2016, its employees found that they had lost their jobs

like this.

Workers were told they had 30 days left on the job.

They showed up today to find this.

TransCare was shuttered.

I was in shock. We were all in shock.

It-- It was horrible. It's absolutely horrible.

MARC SANTA: A work emergency for dozens of paramedics.

Now I have to find another job.

I have another side job to support me right now currently

but that doesn't pay the bills.

Last night, we were told

"See you tomorrow, have a good night."

Well, that's fucked up.

There are certain businesses

you assume might disappear overnight

like a kid's lemonade stand

or any Circuit City in the late 2000s.

Incidentally, they all became kingdoms of optical cables

and loose batteries governed by rats.

And that's absolutely fine, but it is not great

when what's disappearing is a community's

life-saving medical service.

And it is not just that TransCare folded.

It's that in a bankruptcy court ruling last year,

a judge recommended finding Lynn Tilton liable for...

...which, I guess, isn't totally shocking

from a woman whose employees were encouraged

to strip value out of fucking emergency rooms.

Now, I have to say, Tilton denies having done

anything wrong and has challenged that recommendation

in federal court, and the thing is

I'm not just mad with Lynn Tilton here.

I'm mad that we're operating a system

where a vital service is left vulnerable

to the Lynn Tiltons of the world.

So what can we do about this?

Well, as I've said before, ideally, we transition

to a Medicare for all approach,

but that doesn't seem to be in the cards right now.

And in the meantime, there are smaller things

that we could and should do.

For patients, we need to put an end to surprise billing,

and the good news is Congress passed a bill last year

called the No Surprises Act, making it illegal

to send patients steep medical bills

when an out of network provider is unexpectedly involved

in their care. The bad news is while that applies

to air ambulances, the bill, for some reason,

explicitly carved out ground ambulances,

in other words, most fucking ambulances.

As for EMS providers, we should establish

a lead federal agency dedicated to them,

and they should absolutely be labeled

an essential service, especially because

that's what everyone thinks they are.

But for that label to mean something,

it has to come with funding at the local,

state, and federal levels.

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.

Remember that parade that Bill de Blasio promised?

It actually took place last month.

But you know who notably did not attend? EMTs,

many of whom boycotted it because of stagnant wages

and the fact that they...

Look, last year, everyone was anxious to show

just how much they supported EMTs.

Well, now, is the time to fucking prove it

and make big changes on their behalf.

And if we do do that,

maybe we'll collectively be worthy

of a siren that sounds like this.

(SHRILL AMBULANCE WAILS)

Get yours, Mickey, you filthy mouse.