In the words of President Ronald Reagan, “the…inescapable truth is: government does not have all the answers. In too many instances, government does not solve problems; it subsidized them.”
With those words in mind, consider for a moment the government’s response to a growing crisis of access to medical care in small communities across America, a crisis which will rob, yes rob, small communities of access to even the most basic medical service, access to emergency and non-emergency ambulance transport.
Take just a moment, close your eyes, and imagine for a minute that you live in a large city in Anytown, America and you encounter a medical emergency for a member of your family, a friend, a neighbor, or simply a stranger who needs immediate medical attention. Of course, your obvious and immediate response would be to dial 911 and wait for the ambulance to arrive. Now, take just a moment, to imagine for a minute that you have a family member, a friend, or a neighbor who needs non-emergency medical transport. Again, your obvious response would be to call the local public transportation provider to schedule free or low-cost transportation.
Now, take just a moment, close your eyes, and imagine for a minute that you live in a small community in Anytown, America and you encounter a similar medical emergency for a member of your family, a friend, a neighbor, or simply a stranger who needs immediate medical attention. However, when you dial 911 for an emergency ambulance you discover that there is no emergency ambulance service available to respond to the medical emergency. Now, take a moment and imagine for a minute that you have a family member, a friend, or a neighbor who needs non-emergency medical transport. However, when you search your local community for free or low-cost public transportation you discover that none exist.
Next, take just a moment, close your eyes, and imagine for a minute that you live in a small rural community in Anytown, America and you learn that the local emergency ambulance service, or the local ambulance service which had been available for non-emergency medical transport had been forced to shutter its doors. Most importantly, take just a moment, close your eyes, and imagine for a minute what will happen to the hundreds, or thousands of family members, friends, neighbors, or strangers who need emergency or non-emergency medical transport and the ambulance never arrives.
While it might be hard for most to imagine a situation where emergency or non-emergency ambulance service would not be available, it is not hard to imagine similar situations for the thousands who live small communities across America. While some of the situations can be attributed to dwindling populations, or limited community finances, some of the situations can be directly attributed to government officials who believe they know better than doctors and medical professionals as to what is, and, what is not, a medically necessary service.
Consider for a moment a hypothetical situation where a poor, county government in a small community in Eastern Kentucky has been providing emergency and non-emergency ambulance services, ambulance services which would otherwise be unavailable. Consider that this same hypothetical community has learned that a government attorney has determined that in their opinion for the most part non-emergency ambulance transport was not medically necessary. Finally, consider that this same hypothetical government attorney would suggest that not only were these non-emergency medical ambulance transports not medically necessary, the same hypothetical government attorney would suggest that it was time in their words to end the practice of using ambulances as taxicabs in Eastern Kentucky for services that this non-medical government attorney had decided were not medically necessary.
Most troubling today is what appears to be a quiet crusade by the federal government to curtail costs associated with Medicaid and Medicare simply by denying access to medical services, whether ambulance transports, or the myriad medical services with a simple decision that a service was not medically necessary. This myopic viewpoint of medical necessity will eventually result in a medical crisis of massive proportions in small communities across America, and in small communities across Kentucky.
While there had been many predictions during the debate over the Affordable Care Act that the expansion of healthcare would result in so-called death panels, panels which would decide which services would be available, there never was a need for death panels. Instead of death panels, the government had a stealth plan buried in thousands of pages of government regulations, a plan which would allow non-medical government officials to define with the stroke of a pen whether a service was, or was not, medically necessary.
So, let’s take a final moment to reconsider our hypothetical Eastern Kentucky community and the future of ambulance services. While it would be nice to continue the charade that this Eastern Kentucky community is hypothetical, it isn’t. It is an actual Eastern Kentucky community which faces the real possibility that it will have to end its county sponsored ambulance services and shutter it doors because of decisions by a non-medical government attorney as to what is, and what is not, medically necessary.
One is left to wonder what will happen if this small Eastern Kentucky county run ambulance service must shutter the doors of its ambulance service? Maybe, just maybe, county officials should simply send the keys to the county ambulances to the government attorney responsible for these nonsensical decisions regarding what is, and what is not, medically necessary. Maybe, just maybe, the county officials should also tell the local 911 dispatch office to direct its more than 100 monthly emergency ambulance calls to the same government attorney.
Of course, there is little doubt that the response times from the big city to answer medical emergencies in this small Eastern Kentucky community will likely result in many unforeseen tragedies. With that said, those in small Eastern Kentucky communities, and in small communities in Anytown America, will know that they have done their part to save limited healthcare dollars to ensure that the same service which will no longer be available in these small communities will still be available in large cites across America, and in Kentucky.
So, as I often do as I close, I would invite each of you to join me on my imaginary mountaintop, and help me shout as loudly as possible to any government official willing to listen that it is time to end this crusade to deny small communities across America, across Kentucky, and in Eastern Kentucky, access to the most basic medical services which are available to those fortunate enough to live in large cities in Anytown America. Of course, instead of my usual imaginary mountaintop, I would invite each of you to join me on a real mountaintop in Eastern Kentucky; and of course, I would also invite those government officials willing to listen and end this nightmare to join me on a real mountaintop in Eastern Kentucky, that is, if any of the government officials can actually find their way to the mountains of Eastern Kentucky.
Mark Wohlander, a former FBI agent and federal prosecutor, has been traveling to his adopted home of Eastern Kentucky for nearly thirty years, and practices law in Lexington, Kentucky.
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