Home 2017 Races A simple way and horrifying way to explain Trumpcare’s impact on all...

A simple way and horrifying way to explain Trumpcare’s impact on all Americans

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by Kellen Squire

Patients arriving in an ER via ambulance still get to wait… and wait… and wait…

Now we have the vaguest outline available for the Senate’s version of Trumpcare, it pretty much confirms that it’s as bad as we thought it was. Long story short- cut as much care as possible to enable funding of huge tax cuts, with amazingly interesting corporate handouts to boot. Some of it would be hilarious if it weren’t so tragic- like the “party of personal responsibility” trading the “No Free Rider” amendment that forced everyone to pay at least a little, with a $50b handout to insurance companies– and on top of that, they get to completely deduct executive salaries that’re greater than $500k. What a deal! I’m glad we have a master negotiator for a President!

Now, even that explanation is a little nebulous, since huge tax cuts and deductions don’t mean much to a lot of people, and the magnitude of $50b is hard to imagine. It’s like winning the lottery. You know it’s a thing, but it’s hard to comprehend what that means in your life.

Since I’m an emergency department nurse running for the Virginia House of Delegates this fall, I thought I’d sit down and illustrate exactly what that means, in a relatable way you can take back to your friends and family. Be it your MAGA-hatted uncle, your politically uninvolved friend, et cetera; just to help bring home just how this reckless and incredibly ill-conceived bill is going to affect them personally, even if they have great insurance and good primary care provider- that means Trumpcare is gonna ruin someone else’s day, not theirs.

Bzzzt! Oooh, I’m sorry, that’s not correct. We all get to wade waist-deep in this upcoming scheisse-fest. And to help explain how, we’re going to use the emergency room as an example, since the ER is one of the few places in medicine where everyone (regardless of class, creed, color, religion, economics, etc) is likely to go at some point. It’s also the one place that everyone truly starts out as equal- or, at the very least, as close to it as possible.

In my ER, in fact, we’re not even allowed to take payment information until you’ve seen a doctor. This is because of a law signed by notorious socialist Ronald Reagan in 1985 that codified into law anyone seeking medical treatment would get it, period. End of story. It’s probably been the biggest unfunded mandate of all time, but a necessary one… unless you’re just peachy keen with people dying in the streets.

So! Trumpcare passes, and becomes the law of the land. Since we just denied millions of people health insurance, making them unable to get reliable primary care and preventative services, congratulations to all my brothers and sisters in emergency services! You just became the primary provider of healthcare services for upwards of ten to twenty percent of the entire country! And that’s not just the nurses and doctors in the ER, but firefighters, EMS, and even law enforcement- they have to deal with it a hell of a lot more than you’d think, and they are absolutely included in our umbrella of emergency services, and will have to deal with this fallout.

But that’s okay; you’ve got great insurance. So you’ve got no problem! But, oh no! Your nine-year old daughter falls off her bike at 5:45pm on a Friday afternoon and slices a three-inch laceration into her chin that’s bleeding profusely. Your family doc is done for the day, so guess where you have to go? Ahh, yes, the ER!

Do you like Disney World? Great! Because it’ll be just like that, minus all the rides and attractions. Yup, just a giant bill and lots of waiting. And waiting is what you’ll do, because all of the people I mentioned before, the ones Trumpcare has forced into the ER- they’ve been waiting ahead of you for several hours already! Get comfortable in that shoulder-to-shoulder waiting room.

Ahh, but you’ve patient consoled your daughter for several hours, and finally get back to a room. Great! Well, lacerations are time consuming to deal with, so expect the provider to put it off to last, after they finish (necessarily!) with any patients that are having acute problems and may decompensate while they’re doing the suturing. And that’s IF they don’t decide to consult with Plastics, since this is a facial laceration and doing it poorly will result in a scar that’d make Harry Potter jealous.

And if they do a Plastics consult, that cash-register noise you just heard was the hospital billing department, who are grinning and rubbing their hands together in excitement. Since the Republicans decided to repeal the “personal responsibility”, “no free rider” act from Obamacare that stipulated everyone had to have health insurance, lest their income tax refund be penalized, the hospital has to make up the money from folks who either can’t; or, yes, even refuse to pay! I know you’ll share the hilarity of Republicans being so reflexive on having to destroy anything associated with Barack Obama they’ll even destroy their own party’s platform when you get your bill in the mail!

Ahh, you say, whatever- I can maybe handle that, and you’re just trying to scare me… if anything was really wrong, or if I called an ambulance, I’d still get straight back into the ER, seen quickly. This ain’t a third-world country.

Well, let me tell you about that! Because, unfortunately, I’ve got bad news for you; your mom just slipped and broke her hip! This is depressingly common, ground-level falls are one of the most common morbidities among folks over 65. Luckily, though, you were there with her to see it happen, so you could call 911 immediately. In just a few short minutes, that rescue squad will show up at your door!

Ooooh, but small problem. The local volunteer rescue squad has another empty building call. See, the county you live in relied heavily on their volunteer crews before Trumpcare was passed, but now that it’s the law of the land? They worked them so hard they burned them out! And since they couldn’t reimburse them training, meal, or uniform costs, the state, in a last ditch effort to get more volunteers, removed all training and certification requirements for EMTs (THIS IS NOT A JOKE, THIS ACTUALLY HAPPENED IN VIRGINIA). But we managed to take all of these well-meaning, community minded volunteers and burn them out by asking them to do a full-time job for no money, no training, and no support.

So, the call goes to a paid crew of firefighters and EMTs. Now, unfortunately, that paid crew may have to range over an area of a couple hundred square miles. So it might take ’em awhile to get there! Hip fractures are notoriously painful, so do your best to keep your mom comfortable while the ambulance is on the way.

Almost a couple hours after you called 911, finally! You arrive in the ER, and go straight back to a room to get seen. Oooh- wait. Nope. No, you’re going to triage. Yes, yes, I know; your mom broke her hip, but have you seen the ER today? There are six other ambulances in queue when you pulled in. Why don’t we see if your mom can sit in a wheelchair for a little bit, or possibly a hall bed or triage bed, if they’ve got one available.

Then you’ll get to see the maestro for the entire department- the triage nurse! Though she or he is overworked and inundated, they know precisely what your mom is going through, and are gonna do their best to put an IV in her, and then grab one of the docs and beg them to give her something for pain- ibuprofen, or maybe toradol if they’re lucky. If they know it’s going to be a long wait, though, she might be lucky enough to get a shot of dilaudid, and since she’s been in pain so long, it’s going to take a hefty dose to quiet it.

And on that note, congratulations! Along with her broken hip, she’s also acquired an opiate dependency! That’s right, most narcotic addictions start in exactly this fashion- it’s not “junkies” who’re getting hooked on painkillers, it’s normal folks like you and I. And not only that, but you’d be stunned to find out the average age of a new onset narcotic addiction isn’t in the teens… or twenties… or thirties… or even forties! Nope, in fact, older Americans are one of the most at-risk groups! Oooh, and remember, too, those “junkies” weren’t always so- they started out “normal” too, and now your mom is well on her way to joining them!

When your mom is finally seen, she’ll get more pain meds, x-rayed, et cetera, but then she’ll at least get to a hospital inpatient room, and be able to relax, right? Oof. Sorry about that. If she doesn’t need surgery emergently, she’ll be boarding in the Emergency Department, because the inpatient beds are all full. Possibly for days, in fact; but don’t worry! Even though the ER staff is incredibly overworked, they’ll do their level best to provide for your mom.

In fact, the nurses, techs, EMTs, and doctors will burn themselves right the frick out trying to take care of your mom. Her nurse will skip lunch, skip breaks, even ignore a screaming bladder, just to make sure that hip fracture pain stays quieted (along with the other four to seven patients she or he is looking after). That nurse’ll work twelve or sixteen hours straight (“Can you just stay for an extra four? We’re so backed up, and had two call-outs. Please!”) because they know people need help, are suffering. And as a consequence, that nurse will also be hard t work exhausting themselves emotionally and physically, destroying personal relationships, ruining their home life, all because they’re not willing to let your mom be the one to suffer for this Trumpcare nonsense, anymore than she already has.

And we nurses aren’t alone in that; EMTs are . And police officers. And firefighters. We’re not going to ask for help for us; hell, no! We’re going to keep shouldering these loads for the people who need our help. Why, we had a firefighter in our community not long ago that attempted to commit suicide rather than have to ask anyone else for help. Asking other people for help when there are so many that need YOUR help is a deadly sin in emergency services, much to my incredible dismay. I’ve seen people turn to drugs, become addicted to narcotics, just to take the edge off to get them through another day. It’s okay, see- they don’t have a problem, they’re just trying to make it to another day of helping people. A percocet here or there isn’t going to hurt, right?

There’s a point when hard work and perseverance in the face of incredible odds isn’t enough to hold the line. This is what Republican legislators are counting on to bail them out on this POS bill. They’re counting on the heroes that live among us to save their asses- give them cover from having to actually govern. Give them the cover they need to pass this massive tax cut for the rich, at the expense of all the rest of us.

They’ll tip their hat to my brothers and sisters in emergency services, broken and battered, and say “Hah, without you guys the Democrats’ worst prognostications would’ve totally come true! Thanks! Oh, and sorry; can’t approve that .5% tax increase on cigarettes. I know it would’ve paid for all your training and equipment, but I got lobbyists to answer to. See ya!”

And we’ll just take it; nod and keep working. Because we don’t complain. We just work; work until we can’t do it any longer.

This is what I realized in the wake of last November’s election. These were the stakes. I was going to watch a bloated, POS bill like Trumpcare get actually slammed down our throats, because we have a Congress in Washington, and House of Delegates in Richmond, full of career politicians, who are completely out of touch with their constituents. Completely.

And I couldn’t sit by and do nothing. So I’m standing up to fight Trumpcare here in Virginia- fight against a Republican legislator who’s comfortable sneering that Trump Values are Virginia Values. That killed Medicaid expansion here in Virginia; that was instrumental to assisting Operation Red Map’s redrawing of our political boundaries. That proudly pushed the Transvaginal Ultrasound law. That’s in charge of the entire Republican re-election effort here in Virginia this fall.

But I can’t do it without your help. My opponent might be fine taking corporate money; he might be fine taking upwards of $300k from a single donor alone; he might sleep like a baby at night after arguing for, and taking money from, mountaintop mining and fracked pipeline interests. But not me; my campaign is built on grassroots support. It’s what has powered my campaign so far, and will continue to do so going forward.

Even $10 goes a long way to powering us forward; even Bernie Sanders was built on $27, so imagine what that can do for us. I need your help today, to power us forward to fight to save my brothers and sisters in Emergency Services;  to fight to save people with disabilities, pre-existing conditions, or who aren’t rich. Because my race is one of the most consequential in the entire Commonwealth to enabling us to deliver a House of Delegates in Virginia this fall that’ll actually work and govern on behalf of the people of the Commonwealth of Virginia.

Thank you.

Kellen Squire is an emergency department nurse from Barboursville, VA, running for the Virginia House of Delegates in the 58th District of Central Virginia this fall.

  • old_redneck

    Excuse me — I’m just an old redneck — but I must call BULLSHIT on Ms. Kellen Squire.

    I am an Advanced Life Support EMT with a rural volunteer rescue squad in Virginia.

    Ms. Squire states: “. . . the state, in a last ditch effort to get more volunteers, removed all training and certification requirements for EMTs (THIS IS NOT A JOKE, THIS ACTUALLY HAPPENED IN VIRGINIA).”

    THIS IS NOT A TRUE STATEMENT. In fact, not one word of it is true. In order to become an EMT in Virginia, you must:

    1. Complete a training course certified by the Virginia Dept of Health, Office of Emergency Medical Services. Course length ranges from 6 months to two semesters, depending on where you take it.

    2. Pass a practical exam consisting of six stations dealing with medical emergencies, trauma, and use of various equipment.

    3. Pass the National Registry written exam, which is the same written exam required of EMTs nationwide.

    After this, depending on your regional or squad requirements, you must then be proctored by a licensed EMT for anywhere from 12 to 20 patient contacts before you are free to be the Attendant In Charge on a call.

    Yes, it is true that volunteer squads are dying statewide. I can’t speak for all counties but in my county and the surrounding six counties with which I am familiar, the decline in volunteers for rescue squads is due to:

    1. Changing demographics — as the population ages, all organizations that depend on volunteers are having big problems with recruitment and retention.

    2. Economic pressures. Volunteers are not paid. Young families need income to put shoes on the baby’s feet and food on the table. With wife and husband working two jobs each, there’s not much time left for volunteering.

    3. The National Registry exam is more rigorous than the exam that previously came from OEMS and it’s costing us some people.

    Her example of a broken hip does not square with reality. If I encounter a patient with symptoms of pelvic or femoral fracture — difficult to differentiate in the field — I immobilize the pelvic area, immobilize both legs, start an IV on the spot, and — depending on a lot of factors — I may administer morphine or fentanyl for pain management. I have to be careful with pain killers because the ER docs I know want the patient to be talking when they arrive. Because we have access only to small rural general hospitals, a patient such as the one she describes would go on a helicopter to a Level I trauma center.

    Three years ago our county hired paid crews who are on duty 24/7/365. Our dispatchers are trained so that, in most cases, they can differentiate between a call that requires the county crew with a paramedic or a call that can be handled by the volunteers, often with a BLS EMT as AIC. We volunteers, paid crews, and ER personnel get along famously. We train together, attend each other’s meetings, and respect each other.

    But, then, I’m just an old redneck. WTF do I know about anything?

    Gotta run . . . the tones just dropped — 72yo male with a cardiac history experiencing sudden onset of substernal chest pain and difficulty breathing. The paid crew is out with the deputies on a domestic with shots fired.

    • Hey, old redneck! Glad you’re out there fightin’ for rural Virginians.

      You’re not wrong about what we require volunteer EMTs to do for training, but that’s only because the state OEMS stepped up and short-circuited the General Assembly’s attempt to kneecap those standards. That’s the reason why you’re technically correct that “THIS IS NOT A TRUE STATEMENT.” It’s because we were all saved from politicians who were bound and determined to engage in a race for the bottom by the consummate professionals at OEMS.

      In theory, if someone other than George or the other hard-working folks we have in charge there were to leave, and new folks bend to the pressure of the GA, those standards would come into play. Lucky for all of us, none of the folks I’ve seen who’d be in line for OEMS would ever let that BS play.

      You’re absolutely right, too; and in regard to example 2 about volunteer squads, it used to be your manager would hear those tones go off and let you take off to respond, but employers these days just aren’t nearly as understanding; that, and we’re leaning so hard on the volunteers AND expecting them to pay up, as it were, it’s just unacceptable.

      I’ve never seen Pegasus or Lifecare go after a possible hip fracture secondary to a GLF; and my scenario was mostly describing what we could easily expect with Trumpcare coming into the fore. ACFR or Medic 5 or someone in our area would, indeed, usually give someone like that fentanyl, but if the paid crews are out, if you’ve got only a basic available, and if the ER is full… I take it you’ve never seen RMH or UVA on a… well, on any given day, really. I’ve seen and heard of hip fractures be set in wheel chairs in triage. And that’s *now*.

      We lean on EMS folks hard enough as it is now; you note, quite correctly, their professionalism is unparalleled, but hard work and perseverance only gets you so far; if we throw enough folks into the safety net for those of us in emergency services to catch, it’s not likely to be pretty.

      Keep up the great work, you and the other EMTs, paramedics, and firefighters out there are playing a role for our communities far beyond what you’re ever expected to do, as not just a medical professional, but a public servants as well.

      Oh, and that’s Mister, not Miss. Heh.

      • Quizzical

        I went to Google this issue and found nothing – nothing except this article about a Norfolk doctor who has come up with a more effective treatment for sepsis
        https://www.ems1.com/patient-care/articles/224145048-Doctor-claims-to-have-found-cure-for-sepsis/
        Huh!

        • Oh, is that the vitamin C thing? That’s really cool.

          So, here’s the full scoop in technical terms; a delegate from SWVA was tired of not having any volunteer EMTs and firefighters, since their budgets are so tight they rely on them heavily, so they advanced a bill in order to legislate a 40-hour EMT class. Someone on another forum tried to jeer at me for the “no training” jab I made, retorting “See?!? Forty hours isn’t no training!”

          No, but if you want an EMT who’s only had a Monday to Friday, 9am-5pm, worth of training before we declare ’em free to roam, then move to a different state.

          Anyway, so in response to this, OEMS simply eliminated class minimum hours, since they couldn’t mandate MORE hours. But they kneecapped that by mandating that to be eligible for state training funds you have to be in the top 16th percentile, I believe it is. Brilliant if you think about it, and I’ll bet the legislators who wanted to conduct a race to the bottom instead of fund EMTs appropriately were steamed.

      • Edward N Virginia

        A good measure of MR Squire’s integrity and intelligence is this excellent reply. We have also found MR Bell to be intelligent and full of integrity. But, too beholden to corporate interests (energy corps, development and construction corps, finance and banking corps, etc: easy to look it up on VPAP website). We hope that many will consider Mr Nurse Squire!

      • Conservative

        When I was young being a volunteer firefighter was considered a high honor, people competed to be able to be a firefighter, there was a lot of pride in it for the people who served. They were celebrated, they held carnivals, there were parades that they participated in, there was comradery, picnics, it was fun! Wives were involved too, it was a community effort.

        Now young people just sneer at firefighters, most don’t even know they are volunteers, they treat them like the hired help. I’ve literally heard young women make sexual remarks about local firefighters in front of their wives.

        • Yes, unfortunately not only are volunteers abused and taken advantage of, but- while I don’t know if people *sneer* at them, certainly there’s less of a respect IMO of what volunteer firefighters and EMTs do for our communities. We don’t support ’em like we ought to, though, so I’m not surprised it’s happening. But I don’t intend to let it continue.

  • Conservative

    I remember when the ACA law was in the works I had a conversation with a young person about how it was going to affect a group of young people. The group I was talking to were set on having the ACA law passed, but to my amazement, when I explained to them that from now on they will be required to have health insurance, that at some point they would not be on their parents’ plans and would be required to purchase health insurance, they called me a liar, not one of them believed that was true. Past all the rhetoric, I don’t think a single one of them actually knew what was in the law, all they knew was that they supported it.

    Now I think it is very similar. If you’re reading this text, ask yourself this, do you REALLY even know what the new Republican laws say ? I mean I know you hate them, everyone does, of course, but do most people even know what it is they hate about it ? “Republicans want it, so it must be evil …”, right ?