While I was sitting in a coffee shop on New Year’s Day, the man next to me asked me what I was reading.
It was "An American Sickness: How Healthcare Became Big Business and How You Can Take It Back"
by Elisabeth Rosenthal,
which I had been looking at because it is highly relevant to the conversation about American healthcare
sparked by the killing of UnitedHealthcare CEO Brian Thompson.
In fact, the book was directly referenced in the accused shooter Luigi Mangione’s manifesto.
Coincidentally, I had just read Rosenthal’s discussion of why ambulances are so expensive,
and the man next to me turned out to be an Emergency Medical Technician (EMT).
So we quickly got into a fascinating—and disturbing—conversation about his life and work,
one that I think illuminates a lot about the problems with not only American healthcare but also with our economic system more broadly.
At first, the man, whom I’ll call D, told me some basic facts about his work that didn’t seem to have political implications.
He was from New Orleans but had been working lately on a contract basis for a company out in Texas.
He was back in town for the New Year but heading back west soon. The work in Texas paid better, he said.
Then, as he progressively revealed more facts about his work to me, it became clear that his life demonstrated the fundamental brokenness of our system.
D casually mentioned that when he had worked as an EMT here in New Orleans, he had been homeless for months on end.
I was shocked. How?
Well, first, even though ambulances are incredibly expensive for patients,
EMTs are not actually paid very much.
The average hourly pay in the area is under $14, even though EMTs do crucial work saving lives
and have to do a lot of what doctors and nurses do with far fewer resources and in incredibly stressful and time-sensitive conditions.
D was not only being paid little, but even though he was working 7 days a week, 12 hour shifts, he was only getting paid for 3 of those nights.
How could that be?
Here was what had happened: D had worked for a private ambulance company.
They had made him what sounded like a good offer:
they would pay to train him as a paramedic (a higher level than a basic EMT)
if he committed to working for them for three years afterward.
Paramedic training requires both coursework and up to 1,200 clinical hours working at a hospital.
The company sent him to a community college in a different city for four months to do his coursework,
then when he came back to town he needed to do his clinical hours.
The clinical hours, which he did 4 nights a week, were unpaid,
because they were considered part of his education.
But the low salary meant he couldn’t afford rent, and he ended up living out of his car.
Now, the work of an EMT is incredibly difficult, especially in a city with a lot of violence like New Orleans.
D was working long shifts, 7 days a week, seeing incredibly distressing and traumatic things.
(He said seeing violence against children was the most difficult to deal with.)
Eventually he burned out, and needed time off. But, he says, when he came back he was told that he needed to have his clinical hours completed by a certain date,
or else none of what he had done already would count.
The completion date was not possible to meet, since by the time the company had processed his paperwork the deadline had passed.
As a result, D not only lost credit for all the unpaid hours he had done already,
but he was told he would have to repeat the four months of coursework if he wanted to get his paramedic certification
—and this time the company would not pay his tuition, so he would have to take on debt.
Worst of all, the company said that because he did not complete the program, he was on the hook for the tuition and board,
and had accrued a debt of $14,000.
This meant that despite doing hundreds of hours of unpaid work, working seven nights a week,
he actually ended up being pursued by a debt collector, and didn’t even receive his paramedic certification!
At that point, D quit to go and work in restaurants, which was better-paid work.
But he missed the satisfaction of helping save people’s lives, and so he returned to being an EMT.
He told me he was happy with his current life situation, saying he’d actually been very fortunate and has no complaints.
But when I inquired about what was better, he said that his new job in Texas paid less by the hour than he had been earning in New Orleans,
but he was able to stay in a house out there that his mother owned in exchange for helping to renovate it.
In other words, he hadn’t found a job that actually paid EMTs a living wage, but he’d been able to depend on family resources to make up for what his employer wouldn’t provide
https://www.currentaffairs.org/news/dont-tell-me-this-is-a-functional-country
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