\n \u00a9 2024 Gwen Dewar, Ph.D., all rights reserved<\/span><\/p>\n Who should decide whether a child gets access to life-saving care? Or if the child\u2019s family should receive a crippling financial blow \u2013 one that might permanently and negatively alter the course of their lives? In traditional cultures throughout the world, folks share similar values about this: Some things should not be determined by the whims of profiteers.<\/strong><\/p>\n You\u2019ve rushed your child to the local hospital. The doctors determine that your child has a severe, or even life-threatening condition. It is medically necessary to transport your child \u2013 by air \u2013 to a facility for immediate surgery.<\/p>\n What do you do? It\u2019s no-brainer. Your child\u2019s life hangs in the balance. An air ambulance is necessary. So your child is transported, gets treated, and \u2013 we fervently hope \u2013 survives and thrives.<\/p>\n And then you get a surprise bill\u2026for nearly $60,000, or maybe even more. Because your health insurance company decided to reject your doctors\u2019 expert determination that the air ambulance was medically necessary.<\/p>\n On December 9th<\/sup>, 2024, I heard about a case like this in a local news report<\/a>. There was a happy ending, but only after local, investigative reporters got involved with the story.<\/p>\n Unfortunately, there have been many other cases like this in the United States. To see what I mean, do an online search, using the keywords \u201cair ambulance bill parents.\u201d Or read this account by Maura Kelly<\/a> in a 2020 article for the peer-reviewed journal, Annals of Emergency Medicine<\/em>.<\/p>\n Americans already know why. Alone among affluent, industrialized nations, the United States allows the financial authorization of life-saving treatments to be decided by private corporations. <\/p>\n We\u2019re also the only the only such nation that offers only a weird patchwork of health care insurance solutions, so that every life change (of employment, income, family size, or state of residence) can cause families to lose their health coverage, and force them to reapply to new plans.<\/p>\n It could be even worse. Before the passage of the Affordable Care Act, millions of Americans who didn\u2019t get health insurance through an employer were either denied coverage because of pre-existing conditions, or offered coverage at such a high price it was totally unaffordable. And thanks to Medicaid, and to the national Children\u2019s Health Insurance Program (CHIP), more than one third of American children receive health care coverage that would otherwise be unaffordable for their families.<\/p>\n But this highlights the vulnerable nature of the patchwork. <\/p>\n Since 2023, nearly 4 million children were disenrolled from Medicaid and\/or CHIP \u2014 approximately 70% for procedural reasons, such as parents not realizing what paperwork they had to submit to maintain coverage (Alker et al 2024). And Republican politicians have signaled their intentions to restrict Medicaid funding, stop the enhanced subsidies for the health plans offered through the Affordable Act marketplace, and weaken protections for folks with pre-existing conditions \u2013including pregnancy (Orris and Heyison 2024). <\/p>\n Such actions would likely make millions of working families fall through the cracks \u2014 earning too much money to qualify for Medicaid, and too little to afford private insurance.<\/p>\n So health insurance is a huge part of what\u2019s wrong with the U.S. health system. But it isn\u2019t only that we have insurance companies trying to deny benefits in order to please their investors, or that many people can\u2019t afford the health care coverage they need.<\/p>\n There\u2019s also the question of allowing vital, public survival services (like air ambulances) to be controlled by someone other than medical caregivers and the people. <\/p>\n Something terrible happens. Decisions are made under dire circumstances. Patients rely on the expert advice of doctors \u2013 the folks best qualified to judge. Yet, in the cases we\u2019ve discussed, health insurance companies have rejected those expert medical decisions.<\/p>\n What if the air ambulance isn\u2019t \u201cin network\u201d with your insurance company? According to estimates, approximately 50% of air ambulance services have ended up being out <\/em><\/strong>of network (Turrini et al 2021). In 2021, U.S. lawmakers passed the \u201cNo Surprises Act,\u201d which was designed to protect consumers in these situations. However, the Act has been challenged in the courts. <\/a>So it remains to be seen how this will turn out.\u00a0<\/p>\n Put these factors together, and we can see this isn\u2019t just a problem with the way Americans handle health insurance. It\u2019s a problem with the way Americans handle many aspects of essential care.<\/p>\n Decades ago, most air ambulances were owned and operated by hospitals. Today, 73% of all air ambulance helicopters are owned by just three for-profit companies.<\/em> <\/strong>And there is a crazy-big markup for this service.<\/p>\n In 2017, the median cost of an air ambulance in the United States was $36,000. Yet the operating costs represented only $6000 to $13,000 of this total.<\/strong><\/p>\n Where am I getting these statistics? From Dan Goldbeck and Malcolm Mahoney, writing for the American Action Forum (AAF), a think tank that describes itself as \u201ccenter-right on domestic economic and fiscal policy issues.\u201d As these authors note, the \u201cshockingly high price tag\u201d of air ambulance services reflect the fact that \u201cfirms have the ability to inflate prices to exorbitantly high rates, often much higher than the operating cost.\u201d<\/p>\n As I have written elsewhere, the evolution of our species has depended on cooperation, sharing, and supporting families with children<\/a>. Even today, the world\u2019s remaining hunter-gatherers understand that raising children is a community effort \u2014 not a personal hobby. Everyone\u2019s well-being \u2014 everyone\u2019s survival \u2014 depends on each new generation growing up healthy, strong, smart. It simply isn\u2019t possible for parents alone to make this happen. It\u2019s too big a job. It has always been too big a job.<\/p>\n This understanding about our humanity has been shared by people in traditional cultures throughout the world. And I\u2019m convinced that most Americans \u2013 regardless of their politics \u2013 agree with the basic premise: There are things in life \u2013 like essential medical care \u00a0\u2013 that should not be under the control of corporate profiteers.<\/strong><\/em><\/p>\n But Americans have been stuck with a such a system, and it costs us. In a study comparing the United States with 10 other, high-income countries, researchers found that Americans were spending the most on health care \u2014 far more than anyone else. Yet they were also having the most trouble accessing affordable care.<\/em><\/strong> <\/p>\n Moreover, the United States ranked dead-last for health outcomes, including infant mortality and life expectancy after age 60. And it had \u201cexceptionally poor performance\u201d for two measures: Maternal mortality and avoidable mortality (Schneider et al 2021).<\/p>\n What would our ancient ancestors make of this? A society that has life-saving medicine and technology\u2026and yet fails to use this power to support its members?<\/p>\n Goldbeck D and Mahoney M. 2023. Addressing the High Costs of Air Ambulance Services.\u00a0American Action Forum. Accessed online<\/a> December 15, 2024. <\/p>\n Kelly M. 2020. Sky-High Air Ambulance Prices. Ann Emerg Med76(5):A17-A20. doi: 10.1016\/j.annemergmed.2020.09.447.<\/p>\n![\"silhouette](\"https:\/\/parentingscience.com\/wp-content\/uploads\/ancient-family-values-Toddler-silhouette-sun-by-PLFILM-shutterstock_2422574701-min.jpg\" "\\"ancient")
<\/figure>\n![\"Gold](\"https:\/\/parentingscience.com\/wp-content\/uploads\/PS-Bites-Badge-Dewar-108x180-1.png\"\/ "\\"PS-Bites-Badge-Dewar-108x180-1\\""){kind=icon}
<\/figure>\nWhy do these things happen?<\/strong><\/h2>\n
Working families at risk<\/h2>\n
For example, consider these points about air ambulances.<\/h3>\n
![\"closeup](\"https:\/\/parentingscience.com\/wp-content\/uploads\/Air-ambulance-and-health-care-by-Contributor-Davide-Zanin-Photography-shutterstock_1353415289-min-300x200.jpg\" "\\"Air")
<\/figure>\n1. People don\u2019t get a choice about using air ambulances.<\/strong><\/h4>\n
2. People don\u2019t get to choose which<\/em> air ambulance services to use, which puts them at risk for dramatically higher bills.<\/strong><\/h4>\n
3. Air ambulances used to be run by hospitals. But nowadays, most air ambulance helicopters in the United States are under the control of just three private companies\u2026and there have been huge markups on air ambulance services.<\/strong><\/h4>\n
We can do better. It is part of our heritage to do much better.<\/strong><\/h2>\n
References<\/strong><\/h2>\n