Notes From the Cockpit – Health Care & Helicopters

I flew a medical helicopter for twenty years. In that time I saw at least one of every illness, trauma, malady, genetic disorder, ailment and medical anomaly known to modern medicine. I saw gunshot wounds, self-inflicted and otherwise, heart attack victims too numerous to recall, electric shocks, pharmocological shock, burns, drownings, highway trauma and farm injuries that convinced me mine was the safer career. I’m not a doctor, don’t even play one on TV, but I was immersed in the so-called health care debate for a long time, from the real grass roots level–the pre-hospital side of things. I can comment on the needs of this society when it comes to health care, and health insurance.

There were a few patients aboard my medical helicopter who had no business being there, but very few. In twenty years, I flew 3,200 medical patients, and I can say that no more than a dozen of those lacked the medical necessity to be flown, rather than driven in an ambulance. Admittedly, some of those few patients could have driven themselves to a hospital. But in any human-devised program some people are going to slip through the cracks, or game the system. There’s no such thing as a perfect plan.

My patients then were, by and large, very ill people. They needed the highest level of medical care available, and at the fastest means of delivery. That was me and my crew in the helicopter. There were, without fail, those who questioned the use of the aircraft, asking about its cost. Our canned response to those folks had a lot of ambiguity, delivered in medicalese, with a dollop of changing the subject. It was obvious when those queries appeared, we said, dismissively, that the inquiree had no personal need of the helicopter, or his (or her) question would not have been posed.

The bottom line of this discussion is, that the helicopter was used only for emergency patient transport, and that determination was always made by someone highly trained and immersed in medical assessment–a physician, EMT, nurse, Paramedic or other professional person. No family member of a patient was authorized to request the helicopter. So, when I lifted from the helipad atop the roof of the hospital, I knew the client who awaited the helicopter was very ill, traumatized, critically injured in some way, or in a life or death situation. I didn’t fly for nosebleeds.

So what’s the point of all this? What lessons are there to learn from all those patient flights? It all centers around a subject near and dear to everyone’s heart just now: Health Insurance.

We all need it. Without health insurance we’re all just one broken leg, a serious burn, medical setback or cancer diagnosis from financial disaster. No reasonable person can dispute this. With no health coverage, we’re at the mercy of the system. Did I fly people who lacked health coverage? Yes, I did. Did they receive care at one of the finest health care institutions in the country? Yes, they did. And hidden in all this prose is the core of the dilemma we face in this country.

Let’s be clear about this. No one lacks health care coverage in America. Not one individual who walks, rides, drives, crawls–or flies into an American emergency room will be turned away. Indeed, in many cases, those lacking insurance coverage who are flown, or drive, or crawl into our towers of medical learning and knowledge, the citadels of health care in America, often receive better medical care than those who hold excellent health care insurance. Again, no one lacks coverage.

What’s this got to do with helicopters? Everything, with a thought to insurance. We’ve reached a point in this society where mission creep has defined health insurance. We buy insurance, and then we expect that policy to take care of virtually all our health care needs–from routine office visits with our physicians, to minor medical crises like bee stings, broken arms, sunburn and measles, to life-threatening events like major falls, heart attacks, cancer treatments, medical crises, you name it, even the flight in the helicopter if need be. We’ve lost sight of what insurance ought to be for, and that is, emergencies. The system we have now is like buying car insurance, and then billing the insuror for our gas and tune ups. It’s equivalent to buying home owner’s insurance, then charging the insuror when the house needs paint.

Plus, no one knows what anything costs. There are no price tags on any ‘product’ available to the medical consumer. I mentioned those who asked about the cost of a flight in the helicopter. As a pilot, I had a vague idea what the cost was, a ballpark figure that was likely well off the mark in many cases, so I used to shun those people. But at least they were asking the question, and those questions aren’t being asked today, so those folks were ahead of the rest of us.

A possible solution would be highly controversial, but would look like this: Everyone would be required to establish a health care resource, an annual pool of funds that the consumer must tap into for all but the most expensive, most critical medical care, like current pre-tax medical set aside programs. Doctor’s office visits would come from this pool; casting a broken leg would be insured. Prescriptions for sunburn medicine come from the pool; burn treatment from a house fire comes from insurance. Removal of a mole or skin lesion, resource pool; treatment for melanoma, insurance. And on and on, decisions made by experts, in consultation with us, the consumers. This system would force people to consider not only whether they need the care or not, but also the actual cost of the care. It would also encourage a patient to shop around for whatever treatment appeared least expensive, resulting in more choices, thus lowering costs of those routine medical interventions.

The model needs to be this: If the person may need a flight in an aircraft, (airplanes do medical flights, too), then their insurance likely will kick in. If they would not be flown under any circumstances, then they may need the coverage of their own pool of resources. In twenty years I never flew a patient with a nosebleed. There were a few patients lacking the need for the helicopter, but very few. Those I flew needed the coverage, even if some didn’t have it. For those lacking coverage, we all paid the bill. I don’t know how much it was, but it wasn’t cheap. And it’s not getting cheaper.