950: Emergency Medical Services | Skeptical Sunday

950: Emergency Medical Services | Skeptical Sunday

[00:00:00] Jordan Harbinger: Welcome to Skeptical Sunday. I'm your host, Jordan Harbinger. Today I'm here with Skeptical Sunday co-host, Michael Regilio. On The Jordan Harbinger Show, we decode the stories, secrets and skills of the world's most fascinating people and turn their wisdom into practical advice that you can use to impact your own life and those around you. And our mission is to help you become a better informed, more critical thinker. During the week, we have long form interviews and conversations with a variety of incredible people from spies, to CEOs, athletes, authors, thinkers and performers. On Sundays, we do Skeptical Sunday. We're a rotating guest co-host, and I break down a topic that you may have never thought about and debunk common misconceptions about that topic. Topics like Reiki healing, the lottery, diet supplements, GMOs, toothpaste, chem trails, hypnosis, internet porn and more. And if you're new to the show or you want to tell your friends about the show, I suggest our episode starter packs. These are collections of our favorite episodes organized by topic, and they help new listeners get a taste of everything we do, here on the show. Topics like persuasion and influence, abnormal psychology, technology and futurism, crime and cults and more. Just visit jordanharbinger.com/start or search for us in your Spotify app to get started.

[00:01:13] Today, emergencies are inevitable. That's kind of what that means. Homeowners plan for what to do if there's a fire, there's an earthquake, there's a flood, or in your crazy Uncle Frank's case — an alien invasion. Many people's stock emergency supplies in case a hurricane hits or the power goes out, or some households keep a backup generator. We got like water here and some food, solar panels, whatever. We try to prepare for medical emergencies, but when things become more than just a first aid kit or an EpiPen can handle, we dial those three magical digits — 911. And we trust that wherever we are, at least in the United States, maybe Canada, help will hurry to the rescue. But is that reliable? And when you see the cost when the bill comes, are you going to have another medical emergency? What is the truth about America's emergency medical services? Today, comedian Michael Regilio is here to sound the alarm about a medical system on life support.

[00:02:06] Michael Regilio: Hey Jordan, how are you feeling?

[00:02:08] Jordan Harbinger: I feel like a million bucks, which is about half the cost of an ambulance ride in the United States.

[00:02:13] Michael Regilio: Outstanding. Now, stay that way.

[00:02:16] Jordan Harbinger: I do plan to stay that way.

[00:02:17] Michael Regilio: Well, that's the problem. All the diet and exercise in the world can't keep you from an accident or medical emergency. And when a personal tragedy strikes in the United States, someone yelling, "Don't call an ambulance." is as common to hear as someone yelling, "Call an ambulance."

[00:02:32] Jordan Harbinger: I've heard several stories of someone needing medical attention, but worries in the moment, that the ambulance ride will bankrupt them, which is really sad if you're sitting there clutching your chest and you're like, "I, my debit card account is empty." As you collapse to the floor.

[00:02:48] Michael Regilio: Of course, and despite popular belief, an ambulance ride is not expensive because of its advanced features or medical staff, but one of the main reasons for the high price tag is our health insurance does not cover ambulance rides. As I've mentioned in a previous episode, on our third date, my wife nursed me back to health when I snapped a rib after falling off her pull-up bar.

[00:03:11] Jordan Harbinger: I think it's a little ambitious that you were showing off with pull-ups on the third date. No offense, Regilio. I just think you were trying a little too hard.

[00:03:19] Michael Regilio: Actually, I was trying to do a back stretch before a hike because I was afraid I might throw out my back.

[00:03:24] Jordan Harbinger: Okay, okay. I take it back. That's actually kind of sad. You actually weren't trying hard enough, it seems.

[00:03:31] Michael Regilio: Well, if you think that's sad, I spent an hour on her apartment floor, unable to move, trying to figure out how to get to the hospital without an ambulance because like so many other Americans, I just couldn't afford it. And here's the baffling part — while researching this episode, I learned that neither can many of the EMTs who drive and work in the ambulance.

[00:03:53] Jordan Harbinger: That is surprising. I mean, there should be an employee discount, but that's not really the grossest part. They're actually trained medical professionals working in a high risk environment. I mean, I see the things speeding around. They're getting bled on, vomited on, probably bitten and cut with whatever, or just punched for no reason.

[00:04:09] Michael Regilio: Absolutely. Yeah. And EMTs have a much higher risk of dying in a traffic collisions than police and firefighters, yet they make a medium wage of only $36,000 a year. This is despite EMTs having an injury rate three times the national average. EMTs are 10 times more likely to have suicidal thoughts or behaviors. In a nutshell, it's one tough unappreciated job.

[00:04:33] Jordan Harbinger: Yeah. 36 grand. Isn't that kind of like a grocery store clerk-level salary?

[00:04:39] Michael Regilio: Yeah, it is. But here's the thing, most grocery stores offer their full-time clerks medical insurance. Many EMTs don't have health insurance.

[00:04:47] Jordan Harbinger: Why do some EMTs — you said most, but why do some EMTs have health insurance and others don't? I thought this would be like a standardized industry across the the board.

[00:04:56] Michael Regilio: No. In some sense, there is no industry. There is no single federal agency that oversees America's EMTs. America doesn't have a one-size-fits-all regulated emergency response industry. We have 19,000 different individualized industries. Some are municipal departments, some are managed by the fire department but staffed by private companies and some are just volunteers.

[00:05:21] Jordan Harbinger: Oh, okay. That explains why you see so many ambulances with different things written on the side. I've expected it to say like, "Detroit or San Jose, EMS." And sometimes you see that, but then other times you see like, "King ambulance code" and you're like, "What the, what is going on?" I appreciate volunteers, but I'm not sure about having a volunteer perform an emergency tracheotomy on me, as I'm laying on a restaurant floor.

[00:05:44] Michael Regilio: Yeah. Oh yeah, look, don't let the name volunteer fool you. This isn't your retired neighbor. They are still qualified. It's just that, many communities can't afford full-time EMTs, so volunteers have to jump in.

[00:05:55] Jordan Harbinger: So, it would be an honor to have one of these kind and generous souls opening up my trachea, I suppose.

[00:06:01] Michael Regilio: Uh, yeah. Sure, Jordan.

[00:06:04] Jordan Harbinger: I would imagine the job has a lot of burnout though. I mean, it, it's got to be super stressful. And if you're essentially a volunteer, yikes.

[00:06:11] Michael Regilio: Yeah, absolutely. Paramedics see things every day that would haunt most people for life. They witness the most gruesome car accidents, mass shootings and just bizarre and awful accidents. It takes an incredible mental toll on a person.

[00:06:24] Jordan Harbinger: Plus the physical demands of the job have to be taxing, right? You see that a lot of people — you have to huff and puff all over the place with a lot of this stuff.

[00:06:32] Michael Regilio: Absolutely. And there's a reason you don't see a lot of older EMTs. The job is beyond taxing. And EMT is lifting and carrying people all the time. And although there are physical requirements for the EMT, there are no such requirements for the patients. EMTs have to carry people of all different sizes downstairs no matter what. It's a tough job.

[00:06:52] Jordan Harbinger: Yeah. My imagination is running wild with the type of people that you, and maybe one other person, would have to get down several flights of stairs. I've seen — I watched a little TLC here and there. What if you had to get one of those people from one of those shows? You know what I'm talking about. Onto a gurney and downstairs. You need like seven or eight guys to do that. Fit guys to do that. I don't even know, even then it would be hard.

[00:07:14] Michael Regilio: Yeah, right.

[00:07:15] Jordan Harbinger: It's not a job anyone can do well. I feel like we really are — we're asking too much of these folks.

[00:07:20] Michael Regilio: And we don't respect all they do. Look, this patchwork of systems is due because the vast majority of states do not consider emergency medical services or EMS, to be an essential service.

[00:07:32] Jordan Harbinger: How is that pos — what?

[00:07:35] Michael Regilio: The vast majority of states do not consider EMS to be an essential service.

[00:07:40] Jordan Harbinger: I feel like I should say, "I heard you." I just find that fact completely insane. It seems like the very definition of an essential service, is the person that comes to make sure that you can get to the hospital when you're having a medical emergency. After you've stuck a fork in an electrical socket, or you're choking. I mean, that's fire, police. and EMS. There's a reason that they were pre-made buttons on my phone in the 90s. That's crazy.

[00:08:05] Michael Regilio: Yeah. Well, with emergency medical services responding to around 30 million calls annually, it is insane that we do not designate EMS as an essential service. The story of modern EMS is actually quite convoluted.

[00:08:17] Jordan Harbinger: How so? I just figured it was an offshoot of the fire department or something.

[00:08:22] Michael Regilio: No, it wasn't until 1968 that the first 911 call was even placed. Before this, when there was a medical emergency, people would call the police, or fire department, or poison control — whatever seven digit phone number corresponded with their emergency. The police might show up with a paddy wagon to transport a person in need, but local funeral homes ran ambulance services. The hearse was used to transport people to the hospital. Funeral home workers were not trained in any first aid, so they administered no medical care until a person could see a nurse or doctor. This was colloquially known as, "Scoop and scooped."

[00:08:58] Jordan Harbinger: Yeah, that's creepy that they would send a hearse. And I would imagine funeral home workers are not trained in first aid. They can embalm you, which is not usually what I'm going for when I call an ambulance to get to the hospital, when I'm bleeding out. So, why the hearse? It seems — were they cutting out the middleman? Not trying to be dark, but that's — why?

[00:09:15] Michael Regilio: Well, that is pretty dark. But no, it was just funeral home side hustle.

[00:09:18] Jordan Harbinger: So, I suppose a hearse is quite ideal for transporting people who are laying down. It's like the one of the only cars aside from an ambulance I can think of that actually does that.

[00:09:27] Michael Regilio: Right, exactly. I mean, think of the Ghostbusters car. That was a 1959 Cadillac hearse-ambulance combination converted into the Ectomobile. Those types of hybrids really existed for emergency services and it was a poor system. Imagine, hoping for the comfy hearse instead of the dirty paddy wagon when you need help.

[00:09:47] Jordan Harbinger: Oh yeah, right. The paddy wagon for criminals who are possibly smoking, spitting on the floor, puking, whatever, urinating in there, and they're like, "Hey man, this is what we got. So take your lacerated ass in there and lay on the cold metal dirty floor, while we race to the hospital because this is your only option." The very least, it sounds like we're stretching the duties of police to the extreme.

[00:10:10] Michael Regilio: True. I mean, they could be responsible for finding the guy who stabbed someone while helping the stabbing victim. Without medically trained responders, many people died on the way to the hospital who could have been saved with immediate treatment. This just wasn't an effective system for people suffering medical emergencies. Things had to change. And in 1968, they began to.

[00:10:30] Jordan Harbinger: Okay. I remember when I was a kid, we had the different stickers for like poison control, fire police, and it was never a number that you could remember easily. It was always just a regular seven-digit number. So in 1968, they're using 911. Is that the big change?

[00:10:44] Michael Regilio: No. An organization called Freedom House was established. Freedom House started in Pittsburgh's Hill District, a predominantly black neighborhood. It was the first EMS staffed by trained paramedics. And notable for the time, Freedom House's staff was majority African American.

[00:11:00] Jordan Harbinger: This is so difficult to believe. So we've only had trained paramedics, arriving in an ambulance, responding to emergencies, for like 50 some odd years. That's it.

[00:11:10] Michael Regilio: Yeah, I know. Freedom House revolutionized medical care for people at the scene of an accident and for those on the way to the hospital. They set a new standard for emergency care. Freedom House offered more than just emergency medical care. It provided the first nationally recognized paramedics training program in the country. And offered career opportunities for people with no formal medical training. It even turned high school dropouts and ex-cons into skilled paramedics and dispatchers.

[00:11:37] Jordan Harbinger: So that's a cutting edge program, which is interesting because it was in a low income area from the sound of it.

[00:11:43] Michael Regilio: Yeah, it was a really cutting edge, really interesting program. It was. And by 1972, Freedom House had 35 crew members and received over 7,000 calls a year. It was the leaders of Freedom House that established the National Registry of Emergency Medical Technicians. They pioneered several medical techniques, including using air cast to stabilize injured bones, allowing medics to transmit EKGs, administering Narcan to overdose patients, and performing CPR.

[00:12:11] Jordan Harbinger: It's so wild to think this is all so new. I know for younger listeners they're like, "50 years. It's a super long time." But as a 43-year-old, I'm like, "Well, it's not really that long." I mean, we've had fire departments for, I would assume, centuries. Police also. Nobody thought we needed this before? It's insane. What an a amazing success story, though. So, is Freedom House still rocking and rolling?

[00:12:32] Michael Regilio: Uh, no. Because when word got out that the black residents of Pittsburgh were getting better care than the rich white residents, it became a political problem. Pittsburgh's mayor dismantled the program.

[00:12:45] Jordan Harbinger: Wait a second. So — sorry. I don't even mean to laugh because this is so tragic, but it's ridiculous. So instead of building an EMS program for everyone else based on the success of Freedom House, they just decided, 'Hey, let's get rid of the program that's helping the poors." That's so on-brand, somehow. God, that's embarrassing.

[00:13:05] So, staying alive was a privilege of white people, but also, "Hey, let's not make it too convenient. Let's just get — " what a weird and stupid step backwards.

[00:13:14] Michael Regilio: Right. Just for the record, Staying Alive is a surprisingly dark and creepy film with a killer soundtrack.

[00:13:20] Jordan Harbinger: Okay, fair. The soundtrack was for privileged whites. We can get that. We can agree on that.

[00:13:24] Michael Regilio: Oh, I think we can. Look, Freedom House crew knew they were in trouble when the word came down that their ambulances siren was disturbing people and were instructed to switch over to a bell, like on an ice cream truck. The dismantling continued. And on October 17th, 1975, the Freedom House ambulance responded to its final call.

[00:13:43] Jordan Harbinger: Can you imagine? "Hey, by the way, we're not going to be able to come back again. This is the last day." As you're loaded into the ambulance.

[00:13:49] Michael Regilio: Lucky you.

[00:13:50] Jordan Harbinger: While half your blood is on the pavement. What a loss. So, did Freedom House ever spread out of Pittsburgh? I mean, we have EMS now, so. What happened?

[00:13:59] Michael Regilio: Well, technically no. But Freedom House set the standard by which we run all EMS services today. We owe them a great debt.

[00:14:06] Jordan Harbinger: Trained paramedics riding in ambulances was certainly an improvement over, well, everything we just talked about.

[00:14:12] Michael Regilio: Of course, yes. And in 1970, California Governor, Ronald Reagan signed the first paramedic act into law, the Wedgworth Townsend Paramedic Act. It allowed trained paramedics to begin lifesaving care on scene and federal dollars to be used for our nation's EMTs.

[00:14:28] Jordan Harbinger: So score one for the Gipper. I've heard of Reagan. He was not the president when I was born. I just figured that out, by the way. I had to do — I had to go all the way back. Turns out, I was a Carter baby this whole time. I never knew.

[00:14:37] Michael Regilio: Yeah. Well, and then take that point you scored for the Gipper and remove a point because by the time he was President Gipper, Reagan decided cutting budgets and deregulating services was the way to go. So he cut federal funding and oversight of EMS, which pushed responsibilities back onto the states.

[00:14:54] Jordan Harbinger: Okay. So the 80s weren't just bad for fashion. Got it.

[00:14:57] Michael Regilio: Are you saying that that picture of me in a Miami Vice inspired, day-glow green shirt with white parachute pants isn't awesome?

[00:15:04] Jordan Harbinger: No, it's awesome. I'm just saying the fact that you're wearing that outfit right now, is a bit odd, but let's continue.

[00:15:11] Michael Regilio: Yeah, you got me. Okay. Look, with the onus of funding on the states, as well as the decision to designate EMS an essential service, we find ourselves in the situation we are in today. Many of the EMS programs in the United States are suffering and unable to provide the services they intend.

[00:15:30] Jordan Harbinger: So, that sounds incredibly dangerous. Literally, life threatening to anybody who would need emergency medical care.

[00:15:36] You know what's more affordable than an ambulance ride, Michael? Literally everything. But also, the fine products and services that support this show. We'll be right back.

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[00:18:03] Now for the rest of skeptical Sunday.

[00:18:07] So what is being done to keep these services going? Because obviously we're not going to get rid of ambulances, right?

[00:18:12] Michael Regilio: Right. Well, we'll see as I research this, there's a lot of problems with what's going on right now. EMS, particularly in rural areas, have to fundraise. So your friend that has a GoFundMe to pay for his recovery after a car accident, is competing for the same dollars as the paramedics that rushed him to the hospital.

[00:18:32] Jordan Harbinger: Ugh. And so it sounds like nobody cares about care.

[00:18:36] Michael Regilio: Look, it's a vicious cycle. Because EMTs are so underfunded, the cost of those in need is outrageous. They must recoup their costs somehow. And very often, EMTs only get paid when they bring a patient to the hospital. If they show up and the patient won't go, the MS eats the cost.

[00:18:52] Jordan Harbinger: Oh, wow. I didn't realize people could turn down paramedics who arrive on the scene. I mean, I guess that they're — they can't kidnap you, but do people just go like, "No, I'm not getting in that ambulance."

[00:19:03] Michael Regilio: Yeah. In fact, my wife slipped in the shower and was knocked unconscious. I called 911 and amazingly, they walked her out of the bathroom, took her blood pressure and said, "You need stitches and an MRI immediately, let's go." even right after being knocked out, she had the sense to say, "No thanks. I'll get a ride." She signed a waiver, they left, and I drove her to the ER. It significantly cut our costs.

[00:19:25] Jordan Harbinger: Wait, so your wife fell in the shower and knocked herself unconscious. What number date was that, by the way?

[00:19:32] Michael Regilio: It was actually supposed to be the day I proposed. It's a sore subjective, if you know what I mean?

[00:19:37] Jordan Harbinger: When you guys say you fell for each other, you ain't kidding. I mean, it's — but it really though, it almost seems like each of you is competing to be the biggest clutz in your relationship. Mr. Snap-a-Rib while stretching. How do you —

[00:19:49] Michael Regilio: Look, this is true, but situations like this incentivize paramedics to bring people to the hospital when unnecessary. Which brings us to another industry colloquialism called, "You Call, We Haul"

[00:20:02] Jordan Harbinger: So that's catchy. In fact, I once knew a law firm whose slogan was, "We're not happy until you're not happy." which is so hilariously accurate. But "You Call, We Haul" sounds a little bit like, I don't know, chateauesque.

[00:20:15] Michael Regilio: Yeah, it does. Yeah. So the revenue stream for many EMS is patients. By law, they must accept Medicaid and Medicare, despite those prices being set very low. To understand today's EMS, we need to understand that private insurance companies play a little game with caregivers. Where they offer a smaller amount than they're being billed and say, "Take it or leave it.' eMS isn't required to accept private insurance at all, so many just don't accept it. In some cities, all EMS ambulance services are out of network for all insurers. So everyone gets a bill. You get a bill, and you get a bill, and you get a bill.

[00:20:51] Jordan Harbinger: It's like EMS Oprah.

[00:20:54] Soundbite: You get a car! You get a car! Everybody gets a car!

[00:20:58] Michael Regilio: Right and that's how you get a surprise $3,000 bill.

[00:21:03] Jordan Harbinger: Which explains why people are yelling, "Don't call an ambulance."

[00:21:07] Michael Regilio: Which is why there's a recent phenomenon called Uber ER. People are calling an Uber instead of an ambulance.

[00:21:15] Jordan Harbinger: So this isn't actually an Uber feature. It's just instead of calling an ambulance, you call an Uber and you, what? Hold napkins over your bleeding leg and you're like, "Hey man, um, ER, Kaiser Permanente." And you just pray that Pradeep is cool with that.

[00:21:29] Michael Regilio: Mm-hmm.

[00:21:31] Jordan Harbinger: Ugh. I hope they're not using the Uber pool. Imagine sharing a car with somebody who's just like, bleeding from their eyeballs or something. Ugh.

[00:21:39] Michael Regilio: I mean, even if they use an Uber X, I doubt the driver is excited to pick up a person with explosive diarrhea.

[00:21:45] Jordan Harbinger: Man. Too far, Regilio. Gross.

[00:21:48] Michael Regilio: Look, it's just a bad idea to be sick or hurt in the back of an Uber. Trying to Google which hospital has a trauma unit. The lack of funding has led to the rise of private for-profit EMS companies. That's what you mentioned.

[00:22:02] Jordan Harbinger: Mm-hmm.

[00:22:02] Michael Regilio: Today, close to 25 percent of all EMS are privately owned. And I don't think I need to tell you that when the goal is money and not care, the thing that suffers are the patients.

[00:22:13] Jordan Harbinger: Yeah. I mean, there's such a good pun in here, but I'm — whatever. I'm losing my patience with the entire system and I've never had to ride in an ambulance either.

[00:22:22] Michael Regilio: Right. Which is still better than the old days when they were losing their patients on the way to the hospital. But, uh —

[00:22:29] Jordan Harbinger: Oh man.

[00:22:29] Michael Regilio: I digress. And it's the entire system that's messed up, particularly in rural areas. The situation has gotten so bad that many rural areas are dubbed "Ambulance deserts"

[00:22:39] Jordan Harbinger: Is that like a food desert where there's a — mostly a lack of nutritional food. And so, instead of — Well, here though, instead of no nutritional food, there's just no ambulances? First of all, that's heartbreaking, but I'm surprised that that's even legal. So what do you — you're just screwed if you live in that area, period. That's it?

[00:22:55] Michael Regilio: Well, I mean, an "Ambulance Desert" is defined as being 25 minutes or more from an ambulance station.

[00:23:00] Jordan Harbinger: Okay.

[00:23:00] Michael Regilio: Four out of five counties across the nation have at least one "Ambulance Desert" That affects about 5 million Americans.

[00:23:07] Jordan Harbinger: That is not something you think to ask your real estate agent when you buy a piece of property. That's for sure.

[00:23:12] Michael Regilio: Yeah. And many of these communities are underserved American Indian reservations.

[00:23:17] Jordan Harbinger: Mm-hmm.

[00:23:17] Michael Regilio: Tribal EMS programs do exist, but available resources are scarce due to the isolation of the reservation population and climate extremes that affect many reservations. The chance of surviving a car accident injury is significantly less in these communities than in the rest of the country.

[00:23:34] Jordan Harbinger: So basically, they need a version of Freedom House that the government can then come in and stop because it makes everyone look bad. Got it.

[00:23:41] Michael Regilio: I mean, they kind of have one. I read a story about how a physician and his wife used the retirement money to fund two ambulance stations in a North Dakota Ambulance Desert at the Fort Berthold Indian Reservation.

[00:23:53] Jordan Harbinger: So good people doing good things, I suppose.

[00:23:55] Michael Regilio: Well, but when it's for the public good, it shouldn't be private individuals using their retirement fund. It should be funded by, you know, the public.

[00:24:05] Jordan Harbinger: Yeah, you got me on that one. So, don't some communities have a monthly buy-in or something like that? I mean, can you sort of set up almost like a private — well, I guess, taxed to fund an EMS program?

[00:24:17] Michael Regilio: Yeah, they do have that, but it's not the norm. And even if you live in a community with that type of buy-in, you'd better only have your emergencies in that community.

[00:24:26] Jordan Harbinger: Right. I didn't think about that. Right. You're across the street, they can't come get you now. EMS must be in network, like our health coverage or your cell phone plan.

[00:24:36] Michael Regilio: Right. Not to mention the nightmare of what happens next. Even if you escape the cost of an ambulance ride by taking Uber or getting a ride from a loved one, things don't get better in the emergency room.

[00:24:47] Jordan Harbinger: Well, the EMS just drops you off, I guess. It's not like an expensive ambulance ride gets you priority at the hospital. You're not arriving at the club in a limo.

[00:24:56] Michael Regilio: Exactly. And two new studies out of the University of Michigan's National Clinician Scholar Program depict the depressing reality of emergency rooms in the United States. Often, ERs don't have enough beds for everyone in need, and even if they did, there's not enough staff to provide medical care for the people in the beds. After hours of sitting in an ER waiting room, many people continued to suffer lying in a bed that they put you in, in the hospital hallway.

[00:25:23] Jordan Harbinger: That is surprisingly gross. I thought the hallway thing — you expect to see that in a developing country, third world country, when there's a natural disaster. Not because the hospital in your city is full. That's crazy.

[00:25:36] Michael Regilio: Man. There's even a term for putting patients in hallways called "Boarding" In the studies, researchers examined how long patients "Boarded" and how often, they just left before receiving care.

[00:25:47] Jordan Harbinger: So just bounce out like, "Okay, the bleeding seems to have subsided. I got some duct tape in the car. I'm just going to leave now, without seeing a doctor."

[00:25:54] Michael Regilio: I mean, can you imagine going to the emergency room and eventually saying, "Screw it, I'm going home." I mean, I've waited so long for a table at a restaurant that I've left, but I was just hangry. I can't imagine being really sick and thinking, "I'd be better off at home."

[00:26:08] Jordan Harbinger: Yeah. "Boarding" — that word sounds like a euphemism for, "Eh, this guy will be fine. It's not that serious."

[00:26:14] Michael Regilio: Yeah. When hospital occupancy topped an 85 percent during, you know, that pandemic thing we had, boarding times exceeded 6.5 hours.

[00:26:25] Jordan Harbinger: I've been — I went to the hospital once when I was young, for a separated shoulder, high school. I was there for like 13 hours or something crazy because it was a non-urgent thing. And it was a Friday night. Apparently, everybody acts the fool on Friday nights. So waiting in the hallway of a hospital to be seen by a doctor for six and a half plus hours, just clearly the system is broken both inside and outside of the hospital.

[00:26:48] Michael Regilio: Right. Which is why it's not surprising that the National Institutes of Health found several hospitals were over 10 percent of emergency room patients leave before being seen.

[00:26:57] Jordan Harbinger: 1 in 10. Man, I can't get my head around that. I even, I stayed — although, I was kind of a kid and couldn't get a ride anywhere. But still, that's so pathetic, really.

[00:27:07] Michael Regilio: Dr. Ted Melnick, an associate professor of Emergency Medicine at Yale School of Medicine said, quote, "A critical number of American emergency departments are functioning in disaster mode daily. With dangerous and uncomfortable wait times.

[00:27:22] Jordan Harbinger: I mean, uncomfortable sounds like an understatement when we're talking about a whole workday with a time. What about urgent care centers? We have a ton of those around here. There's one like down the block. Do they alleviate the problem where they exist?

[00:27:34] Michael Regilio: Urgent care centers aren't a good solution because they are only options for people with insurance or disposable incomes.

[00:27:41] Jordan Harbinger: Yeah, I suppose I hadn't thought of that. So after people stress about getting to the hospital in an emergency, then they have to stress about long waiting times, and that alone makes me sick. And that's not even counting the bill they get after they get out of there.

[00:27:53] Michael Regilio: Right. Some emergency rooms advertise their wait times. So if you're not too sick, check online first. It's like the same system at the DMV or Universal Studios rides.

[00:28:03] Jordan Harbinger: Right. You got an app for that like, "Oh, the wait time is only 68 minutes. Maybe if I get there now, I'll be seen before tomorrow." So that's not much of a solution. You know, I'd like to think my health is more valuable than a seat on that Harry Potter ride.

[00:28:18] Michael Regilio: And the problem is just going to get worse. Experts predict emergency room visits will continue to increase as the growth of the US population increases. Especially the growth of people over 75.

[00:28:30] Jordan Harbinger: So, as Americans live longer, the care quality actually goes down?

[00:28:35] Michael Regilio: Mm-hmm. Older patients are sicker and require more attention in longer stays, which reduces capacity. One Massachusetts Hospital recently reported that the length of the stay at the hospital has increased by almost one full day. And research suggests that overcrowding in hospitals will require a 90 percent expansion of emergency room capacity by 2050. And 72 percent more space for inpatient beds. That also sounds like a lot more ambulance rides will be necessary.

[00:29:08] Jordan Harbinger: Geez, and that's no small projects. Are there any other solutions besides building a hospital, on top of our hospitals?

[00:29:15] Michael Regilio: The explosion of urgent care centers remove some of the burden on the hospitals. Another popular model being looked at is care at home, under a hospital's direction. These have some similar pros, like alleviating hospital overcrowding but it ain't so great in other ways. Cons are things like, nurses can't provide the same care as they do in the actual hospital.

[00:29:35] Jordan Harbinger: Sure. No, that makes sense. So we're going from home offices to home hospitals. I'd hate to see it come to home surgery rooms, right? You might as well learn to perform the procedure on yourself with a doctor over Zoom or something like that. Really gnarly trend.

[00:29:49] Michael Regilio: Yeah, man. I do not have the lighting fixtures for that. And another idea being considered is tent hospitals.

[00:29:55] Jordan Harbinger: Like M*A*S*H, right? Those Vietnam tents. Sitting out there.

[00:29:59] Michael Regilio: Well, no. It's different. Technology has come a long way since the days of Hawkeye and Klinger. The modern military tent hospital is like something off the set of The Martian. And once built, they can morph these tents into permanent buildings that are cheaper and quicker to build than regular hospitals. During the pandemic, hospitals put up tents, and triage and holding areas to deal with how overwhelmed they were.

[00:30:20] Jordan Harbinger: So, excuse the pun, but this — putting up tents in the parking lot really does sound like a bandaid solution.

[00:30:26] Michael Regilio: Right. Well, most actual solutions to these problems face an ideological wall here in the US. Because of the dirty S word. Socialism.

[00:30:35] Jordan Harbinger: Mmm.

[00:30:35] Michael Regilio: Plus, politicians argue about how to pay the bill, instead of why the cost is so high.

[00:30:41] Jordan Harbinger: So are you kind of getting at the concept of universal healthcare?

[00:30:45] Michael Regilio: Look, any concept of public funds for medicine is met with resistance in the United States. The problem has plagued emergency care since those early days of the Freedom House in Pittsburgh. At one point, Pittsburgh's mayor tried to get Freedom House defunded, discredited, and shut down. Many people considered Freedom House to be un-American.

[00:31:05] Jordan Harbinger: Well, they were right because they were getting healthcare.

[00:31:07] Michael Regilio: Yeah.

[00:31:07] Jordan Harbinger: So that is un-American.

[00:31:08] Michael Regilio: Of course. The un-American thing was the notion of public money being used for what was supposed to be a business. So much so that there were private companies calling Freedom House unconstitutional. They saw it as a slippery slope. Once you declare emergency services and essential service, how long until the same goes for the rest of medicine.

[00:31:30] Jordan Harbinger: Yeah. What is it? There's like kind of self-aware. It's like, you're almost getting it. I think we're going to need another entire podcast if we're going to dive into the socialized medicine debate, for sure. I think everybody knows I'm not a socialist, but I have strong opinions on socialized medicine.

[00:31:46] Michael Regilio: Right. Me too. Look, I think we need an entire podcast series dedicated to the subject, and even then, it would just be a general overview. This is a big and complex issue, but it really is at the heart of the medical field's giant problems. It reminds me of what Barack Obama said. It was something like, "If problems were easy to solve, they would be solved. The problems that we see in our society are, by definition the hard ones."

[00:32:12] Jordan Harbinger: I think we've uncovered why EMS is not federally labeled as an essential service. It opens the door to being labeled socialism, and I can see the listener's emails already. I'm going to forward all those to you, by the way.

[00:32:23] Michael Regilio: Great. The fact of the matter is, these are complex issues. But we have to be at least able to talk about them.

[00:32:30] Jordan Harbinger: And I agree, of course.

[00:32:32] Michael Regilio: Right. Here's a simple solution to something I've observed.

[00:32:35] How about — and I know this sounds crazy, but get the hell out of the way of ambulances when they come down the road with their lights and sirens on.

[00:32:43] Jordan Harbinger: People do that, at least where I live. They get out of the way. They pull over.

[00:32:45] Michael Regilio: No, no. This has somehow become a regional thing. In LA, people are slipping. I see people not only failing to pull over, but then using the ambulance is a way for them to get around traffic. I mean, people are going broke for that ambulance ride. We should at least get out of their way.

[00:33:01] Jordan Harbinger: Wow. Yeah. Do a person a solid, maybe pull over for a second.

[00:33:04] Michael Regilio: Yeah.

[00:33:04] Jordan Harbinger: That's crazy. Just so — when you say get around traffic, are you saying the ambulance goes through and people are like, "Yeah, I'm just going to follow that ambulance all the way."

[00:33:10] Michael Regilio: Yeah.

[00:33:11] Jordan Harbinger: Oh my god.

[00:33:12] Michael Regilio: Like the ambulance is like their "Blocker" and they're a runner on a football field or something. And in New York, forget about it. People see the ambulance as just another jerk trying to cut them off.

[00:33:22] Jordan Harbinger: Oh my God.

[00:33:22] Michael Regilio: And that's true. I was just there, man. It's crazy. No one gets out of the way of ambulances. They're like, "Yeah, I got a horn too, buddy." But in fairness, the emergency services medical outcomes projects studies show, that the only time it actually makes sense for an ambulance to speed with its sirens blaring and running red lights is in the case of cardiac arrest.

[00:33:42] Jordan Harbinger: Is that true?

[00:33:43] Michael Regilio: Absolutely. When someone suffers cardiac arrest, time is truly of the essence.

[00:33:47] Any other emergency, even with gunshot wounds and strokes, it makes more sense for ambulances to follow traffic laws. An ambulance driver is twice as likely as you or me, to have a fatal traffic accident. The National Highway Safety Administration estimates about 10,000 ambulance crashes —

[00:34:06] Jordan Harbinger: Wow.

[00:34:06] Michael Regilio: Every year.

[00:34:07] Jordan Harbinger: Wow.

[00:34:08] Michael Regilio: These result in an average of one fatality a week because of ambulances speeding with their sirens on. And 75 percent of those fatalities are pedestrians.

[00:34:17] Jordan Harbinger: I would imagine, that's a lot of like folks with earbuds in that were looking at their phone and just got smoked by an ambulance. That's awful.

[00:34:24] Michael Regilio: I mean, it could be. I am sure that accounts for some of the reported 10 EMS injuries that happen every day. Research shows that over 50 percent of all ambulance insurance company payouts are because of ambulance collisions.

[00:34:39] Jordan Harbinger: Great. So now we need EMS for EMS.

[00:34:42] Michael Regilio: EMS, EMS. But more importantly, everyone needs to be mindful that our emergency funds need to include the cost of EMS, whether we are driving or riding in the ambulance. And god forbid you need a helicopter lift.

[00:34:56] Jordan Harbinger: I didn't even think about that. So great. Now along with my kids college fund, I got to start an EMS fund. I've heard those helicopter rides can be like 30 to a 100 grand.

[00:35:05] Michael Regilio: Oh, I didn't even cover those because it's just ridiculous. If they call a helicopter on you, I don't care what's wrong with you, don't get on it.

[00:35:12] Jordan Harbinger: Yeah. Oh man.

[00:35:13] Michael Regilio: And until things change, and EMS becomes a human right, I will do my part as a real American and I'll just die of a treatable emergency in the back of an Uber

[00:35:23] Jordan Harbinger: Yeah. Or you'll get hit by an ambulance, limping to the ER.

[00:35:26] Michael Regilio: Hey, at least they'd have to pay for my funeral costs.

[00:35:29] Jordan Harbinger: Man, so dark Regilio. How about you just try not to fall before the next podcast? How's that?

[00:35:35] Michael Regilio: Will do.

[00:35:37] Jordan Harbinger: Thanks all for listening. Topic suggestions for future episodes of Skeptical Sunday can go right to me, jordan@jordanharbinger.com. Show notes at jordanharbinger.com. Transcripts are always in the show notes. Advertisers, deals, discounts and ways to support the show are all at jordanharbinger.com/deals. I'm @jordanharbinger on Twitter or Instagram. You can also connect with me on LinkedIn. And you can find Michael @michaelregilio on Instagram or michaelregiliocomedy.com. Tour date's up now as well. We'll link to that in the show notes because as always, no one can spell Regilio.

[00:36:09] This show is created in association with PodcastOne. My team is Jen Harbinger, Jase Sanderson, Robert Fogarty, Ian Baird, Millie Ocampo, and Gabriel Mizrahi. Our advice and opinions are our own, and I'm a lawyer, but I'm not your lawyer. So do your own research before implementing anything you hear on the show. Maybe Google EMS costs in your area before turning down an ambulance and/or helicopter. Remember, we rise by lifting others. Share the show with those you love. And if you found the episode useful, please share it with somebody else who could use a good dose of the skepticism we doled out today. In the meantime, I hope you apply what you hear on the show so you can live what you learn, and we'll see you next time.

[00:36:49] You are about to hear a preview of The Jordan Harbinger Show with wildlife trafficking investigator, Rachel Nuwer.

[00:36:55] Rachel Nuwer: Just imagine like, long cages and just like animals crammed into these cages, like yowling in frustration. There was some bears there that were like equally sad. Everywhere we went, there was just ivory, rhino horn, pangolin scales, all just openly for sale. Like you didn't have to ask or go into some room. It's just like out there. It was disgusting. It's horrific. The people who have the money and the power, they get the real thing. So they're commissioning people to like take a photo of the dead animal and like bring back what they call wet horns, which is a horn like with flesh still stuck to it. Between 2007 and 2015, 30 percent of Savannah elephants disappeared, and poaching was a major driver of that, of course. There's tons and tons of corruption. And corruption really is what greases the wheels of the illegal wildlife trade. You know, if you're like a big enough player, you can avoid punishment — whether you're a trafficker or whether you're a country. Criminals just want to make money. Like they don't care, like what it is. And wildlife just happens to be one of the easier ways because nobody's looking for it. Again, this is why we need to really go after the big bosses, the criminals running these enterprises and making this happen at an international level and just change people's minds. Because if people stopped paying money for this stuff, like people wouldn't bother going to kill rhinos and elephants and everything else. Let your voice be heard, share information about it. We can only actually fix the problem if we know the problem exists in the first place. It's a real shame just that there's been so much value placed on species, you know, why?

[00:38:30] Jordan Harbinger: For more about the shadowy world of illicit wildlife trafficking, check out episode 545 of The Jordan Harbinger Show.

[00:38:39] This episode is sponsored in part by Court Junkie. If you're a fan of true crime, check out Court Junkie. Court Junkie is a true crime podcast hosted by Jillian Jalali that covers court cases and criminal trials. Learn about a nurse at a Texas hospital who was charged with murdering his patients. We did a show about that as well. Prosecutors claim he's a serial killer, but of course he says he's innocent. Hear from a local reporter who gives his perspective on the case. And what happened to 13-year-old Dylan Redwine? Dylan's father, Mark, went on trial last year for his murder. Hear all of the important testimony from both the prosecution and the defense. Host Jillian Jalali, who in my opinion, is very sharp and smart and interesting. She uses audio clips and interviews to focus on the facts of one true crime case per episode. In the end, the listener can decide — did the criminal justice system actually work?

[00:39:24] Subscribe to Court Junkie on Apple, Spotify, or wherever you get your podcasts.