A ‘Thank You’ to Governments (On Behalf of CP/MIH Programs That Deserve to Get Paid)

A group of people on a Microsoft Teams call. — It takes a village to make mobile medicine successful. (Screenshot provided by the author.)

I am a political centrist who consumes media accordingly: I read The Wall Street Journal and watch CNBC almost daily, while at the same time, I listen to podcasts from the likes of Vox’s Ezra Klein; and I had the honor of serving in the Obama-Biden White House.

In this age of polarized perspectives, readers will attempt to label me based on whether they agree or disagree with any given point, but one can hardly argue that I skew too far to either side. Indeed, I have been bandying about for some time now, with a dear friend is also in our profession and who sits just on the other side of the aisle, about a split ticket presidential run someday because we do believe that our country could use it.

Thank You

With that in mind, this note is not a love letter, but rather, a “thank you” note to a cadre of federal partners who bolstered the faith of many, and gave reasons for hope to others, about the notion that the federal government is interested in supporting Mobile Medicine in its service to the community.

But, as I mentioned in my presentations during EMS World 2023 and the concurrent NAMIHP Summit—part of the onus on agencies hoping to work with the federal government (or any level of government) is to look away from the “center of the curve,” and find parts of the governmental community that are less targeted but that are just as worthy of collaboration in order for both sides to give the other a win.

I was disturbed—but not surprised—when I asked the attendees in both of my talks (one in each section of the weeklong conference) to volunteer whether they had attempted to fund their agencies’ programs using monies from someone other than the Center for Medicare and Medicaid Services or FEMA’s U.S. Fire Administration. In each case, fewer than a half-dozen hands raised, out a moderately packed house. Not even six people.

And yet…

I was able to tell anecdotes of a colleague in Texas who, for example, was the only applicant to a multi-million dollar federal program that helped him rebuild his emergency operations center after a weather disaster;

I told of the federal government’s “full court press” on the Safe Streets & Roadways for All program—a multi-year, multi-billion dollar initiative to equitably stanch the crisis of deaths on roadways, highways and railways…yet at the 2023 Governors Highway Safety Association conference in August, government leaders said they are “having trouble giving away the money.”

One of my statewide contracts is funded by a “color of money” that I thought was part of a larger federal agency, but it turns out, this particular administration office has its own federal appropriation (i.e., its own color of money).

Figure It Out

There is much to learn, but when the question is “figure it out or shut it down,” a phone call is a low bar to hurdle. The magic of my recent experience—and the inspiration for this “thank you” essay—was the dynamic response of several federal agencies to a small fire-based community paramedicine program that (like so many of its colleagues) is conditioned to figuring things out through grit and persistence. To steal the phrase used by my partner in the field, we were “gratefully a little overwhelmed” by the federal agencies’ willingness to help. And “with all of [the] potential funding sources.”

I found over $100 million for which a fire-based ambulance service in Alaska was eligible to power its community paramedicine program. But applying for government funds can be complicated, so I reached out to several high-level agencies, including the Alaska Commission on Aging, which jumped at the chance to offer guidance and facilitate introductions (especially in light of Alaska’s unique demographic and geographic challenges when it comes to caring for elderly patients).

Diverse Regions

Next came the Office of the Assistant Secretary for Health in HHS Region 10, which serves the (massive, and massively diverse) states of Alaska, Idaho, Oregon, and Washington. We could not have received a more compelling, enthusiastic, and optimistic response from a cadre of agencies that were hungry to help. Specifically, five federal agencies actively engaged in a nearly two-hour long conference call:

Administration for Community Living
Health resources and Service Administration
Office of Intergovernmental and External Affairs
Office of the Assistant Secretary for Health
Substance Abuse and Mental Health Services Administration

The Math is Fascinating…

Renée Bouvion, the regional administrator, joined our conversation herself to ask what we needed and invite us to stay in touch. These federal leaders offered advice on how to engage the gamut of communities from health care researchers seeking to understand independent seniors’ needs; to agencies working to interrupt the cycle of substance use disorders; to those who care about polychronic patients struggling with a range of Social Determinants of Health from weather challenges to housing insecurity.

When working in D.C., was I able to understand the barely conceivable burden associated with responsibility for over 300 million lives and livelihoods. The math is fascinating, and daunting. To see a microcosm of it, pause while shuffling through any airport (the bigger the better, like Atlanta or New York or Chicago) and consider that every person has a reason for being there—a vacation, a job interview, a birth, a death—and likely, bags that need to travel, too.

Multiply those logistical realities by the scale of a country to get close to what the modern federal bureaucracy deals with. Languages, states, territories, agendas, technologies, lobbyists, media. Plus, the people behind the work have their own hopes, fears and families to keep in mind.

Politics

By design, the legislature (and its purse strings) brings the federal bureaucracy to the local level, so the action happens where needs become deliverables. It’s been said countless times that “all politics are local.” There, your work has an outsized impact on community health and safety—a reality enshrined in law even if a few adamant voices believe nothing short of the word “essential” will do the trick.

For example: Did you know that the Affordable Care Act is a reality because of Mobile Medicine? Some readers will be proud of that fact; others will chafe. The Supreme Court Justices made clear that we have the right to choose to eat too much (and too poorly), to never visit the doctor or take antibiotics, to practice unsafe sex or drink in excess; we live and die by these choices. Yet, when our car wraps around a tree and we’re unconscious, and some bystander (or an in-car dispatch) calls 911, an ambulance will arrive to rescue us. Someone should be paid for that service, because ambulance operations cost money.

Under the current EMS business model, the public somehow pays if the patient can’t — or won’t—thanks not to a liberal Democrat, but to conservative hero Ronald Reagan, who signed EMTALA into law in 1986, guaranteeing access to emergency care regardless of ability to pay. In effect, it was President Reagon—not President Obama—who created “socialized medicine” in America.

Big Money

Two decades on, during the Supreme Court’s Obamacare debate, Chief Justice John Roberts said: “When you need police assistance or fire assistance or ambulance assistance, the government is going to make sure to the best extent it can that you get it.”

The public may take Mobile Medical services for granted (even during disasters), but that doesn’t change that your work costs money, and your agencies rack up a $3 billion nationwide IOU each year.

It does, however, mean that the federal government is prepared and willing to help Mobile Medical services—a nice bumper sticker message that turned real in a wonderful way, without regard for the service’s size or patch color. All that mattered was the mission and the ability to measure its impact.