As the health care debate continues, political pundits, as well as hacks, talk in sound bites about insurance reform without understanding many of the challenges that face the system and add to its cost. Imagine if the discussion was about solutions to real problems instead of hot button, polarizing topics. What if we were truly using the Pareto Principle to identify the vital few improvements that would really enhance health care in America?

In a former life, I worked as an urban street paramedic. Few people realize that, in addition to responding to heart attacks, shortness of breath, elderly falls, and fender benders, much of EMS work involves serving those who are uninsured and plagued with chronic health problems. EMTs and paramedics are the street level primary care and public health safety net for many.

A select segment of these patients are very high utilizers of ambulances and emergency rooms for their health care. Labeled, “frequent fliers,” they can sometimes call multiple times a week. Most paramedics see them as just a part of the job. Some systems have viewed them as a nuisance and have developed programs to deny them service or even have them arrested for 9-1-1 abuse. Few have looked at helping them.

A colleague today sent me a great article in the Washington Post about a “frequent flier” in the DC Metro system. The journalist did one of the best jobs I’ve seen of profiling these people, explaining the reality of the problem, and talking about programs like San Francisco Fire Department’s HOME Team. The San Francisco Chronicle once estimated just 362 patients resulted in $11.6 million in ambulance and emergency department charges during an 18-month period. It’s a big issue and one I firmly believe is a wonderful opportunity.

What if health care improvement was focused on helping them too? Please read the full article here.