Original subtitles

Welcome to the show. Still, all being well, only taking place in this blank

void for four more shows.

Can't come soon enough. Okay, I think I liked you better when you were silent.

You know what wasn't silent? When you fucking blew me up. Remember that?

I do, I do.

It's been a busy week. A bunch of idiots got mad that a 24-year-old wouldn't do

flips for their amusement, Bob Odenkirk scared the collective shit out of

everyone, and the House began its investigation of the January 6th

insurrection. Although, perhaps the most interesting exchange took place out of

the hearing room, as Congressman Jim Jordan struggled to answer a pretty

basic question.

Yes or no, did you speak with President Trump on January 6th?

Yeah, I mean, I spoke with the president last week. I speak with the president

all the time. I spoke with him on January 6th. I mean, I talk with

President Trump all the time. On January 6th, did you speak with him before,

during, or after the Capitol was attacked?

I'd have to go. I spoke with him that day after, I think after.

I don't know if I spoke with him in the morning or not.

I just don't know.

I'd have to go back.

I mean, I don't know when those conversations happened.

But what I know is I spoke with him all the time. Oh, okay, then.

That sounds reasonable.

You seem to be employing both the nervous energy and deeply suspicious

denials normally reserved for Woody Allen.

Why wouldn't I find that reassuring?

But instead of that, I'd like to briefly focus on Afghanistan.

The U.S. withdrawal from there is nearly complete, ahead of the August 31st

deadline set by the Biden administration.

But many are concerned about who is being left behind.

As America ends its longest war, the translators left behind are begging the

Biden administration to cut through the red tape and grant them special visas to

come to the U.S. Today, Independence Senator Angus King told reporters the

president's hair should be on fire over this situation.

It's true. This is a situation Biden's hair should be on fire about, both

metaphorically... And literally, it'd frankly be a huge improvement on his

current look, which I'd describe as business ghost, also known as the same

Doc Brown or the flat Jamie Lee Curtis.

Because the fact is, there are thousands of Afghans who helped US troops during

the war who badly need to be evacuated because the Taliban very much wants to

kill them.

Since 2014, more than 300 translators or their family members have been killed.

And I will say, publicly, Biden has been sending some encouraging messages.

Our message to those women and men is clear.

There is a home for you in the United States, if you so choose, and we will

stand with you just as you stood with us.

Oh! Well, that sounds great. Although the if they so choose part there is

doing a lot of work because it's clearly not so much their choice as it is ours.

We are the ones in charge of the process, so putting the choice on the

applicants is basically a surgeon handing you a scalpel saying, there is a

tumor-free pancreas in your body if you so choose, and I will stand with you. I

think you might be fundamentally confused about who has power over the

outcome here.

And the application process has been a mess for a long time.

As we discussed on the first season of this show, presumably 40 years ago, just

applying for a special immigrant visa can be a nightmare.

And while 18,000 Afghans have applied on behalf of themselves and their families,

representing an estimated 53,000 people in total, many have been stuck waiting,

and in some cases, for years.

Monir Nuri has been waiting on a special immigrant visa for nearly a decade.

He first applied for a special immigrant visa in 2013 and said he's been rejected

four times.

Mounir was told by the State Department that his documents were fraudulent, but

was not giving a specific example to appeal.

There is more than hundreds and hundreds more special force interpreters left

behind. They have the same issues.

And I don't want to be left behind. Yeah.

Of course not. And we can't let that happen. Because it's practically a death

sentence. Being left behind in this context is even worse than seeing left

behind the 2014 Nicolas Cage faith-based thriller about the Second Coming that

boasts, and this is true, a solid 1% on Rotten Tomatoes. Clearly, there aren't

many things worse than seeing left behind. But I'm gonna say getting

abandoned to be murdered by the Taliban is definitely one of them.

And it's not just that interpreter who is frustrated here. The U.S. soldiers he

worked alongside are also appalled by this situation.

We're filling out all the paperwork. We're going through all the due

diligence in the process to make this right, and nobody is responding with any

information that would be critical to getting him out of country. Like, this

is, like, both a huge leadership failure for me, like, personally and in the

military. Um, the fact that I haven't been able to get my guy out. That does

sound maddening.

Particularly because getting my guy out is basically what we've been conditioned

to think the military does.

It's supposed to be saving Private Ryan, not filing paperwork on Private Ryan's

behalf, waiting a few months, filing requisition paperwork to track down the

initial paperwork, and then learning Private Ryan was shot in the head by a

Nazi last month.

And there is real urgency here. As the Taliban currently controls about half of

Afghanistan's 419 district centers, and while they've yet to capture any of the

provincial capitals, they are... pressuring about half of them. This is

basically the Bill Cosby comeback tour of political crises.

We can all see where it's going, and if we don't act quickly, something terrible

is going to happen.

And yet, incredibly, there are some, like Supercut superfan Rand Paul, who

have questioned whether we should be evacuating all of these people at all.

I would encourage them rather to stay and fight.

I think it would be good to have many English speakers in Afghanistan. The

future of Afghanistan could be a bright future.

But they're going to have to fight for it. And ultimately, it is their fight.

Okay, first, fuck all the way off. And second, fight with fucking what exactly?

Their working knowledge of the difference between their, their, and

their? Also, telling translators to stay and fight the Taliban is pretty rich,

coming from a guy who couldn't even win a fight against his neighbor on his own

front lawn.

And the administration may point to the fact that this month, 2,500 Afghans are

being flown in stages to an army base in Virginia, and that they're negotiating

with third countries like Qatar and Kuwait to house Afghans at military

bases while they await visa approval. But so far, a tiny percentage of the

people in the pipeline have been evacuated. And the fact that we are just

scrambling now for a plan is inexcusable. When we've had 20 years to

develop one, and for around half that time, Biden was in the white... in the

White House.

If we really want to make sure these applicants are safe, we could bring them

to the U.S. for processing.

Guam has been suggested, and we should do that right now, because the clock is

ticking, and the translators in Afghanistan are well aware of that fact.

While evacuation plans to a third country may still be uncertain, the

Taliban death threats here are crystal clear.

The Taliban have said interpreters will not be in danger as long as they show

remorse for their treason.

A Taliban promise sounds inherently like bullshit.

It also sounds like a pretty racist soft-call romance paperback written by a

white woman who's never met anyone from there. But mostly, it sounds like

bullshit. There is no reason to believe things will end well for anyone we leave

behind. These people helped us at great risk to themselves and their families.

And if you don't think we should give them a safe home here in return, then

all I have to say is this.

Actually, can I get a translator for that? He said, fuck you.

Yeah. Yeah, I did.

And now, this.

And now, Jim Cramer loves Chipotle.

The worst restaurants are going up and not the best ones. But Chipotle is the

best. I'm from Philly. There's two Chipotles I absolutely love on Walnut

Street. I love the... Look, we've been eating Chipotle the whole way. You know

that. Now they're back and they seem to love Chipotle, as I do. I still love

Chipotle. We ate some Chipotle for lunch today. It was awesome. I had a burrito.

Obviously, I think a burrito brings us together tremendously, but, you know, I

love... I'm a homeboy when it comes to Chipotle. Better eat a Chipotle than

McDonald's. But to be fair, no one looks good when you're comparing themselves to

Chipotle. Everyone goes to Chip... I went to Chipotle last week. I have

Chipotle almost every week. I had Chipotle yesterday. We have Chipotle all

the time. Why? Well, because you're able to sit down and get your cilantro lime

roasted cauliflower, which is unbelievably good. David, have you ever

had Chipotle?

Yeah, I have. I have.

I've had it. Yeah.

Yeah.

Yeah, it's a big favorite. My son likes it a lot. He enjoys it a great deal.

What's a queso? I don't know. It's got cheese in it. It's got cheese. Yeah. A

lot of cheese, right? Isn't that what queso is? You ever have the bowl?

It's good.

You ever have the bowl? I have had a bowl.

I've had a bowl. I've had a burrito.

Yeah. Okay. Did you ever get the box? But I'm not... Did you ever get the box?

No. I'm not... Okay, excuse me. I don't go there that often. All right.

Moving on.

Our main story tonight concerns ambulances. You know, big ouchie trucks

that go whoop-whoop.

Ambulances can be an annoyance to city dwellers with their shrieking sirens.

Although, not if you live in Brussels, where that siren sounds very different.

Okay. That is just an objectively better siren. It sounds like Mickey Mouse

getting fucked on a washing machine in a good way.

And I do know that that is hard to picture, so please, let me help.

Oh, boy!

I mean, that's fantastic.

I'd far rather be woken up by the sound of America's rats getting railed on the

spin cycle because I'd immediately laugh, then remember that someone was

having a medical emergency and feel bad, then hear the siren and laugh myself to

sleep again.

What a siren!

Anyway, ambulance crews clearly play a critically important role across the

country, so it is no wonder that during the height of the pandemic last year,

they were among those who got an outpouring of gratitude and knightly

applause, with New York's mayor even making this pledge.

I want to guarantee you one thing, that when that day comes that we can restart

the vibrant, beautiful life of this city again, the first thing we will do is we

will have a ticker tape parade.

down the canyon of heroes for our healthcare workers and our first

responders. We will honor those who saved us.

Okay, first, I don't know if a parade is quite the dangling carrot de Blasio

seems to think it is, because parades, and this is true, suck.

They are loud, crowded, and go on approximately four hours too long. The

only good thing about the Thanksgiving Day parade is seeing which country

singer gets to lip sync next to the Jolly Green Giant's dick.

But second, there was a small irony in all the vocal appreciation that took

place last year, as this EMT that we featured pointed out. Right now, I'm

doing all of this with no health insurance.

The job doesn't offer it, and our affordable marketplaces aren't very

affordable. If I get sick, and, okay, I go get tested positive...

I can't go to the hospital. You know, people come out and they show us their

support, and I love it. I love... I've eaten so much pizza in the last two

weeks, it's been great.

I don't need pizza.

I need to be able to pay my bills.

Right. People clapping and giving pizza in appreciation was very nice, but it

wasn't a substitute for the things that they actually needed, like a living wage

and health benefits.

Think about it like this. If you had a heart attack... and paramedics showed up

with a pepperoni pie and some garlic knots, you'd be grateful, sure, but

you'd also be justified in pointing out that that's not everything that the

situation demanded.

And that man's story is by no means a one-off.

EMS workers around the country are shockingly underpaid, which is kind of

amazing, especially when you consider how prohibitively expensive taking an

ambulance can be. So much so, you'll often see local news stories like this.

It was rush hour at the Mass Avenue station when this passenger stepped off

the crowded train.

Surveillance video shows the moment her leg dropped into the gap, trapping her

between the train and the platform.

As other commuters rocked the train to dislodge the woman's leg, a Boston Globe

reporter tweeted from the scene.

Wow.

It is a pretty strong indictment of our current healthcare system that that

woman's main concern was getting crushed financially even while she was getting

crushed physically.

So given that, we have injured people begging bystanders not to call

ambulances and the EMTs who work inside them forced to live off pizza donations.

Tonight, let's take a look at our emergency medical services, specifically

how they function...

why they can be so expensive, and what we can do to fix things.

And the first thing to know is there is absolutely no consistency when it comes

to EMS in this country. When you talk about emergency medical services, you're

actually talking about 19,000 locally run EMS providers with wildly different

structures. To give you an idea of just how much variance exists, in Houston,

EMS is provided by firefighters cross-trained as paramedics or EMTs. In

New York City... It's under the fire department umbrella, but it's a separate

division and supplemented by private companies. In Pittsburgh, it's a

freestanding municipal department of its own. And in rural Wyoming, EMS is mostly

provided by volunteer-based organizations.

And frustratingly, in no part of the country does EMS have ambulances that

sound like this.

The very fact our sirens could sound like a Pacini aria performed by a

flustered parakeet, and yet we choose for that not to be the case, makes us a

bunch of fucking idiots.

But all of this is to say, if you have seen one EMS setup, you've seen exactly

one EMS setup.

And one reason for this is that there is no single federal agency overseeing and

supporting EMS in the same way that, for instance, fire departments have the U.S.

Fire Administration.

And the frustrating thing is, it didn't have to be this way.

Back in 1973, Congress enacted the EMS Systems Act, which created a new program

to help develop regional EMS systems, something that was badly needed.

Prior to that, ambulance services were frequently provided by hearses simply

because they were long enough to transport a human body.

Now, unfortunately, under the Reagan administration... budget cuts eliminated

direct federal funding and oversight, shifting the responsibility onto the

states, many of which opted to direct their money away from EMS and into other

public health services instead.

Which brings us to an absolutely incredible fact.

Unlike other first responders, such as police and fire departments, right now,

in all 39 of these states, EMS is not considered an essential service.

Meaning local governments...

don't have to provide it to their citizens, which, as a practical matter,

means EMS generally has much less access to government funding.

This is a huge deal.

And if this is surprising news to you, you are not alone.

Just listen to this Utah state representative.

I became aware of the fact that this issue existed when I asked the question,

uh, to Chief Brad Hennig.

Chief, what can I do for you?

And he said, he started explaining to me this issue, and I was like, really?

Because I thought... I thought this was an essential service too. I didn't know

any better.

Yeah, of course he was surprised.

Finding out that EMS is not deemed essential is like finding out that most

states don't consider geese to be birds.

That's what they are.

They have beaks, wings, feathers. They rain shit from the sky.

Sully Sullenberger is their Jeffrey Dahmer. They're fucking birds.

I didn't realize anyone was even disputing that.

EMS providers can be so strapped for cash, especially in rural areas, that

they have to fundraise for themselves.

Do a quick search on GoFundMe right now, and you will find multiple outfits

trying to raise money for equipment, gear, and updated ambulances. And you

know our healthcare system is fucked up when patients and providers are relying

on the same crowdfunding platform.

Some people even do fundraising stunts for their local EMS, whether it's this

guy doing a polar bear plunge for a thousand bucks, or this DJ doing a three

-hour livestream that raised money for EMS workers in New York. And I have to

say, my admiration for that man's generosity is almost enough to overcome

my horror at the idea of a three-hour livestream DJ set.

It's like someone donating a million dollars to cancer research by writing

out a check in turtle blood.

Love the end, hate the means.

And these massive funding deficiencies start to explain why it is that EMS

workers, like that guy you saw earlier, are so terribly paid.

The median annual wage is just over $36,000.

Well below what police officers and firefighters make, and for a dangerous

and stressful job.

EMTs and paramedics have an injury rate about three times the national average,

and they're roughly ten times more likely to have suicidal thoughts or

behaviors. So, it is no wonder that ambulance services can have real trouble

finding or retaining workers and volunteers, especially in rural

communities.

Experts now warn that close to one-third of all rural emergency medical services

are in immediate danger of closing down.

In rural Marmoth, North Dakota, no one remembers the last time the town had a

doctor. The ambulance is the community safety net.

We are literally one person away from closing. If we lose one of our EMTs, one

of our care providers, we will have to look at shutting down and closing our

doors. That is terrible.

No workplace should be in danger of shutting down because it loses one

person. Unless that is that Workplace's The Sex and the City reboot.

What are you thinking?

It's never gonna work without Kim Cattrall. It's not that any of you are

bad, it's that you only work together.

I can't appreciate my Puritan Charlotte if I don't have my naughty Samantha.

And I live for Miranda Hobbs. But if she's not serving side-eye while

Samantha uses penne pasta to describe her new Italian lover's dick, what is

the point?

And to be clear, this isn't just a rural problem.

Some big city services are stretched to breaking point, too. Take Chicago, where

its EMS is operated by the fire department.

Both workers and city officials have complained for years that not enough

resources have been allocated to EMS, leading to an ambulance shortage.

And while the fire department says its fleet meets the needs of residents, a

local news investigation found some pretty harrowing stories.

One analysis of 700,000 medical 911 calls found in 19% of them, it took an

ambulance more than seven minutes to get to the scene.

Sometimes there just isn't one.

Wow. We are out of ambulances. That is just not something you want to hear. I

think we all know when you call an ambulance, you want it to show up like

that.

What's wrong with you? Oh, no, I'm sorry, George. I did it again. I'm

sorry. How hard is it not to snap your fingers?

You know what? It turns out it's surprisingly hard.

You know, I got the power to just clap my hands and summon Kermit the Frog

anytime I want. Do you think I use it? No, I do not, because I respect Kermit.

Yeah, yeah, I get that, but, uh, hey, George.

Do it.

Do it now.

Please.

This better be good, George.

It's not.

Well, I thought that went very well.

Anyway, um, where were we? Oh, that's right.

Emergency medical services in America are underfunded because in most places,

they're not supported by federal programs and local dollars the way that

police and fire departments are. And the fact they are so underfunded starts to

explain why they can cost so much.

Because for many, the way they recoup their costs is by billing patients.

Although, interestingly, if they don't physically transport those patients to a

hospital, they can be out of luck.

You're reimbursed based on the number of patients that you transport to a

hospital.

So you could get called a thousand times a year and only transport 750 patients.

Those other 250 calls, you made no money on. Yeah, it's true.

And policies like that can not only put EMS providers even further into a

financial hole... It can also incentivize them to take patients to the

hospital even if it is not totally necessary, which makes no sense.

It's a practice known throughout the EMS industry as You Call, We Haul, which I

admit is a fun phrase, although to be honest, nowhere near as fun as the fire

department's motto, You Hurt, We Squirt.

And EMS's funding structure doesn't just serve providers poorly, it serves

patients poorly too. Because right now... Patients and their insurance

reimbursements are most EMS outfits' primary funding sources, which is just

not a good situation for either side.

Some patients have Medicare and Medicaid, and by law, EMS providers are

required to accept their reimbursement rate despite many saying that they are

set too low.

But for patients with private insurance, the fact is, EMSs are not required to

accept that at all.

In fact, many choose to keep themselves out of network... for most insurers,

meaning that they can generally set their rates wherever they want.

This situation can often leave patients facing so-called surprise bills, some of

which can be absolutely ridiculous.

Baby Sawyer just couldn't wait to enter the world.

Katie Morita's water broke a week before he was due. She and husband Daniel raced

to Sutter Roseville. With the emergency room in sight, Katie screamed for him to

stop the car.

I said, don't push. And I said, I have to push.

She went like this. And I pushed.

And then popped. And he came out. Roseville PD called the paramedics, who

cut the umbilical cord and drove Katie and Sawyer a matter of a few hundred

yards to the hospital door. The entire time with the paramedics.

Ten minutes.

It is such a blur.

But later, it would come into focus when two equal AMR ambulance bills showed up,

one for Katie, one for baby Sawyer, totaling more than $3,500.

Not even a full minute worth of an ambulance ride. We had already done the

hard part. We delivered our child in the front seat of our car.

Well, hold on there. Did we really do the hard part, Dan? Because from what I

just heard, you did some driving and then sat back while your wife, in your

words, popped out a human, so I'm not sure you really did the hard part so

much as you were just sort of there.

Come on, Dan, be an ally.

Read a tweet.

And there can be absolutely crazy examples of surprise billing, even when

EMS is run by the city.

In Houston, literally all city-run ambulance services are out of network

for all insurers.

And a study of one large national insurance plan found that 71% of

ambulance rides had the potential to generate a surprise bill. And when you

know that, is it any wonder that that woman begged people not to call her an

ambulance? Or that this incredibly grim trend has emerged?

Ambulance or Uber?

That's now the choice as more Americans are using Uber and other car services to

get to the emergency room.

42-year-old tech magazine writer Chandra Steele did it. What were your symptoms?

I had some internal bleeding. You had internal bleeding and you took an Uber

to the hospital? Emergency room doctor Robert Glatter of Lenox Hill Hospital in

New York says Uber ER, as it's been nicknamed, is not a smart idea in a

crisis. They don't have any kind of oxygen. They don't have intravenous

fluids or IVs. They don't have paramedics. That's the main difference.

They have a driver. Right.

They also may not know which local hospital has a trauma, stroke, cardiac,

or pediatric unit because they're Uber drivers.

The most they have are tiny water bottles you're afraid to drink from and

a charger for a Samsung phone you do not own.

So, to recap, instead of all of us paying a little bit all the time for

ambulances, we have a system where some of us pay an awful lot... all at once

when we have a terrible emergency.

And if you're thinking, how could this possibly get any worse? Well, wait, it

can. Because for-profit businesses are also involved here. In fact, currently,

private companies represent about 25% of all ambulance providers.

And many of them are owned by private equity firms who've been acquiring

distressed local ambulance providers for decades now.

Remember that baby?

who got a bill for being born, that came from a private for-profit company,

American Medical Response.

They are currently the largest ambulance company in the U.S. and are owned by one

of the country's largest private equity firms.

And when a private equity firm swoops in to help wring profits out of ambulance

services by keeping costs low and revenues high, things generally don't

change for the better.

Take Transcare, an EMS company acquired out of bankruptcy by a private equity

firm run by this woman, Lynn Tilton.

And a few things to note about her.

Aside from serving looks that can only be described as, my style icons are

Wayne Newton and a Ferrero Rocher candy, Lynn Tilton is a self-described poet,

already one of the biggest red flags imaginable. We looked, and one of the

only things close to poetry we could find from her was this Instagram post.

I am wild and free. I am a warrior of light. I am me." Which feels less like

real poetry, more like someone with a concussion trying to remember Kesha

lyrics. Lynn Tilton was also the star of the sadly canceled reality series, Diva

of Distressed, where she portrayed herself as a savior of troubled

companies in inspirational moments like this.

One of the things we do is we all commit...

So I'm gonna ask you all to commit with me that we will not stop until we have

achieved our goal.

I commit.

We do. Thank you.

Commit! Commit!

No pussies in my mill!

She seems great.

And Lynn Tilton certainly knows how to instill a sense of courage in those

around her. It reminds me of that famous FDR quote, the only thing we have to

fear is pussies in my mill.

And Tilton promised to bring that uplifting leadership style to Transcare.

But many who worked there described rough conditions on her watch, with one

former employee saying they were sent out in a vehicle where the brakes didn't

work properly, and during the 2014 Ebola scare, had trouble getting enough

sanitary wipes to disinfect their ambulances.

Former staff even said they were pressured by Transcare supervisors to

go... ER shopping, meaning they would steal medical supplies from the ERs to

restock their ambulances.

And when Transcare inevitably ended up filing for bankruptcy in 2016, its

employees found out that they'd lost their jobs like this.

Workers were told they had 30 days left on the job. They showed up today to find

this.

Transcare was shuttered.

I was in shock.

We were all in shock.

It was horrible.

It's absolutely horrible.

A work emergency for dozens of paramedics. Now I have to find another

job. I have another side job to support me right now, currently, but that

doesn't pay the bills.

Last night, we were told, see you tomorrow, have a good night.

Well, that's fucked up.

There are certain businesses you assume might disappear overnight, like a kid's

lemonade stand or any circuit city in the late 2000s. Incidentally, they all

became kingdoms of optical cables and loose batteries governed by rats. And

that's absolutely fine, but it is not great when what's disappearing is a

community's life-saving medical service.

And it is not just that Transcare folded.

It's that in a bankruptcy court ruling last year, a judge recommended finding

Lynn Tilton liable for nearly $42 million for stripping... of getting

value out of the company, which I guess isn't totally shocking from a woman

whose employees were encouraged to strip value out of fucking emergency rooms.

Now, I have to say, Tilton denies having done anything wrong and has challenged

that recommendation in federal court. And the thing is, I'm not just mad with

Lynn Tilton here.

I'm mad that we're operating a system where a vital service is left vulnerable

to the Lynn Tiltons of the world.

So, what can we do about this? Well...

As I've said before, ideally, we transition to a Medicare-for-all

approach, but that doesn't seem to be in the cards right now. And in the

meantime, there are smaller things that we could and should do.

For patients, we need to put an end to surprise billing. And the good news is

Congress passed a bill last year called the No Surprises Act, making it illegal

to send patients steep medical bills when an out-of-network provider is

unexpectedly involved in their care.

The bad news is, while that applies to air ambulances, the bill, for some

reason, explicitly carved out ground ambulances. In other words, most fucking

ambulances. As for EMS providers, we should establish a lead federal agency

dedicated to them. And they should absolutely be labeled an essential

service, especially because that's what everyone thinks they are.

But for that label to mean something, it has to come with funding at the local,

state, and federal levels.

And there is no better time to make these changes than right now, when we

still remember the absolute hell of what these workers went through last year.

Remember that parade that Bill de Blasio promised?

It actually took place last month.

But you know who notably did not attend?

EMTs, many of whom boycotted it because of stagnant wages and the fact that they

worked during the pandemic without hazard pay.

Look, last year, everyone was anxious to show... just how much they supported

EMTs. Well, now is the time to fucking prove it and make big changes on their

behalf. And if we do do that, maybe we'll collectively be worthy of a siren

that sounds like this.

Get yours, Mickey, you filthy mouse.

That's our show. Thank you so much for watching. We'll see you next week. Good

night.