Actually in my area only about 39% are insured as in patients almost 75% are on Medicare. The reason of collection are only about 80% of what is billed, yet good management techniques can still operate in the black.
Here is another problem you fail to address. According to the census over 330 people are turning the age of 60 every hour and thus increasing the "baby boomer' generation as one of the largest retirement groups in the history of the U.S. In other words fixed income and poor retirement outcomes. You actually believe that the tax base can maintain itself?
This is also one of the reasons the sudden surge of EMS calls and it is predicted within 5-10 years, that one can double or triple their EMS responses.
I believe that this is where you and I disagree on what is vital for the city. Relying on the fear factor of the community in regards to fire protection. Statistically, the fire service has done too good of a job in fire prevention as in codes and education. Fire suppression responses are down in comparison than before. Any other business would have to adjust and be accountable or basically be truthful.
Again, during poor economic times and high unemployment the tax base rate drops tremendously. Loss of jobs does not sustain a tax base. Simple logic still acclaims money can not go out if it does not come in. Would it not make more sense for a community to contract to a third party EMS that would provide that service for a reduced rate or even free in lieu of charging all?
What about setting up a third party EMS that can operate within the revenues without tapping into citizens that is not in need? Why pay for personnel and equipment not needed?
Again, my point that Fire Based EMS is a poorly managed system. They are dependent upon tax revenue, as most Fire EMS administrators have little to no healthcare management. In reality, that what is EMS or should be, nothing else. It can be done within a Fire EMS system, but I have seen few of those that actually make a profit so those monies can be placed back into the ear marked section and reduce tax revenue on the budget. Unfortunately, this is a rarity and not the norm because of the traditional methodology of Fire administration is only to operate off cities monies or grants. Again, I state poor management and poor administration due to failure to understand EMS as a healthcare industry and nothing more.
So basically, you are describing.. no matter how bad the economy becomes or gets, tax payers should fund fire services to maintain a healthy and prosperous lifestyle of firefighters? That as a public utility, pay structures should have no regard upon the economic times as in reduction of pay or benefits even though citizens that provide the monies are suffering? In other words, to hell with them as long as we get our $$$ and benefits? Then let's hide behind the "what if" fear factor and promote the Union to ensure that we get our way. Let's hoodwink them, knowing there are other options that would not tap into their personal finances and provide the same or better care. Shameful.
A facade promoted that disaster may strike at any time, and again no accountability to the citizens. There is a difference between from not a being a good idea to the reality of no money to fund them. Why should others make up the difference or have cuts in other needed areas because of luxury of a good union? Truthfully, if you know there is a better and cheaper way to fund an EMS that could provide the same level of care and service, would it not be lying to the public? Would it not be solely for self reasons? Can you truthfully say that you have what is in the best interest of the public or to thy self?
R/r 911
Sure, fire responses are down. What do you mean by adjust and be accountable? Downstaff and close stations? With greatly increased response times and reduced manpower as a result, our fireground ops will need to be reduced to that of only defensive operations. The vast majority of buildings here are type 5 construction, and will be well involved by the time we arrive. Conditions will be untenable, and any search ops will be called off. Interior attecks will be a thing of the past. we'll just surround and drown the structure from now on. It takes about 12 FF's to save just one during a mayday, 12 we'll no longer have. No more RIT level 2 or 3. If we were here a few minutes sooner, maybe we could've pulled out little Johnny from his bedroom, but now it's too late. Yes, this is a "what if" scenario. As I've stated earlier, we can't predict incident times and types, as we lack the ability to predict the future. We'll always have our space heaters, food on the stove, improperly discarded cigarettes, arson and such.
how would it be profitable for a third party EMS organization to contract with the community if they'll be in the red (uncompensated cases, poor medicaid reimbursement, etc). If the community isn't turning a profit from EMS, how would a third party magically do it?
My understanding is that Fairfax uses third party billing for it's residents only, causing them nothing. Hardship waivers are also entertained if the pt has no real means of paying. Our Ambulance division essentially acts as a third service, except that personnel are crosstrained to ride both sides. It saves money on staffing. Again, if EMS here turns a profit, it's better to let the county keep it. If it isn't turning a profit, no private provider would want to take it over, lest they go bankrupt.
The union has worked hard to get us where we are at this time. We have families to feed, bills and mortgages to pay. Many of us came here instead of other areas due to the salary, benefits and working conditions. If the county starts dramatically reducing pay/benefits, there'll be a mass exodus to other jurisdictions, and will ultimately cost the county more in hiring, training, OT, so on and so forth.
In my personal case, I moved out at 22, always lived within my means. I didn't run up much credit, and neither has my wife. We've always driven older, much older cars, lived in apartments, and were living one or two paychecks away from bankruptcy at times. We could've bought expensive toys on credit, or been approved for a sizeable mortgage, and got into the flipping game. We both grew up with single parents. I've gone hungry at times, and her mother was on welfare for a brief period (she used it to eat, then got a job to get off of public assistance! Imagine that!). I've always worked several jobs to stay ahead, such as loading trucks, Snapple delivery, bouncing Latin and Hip-Hop clubs, as well as several EMS jobs at the expense of family time. We did the right thing, and didn't contribute to this recent economic downturn.
We made the decision to move here for this job, which will take care of us and reward us with a comfortable lifestyle. So yes, I have a huge problem with giving a large part of that up for the greater good. I, as many others, took the job based on what they are promising. If these types of setups didn't exist, I probably would've went to nursing school. However, it's no longer necessary to spend another 2-4 years in school at the further expense of family time, as we're set up pretty well here.
Call it entitlement, or whatever we want, but we've done what we're supposed to regarding finances, and we're finally getting ours. I love my job, both sides. I respect the community I serve tremendously, and strive to do my job to the best of my ability, for their benefit. I'm also willing to die on the job if that's the way it goes down. It's what we signed up for, quality EMS/public service is what the community is paying for.
We're not the ones who kept trading up for larger houses, or getting an ARM with the intent of flipping. I wasn't the one giving out sub prime mortgages to the underpriveleged. We weren't living our lives on credit, then claiming bankruptcy when the bubble burst. We didn't partake in expensive toys, and we took only one vacation the whole time we were married prior to taking this job. we still don't own a house, but that'll change soon.
So, we traveled far away from home, leaving friends and family for what this place promised us. We've done nothing wrong.
If that's selfish, then it's selfish. I have no problems going to sleep every night.
Once more, and this bears repeating, it's appropriate to propose the question "what if" regarding fire and EMS. We can't predict the number of calls, the type, and time of origin. We can't.
Also, if we're concerned with helping the public so much over our personal needs, putting the public first, then volunteer. We work JOBS. Our JOB pays the bills. If you want to truly put the public first, then donate every penny of your disposable income to various charities. Work a second job and give away that paycheck, too.
