The states need to take over EMS

[thegreypilgrim]

It is becoming apparent that EMS represents a tremendous cost to local communities - both in terms of user-fees and in consuming significant portions of government budgets in the form of public safety funding. The civil grand jury report published by the County of Santa Clara last year makes a strong case for this.

It is also because of local funding that there is a tremendous disparity in service availability and quality across jurisdictions. Obviously places like Independence, CA is not going to be able to afford a remotely similar level of service as Los Angeles. It is not difficult to find analogues throughout the nation.

Given these problems, I think it is clear that what must happen is the states will have to completely take over EMS operations. Doing so would come at a significant cost, but these will be offset by overall savings to the tax base as a whole and could impact national health expenditures by insulating the costs of ambulance service.

Take King County Medic One as an illustrative example. The citizens of King County pay $0.30 per $1000 of assessed property value per year. The county government began collecting this levy in 2007 and has never exceeded the $0.30/$1000 rate. The levy completely funds Medic One's operations and the residents of King County are not charged a fee for ambulance service there. In the 5 years it has been in operation it has generated over $600 million despite the fact that the typical resident of King County probably only paid around $85/year for Medic One services (according to NAR data the median home price in the Seattle-Tacoma-Bellvue metro area was $285,000).

Imagine if this program expanded to include the entire population of Washington. You could provide a robust, professional level of service to the entire geographic area at a much lower cost to each individual person. I don't see why this model couldn't be reproduced in each of the other 50 states.

 

[Jon]

...I don't see why this model couldn't be reproduced in each of the other 50 states.

[Sarcasm]Because my state is DIFFERENT![/Sarcasm]

One of the interesting things about the USA is that we are a collection of states, with much of the power and responsibility for services held at the local (municipal/county) level. This is a blessing and a curse. Blessing because my tax dollars DON'T directly pay for services to an area I don't live in. Downside? A lot of people play politics with emergency services.

It's crap. And it's life.

 

[thegreypilgrim]

Because my state is DIFFERENT!

Gah! No it isn't! I'm so tired of hearing this. They just aren't significantly different enough to warrant this level of nonsensical planning.

One of the interesting things about the USA is that we are a collection of states, with much of the power and responsibility for services held at the local (municipal/county) level. This is a blessing and a curse. Blessing because my tax dollars DON'T directly pay for services to an area I don't live in. Downside? A lot of people play politics with emergency services.

It's crap. And it's life.

Yes they do! And because of that the overall burden to you is less!

 

[JPINFV]

I don't see why this model couldn't be reproduced in each of the other 50 states.

Economies of scale requires a centralized population. Los Angeles, CA can provide more EMS services because they have that huge population to draw funds from and support. Thus it's much easier to justify having more 'toys' (specialty units, non-direct care departments such as QA, training, public affairs, purchasing, etc) besides an ambulance because the cost per capita of the additional 'toys,' and when it comes to expendables or large scale capital expenses (buying multiple ambulances, monitors, ventilators, etc), the large volume grants bargaining power to get a lower cost per unit.

Why should a population of 3.7 million directly subsidize a population of 600+ change. Shouldn't the 600+ change move to be with the 3.7 million if they want the benefits that comes with living in a population of 3.7 million?

What's next, an ambulance every 10 miles along the 15 on the way out to Vegas because some dude owns a shack and deserves the same benefits as someone living in LA?

 

[thegreypilgrim]

Why should a population of 3.7 million directly subsidize a population of 600+ change.

No, this would apply to the entire state. So a population of 37.6 million will be subsidizing a population of 600. Which it already does for numerous other services at little cost to each individual due to economies of scale.

Shouldn't the 600+ change move to be with the 3.7 million if they want the benefits that comes with living in a population of 3.7 million?

Of course, but that just isn't going to happen.

What's next, an ambulance every 10 miles along the 15 on the way out to Vegas because some dude owns a shack and deserves the same benefits as someone living in LA?

No, and you're attacking a straw-man. I suggested a scalable program. Rural communities would still have less coverage than metropolitan ones, but if we can provide a reasonable level of full-time service to rural areas than we certainly should. And seeing as we can, we ought to do so. This would provide additional benefits beyond the service of human need, such as removing a significant barrier to progress of the EMS profession.

 

[Bullets]

If I live in a rural area but pay the same .30/1000 rate as those in the city I want the same level of service

 

[Veneficus]

If I live in a rural area but pay the same .30/1000 rate as those in the city I want the same level of service

"Men in hell want icewater."

Something that has not been mentioned here is that people who live out in the middle of nowhere have to pay more to get the same things.

It cost more in fuel to get there.

It costs more in time. (Time is money)

If you want me to drive out to BFE, you need to be ready to compensate me for travel time, for fuel, and other consumables.

As for assessed taxes. I maintain that the only equitable way to tax for emergency service is a sales tax.

Because everyone purchases things.

Whether you are a citizen, visitor, or undocumented resident, you have to buy stuff. Electricity, food, you name it.

Some states have realistic issues providing uncompensated care for a variety of reasons. Charity hospitals are becomming less and less.

How do you fix the EMS system and still include it under transportation?

How do you maintain EMS as part of public safety, instead of health and welfare?

Fire and Police don't need to rely on outside agencies, like a private hospital. They provide value by protecting the public at large.

Since EMS largely takes no role in health and prevention, it does not serve society, it serves the individual.

I would bet no matter where you live, if you are willing to pay the right amount, you can have the same level of service everywhere. (perhaps better service than most)

I agree everyone should have access to a reasonable level of healthcare, but at some point, people isolate themselves from it and it is not the responsibility of those who didn't to make up for it.

In many places around the world, most people live in population centers for a reason.

Throughout human history, people have had to band together for survival and mutual benefit. But in the US somewhere, in the last 30 odd years, we went from a community to an every man for himself culture.

When you choose to break up society, you choose to lose the benefits it confers.

Of course the US is the only Western country I routinely see preparing for the collapse of society. It is a nation where almost every person is gripped by fear. From worrying about having their personal (lack of) wealth taken away to buying weapons for "protection" from impending doom.

Violence is the last resort of the desperate.

(If you don't think this relates to EMS at many levels, have a look back at this thread during the next "what sword or gun do you carry on duty thread."

 

[medicsb]

If I live in a rural area but pay the same .30/1000 rate as those in the city I want the same level of service

Why? To get the same level of service in a "rural" area is likely to be far more expensive than 0.3/1000. To get half the service for 0.3/1000 would likely be a steal.

 

[nocoderob]

CA gov't has run this state into the dirt and you think they should attempt to run EMS? Using Medic One as an example is meaningless. The state would simply reallocate the profits to some other pet project, bullet train, state worker compensation/retirements, or other BS handout. All the while EMS would be running at bare bones equipment and personnel wise.

 

[LearningByMistakes]

Veneficus, if you have such a problem with this country and OUR 2nd amendment, please feel free to move to the socialist country of your choice. I would be more then willing to assist you with your move.

 

[Tigger]

Why? To get the same level of service in a "rural" area is likely to be far more expensive than 0.3/1000. To get half the service for 0.3/1000 would likely be a steal.

True as that may be, it's going to be difficult to convince others to the contrary. Why common logic eludes so many is one of life's great mysteries.

 

[WolfmanHarris]

Veneficus, if you have such a problem with this country and OUR 2nd amendment, please feel free to move to the socialist country of your choice. I would be more then willing to assist you with your move.

And therein lies an example of why there is a profound lack of meaningful, reasoned debate in your country even as it's gripped by it's greatest decline since the 1930's with no end in sight.

Nowhere did Ven argue for someone to take away your guns. Not in the least. Not a hint. He referred to it as an example of a troubling cultural shift defined by fear and self-destructive individualism. Things are far from great in the USA right now and rather than debate the causes or merits of one solution or another you trumpet the same tired rhetoric.

I hardly pretend to an expert of the US constitution but nowhere have I seen anything that places the second amendment (your right to bear arms) over the fifth (his right to question to continued relevance and necessity of the second). Furthermore, look up amendment; if a constitution needed to be amended once to include the right to bear arms than is it not possible that the nation may reach a point where it feels that amendment is no longer necessary ad requires amending? I don't know but discussion, questioning and debate are just as much part of eternal vigilance as a gun cabinet are they not?

 

[LearningByMistakes]

Why thank you for educating me Wolfman Harris. I always appreciate my friends from Canada explaining the US Constitution to me.

You do understand that the first 10 amendments are known as OUR Bill of Rights, Rights granted to THE PEOPLE, not to be taken away by the government? The traditional American philosophy teaches that Man, The Individual, is endowed at birth with rights which are unalienable because given by his Creator, NOT a government.

And as to debate, I saw nothing stated by Veneficus as anything other than bashing of American principles & ideals. As such I responded.

So what you’re telling me is that Veneficus has a right to his opinion, however I am not allowed mine. Or in typical Liberal/Progressive speak, agree with me or you are wrong.

 

[medicsb]

Why thank you for educating me Wolfman Harris. I always appreciate my friends from Canada explaining the US Constitution to me.

You do understand that the first 10 amendments are known as OUR Bill of Rights, Rights granted to THE PEOPLE, not to be taken away by the government? The traditional American philosophy teaches that Man, The Individual, is endowed at birth with rights which are unalienable because given by his Creator, NOT a government.

And as to debate, I saw nothing stated by Veneficus as anything other than bashing of American principles & ideals. As such I responded.

So what you’re telling me is that Veneficus has a right to his opinion, however I am not allowed mine. Or in typical Liberal/Progressive speak, agree with me or you are wrong.

No one said that you cannot express your opinion and no one said you have to agree with the majority in order to speak. Do not misconstrue freedom of speech to also mean freedom from retort. You can say whatever you want, but so will others here, possibly in response to something you've said. Also, America is not above criticism and I, as an American, generally agree with Ven's assessment of present day America. So, there.

 

[bigbaldguy]

Take it down a notch everyone. No other warnings will be given.

 

[med51fl]

It is becoming apparent that EMS represents a tremendous cost to local communities - both in terms of user-fees and in consuming significant portions of government budgets in the form of public safety funding. The civil grand jury report published by the County of Santa Clara last year makes a strong case for this.

It is also because of local funding that there is a tremendous disparity in service availability and quality across jurisdictions. Obviously places like Independence, CA is not going to be able to afford a remotely similar level of service as Los Angeles. It is not difficult to find analogues throughout the nation.

Given these problems, I think it is clear that what must happen is the states will have to completely take over EMS operations.

If we agree with this, then where do we stop? By this logic the State should also run all fire-rescue, police departments, sanitation, utilities, etc. I think this has been tried in some other countries with very mixed results. I do not feel that the State taking over is the answer.

 

[JPINFV]

CA gov't has run this state into the dirt and you think they should attempt to run EMS? Using Medic One as an example is meaningless. The state would simply reallocate the profits to some other pet project, bullet train, state worker compensation/retirements, or other BS handout. All the while EMS would be running at bare bones equipment and personnel wise.

You mean like the gas tax? After all, soooo much of that is going to infrastructure like it's supposed to.

 

[DPM]

CA gov't has run this state into the dirt and you think they should attempt to run EMS? Using Medic One as an example is meaningless. The state would simply reallocate the profits to some other pet project, bullet train, state worker compensation/retirements, or other BS handout. All the while EMS would be running at bare bones equipment and personnel wise.

I think Medic one is actually a very good example, and comparing it to bullet train is ridiculous.

(On a side note, Public mass transit saves people money and creates more jobs in the long term compared to increasing airport / road capacity.)

This country needs to accept that we're not the best at everything. We have SOME of the best healthcare in the world, but we do not have the best healthcare system. The word socialist is banded about in a derogatory term, but if nearly every other developed nation in the world (nation's with lower infant mortality rates, lower levels of heart disease, higher life expectancy etc) then maybe they're doing something right.

 

[JPINFV]

Why thank you for educating me Wolfman Harris. I always appreciate my friends from Canada explaining the US Constitution to me.

You do understand that the first 10 amendments are known as OUR Bill of Rights, Rights granted to THE PEOPLE, not to be taken away by the government? The traditional American philosophy teaches that Man, The Individual, is endowed at birth with rights which are unalienable because given by his Creator, NOT a government.

1. "Granted" isn't the right word as those rights aren't "granted" by anyone or anything.

2. Under a plain reading of the 9th and 10th amendmend, the first 8 should be preceded by a "including, but not limited to" clause. There actually was a strong movement (Federalists) arguing that to list any rights would put any unlisted rights at risk.

And as to debate, I saw nothing stated by Veneficus as anything other than bashing of American principles & ideals. As such I responded.

So what you’re telling me is that Veneficus has a right to his opinion, however I am not allowed mine. Or in typical Liberal/Progressive speak, agree with me or you are wrong.

Wait, so "every man for himself" is not an American principle? There isn't a significant portion of American citizens who could rightfully be described as coming from the "dem forinears are commin to kill us" and end up fleeing to firearms against an enemy that doesn't exist in the manner believed outside of their mind?

 

[JPINFV]

I think Medic one is actually a very good example, and comparing it to bullet train is ridiculous.

(On a side note, Public mass transit saves people money and creates more jobs in the long term compared to increasing airport / road capacity.)

The problem is that the bullet train is not going to be significantly cheaper than flying, will take significantly longer, it will not create a significant number of new jobs (ignoring the fact that the government's job isn't to directly create jobs), that the destinations aren't designed with mass transit in mind (you have to get from your origin to the station and the station to your destination after all), it's already projected at least double the initial estimate used to pass the bond measure, and the initial line goes from farmland (Madera) to a prison (Corcoran).

The design is neither fiscally, politically, or economically sound.

This country needs to accept that we're not the best at everything. We have SOME of the best healthcare in the world, but we do not have the best healthcare system. The word socialist is banded about in a derogatory term, but if nearly every other developed nation in the world (nation's with lower infant mortality rates, lower levels of heart disease, higher life expectancy etc) then maybe they're doing something right.

So the nation has a public health crisis, not a medical crisis? Want lower levels of heart disease, get out of the couch and into a gym. Want lower levels of infant mortality, get pregnant mothers to start taking care of themselves. Want to safe lives, invest in public health, want to save individuals, invest in medicine. The most magnificent trauma system in the world with unlimited funding can't compete with seat belts and crumple zones in terms of lives saved.