By now you have probably received a letter in the mail from the Village of Trumansburg, which invites you to come to a public hearing on Wednesday June 18th 7pm at the Elementary School Auditorium, to discuss the plan to hire Professional Ambulance Billing (PAB) to bill every recipient of ambulatory care, regardless of whether or not they have health insurance. It's a shame that this bulk mailing, which costs the taxpayers several hundred dollars, couldn't have been more informative, since our officials claim to be supportive of citizen participation, and informing the public. (I was denied the opportunity to contribute in any way to the letter) This is a very important issue, with grave consequences, and it deserves your attention. I hope you will attend the hearing, and discuss this with your friends and neighbors.
Our current ambulance service, is taxpayer funded and recipients are never billed. We democratically decided to form this service and fund it through our taxes. In 2008 the cost was $300,535.00. Spread over the population of the district, about 10,000 people, the cost per person is about $30/year. This is a reasonable tax to pay, for an excellent service, largely staffed by dedicated volunteers. It is incumbent upon us to continue to pay this tax, and not try to shift the tax burden onto society at large. This is the essence of this scheme. By entering into relationships with private for profit corporations (PAB, and insurance companies) we could shift our taxes onto the already very expensive national health care system. This is perfectly legal, but completely wrongheaded. If we shift this cost, when it lands on the national system, it will be inflated by the overhead and profit of the private health care companies, about 30%.
Ironically, the potential tax savings (they are estimating that PAB would collect $252,000 for the Village) would quickly be offset in the form of higher insurance premiums paid by those of us that have health insurance. The private health insurance companies keep data sorted by zip-code, so when their computer systems recognize higher costs in our area they will automatically increase premiums to cover those costs and of course, they will add their profit onto this increase.
Trustee Christopher Thomas, put together a Task Force which recommended hiring PAB. Most of us have health insurance from one of the big private health insurance companies that rake in tremendous profits, while famously denying coverage to as many of us as they can, in-order to increase the bottom line. ( Anyone who hasn't seen Michael Moore's latest documentary ought to do so.) So, most us that receive ambulatory care in the next few years, probably will have the bill paid by our insurance, if our insurance company, in their infinite wisdom, deems the care necessary and appropriate. But, Chris Thomas says that about 15% of the population is uninsured. That's about 1500 people in the area served by the Trumansburg Ambulance.
Suppose you were one of these people, and you had lived and worked here (that's right, most of these people are hard working - not the welfare queens that some would like to think) and payed taxes for ,say, 20 years. You then, would have contributed your share to the purchase of the ambulances, equipment, training, etc. that allow the service to exist. Imagine, then, that you hear that the ambulance service is going to begin to bill for it's services and that a typical call, and transport to the hospital costs $800. Imagine now, that your child has a serious asthma attack one night. You think of calling 911, but you know that if you do, they will call an ambulance and you know that you can't afford $800 right now. Your having trouble paying the mortgage, and your husband just got laid off. So you put the kid in the car and head for the hospital, but she dies on the way. The EMT would have been able to save your child, if you had called 911.
Is this fair? How can anyone justify this? Some will say, that we can inform the public that if they don't have insurance, that the Village will not demand that the bill is paid. Actually, it is very difficult to inform the public. The average citizen doesn't know who the Trustees are, or what issues are in front of the board. They aren't interested. They have enough to worry about with work, and health problems, etc. So, the scenario above, or something like it is very likely to occur. Mayor Petrovic spoke of creating a fund to help pay for those without insurance, but Chris Thomas said that he is not in favor of advertising the existence of such a fund because it would encourage non-payment. Chris said that if one can pay, one should pay, ignoring the realities of credit cards and debt, and bankruptcy, and foreclosure.
Chris Thomas's Task Force Report claims that we could save $252,000/year with his privatization scheme. That works out to about $25/year for each of us. Do you want that $25, or would you rather not risk the lives of some of your neighbors? Aren't we all in this together? Didn't someone say we're supposed to care for the least amongst us?
I have objected to this plan at several Village Board meetings, and Chris and I always argue over my use of the term "privatization" He claims that it is not privatization because the equipment, building, and vehicles would still be the property of the Village, and that the paid staff would still be employees of the Village. That's true, but we would be entering into business with private, for profit insurance companies and a private, for profit billing company. I'm sure everyone is aware of the failed attempt to privatize Social Security. Bush's plan was to allow the funds from our Social Security taxes to be handled by private investors on Wall Street. Under his plan the employees of the Social Security Administration would have continued to be government employees, and the buildings in which they worked would continue to be the property of the government. All of our national media referred to this plan as "privatization" This is the correct term for both. We are also privatizing our military, with disastrous results (Blackwater, Haliburton, KBR) We are privatizing our schools, our roads, and our voting systems. Proponents always tell us that it will save taxpayer money, and provide better quality services. The results have been just the opposite. If we privatize our ambulance service, we increase costs on a national scale while temporarily reducing costs within our community. The billing service and the insurance company's profits have to come from somewhere. As we and other municipalities privatize, insurance companies will raise their rates. By privatizing, we encourage the cost of health care to spiral further out of control.
Polls show that a large majority of us are in favor of universal single payer health care in our country. Universal means that everyone is covered. Single payer means that the tax payers pick up the tab, instead of the mess we have now, where we have a mix of private health insurance companies, and Medicare, and Medicaid, and the unfortunate 15% who either pay out of their own pockets, or go without, and often suffer from poor health or die. (or they pay with credit and are driven into bankruptcy - the biggest reason for bankruptcy is medical emergencies, and Congress recently reduced access to bankruptcy protection) Emergency Medical Services, are an important part of our health care system. Critical outcomes are often decided based upon access to these services. This critical part of the overall health care system is currently universal, single payer in Trumansburg, Ulysses, Covert, and Hector. We pay for it in our taxes. The Trumansburg Village Board can't give us a universal single payer health care system, but they don't have to take away the portion of it that we already have in our fine ambulance company. Why would we want to move in the opposite direction, from that which polls show the majority of Americans want and the rest of the industrialized world already has?
Self employed trade workers, like myself, often can't afford health insurance. I'm lucky that my wife works at Cornell, so the family is covered, but I would be willing to pay more than the $25/year that Chris Thomas wants to save me, to have him go away, and leave us alone. Then next time a friend falls off the roof, I can call 911 and tell him, no worries, the rides on me.
Chris Thomas is proposing a retirement program called the Length of Service Award Program (LOSAP) at the same time as his privatization plan. Some of the money collected from insurance companies, would go towards funding this program. He claims that this would have to be decided by referendum, but for some reason, Chris seems to think that the LOSAP referendum would be Trumansburg only. Why exclude the rest of the district? They are partners in funding the Fire Dept. and the ambulance service. Can't we somehow include them in the LOSAP decision making and funding? Doug Austic pointed out that Ulysses funds 65% of the Fire/EMS. presumably they would have to shoulder 65% of contributions to LOSAP. But Ulysses can't vote? Dave Kerness asked this question, and Chris answered that the Village of Trumansburg, being the owner of the Fire Department, would bear the legal responsibility to honor the LOSAP obligations to retirees, in the event of the program going bust. Hmmm. Aren't there lots of pension programs going bust nationally, and aren't the losers the retirees as opposed to the employers?
I think Chris decided to bring LOSAP forward at the same time as his privatization plan, in-order to tug at the heartstrings of the public that understandably wants the best for the volunteers, thereby increasing acceptance of his plan. Our economic outlook is scary though. I think we should be very cautious about contributing to a the LOSAP fund. Economists that I am reading are advising everyone to get out of the stock market, and invest in Euros or Canadian dollars or gold. Do we know how safe this investment would be? I have spoken with several of the volunteers and none of them seem enthused about the LOSAP program.
Chris told the Town Board that they were considering using National Benefit Life to handle LOSAP. If you google that name you get a website that is under construction. (very reassuring) LINK And you find this site LINK which enumerates violations of State Insurance Law in 2002.
LOSAP might encourage a few older volunteers to stay on. A smarter long range plan would be to encourage younger people to volunteer by offering incentives such as college loan reimbursement, community college tuition assistance, or vocational training reimbursement. These programs should only be initiated if the people are willing to pay for them with a modest tax increase. Programs such as LOSAP or these other ideas should not be considered a reason to privatize our ambulance service.
I recently met with a neighbor of mine, who was an active member of the Trumansburg Volunteer Fire Department and part of the volunteer staff of the Ambulance/EMS for several years. I told my neighbor that if I were a volunteer with the Ambulance/EMS service in it's current form (fully taxpayer funded) I would feel proud to be a part of a group that devoted time to helping their neighbors in times of need, and I would feel good about being able to say "there's no charge for this". If my Ambulance company then entered a relationship with private for profit insurance companies and billing companies, and I was now required to get customer's social security numbers and insurance company information, this would change how I felt about the work. My neighbor informed me that the number of volunteers in Trumansburg is relatively high presently. We are not having nearly as much trouble maintaining sufficient numbers of volunteers as neighboring communities are. Perhaps this is because a fully taxpayer funded service is good for morale. My neighbor felt that some people might be less apt to continue to serve if we took this step towards privatization.
A significant portion of the current operating budget of the ambulance service comes from donations. Donors contribute because they realize that the service is entirely dependent upon the community. If we enter into this relationship with PAB and the private health care insurance industry, potential donors will feel less inclined to contribute because they will assume that costs are being covered by the insurance. Inevitably this will cause a reduction in donations.
Before launching into partial privatization of the our ambulance, take a careful look at what we have now. Now, the Service is supported entirely by taxes, the service is available to all of us—no bills, all of the funds go to equipment and supplies or salaries that stay within our community. It’s neighbor helping neighbor. When one of us is seriously ill, our EMS rushes us to the hospital. No one ever asks whether we can pay for the service, or for that matter who will pay. In effect, our EMS performs as it would in the kind of single payer system that roughly 60% of us would like to see introduced throughout the health care system.
If we go ahead with this privatization scheme, we will save about $25/year in Village tax, but those of us who are insured will in one way or another pay for that with higher premiums or lower salaries. (In the end it comes out of our pockets even though we may not notice it through the smoke and mirrors.) Those of us with insurance will be paying say $35 for the $25 tax break that everyone in Trumansburg receives. (If you actually believe that they will reduce our taxes) The only ones who actually save with be the 15% who don’t have insurance, provided they never use the ambulance.
It would be hard to improve on the EMS we have today and there is little doubt that, if we allow private insurance companies to enter the picture, it will be more complicated and cost society more in the long run.
Chris Thomas ran for trustee in March of '07 on the Democratic Party line. Examination of the Board of Elections data, however, indicates that he was a registered as a Libertarian. Libertarian principles are so far from the generally accepted principles of the Democratic Party, that we might consider his run on the Democratic Party line to be deceptive. A Libertarian would probably feel that the state would have no right to create a universal single payer health care system, and he would not fault the multibillion dollar private health care industry for continuing to maximize it's profits. It would be logical, from his point of view, to reduce local taxes, by collecting whatever we can from the enormously profitable private health care insurance industry, instead of working to change the system. Libertarians, generally have no objection to the corporatization of all functions of the state. Our hospitals and ambulance services all over the country, were largely not for profit entities before the rise of the Libertarians and the neoconservative Republicans. Our very own Trumansburg Village Board has resisted this form of privatization, in the recent past. It's up to us to urge them to reject this plan again.
