Trumansburg Ambulance Funding

Last Years Town Board Resolution

2011-03-07T10:25:00.000-08:00

I posted this at Finding Ulysses, but I ought to have this important resolution here too. It's amazing how the EMS Task Force continues to press ahead towards privatization in spite of this resolution from the town.

Town of Ulysses – Resolution

Whereas, the Ulysses Town Board is concerned that the proposed changes to the Village of Trumansburg’s EMS program are being implemented in a manner with little serious consideration of input from the Town of Ulysses or it’s residents, and

Whereas, the Ulysses Town Board believes that the proposed insurance – only billing plan has not been well enough considered in some aspects that can have serious consequences for equity and ensuring that no one in our community might refuse care or emergency services for fear of the costs, and

Whereas, the community has had little to no input on options to receive EMS that may be more economical or provided in a faster manner, and

Whereas, the Ulysses Town Board also believes that calling the current proposal “insurance only” is deceptive, and the task force process is not open and transparent with minutes taken and made available to the public.

Therefore, be it resolved that the Ulysses Town Board is not in support of the proposed changes to the Trumansburg EMS under the current process.

6/23/2010

"Insurance Only" is Illegal

2011-01-29T06:57:00.000-08:00

Here are links to the memos from the attorney for the Town of Ulysses when she responded to a request from the Supervisor for opinions on the legality of options being considered by the Trumansburg Village Board, to begin a fee for service EMS

http://www.westhillwoods.com/EMS%20Billing%20November%202010.mem.pdf

http://www.westhillwoods.com/EMS%20Billing%2010-11-10.mem.pdf

Supervisor elect Marino's 12/14/09 Letter to VB

2010-06-19T04:22:00.000-07:00

December 14, 2009

Dear Mayor Petrovic and Trustees Hrubos, Hart, Nottke, and Thomas:

We the undersigned members of the Ulysses Town Board as will be constituted on January 1, 2010 respectfully request that the decision on EMS billing be postponed. We as members of the Town Board who will have the responsibility to contract for EMS services for Ulysses, want to work with the Village Board on this issue. We need to understand more fully what the consequences and details of the proposed plan mean for Town residents in terms of cost savings, service, and fairness. As such, we oppose the Village moving forward at this time with the insurance-only billing plan as currently outlined, with the level of detail provided to us.

As elected officials, we all want to reduce costs to taxpayers while maintaining services. We understand that billing offers the opportunity to generate revenue to help control the escalating costs of maintaining the current ambulance EMS if volunteer numbers continue to decrease and need to be replaced by paid staff. The argument for recovering some of the money our residents pay to health insurance companies to help lower taxes is a compelling one.

But if as a community we continue to support ambulance service with taxpayer dollars, we believe it is important to do everything we can to ensure that everyone, irrespective of their financial resources will not hesitate to call 911 if they or a loved one need an ambulance. This was a major concern voiced by many at the public meeting on the billing option last year. We are concerned that the insurance-only billing plan as presented to the public on November 12, 2009 has not been well enough considered in some aspects that can have serious consequences for equity and ensuring that no one in our community might refuse care or emergency services for fear of the costs. Your response at the November meeting to questions such as how high deductibles will be handled was that these sort of issues are details, not important to be worked out until after the decision to move to billing is made. We are not comfortable with this approach.

Many of our residents who are self employed or work for small businesses by necessity have health insurance with a high deductible that has to be met before benefits are paid. These residents could end up paying several hundred dollars for an ambulance, while others pay little or nothing, depending on their insurance coverage and how the Village chooses to handle collection of the bill. This is not a small detail in the policy, as it impacts sectors of the population very differently.

Another concern is that the support for this major change in policy that impacts so many people is not very strong. The Ulysses Town board voted 3 to 2 in favor of support for billing, with those opposed concerned there was not enough information on all aspects of the issue. Both incoming members of the Town Board are opposed to moving to billing with the currently proposed plan. The Fire Department vote on December 2 was also closely split, with a small majority (53%) in favor the billing process and 47% opposed. Concerns were raised about both the legality of insurance-only billing and the reaction of people in need to taking help when responders cannot assure them that there is no cost. The internal conflict created within the Fire Company between those that favor vs. those that oppose is cause for concern.

The Village should not go forward with a change in policy that has such large ramifications without trying to achieve better consensus among those responsible in some way for implementing it. Why rush at this time to put this plan into place without answers to all of the questions and all of the options fully explored? This issue will impact the residents of our area for many years to come. Shrinking resources and increasing expenses make it necessary to consider the costs and benefits of a change in our current 100% taxpayer-funded EMS, but our Boards can certainly afford to take a little more time to be sure we make a policy decision that serves the greatest good for the most residents.

The new Ulysses Town Board looks forward to working with the Village on this difficult issue as well as the other challenges that face our community in these times of economic uncertainty. The taxpayers expect and deserve a commitment to inter-municipal cooperation from all of us.

Sincerely,

Roxanne Marino (Supervisor-Elect)

Lucia Tyler (Councilperson)

Kevin Romer (Councilperson-Elect)

David Kerness (Councilperson)

Chris Thomas's 12/14/09 Resolution

2010-06-19T04:18:00.000-07:00

(this was passed right after getting the above letter from Supervisor elect Roxanne Marino)

Resolution to Create a Municipally Controlled

Fee-for-Service EMS Company.

The following resolution was offered by Trustee Thomas, who moved its adoption, seconded by Trustee Hart, to‑wit:

Whereas, an increase in EMS paid personnel, escalating costs of EMS service, and historic financial uncertainty has caused the Village of Trumansburg to seek methods to reduce the tax burden for EMS ambulance service;

Whereas, fee-for-service has been identified as a viable and legal solution, as researched and determined by Village attorneys, to these escalating costs;

Whereas, the Village of Trumansburg has investigated various options that minimize cost and maximize provision and quality of service and has determined that a municipally controlled fee-for-service EMS ambulance service is in the best interest of the citizens and residents of the Trumansburg Fire District;

Whereas, such a system will require that current EMS ambulance services be legally separated from the Trumansburg Fire Department such that a new nonprofit company will be formed for the purposes of providing EMS ambulance services to the Trumansburg Fire District;

Whereas, a newly established EMS ambulance service will continue to reside in and operate from its existing location within the Trumansburg Fire Department;

Whereas, a fee-for-service EMS ambulance service will take the form of an insurance only service for the purposes of protecting the most vulnerable patients within our fire district, those who lack any form of insurance coverage;

Therefore, be it resolved that the Village of Trumansburg shall move forward in good faith to establish any and all requirements, policies and procedures necessary to adopt a fee-for-service EMS ambulance service with a target inception date of June 1, 2010.

I HEREBY CERTIFY THAT THE ABOVE RESOLUTION WAS ADOPTED BY THE TRUMANSBURG VILLAGE BOARD OF TRUSTEES AT ITS REGULAR BOARD MEETING OF FEBRUARY.

WITNESS MY HAND AND SEAL OF SAID VILLAGE THIS FIFTEENTH DAY OF DECEMBER, TWO THOUSAND NINE.

_______________________

Tammy J. Morse

Village Clerk

VOTE:

Thomas	Aye
Hart	Aye
Hrubos	Aye
Petrovic	Aye
Nottke	Nay

Jim Mason's Report

2010-06-19T04:10:00.000-07:00

This is a report prepared by Jim Mason, that was largely ignored by the Village Board.

An Examination of the Trumansburg Fire Department Volunteer Ambulance Service

Six years ago a decision was made by the Village of Trumansburg to move to a system of paid EMS providers during the day while maintaining volunteer coverage at night. The intent of the system was to provide high quality pre-hospital emergency care for patients while operating at the lowest cost to taxpayers. The stated reason for implementing this system was the decline in the numbers of trained EMS volunteers available in the village or its environs during the daytime hours. Currently, the fire department claims thirty-three certified EMS providers within its membership. This is more than at any point in the history of the department and far more than most volunteer fire departments in the area.

Trumansburg Fire Department certified EMS providers include: 5 - CFR (Certified First Responders) 21 -EMT (Basic Emergency Medical Technicians) 1 - EMT-1 (Advanced) 5 - A-EMT-P (Advanced EMT-Paramedics) I - CCEMT-P (Critical Care EMT Paramedic)

Professional crews were nevertheless hired to staff the Fire Department's ambulance weekdays from 06:00 to 18:00 hours. Nighttime hours were to continue to be covered by fire department volunteers. This system has since proved to be problematic. The number of volunteers that are now willing or able to cover the evening shifts has fallen far short of what is needed. The task of shift coverage has fallen to a core group of about six to eight individuals.

A Task Force established by the Village recommended that a fee based operation be instituted in order to offset the cost of providing ambulance service with paid crews. As a result of the concerns raised by the residents of the fire and ambulance protection district, the fee-based proposal was temporarily tabled.

Over the past few weeks a survey of Trumansburg volunteer EMS personnel has been conducted to determine why more of them were not willing to volunteer to cover nighttime shifts. The survey also attempted to identify problem areas within the EMS delivery system as a whole and sought suggestions for improvement.

This report was prepared by Jim Mason, Life Member and former EMT with the Trumansburg Fire Company. Ron MacLean assisted with survey data analysis. The report summarizes the information collected through the survey in addition to that gleaned from one-on-one interviews with volunteers, meetings with Fire Department members and officers and others involved in the delivery of emergency medical services throughout the area. This report also includes a recommendation as to the direction the Village should take for delivering pre-hospital emergency medical services within the protection district.

Summary of Survey Responses

Seventeen of the thirty-three Trumansburg EMS providers (approx. fifty percent) responded to the survey. The following is a summary of their responses:

The survey found that nearly fifty percent of the respondents were involved in the delivery of EMS in other agencies, including paid service with Bangs Ambulance of Ithaca. Ten of the respondents have been involved in EMS more than seven years, some as long as fifteen years.

The primary factors keeping them from volunteering for more shifts were: - Already volunteering at the level they want - Work or family commitments - Burned out

Problems within the organization. - Problems with ENO (Emergency Medical Dispatching).

• The four issues identified as critical for the success of our volunteer ambulance service

were: - Patient service - Conflict management within the Department - Communication between leaders and volunteers - Volunteer retention

• The four most valuable volunteer benefits desired were:

- Excellent squad level training - Reimbursement for training - Having a role in planning - Recognition within the Department and Receiving a property tax break for service. (Tie) Note: Receiving reimbursement for fuel expense was also listed by several respondents.

The idea identified as having a negative impact was: Adding one paid crew member to all volunteer shifts. Using paid crews was perceived as having a negative impact on motivating volunteers.

• Of particular note were the concerns expressed about EMD (Emergency Medical Dispatch) protocols. - Unless Trumansburg has submitted a roster for each night's coverage, the county dispatcher automatically dispatches Bangs without giving T-Burg the opportunity to "scramble" a crew. This creates a "why bother" mentality among volunteers who might otherwise respond. - IEMD analyzes the call for its response level and automatically dispatches Bangs if the call is ALS and T-Burg is staffed at Basic.

EMD protocols require dispatchers to dispatch Bangs if T-Burg has not responded to a second tone activation. Second tones are given 4-5 minutes after the first tone. Some dispatchers are sending Bangs at a second tone even if the T-Burg crew is actively assembling and has reported this to dispatch.

Other issues raised:

The staggering training requirements being mandated by New York State on volunteer EMS providers is a significant issue. To become ALS certified, an individual must undergo classroom and practical training that is equivalent to that needed to acquire a college level Associates degree. A series of continuing education courses are then required to maintain certification and individuals must re-certify every 24 months! Average tuition for a paramedic course runs between $3,500 and $4,000. Most individuals seeking ALS certification today are doing so in order to seek employment in the EMS field, not to serve as volunteers. While certification for Basic EMT is somewhat less onerous, it still requires hundreds of hours of formal training in a classroom and hospital environment.

Over a recent five month period the Trumansburg ambulance provided emergency medical services to approximately 264 patients. Of these, sixty three, or about twenty-four percent, were determined by the dispatcher as requiring ALS coverage. On the average, only two ALS calls per week occurred on "Paid" time. The remaining calls were dispatched as requiring BLS response. Twenty-five ALS calls (less than two per week) were dispatched on "Volunteer" time. Data is not available as to how many of these calls were actually covered by volunteer ALS providers.

There are currently six ALS qualified volunteers in the TFD. Of these, only three are active. That number is now down to two because of illness. It is impossible to provide ALS coverage with only two active volunteers. Bangs is therefore frequently called upon during "volunteer" time to respond into the Trumansburg district to provide ALS coverage.

From the taxpayer's standpoint, if Basic Life Support crews were available, there is no justification for having "paid" crews for twelve hours a day at a cost in excess of hundreds of thousands of dollars per year. The approximately ninety ALS calls per year could be covered by the fly car from Bangs, with Trumansburg providing transport. There are simply not enough ambulance calls in the Trumansburg Protection District to warrant full time paid crews.

Problems Identified:

The Trurnansburg Fire Department is currently operating with limited volunteer ALS staffing. The ability to continue to deliver even Basic Life Support services is also a significant concern. Of the twenty-one certified BLS providers currently in the Fire Department, seventeen must renew their certification by May of 2009. Several of these have indicated they will not be renewing their certification because of their dissatisfaction with the current system and its administration. Without these individuals, the future of the Trumansburg Fire Department volunteer ambulance service is in serious jeopardy.

Recommendations

The Trumansburg Fire Department should revert to a fully volunteer ambulance service providing Basic Life Support and transport only. On the occasions where an ALS response is required but not available, Bangs should, and would, be automatically dispatched just as they are under the present nighttime system. This would have minimal impact on patient care beyond what is currently provided. Patient care might actually improve and volunteer response could potentially go up when the volunteers feel they were again playing a key role in the system.

Such a system would however generate a dramatic savings/or the taxpayers in the Trumansburg Fire/EMS Protection District. Only those requiring ALS would be billed, and that would be the responsibility of the commercial service, not the Village.

Two calls (or less) per day can not financially support a fee-based ambulance service. Little if anything over what is currently in place would be gained by such a system, and the loss of our volunteer's service would be devastating. As one survey respondent asked, "does the Village of Trumansburg really want to be in the EMS business? Staffing, training, insurance, uniforms, vacations, liability, all for less than one or two calls per day, half of those at night when the volunteers are the primary responders?" It was also pointed out that for the Village to bill for the services provided by volunteers would be ludicrous at best.

Should the Village decide to implement a fee-based ambulance service, any ciffiliation with the

Trumansburg Fire Department must cease. The ambulance could not in any way reflect identification with TFD, and should be clearly separated from TFD's administration and budget. It would be a separate department, much like the Police Department or the Public Works Department. Even now, the public is being mislead by the Village in using paid, non-firefighters, to operate a Fire Department vehicle twelve hours a day.

We are very fortunate that most of the Trumansburg Protection District is within 10-15 minutes of the hospital's Emergency Department. In most situations, the patient could be transported to the Cayuga Medical Center under basic EMT care in less time than it takes Bangs to respond to the district. Getting the patient to the Emergency Department in the shortest possible time should be our first priority. Under the current system, more time is often spent attempting to treat the patient in the field than it would take to transport them to the hospital!

The Trumansburg Fire Department has provided the community with exemplary volunteer ambulance service for over thirty years. If the Department, for whatever reason, can not effectively continue to operate this service with volunteers, the Village should revert to a "Rescue Response" operation. Ambulance service should be provided by a privately operated "fee-based" commercial service, not the Village. Other rural townships in Tompkins County, some of them much more remote from the hospital than Trumansburg, depend solely upon fire department rescue response supplemented with ambulance service from Bangs. There is no evidence that patient care is any less effective, yet the municipalities do not incur the expense of having a taxpayer supported service. Under this type of system, only those who use it, pay for it. The Village would not have any affiliation with this service, thereby eliminating hundreds of thousands of dollars in annual cost to its taxpayers.

The challenge before us is to maintain our current EMS volunteers and increase their numbers. Aggressively addressing the concerns expressed by the survey respondents is the first step. I would then encourage the Village to seriously consider implementing some, if not all, the desired benefits for volunteers listed in this report. The cost of doing so would be insignificant in comparison to going to a paid, professional ambulance service operated by the Village.

Respectfully Submitted:

James A. Mason December 9, 2008

New Study in JAMA

2010-05-02T04:25:00.000-07:00

An important new study, which should inform us about the fee for service system proposed for our Trumansburg Ambulance, was published in the Journal of the American Medical Association (JAMA) on April 14th. The title is "Health Care Insurance, Financial Concerns in Accessing Care, and Delays to Hospital Presentation in Acute Myocardial Infarction."

This study contradicts the assertion of our Mayor, and every member of the Board (with the exception of Debbie Nottke) that residents will be no more hesitant to call when in need.

Conclusion - Lack of health insurance and financial concerns about accessing care among those with health insurance were each associated with delays in seeking emergency care for AMI.

In other words, this proposed change in our EMS, is likely to kill somebody.

Here is a link to the study

Trustee Debbie Nottke is the only board member that sees this clearly because, to the best of my knowledge, she is the only member with experience in emergency medical care. She recently retired as the head nurse of the Cayuga Medical Center's ER.

Resources - EMS Billing

2009-10-18T06:26:00.000-07:00

We are not the first municipality to struggle with this question of whether or not to save our single payer EMS system. Montgomery County Maryland has a single payer system and they have fought against the privatizers successfully for several years. Eric Bernard, the Executive Director of the Montgomery County Volunteer Fire and Rescue Association sent me these resources,

The first is a press release from the MCVFRA

********

Next we have a study published in the Annals of Emergency Medicine which concludes "economic considerations may effect EMS system utilization among under insured and low income patients experiencing a cardiac event. Prepayment systems (like our single payer system) may increase EMS utilization among these groups"
Some say this study is too old - June 2000. Key question - are economic considerations less significant today?

Annals of Emergency Medicine article

*********

Next we have Circulation - The Journal of the American Heart Association
This is from their conclusion,

financial concerns may undermine a chest pain patient’s intention to use EMS

Circulation article

*********

Finally, we have a 2008 study in Bethlehem PA - Patient and Physician Perspectives on Ambulance Utilization. Here a researcher surveyed patients after they reached the ER, and the results are interesting. For instance, twice as many patients who arrived at the ER without an ambulance said that they knew the cost of the ambulance, as those who arrived on an ambulance.

Patient and Physician Perspectives on Ambulance Utilization

EMS Billing Meeting - November 12th

2009-10-17T14:22:00.000-07:00

Here's a link to a two minute clip of audio from the Village Board Meeting 10/13/09

Sycophantic? Trustee Thomas impressed us with his vocabulary, and he certainly isn't being sycophantic. A better word for what he is trying to do is "placate"

from dictionary.com,

Placate - verb - to appease or pacify, especially by concessions or conciliatory gestures : to placate an outraged citizenry.

There's a lot in this 2 minute clip. It starts off with Chris Thomas. They're talking about the upcoming "public meeting" and how they don't really want the public involved. Chris is going to preach to us, and then they might except some questions, if we don't get out of line and try to express ourselves during our questions.

You'll hear someone say nobody is calling or emailing or writing or coming to meetings or stopping at Village Hall - good point — what's up with that people?

The main concern expressed at last years meeting, was not wether or not and uninsured person would get a bill, it was wether or not someone might die if they did not call for help, for fear of a bill. Insurance only billing does not fully address this concern. Right now, the average citizen wouldn't even be able to name 1/2 of the trustees. How do you intend to inform them all with the critical details of you're billing policies?

Then you'll hear John Hrubos ask about how going to billing will intersect with whatever changes come from Washington, and Chris Thomas answers — he has no idea. Here's an idea; cool your jets, back off, wait and see. Going to billing now is very bad timing.

Hrubos says that Allen says that going to billing will result in higher insurance premiums, but he doesn't think that's necessarily true.

Thomas - No it's not. It's ridiculous.

Maybe I'm just stupid. Somebody please explain this to me. Are these private for profit insurance companies so magnanimous that they (unlike every other business) don't have to balance income vs expenses? They don't keep track of expenses? They don't have a history of raising rates and increasing profit ratios? Or is the Board just hoping that the increased premiums will be spread out over a larger population (kind of like cheating on your taxes)

Mark your calendars - Thursday, November 12th at 7pm at the Village Hall Meeting Room

Bad Ideas are Hard to Kill

2009-10-11T05:28:00.000-07:00

This cartoon ran recently in a Maryland newspaper called the Montgomery County Gazette. We are not alone in this fight against those who would like to privatize wonderful single payer EMS systems. The following is an excerpt from an editorial written by Marcine Goodloe, president of the Montgomery County Volunteer Fire-Rescue Association, and Executive Director Eric Bernard.

In spite of repeated claims that there is no evidence ambulance fees would discourage some from calling for help when needed, the volunteers showed what occurred in Fairfax County, Va., often used as an example by fee supporters. Fairfax County imposed its fee in 2005. EMS call volume dropped from 2004 to 2005 (when adjusted for population growth) and has remained below 2004 levels to date).

The volunteers have given first-hand accounts where rescuers, from fire chiefs to EMTs, witnessed cases where fees played a role in people refusing ambulance service. In fact, at many public hearings and citizen forums the county heard first-hand accounts where ambulance fees caused people not to call and to drive themselves to the hospital in emergencies. What analyses have been done to show that ambulance fees don't deter at least some calls to 911? The county executive has the obligation to prove with facts, not assumptions, that people won't hesitate to call.

There are many reasons why billing is a bad idea, but I'd have to put this one at the top of the list;

* It's likely to kill somebody!

Other reasons,

* The volunteers don't like it - some will quit which,

A.) increases the budget and therefore the taxes

B.) undermines the spirit of volunteerism which is crucial for the well being of the community

C.) makes volunteer recruitment very difficult

* Increases the overall cost to society of the service by envolving for profit corporations

* Moves us in a direction opposite from a single payer health care system which a majority of us support

* The whole country is debating how our health care system will be changed - bad time to change ours - wait

The desire to go to billing is driven by unenlightened narrow self-interest. Opposition to billing is not holistic altruism, it is simply an enlightened, objective view of self-interest. Instead of the short term, capitalistic, free market monetary reward offered by billing, we should consider the well being of society as a whole.

EMS Budget - Special Village Board Meeting 10/1/09

2009-10-02T05:28:00.000-07:00

The privatizers are on a roll. Last night's meeting was attended by all Village Board members, and representatives from the Town Boards of Hector and Covert. Those wishing to go to billing, were in a clear majority, in spite of what, in my humble opinion, is an obvious majority of the public, remaining in opposition.

No resolutions were passed but they took a straw poll of the Village Board. Chris Thomas, John Hrubos, and Rordan Hart are strongly supportive of billing, Debbie Notke said that she was on the fence, and Marty Petrovic said that he is leaning in favor of billing.

Mayor Petrovic said that some form of public meeting would be held before going to billing. This is good. I was worried that they might pass a resolution to begin billing last night, and if it were up to the 3 neocons, I suppose they would have.

You will see a link to an mp3 file of the meeting below. If you click on the link, you can listen from within your browser, but there is usually a way to move this mp3 file to your desktop. In Firefox, you wait for the whole file to move to the browser, (a minute or two) then you go - File - Save Page As..... and you can put it anywhere you want. The advantage is that you can then listen with other programs (Real Player, Itunes etc.) which allow you to adjust equalizer settings and they give you a time counter. With the time counter and my notes below, you can jump to the part that interests you.

Here is a link to the audio

The first half of the meeting was tedious. John Hrubos insisted on going over the Fire Department's 2010 budget with a fine tooth comb, in-spite of very little increase in the budget from this year.

I had encouraged Ulysses Town Board candidate, Kevin Romer to come, and he did, but he couldn't stay long enough to participate in the EMS billing discussion. Sorry Kevin.

0 hrs-45mins-20sec One of the Town Board members asks a question about groups using the Fire Hall and wether they should be charged. This might interest the Back to Democracy steering committee members (of which I used to be one) I have often swept the floor and tidied up after Back to Democracy events, and I doubt, that in the years that I have been going, that we used more than five dollars worth of paper towels and toilet paper, so I think this is a silly thing for the Board to worry about. But perhaps Back to Democracy should donate a family pack of paper towels and toilet paper (with their name on every sheet) in order to alleviate the Boards concern that we are using more than what we are entitled to as taxpayers.

Rordan Hart suggests installing security cameras hooked up to a DVR. Maybe we can catch those rascals using too many paper towels. That'll help control costs!

0 47 42 Marty wraps up the Fire Department budget portion of the discussion, and they approve it. Then they begin a long discussion of the EMS budget, before discussing the revenue side.

0 50 20 Chris describes current staffing. I'm confused, but I think we are staffed entirely with paid professionals except for Monday - Thursday nights from 6pm to 6am - volunteers on call, and Friday from 6pm to 12 midnight - volunteer. He calls this almost 24/3, which is confusing. I wish we could just use percentages. Take the total hours in a week- 168 then 54 of them are volunteers on call. That's 32% volunteer, right?

1 04 0 Chris says that the increase from this years EMS budget to next year's proposed budget is 118,000 but then says that about 25 % of that increase is due to a correction in budget procedures. 118,000 minus 25% = 88,500 increase. So 88,500 divided by 8000 residents of the district = $11. Eleven bucks per person. Eleven bucks to keep our single payer system, keep the volunteers who don't like billing, keep the system as it has been for 40 years, and should continue to be. Eleven bucks to ensure that those without insurance need not fear calling for help when they need it. Eleven bucks. This is a crisis?

1 31 0 After much more of the fine tooth combing of the expense side of the EMS budget (Hrubos upset about expensive coats and too much money on the line for fuel) they finally pass a resolution to except the expense side of the budget. $475,828 Then Marty starts the revenue question. He mentions the public meeting from last year and acknowledges a lack of support for going to billing (doesn't acknowledge the more than 2 to 1 ration against billing) Then he points to the "fairly large increase" in the budget - thankfully he doesn't call it a crisis, as others have. (see my eleven dollar calculation above) Then he states that there will be another public meeting.

1 34 0 Chris says that the call volume went down last year. His figures for estimating revenue are assuming 600 calls per year, down from 675. He figures he can get $351,997 per year by going to billing. Big money. Mighty tempting. The village revenue this year is about 1.5 million. Imagine that's your income. You're fairly rich. It's tax time. You see a way that you could cheat on your taxes and save $352,000. Big money. Mighty tempting. This is an imperfect analogy, because tax fraud is illegal and going to billing isn't, but that aside, the moral implications are the same. Hopefully, some people don't cheat on their taxes because they realize that if they don't pay their share, then that tax burden will fall on others. It's actually worse for the Village, because if they don't pay that 352G, and the insurance companies do, then before billing society back in the form of premiums, the insurance companies will add 15 to 30% profit. The IRS doesn't do that.

1 41 00 Chris describes "insurance only billing" He claims that a very large municipality has signed on and is doing it this way, but he won't tell us what municipality that is. He claims this is because they are still in contract negotiations. So, they are doing it with out a contract? Odd.

1 44 09 John Hrubos asks Jason - is the Town of Dryden billing - yes - and they haven't had anybody refusing care "because that would be a very terrible thing" - Jackie Wright answers -" we don't know that" she repeats this several times. She is the president of the Fire Company. Note that John says here that it would be a terrible thing if someone refused service as a result of our going to billing, then the president of the Fire Company infers that that is a possibility, then a few minutes later, John votes in favor of billing. Chris makes it clear that this magnanimous non aggressive billing does not apply to anyone from outside of the district. So, beware you scum bags from Ithaca that dare drive through our district. If you have an accident in our district, we aint gonna be so lenient on you.

1 50 00 Lots of squabbling over how to divide up the loot. (common theme in old Westerns)

2- 0- 0 Marty points out that Ulysses passed a resolution in support of billing, 3 in favor 2 opposed. Then he admits that the makeup of the board is going to be different in January. That's just 3 months away. Here's an idea, ask Roxanne Marino and Kevin Romer how they would vote. They are running unnopposed (except for me on the Green Party line - and I don't intend to campaign against Roxanne) I'm just guessing, but I think it might be 4 to 1 opposed in January, with Dave Kerness being the only one in favor of billing. Ulysses is the largest customer of the EMS, by far. Some on the Village Board appear to be in a hurry to make a decision in November, before the new Ulysses Board is seated on January 1st. Mayor Petrovic does not seem to share this urgency, so there is still hope.

2 04 0 They go around the table getting their "sense of the board" poll (not a resolution) Hart says we are not allowed to bill for fire and police protection (damn!) but we are expected to bill for water and sewer, so we ought to bill for EMS if we can. "I don't see any reason not to" Here's one - few people are afraid of an $800 dollar water bill, and even if they were, that fear wouldn't have life or death consequences.

Hrubos - "I think that the insurance only billing makes this whole thing work" even though the details are really vague.

Notke - "I'm on the fence"..... "I need to look at all the numbers first" ..."Im not completely sold on this"

Thomas - "I've right from the beginning been all about transferring the burden from the taxpayers to the insurance companies where I think it more rightly belongs" Hey Chris, it's not a burden to the insurance companies, it's an opportunity to generate more profit. But nobody seems to be able to penetrate your determined approach to ramming this through.

Petrovic - I'm leaning towards doing this. Sad. He does suggest an early November public meeting.

2 17 20 Chris says that if we go forward we have to make a decision in November. Marty dissagrees.

2 18 30 Public comment period. Me first - I explain for the umpteenth time that this won't save money. You can defer taxes but it will come back as higher premiums. If we assume that when it comes back (plus profit), it will land on a wide segment of society then it's like cheating on your taxes (see above). Then I complain of unanswered questions about the "insurance only billing" and after listening to myself - I failed to connect the dots. I talked about Rod Ferintino's story about going on EMS calls to vehicle accidents where patients would not accept help for fear of a bill. He can now tell them there will be no bill. If we go the "insurance only billing" will Rod be able to tell someone on the scene of an accident, that there will be no bill? This is an unanswered question. Very important. I think I know the answer.

Then I read this,

You are justifying this move to billing by saying that volunteerism is decreasing at the EMS, which results in higher taxes which our community is unwilling to pay. I believe that the average citizen is willing to pay this modest increase which is peanuts compared to our overall tax bill when all taxes are included. The tax for our EMS is the best value that we can buy with our tax dollars. But lets study this decreasing volunteerism that you like to call a "paradigm shift". A paradigm shift is a radical change in people's perception of their world. When we learned that the earth wasn't really flat and that we couldn't sail off of the edge, that forced a paradigm shift on us. If we were suddenly to realize that our own selfish interests should guide how we structure government services, and that concern for the well being of our neighbors was misplaced, and that greed was good, and volunteerism was outmoded, that would be a paradigm shift. The good news, is that this is not happening. A study of figures at the Bureau of Labor Statistics shows a slight increase from 07 to 08 in overall volunteerism. At the same time there is a slight decrease in volunteerism in the public safety sector. Why would this be?

All that it would take to deter volunteers, is an understanding that their work would be billed for, and a portion of the proceeds would go to further enrich the CEO's of private for profit health insurance companies, and pay for their lobbyists in Washington. It cannot be denied, that if we go to billing, the insurance companies will add profit, turn the bills around, and bill it right back in the form of premiums. That's just how it works.

I want to help. If you would promise not to go to billing for 3 years, I would join the EMS, and try to persuade others to join. I know that the leaders of the EMS have their own recruitment efforts, but they are being handicapped by this talk of "paradigm shifting" and billing. Promise to layoff for 3 years. I will report to the Board on behalf of the volunteers, and I will turn this trend around. If, at the end of 3 years, I haven't increased volunteerism, you can look at billing again.

If we lose our volunteers, we lose much more than money. These volunteers foster a spirit of concern and cooperation and civic responsibility that is crucial to the proper functioning of our community.

Lastly, it is essential that you hold another public hearing before going to billing. The public told you by a two to one margin that they did not want you to go to billing at last years public hearing. The public does not know what you are doing. It would be profoundly undemocratic for you to go to billing without a public comment period.

2 23 17 Geoffrey Hart - He says that because there is a great variation in the rate of use of the EMS service, that the only fair way to deal with it is a fee for service system. Wouldn't that apply to the Fire and Police services too? Why don't we bill for all of these? Because, over the years we democratically decided that it was in the best interest of society to establish these services, and that it would be unwise to structure these service so that someone didn't call when their house was on fire for fear of a bill. Now, people like Geoffrey are arguing that it is resonable to change our system in such a way that we increase the overall cost to society and at the same time create a fear in some people, that if their body (more valuable than their house) is on fire, they don't call for help for fear of the cost.

2 25 00 Jackie Wright president of the Fire Company. She says that she doesn't think the board has looked at all of the options. also "It's difficult when you go to someone's house and they say they aren't going to go because they will have to pay. It has happened, and Brian knows this, I've gone and I've had people say, because the billing issue has come up in the paper, that they're not going to go. Which is exactly what you don't want to do"

Hello? John, Chris, Rordan? Anybody listening?

2 28 32 Chris says that he'd be happy to come to the meeting on Oct 7 and present the proposal and answer questions, but he's not going to debate the issue. (closed mind?) Jackie says the volunteers want to know what the community wants. Marty says we legally can't have a referendum. Jackie says there are other ways. Chris says not effectively.

How about sending out a questionaire to a the whole district or a random sample. Maybe I should do that. If Chris wrote the questionaire, it would have a whole different flavor. Anybody want to fund a mailing of a couple hundred questionaires?

2 34 30 a discussion of the format of the special village board meeting (public hearing has some legal strings they don't like) I ask if it will be the same format as last years meeting. John Hrubos says "We're not going to go thru people standing up and testifying one way or the other on behalf of the EMS" I ask why not? John "Nobody's denying that the EMS provides a valuable service, that is not the issue what so ever" Well of course it's not John the issue is who pays, which has consequences. And that's what most people talked about last year. You were there. Were you listening? I posted the audio on this blog. check it out.

I said "So last year, they told you by a two to one margin not to do it, and you don't want to have the same format because you're afraid you might get the same answer?"

John said "There's no point in it. What was discussed was not the issue"

Yeah right, not exactly what you wanted to discuss. Let's ignore all the troublesome crap about people not accepting help, and increasing overall cost to society, and volunteers quitting.

Hopefully, the Mayor will decide the format of this meeting.

At the end they go into an executive session (don't know what that's about)

EMS Budget - Special Village Board Meeting 8/24/09

2009-08-25T02:19:00.000-07:00

The privatizers are back.

The Village Board met tonight to discuss the "crisis" with the EMS budget. Chris Thomas explained that because of decreasing volunteerism, the EMS budget would have to see an increase of 25% next year. The likely figure for next year will be $425,000. I'm guessing there are about 8000 people served by the ambulance. (Ulysses, Trumansburg, and parts of Hector and Covert) $425,000 / 8000 = $53/person/year. Please, let me pay it. Don't start billing. Don't get into bed with the damn private for profit insurance companies. I've been telling them for a year, and they still don't get it. If we cost shift part of our $53 tax burden, onto the insurance companies, they will shift it back onto us in the form of higher premiums. The cost to the average family of four for health insurance is currently $13000. It is estimated to double in the next 7 to 8 years. $26,000 is nearly half of the average income of a Ulysses worker. That's a real crisis. 18,ooo people a year die, in the US, because they didn't have health insurance. That's a real crisis. Some of those 18,000 died because they didn't call an ambulance because they couldn't afford it. That's a shame.

There is no crisis in paying for our wonderful single payer ambulance. It's the best value I get for my tax dollar. $53 and we get quick response from trained emt's and nobody gets a bill. My neighbor that doesn't have health insurance doesn't need to fear a big bill when her kid has an asthma attack. If we go to billing, the insurance companies will raise premiums to cover the cost - plus profit! Then not only will the uninsured not call when they need an ambulance, but those of us that do have insurance will become part of the system that allows the insurance industry to make obscene profits.

The Village held a public forum last year to get feedback from the community on wether or not to go to billing. The overwhelming majority said NO! What part of "no" don't they understand?

We have to tell them again and again.

here's a link to the audio

0-10-10 Chris Thomas explains that the factor that will result in either a modest tax increase, or going to billing, is decreasing volunteerism. "And knowing that volunteerism is dwindling, like nationally, it's just a trend, um, we obviously can't predict, but, the number has been floated that within 3 to 5 years, we are going to be a 24/7 department, we're not going to have volunteers to cover it."

I've researched this at the Bureau of Labor Statistics, and at the Corporation for National and Community Service. Volunteerism in general is not decreasing, it actually increased slightly from 07 to 08. Volunteerism at Fire and EMS departments decreased slightly. Could this be because what is happening here in Trumansburg is happening in other communities, and volunteers don't like their EMS companies being privatized?

0-14-08 Chris - "...but, and this is a big but, you have to realize that this is based on a 600 call volume, when we start direct billing, if that is the route that we go, the call volume is going to go down, guaranteed." Chris explains that this is because patients who are abusing the system will be less likely to abuse the system, if they realize that they will get a bill. He doesn't seem concerned that some of his constituents who will be wary of a bill, are in real need of emergency service. Conservatives like Chris can't stand the thought of Ronald Reagan's "welfare queen" being supported by his tax dollars. If some hard working Ulysses citizen, that doesn't earn enough to be able to afford the outrageous cost of private for profit health insurance, gets harmed by the move to billing, that's just collateral damage. Chris said that another municipality went to billing, and their call volume went down 40% . I find it very hard to believe that 40% of potential patients decided not to call because they didn't really need an ambulance, and they were only going to call because they knew it was free. I guess I just have a little higher respect for my neighbors than that.

0-17-50 Rod Ferintino "the other thing is, we get on a lot of wrecks (vehicle accidents) and people are seriously hurt and they're refusing to go to the hospital, because they ask, is there a bill? ..... It's going to make it even more difficult for the people in the field to convince people to go ...... there's a lot of people that refuse to go." Rod is an EMS volunteer. He's in favor of billing! He sees people in need of help, who won't accept his help for fear of a bill. He now can tell them there is no bill - and he wants to go to billing! I don't get it. I believe this is called cognitive dissonance. Rod needs therapy.

0-19-30 Chris explains what a great deal we can get from the third party billing company - Professional Ambulance Billing (Buffalo) they will charge $28/ call. They are like a little leech that attaches itself to the big leech, that is the private for profit health insurance industry, that sucks the blood of we the people.

0-24-19 Chris "This is also a highly traveled tourist area especially during wine season, and that means that we're taking care of all the tourists who aren't paying taxes in this area" Right. And if you visit any of the developed countries in the world and need an ambulance, they will take care of you and you won't get a bill. If you go to many municipalities in this country, that have resisted the pull towards privatization, they also will provide free ambulatory care if you need it. It's called civilized society.

0-31-0 Rod says that in Dryden they went to 24/7 paid, and the volunteerism increased. I don't know what they're smoking in Dryden, but the volunteers that I've spoken to in Trumansburg don't like billing, so if 24/7 goes hand in hand with billing, then volunteerism will decrease.

0-36-0 Rod says that it's inevitable that we have to bill. Otherwise we have to put it on the taxpayer, and the "taxpayer has enough on his plate." I'm a taxpayer - I want to pay. Please don't do it! Let me pay! Most of my tax dollars go to pay for wars in Iraq and Afghanistan, and bailing out Wall Street. I don't want to pay for that. This is what taxes should be for. This is the best value I get for my tax dollar. Leave my Ambulance service alone! The tax increase that you are talking about is peanuts compared to my overall taxes. Chill out!

0-39-0 Doug Austic asks how soon we could go to billing. Chris - "The ambulance billing could literally be instituted within two months. We're probably talking about within 6 months. Almost assuredly before the next budget cycle starts."

0-42-30 Rod '' You're gonna find that if you change the system in any way, there's gonna be a lot of volunteers that are gonna be very upset and they're gonna walk out the door" Exactly right Rod. Good reason not to do it!

0-42-20 - Rod and Rordan Hart argue about who is forcing a paradigm shift on who. Very amusing. Rod doesn't quite understand the word. Rordan gets all huffy and says that the "system is forcing a paradigm shift on the Village. ''

If we all were to become selfish bastards like the hero of an Ayn Rand novel, and rebel against taxes and refuse to voluntarily help our neighbors in need, that would be a "paradigm shift", but that's not what's happening here. Is it?

0-52-0 Somewhere around this mark, they talk about the Village needing the town's support, because the town is the largest customer of the EMS. As I write this, the Town has just passed a resolution in favor of billing. The three members at this meeting, Austic, Ferintino, and Kerness, in favor, and Thomas and Tyler opposed. When Roxanne Marino takes office, the balance will shift - 3 to 2 opposed.

0-54-30 public comment period starts with me. I'm the only one in the room against billing. I mention my concern that Chris's "insurance only" idea for billing is really just a smokescreen. I got my back of the envelope calculations wrong here. It's actually less expensive per citizen than I thought. If we continue with our current system, no billing, and continue with the current level of volunteers, our taxes for the EMS will be, on average, about $53/citizen/year. That is not a crisis.

1-02-00 More cognitive dissonance. Jason Fulton, the Fire Chief, says that he would be willing to pay several times more than he now pays, to know that Paramedics were ready to roll from the Fire Hall that have the training and equipment and certification, to save his kid if need be. And yet Jason is for billing. Jason has insurance. He's not worried about a bill. At least 15% of Ulysses, Hector and Covert, don't have health insurance and would be very worried about bills.

1-04-00 Ron McLean (I think) urges the board to inform the public about whichever way they go on billing. I don't think that they intend to inform the public. They did that last year at the public forum, and the public told them, that by a two to one margin, they were against billing. That's not the kind of input they are looking for.

1-06-00 Carstensen "I don't think anybody should fool themselves, that when we shift the cost onto the private for profit insurance companies, that it's not going to come back, it's definitely going to come back, maybe not on Trumansburg specifically, but it will come back on the people. The profit ratio of theses private for profit health insurance companies just keeps going up, and up, and up. When they see an expense come in, they're going to bill for it. So, you might save some taxes, but you're not going to save the people any money, because it's going to come right back, plus profit. One of the reasons that insurance is going up, and it's going to double in the next 7 to 8 years, there's a million reasons, but one of them is probably municipalities, like us, doing just what we're doing.

.............No response

Marty Petrovic moves the conversation to the Fire side.

Public Hearing on Billing for Ambulatory Care 6/18

2008-06-18T20:35:00.000-07:00

Good meeting. Those who spoke against billing overwhelming outnumbered those who spoke in favor. There were perhaps 100 people there. I was dying to respond to some of the pro billing speakers. I'll write about it soon and post some notes and times. For now here's the audio,

You will see a link to an mp3 file of the meeting below. If you click on the link, you can listen from within your browser, but there is usually a way to move this mp3 file to your desktop. In Firefox, you wait for the whole file to move to the browser, (a minute or two) then you go - File - Save Page As..... and you can put it anywhere you want. The advantage is that you can then listen with other programs (Real Player, Itunes etc.) which allow you to adjust equalizer settings and they give you a time counter. With the time counter and my notes below, you can jump to the part that interests you.

LINK

The National Bureau of Economic Research has concluded that the combined federal, state, and local government average marginal tax rate for most workers to be about 40% of income.

Estimated median household income in 2005: $51,900 in Ulysses

$51,900 x 40% = $20,760 median total taxes paid per household

by my math our ambulance costs us about $30/person or $78/household (2.6 people/household)

so $78 per household ambulance tax
out of
$20,760 total combined federal, state and local taxes
tells us that

the ambulance cost that the Village wants to shift onto our insurance premiums, or federal and state taxes (medicaid, medicare) thus risking the health and welfare of many, and discouraging volunteerism, and reducing donations, amounts to less than 1/2 of one percent of our total taxes.

Kind of puts it into perspective doesn't it? Let's put our energy into reducing some serious tax burdens.

0 hours 0 minutes 0 seconds - Marty does the introduction

0-04-16 - Trustee Chris Thomas's talk.

0-05-00 Chris says that the ambulance budget is currently $320,000 and that at the current growth rate, in 10 years it will be over $600,000. This would represent an inflation rate of 8% per year. If you believe the Bush administration when they tell you the current rate of inflation is 2% to 3% per year, then go ahead and panic about the rapid increase in the cost of our ambulance system. If, on the other hand, you prefer to read the work of economists who do not drink Greenspan Koolaid, then you will realize that our actual rate of inflation is even higher than 8%. If the value of our real estate keeps pace with inflation over the next 10 years, then the resultant increase in taxes should cover the ambulance at about the same percentage of the Village tax.

0-05-16 - "a move to direct billing would largely shift this tax burden to private insurance, Medicare, and Medicaid" Key word "shift". Yes, exactly. We can shift the burden, trouble is it doesn't stay shifted onto other entities. They will shift it right back onto us.

0-5-25 "there are two primary reasons the Village is now looking at billing. The first is to try to take control of the escalating cost associated with the EMS service. (with my inane cost shifting plan) The second is to ensure that EMS services and the associated standard of care remain at the highest possible level." - This is a straw man argument. No one has complained of a decrease in the standard of care. If we continue to fund, with increases in line with inflation, then we will continue to have the current high standard of care, without billing.

0-05-45 Chris says we might be able to cost shift $252,000. If we ignore the senseless, and unethical nature of cost shifting, we are then struck with how little Chris intends to save us at such a high price in lost lives and lost volunteers. $252,000 divided by the 10,000 residents of the Fire District, is $25 apiece.

0-06-26 "This (awesome $25 cost shifting) would only be possible, if we are able to maintain our night time coverage with volunteer personnel. If for any reason we are not able to maintain volunteer coverage at night, the money saved would go to adding additional paid staff....." After Chris Thomas's talk, many volunteers talked about what a lousy idea it was. Norm Hummel (paramedic) said he would quit. hmmm.... "If for any reason we are not able to maintain volunteer coverage at night......" Is anybody paying attention here?

0-06-45 '' It would be better, in my opinion, if we had universal health care." Here he insinuates that sense we are never going to get what we want, we might as well give up, see if we can do a little cost shifting, and hope that not too many people get hurt too badly. I'm not sure Chris is being entirely honest here. He doesn't seem to be a single payer, universal health care kind of guy. Remember, he was a registered Libertarian according to the Tompkins County Board of Elections. Ben Curtis was one of the few allies Chris had at the meeting. Mr. Curtis is registered with the Independence Party. This is from their platform " Privatization Plank: Support an aggressive program, of privatizing government functions wherever and whenever possible." This is from the Libertarian Party Platform "All efforts by government to redistribute wealth,.... are improper in a free society." In other words, we have no business taxing ourselves, to support the ambulance service, that might help our neighbors, that can't afford health insurance.

In any case, whether these billing proponents really believe in single payer, universal health care or not, we need to bear in mind, that all politics is local. If we believe in progressive democratic principles (promote the general welfare) we should fight for them at every level of government. Gains at the federal level in workers rights, and civil rights, and a social safety net, have never happened without a mass movement at the grassroots demanding it. If we give up on a local level, the enormous pressure from the lobbyists for the insurance industry at the federal level will win out.

0-07-16 Chris explains when bills would be sent, and reiterates that uninsured and under insured people would receive a bill "by law". Then he attempts to assuage our fears by advocating for "non-aggressive collection" but says that "This doesn't mean that the uninsured don't have to pay" The few people who spoke in favor of billing kept bringing this up. They have fallen for the trick. They are hearing what they want to hear. They are allowing themselves to be comforted by this deceitful "non aggressive collection" argument. They are missing a very important point. If someone refuses ambulatory care for fear of a bill, and dies, it is too late, at that point, to discuss how aggressively the Village would have pursued collection, if they had accepted the care, and lived. They're dead. It will do them no good, in their grave, to know how magnanimous the Village's collection policies are.

Tell me, what percentage of the uninsured are likely to be aware of the collection policies of the Village's third party billing company? Maybe if we had an aggressive public information campaign, we might be able to get the word out to some of them, but such a campaign would invite lawsuits from insurance companies who would claim discrimination against them and their clients. Ask Chris Thomas, and the attorneys for the Village and the Town, if they would be in favor of such a campaign. I have heard Chris speak against the idea at Village Board meetings.

0-08-50 Chris talks about a subscription program, whereby the uninsured could pay 50-75 dollars/year to belong to the club that doesn't have to fear death from lack of expensive care. Two problems with that. A) They are already paying taxes and surely wish you would stop messing with the system and, B) If you succeed with your evil plan, not all of them will join the club and keep their subscription current in perpetuity. This reminds me of a period in our history when we had subscription based, private for profit Fire Departments. If you didn't pay your dues, they would let your house burn down. Ask our volunteers how they like this idea.

0-09-25 "The bottom line is there is no perfect solution, but there are ways to address issues that arise from moving to a system of billing" I'll give you a perfect solution Chris - leave it alone.

0-09-34 Straw man argument again. Hey Chris, who's complaining about standard of care? Chris then claims that an unacceptable number of calls have been answered by Bangs. I'm not sure about his numbers here - Norm Hummel didn't seem convinced. If, however, the community feels that too many calls are not being answered by our volunteers, then we should try to increase their numbers and participation. Senator George Winner's newsletter has mentioned incentives for volunteers such as student loan forgiveness, and credits towards courses at SUNY schools. This makes more sense than Chris Thomas's LOSAP program (retirement fund) because it would attract younger volunteers. Perhaps the Village could incentivize volunteerism in other ways. Perhaps we should occasionally set up a table in the High School to encourage volunteers. Offer free EMT, and paramedic training in exchange for volunteer hours. Scholarships to TC3?

0-10-50 "At night you have an almost 50-50 chance of paying Bangs on top of paying local taxes , insurance premiums, and paying into Medicaid and Medicare" No, Chris. If you have private health insurance, Medicaid, or Medicare, one would hope that they would pay Bangs. We only would have to continue to pay our $30/year each to maintain the Trumansburg Ambulance. That's not really that much is it?

0-11-08 Chris praises the volunteers in the same breath as he promotes the billing system that they reject. (I think that every volunteer that spoke, was against it) He bemoans the decreasing number of volunteers in the same breath as he proposes to make it less attractive to volunteer.

0-12-10 "The vast majority of money collected will be from insurance companies, those who should be paying for this service" No, Chris. We should be and are paying for it. The majority of those who spoke said they wanted to continue to pay for it. "And the argument that the money collected from these insurance companies will immediately and entirely be billed back to our community in the form of premiums, is a red herring not backed up by the least bit of information or research, but instead by loosely connected circumstances."
Well, Chris, nobody said "immediately and entirely", but yes, they will largely, and eventually be billed back to us. Here's some research for you; William McGuire is the CEO of United Health, one of the largest HMO's in the country. He makes 8 million/year plus bonuses, and has amassed 1.6 billion in stock options, one of the largest stock option fortunes in history. Bill gets around in a private jet. Let's look at some business basics. Bill has to balance income, expenses, and profit. If expenses go up (more people billing him) he has a tough choice to make. He can either raise income (premiums), or cut profit. Based on a quick look at his net worth, I think I know which one he has been choosing. Chris can obfuscate with talk about this account and that account and actuarial tables, but I'm not buying it. If we start billing, premiums will go up. There is no free lunch.

0-13-05 Chris talks about who was on the task force that unanimously recommended a referendum on billing. He includes Norm Hummel and Jackie Wright. But they spoke against it! He talks about how great it's working in Alden NY. I don't know what's in the water in Alden, but here in Trumansburg we've got too many good community minded citizens to be bamboozled with this scheme. Maybe Alden is a hotbed of Libertarianism. Maybe you should run for a spot on the board!

I asked Chris for the text of his speech which would have saved me some typing. He said no. I would have posted the whole thing. Odd.

0-14-40 Norm Hummel begins his excellent talk. "Some volunteers, myself included, have a real problem with government receiving revenue from my charity" good point, I never thought about it that way.

0-22-30 Geri Stevenson? 5316 Pine Ridge Rd. 100% in favor of billing. "But I had no idea that the volunteers would feel that their charity was having a price tag put on it" but she wants to bill the insurance companies "as long as our residents who do not have insurance are not really going to be penalized is definitely the way to go"

See what I mean? She fell for the "non aggressive collection" trick. She doesn't sound like the type that would want her neighbor to refuse care for fear of a bill and suffer dire consequences, but she fell for the trick.

0-24-48 Rene Carver 12 Salo Dr. Says by not billing we are subsidizing the insurance companies who are anticipating that they will be billed. Why would they waste time anticipating if they might get billed. They've got mountains of real world data. They know how much they are being billed. All they have to do is add profit, and collect the premiums.

"If, in fact there is a way to ensure that it is very, very, clear to those people (uninsured) that there is a way to have that bill taken care of, short of them writing a check, that would make me feel so much more comfortable. The last thing in the world that I would want to see, is if anyone is in a situation, for whatever reason, that they feel like they can not place that call, I have to wait for it to get worse, before I place that call, that's an area, that I don't want somebody to risk injury or further damage to themselves, or their family"

See what I mean. Another good hearted sucker. Chris Thomas has no intention to make it "very, very clear" that they don't have to pay. In fact, he thinks they should pay. He just said so.

0-27-40 Allen Carstensen 23 Strowbridge St. (that's me!) hey, I've got that right here on my computer. I'll just paste it in,

Health care in the United States is a right not a privilege. Progressives ever since Harry Truman have been trying to pass legislation to build a universal health care system. We find inspiration for the struggle in the preamble to the Constitution.

We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty for ourselves and posterity, do ordain and establish this Constitution for the United States of America.

“promote the general welfare” That's the key. Progressives in every industrialized country in the world except ours, have succeeded in building universal health care systems, to promote their general welfare, and they spend less and get better results than we do. National Polls show that a strong majority of us want it. Our excellent Ambulance service, staffed largely by dedicated volunteers, and paid for by us, is a critical part of our health care system. We democratically decided to form this service and fund it through our taxes. The way our ambulance service is funded makes it a single payer, universal health care service. Our entire system should be funded this way, and yet some in our local government want to go 180 degrees in the opposite direction.

About 1500 residents of our the Fire District served by our ambulance, have no health insurance. Perhaps that many again, are underinsured. If you are lucky enough to have good health insurance, think about your neighbors. Some of them aren’t as lucky. One of them is very likely to need ambulatory care one day soon, and say to themselves, maybe it’s nothing, I’ll be all right, I can’t afford to call the ambulance, and they will suffer dire consequences. How can we rationalize that?

This is all about community, and that we are here to help one another. We need to be able to look at the world through the eyes of our neighbors, especially those less fortunate than us. We are not a lose collection of rugged libertarian individualists. We are a community, and we are obligated to help one another. That is what motivates volunteers to join the Fire Company, and the ambulance corps. If we corrupt the system by entering into a relationship with the multibillion dollar health insurance industry, we will see a rapid decline in volunteerism. We will be shooting ourselves in the foot.

got it in just under the gun!

0-31-06 Bob Howarth, Reynolds Rd. -Ulysses - strongly opposed to billing. The Trumansburg ambulance people saved his life! He doesn't mind paying taxes for it!

0-32-32 Randy Haas 303 Pennsylvania volunteer fire and ems service. Strongly opposed to billing. This is the only mention of privatization - I think he is absolutely correct as I have written in my first post on this blog. He draws an eerie parallel between Alden NY and WWII Germany.

0-36-42 Ron McLean, 3 Whig St.- former member of the Fire Department. Strongly opposed to billing. Reccomends forming a working committee of equal parts from Fire Dept, EMS, Village Board, and the community. Damn good idea.

0-39-30 - Mariane Archangeli - Lake St. Seconds Ron McLeans idea. Strongly opposed to billing.

0-41-45 Michelle Paollilo, Lake St. - Member of Fire Department since 1999 EMT since 2002. Strongly opposed to billing. "We are providing this service as a public good"

0-45-36 Geoffrey Hart, 31 Halsey St. - supporter of billing, naturally. Speaks of how wonderful volunteerism is but that it must function within a corporate structure. WTF? This user fee that we are talking about is a way to assist in maintaining high quality. Wait a minute Jeff, how come, with increasing privatization of health care over the last 30 years, we have fallen from near the top of the World Health Organization's list of countries in order of quality of health care, to number 39? "I fear than in 10 - 15 years from now if we do not introduce a user fee, we will be entirely what some people call privatized --- we'll have to hire Bangs or some other corporation to provide the entire service." Hey Jeff, this plan is a giant step towards privatization, not a way to avoid it! That's the plan! You know that don't you? This scheme "will allow this great quality of volunteerism to survive into the forseeable future ---- the contribution of the volunteers is valued greatly and it will not be diminished (ignore what all the volunteers are saying tonight!)--- volunteers stand out like lights in the darkness (he stole that from George HW Bush)

0-49-54 Justine Kolb, 49 Congress St. - (Chris Thomas's significant other) "I would have loved socialized medicine, I think it would be wonderful, it would be utopia to have that in our country, but we don't have it" (so let's privatize?) "I love the fact, that I live in a Village where they are considering the people that don't have insurance" (yet she ignores the testimony of many of the volunteers that point out the harm that will likely befall them) "And I want to ask you (the volunteers) would you please stay, and give us that dedicated care, because I would much rather have you come to my house, than someone I don't know" (because I desperately need to see my $25/year cost shifted to other budgets, and I know that you are all speaking about how much you detest this change, but it'll be ok, trust me)

0-52-29 Robert Lodder, 12 Prospect St. - against billing. Spoke about the two incidents when the Trumansburg ambulance delivered needed assistance to his family.

0-56-55 Deloris Higareda, Bradley St. - wanted clarification on the cost of the ambulance per Village resident. I've written about this at the top of this post. " It's important to make it very clear to people that they will not have to pay, if they don't have the insurance, the money, whatever, I think that's extremely important" Again it is not part of the plan to make this very clear.

1-02-09 Pete Meskill (Sheriff) Seneca Rd East) strongly opposed to billing. He reiterates that volunteers will walk away.

1-06-52 Patricia Bonzall , 339 Pennsylvania Ave. - "everybody today is in a me syndrome" good point. At one point in "Sicko" Michael Moore turns to the camera and asks are we a part of a me society or a we society? Those of us afflicted with the me syndrome are more concerned with how are tax dollars are spent, than the well being of our neighbors. "It's for the people, by the people, let's keep it that way"

1-10-53 Barnie Bines?, 47 Cayuga - Hadn't decided before the meeting. "I'm coming down on the side of the community now, I would like to keep the system the way it is now"

1-12-42 Jim Mason, Larchmont Dr, - volunteer fire fighter. He was involved in the inception of the ambulance service. Strongly opposed to billing.

1-17-21 Ben Curtis - Cayuga St - supporter of privatization. "I was particularly impressed with Mr. Harts comments" "I want to remind people that there are people in our community that have a hard time paying for property tax" Yes but taxes are the price of admittance to a civilized society. We can't avoid them unless we want to live by ourselves on an island. Remember his party platform "Privatization Plank: Support an aggressive program, of privatizing government functions wherever and whenever possible."

1-20-56 Jackie Wright, Searsburg - Ambulance volunteer - strongly opposed to billing - she points out that when we bill Medicaid or Medicare, it will come right back to us in the form of higher taxes that support those government programs. "who came to you complaining about their EMS taxes, or Fire taxes, did anybody in this room, raise your hand, complain about your taxes. There's two people out of 100, that are complaining about this service" (Libertarians) Jackie tells of a call where an elderly woman had fallen. She wouldn't let them touch her, for fear of a bill. She said she would lay there on the floor until her son could get there in two hours. Jackie was able to convince her that there would be no bill. How the hell can we consider taking away Jackie's ability to persuade her to accept the help? Are we nuts?

1-24-45 Didn't catch the name - Searsburg Rd. "I'd like to rebut a couple of points made tonight - National Health Care - that could be 30,40,50 years the way Washington and Albany run" wrong - it'll be never with an attitude like that. He doesn't like taxes, and he doesn't think any volunteers will leave. hmmm....

1-27-41 Didn't catch the name Swamp College Rd. "our fire protection tax was 99 cents per thousand" good deal!

1-28-53 Deloris Something Ulysses - strongly opposed to billing, she had to use the service several times this year. They saved her fathers life twice!

1-30-40 Blair OBrien - ??

1-32-00 Tammy Ward 2380 W. Seneca - volunteer - strongly opposed - she has had to beg people to accept her help for fear of a bill. She said that it's illegal to tell someone they won't have to pay, once you go billing! Did you catch that? it's illegal to tell someone they won't have to pay, once you go billing! It sounds like the volunteers have been told - it's illegal to tell someone they won't have to pay, once you go billing! Can we put to rest this "non aggressive collections" argument? When someone is in crisis, and they ask, "will there be a bill?" The ambulance personnel are not allowed to tell them that they won't have to pay! "I had to beg my own mother to take an ambulance ride, because she was afraid she was going to have to pay, and I know a lot of you people here don't want that to be your family member, that we can't beg to go, that we can't help, because they're afraid they're going to end up with a bill, because they are so honorable, that they will pay that to deprive themselves of basic needs."

1-35-16 Charles Heath, Iradell Rd - career firefighter with the City of Ithaca and volunteer with Trumansburg Fire Dept. "I'm not in favor of billing at this time"

1-36-59 Ruth Kahn - Rt 228 Her husband (deceased) was a long time member of the Fire Dept. It starts pouring outside, you can hardly hear Ruth, and she's kind of rambling, but I know Ruth as a member of Back To Democracy, and I know she would be opposed to billing.

Meeting Adjourned,

By my count there were 7 people who spoke in favor of billing, and 18 who spoke up against it. Of the 18 who spoke against billing, 9 are current or past members of the Fire Dept. and/or Ambulance Corps. No volunteers spoke in favor of billing. One would think that this would be the final nail in the coffin, and that they would drop the billing plan, but our local government has surprised me before. WD5 appeared dead several times, but keeps rising from the dead. The Village held a special informational meeting on WD5 and passed a resolution , more or less in support of it, after the majority in the room spoke against it. The moral of the story is to be involved, and keep an eye on them. I am lobbying the Town Board to pass a resolution against billing, since they provide 65% of the funds for the Fire Department, Ambulance/EMS.

Norman Hummel's Letter

2008-06-17T16:23:00.000-07:00

Norman Hummel is an active paramedic in the Trumansburg ambulance corps. He has written an important piece that everybody should read. It was published today in the Ithaca Journal and you can find it at the Trumansburg Free Press Blog - http://flakes1.wordpress.com/

Don't forget - the public hearing is tomorrow 6/18, Wednesday evening at the Trumansburg Elementary School Auditorium at 7pm.

Stop Privatization

2008-05-30T14:35:00.000-07:00

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.