Chris Thomas's 12/14/09 Resolution

(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

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

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

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

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

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

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)