As the so-called fiscal cliff looms, the left and the right in Congress are deciding whether to cut public services or raise taxes. Some politicians are completely against new taxes, entitlements and universal health care, arguing they lead to big government.
Fewer tax dollars coming in and greater debt owed to China means the federal budget needs deeper cuts — it's that simple. That means even with the recent move in the Senate to protect FIRE and SAFER grants and the U.S. Fire Administration, a government agency must prove its worth and create revenue to survive the new economic epoch. In addition, any program that expands the government into the private sector — like the fire services' move into EMS — must justify its actions.
So, is fire-based EMS more big government? Is it right for the fire service to expand into these services?
To those who oppose big government, fire-based EMS grows — rather than limits — the size of government and oversteps into the private sector. Indeed, private ambulance companies should bear the burden of service and cost-and-recovery in a free market, not the government.
Of course, there are plenty of chiefs out there who can make the business case for integrating fire departments into the healthcare delivery system. For example, the fire service already has the trained personnel, apparatus, relationships with hospitals, and strategically located fire stations to serve communities, Mike Metro, deputy chief of the Los Angeles County Fire Department, said during a recent interview.
Metro — who also sits on the International Association of Fire Chiefs' EMS Section's executive board — envisions a future fire/medical service that chooses the pathways to care. This means being allowed to analyze a patient's need, determine the severity and then recommend a course of care — whether it is a follow up with the doctor the next day or an ambulance transport to the emergency room. This will improve care and reduce national healthcare costs — with fewer expensive emergency-rooms visits and ambulance rides, he said.
To expand, the fire service has to face those who are dead-set against the expansion of government services. Chiefs need to prove fire/EMS' worth to taxpayers as if they were pitching a business plan to Silicon Valley venture capitalists — with data, charts, graphs and expertise. Indeed, private-ambulance companies are pitching their business plans and, most probably, already have the attention of those with free market, anti-big government philosophies.
Metro understands the competition the fire service faces in the private market (something the industry quietly has named "The Ambulance Wars") and the importance of making a case for EMS.
"The fire service is facing competitors to our fire suppression and EMS deliveries," he said. "It is coming to the point where the fire department has to prove it is the best option for public safety."
It's fair in the current economic times to expect public safety to consider the bottom line and compete in order to stay afloat. The fire service needs to be run like a business, in essence, and create revenue streams. But then again, is that truly the role of the government or is it, constitutionally, the role of the private sector? That's for you to decide.
What do you think? Tell us in the comment box below.