Great Expectations – EMS Service and Cost
12 Friday Sep 2014
Written by parry034 in Parry Sound, Reflections
This post follows up discussions at recent meetings of Parry Sound Council concerning emergency medical services (EMS), basically ambulance services, in West Parry Sound District, with a focus on the north eastern portion of the district. The most recent meeting was held August 26th and is well covered in a pair of articles that can be found in the online edition of the North Star. Here are the links: Article 1 Article 2
It’s an interesting challenge for Parry Sound Council. They essentially are stewards reviewing and approving EMS deployment in the West Parry Sound District, stretching from Georgian Bay on the west to Highway 11 on the east. They are supported by an EMS advisory committee, but ultimately it’s Parry Sound Council that needs to make the decisions. For the most part the decisions aren’t too hard – new ambulance purchases, new stretchers and overall budget approval. This time, it’s not so easy. The challenge is the redeployment of personnel or approval for an increase in personnel and equipment on the order of $600,000 annually. These are costs that would be shared by all West Parry Sound municipalities.
The current status of the situation is that Parry Sound Council has requested a study be done on the EMS servicing levels of the district. The report with recommendations is expected in a few months. In the interim certain temporary arrangements are being implemented.
I have no suggestions on how the matter could or should be handled. But I do have a few questions on the more general concept of what level of services can and should be provided to all residents of the West Parry Sound District and where the funding might come from. It seems to be a case of Great Expectations.
What services can you reasonably expect when living in a town or city? What if you live out in the country far from the nearest urban centre? Can you expect fire protection that arrives in a few minutes in both situations? What about water and sewer? Should you expect a shopping centre just minutes away? Public transportation? School bus service? The list goes on.
There are many small satisfactions that come with living out in the country, away from the hustle, the bustle and the rat race. Not only are you offered a more private situation you generally are able to buy property at a lower cost and pay lower taxes. In some unincorporated municipalities its possible you pay no property taxes or have any type of by-law constraints on what you can do with your property, or on your property.
So what services should you reasonably expect to receive? In theory and in practice you should be able to receive all ‘critical’ services that can be delivered ‘on demand’ and don’t require extensive infrastructure investments like sewers. These services would include core services like fire and police protection, schools, and emergency medical care. Given the significant capital costs it would not be reasonable to expect non-critical services like municipal water and sewers, or public transportation.
There is a general truism that you can expect to be satisfied in any two of three variables in a ‘transaction’: price, quality and timeliness. That means if you get a great price on a product or service and it is delivered in a timely manner you may not reasonably expect to get great quality. If however you get a good price and great quality you should reasonably be willing to wait longer than you would like. If you get all three, that’s remarkable and defines excellent service, exactly what sets some companies above others. If you get only one, let’s say timely delivery but the price is high and the quality is lacking, you will feel taken advantage of.
How does this apply to certain public services like EMS, fire protection, and road maintenance (winter and summer)? How do these three parameters, price, quality and timeliness, apply to services in town and in the country? How should they apply? It seems that there are certain trade-offs that come with living in either the country or a town that go beyond these three simple factors. We want all of the services provided with quality and in a timely fashion but we would prefer not to pay the full cost. But are we willing to accept poor quality services that arrives in a timely manner and aren’t too expensive? Or would we prefer good quality and low cost with slow or delayed delivery? Think about this in the context of EMS services.
I live in Parry Sound and enjoy high speed internet, responsive fire, police and EMS service, and a choice of grocery stores nearby. But this comes with the downside of traffic in the summer, neighbours on all sides, trains and their noise/pollution and threat of derailment running behind my backyard, certain by-law restrictions, and of course higher taxes for what many people believe is over-priced real estate.
In outlying areas it’s often the exact reverse, lower costs but fewer services the further you get away from an urban centre.
So back to EMS services. What level of services should be provided to those who decide to live in the ‘country’? What is an acceptable response time? What is an acceptable cost, and who should pay for it?
The first instinct is to provide timely first-rate health and safety services, including EMS, to everyone regardless of location. So if I have a fly-in home in northern Ontario should I expect timely EMS, fire and police service? What about a cottage at the end of 40 kilometer unpaved road? Where does one set the line for what is reasonable and what isn’t? What costs are reasonable? Who should pay for these services?
(As an aside, it’s like the current delivery of Ontario health care. The price is right (it’s free to the user but not the taxpayer) and the quality is really world-class, but you often have to wait longer than you would like. Want to trade it for the US system; world-class quality, pretty much immediate service but costs that not many of us could afford?)
In the case of the EMS situation facing Parry Sound Council the costs are pretty well understood – about $600,000 or so per year to provide additional dedicated services to the Argyle area if the same level of service/staffing is maintained in South River. The cost would be spread over all of the district’s municipalities with the largest hit being to Seguin Township, Carling Township and the Town of Parry Sound. Seguin has already gone on record as rejecting any change in EMS services that would increase their costs.
Parry Sound Council is hoping that the new report and recommendations will provide a solution that solves the issue of cost and service level. I believe that it will be disappointed, there is no easy solution. It’s limiting services or increasing taxes. Hopefully the report perhaps will suggest a course of action that provides an ‘acceptable’ level of service at a not too much higher cost.
Back to the issue of great expectations. The Smart Community is a similar attempt to satisfy expectations, in this case at the expense of others. As I have previously noted, the Smart Community is an initiative to ‘wire’ all of the district municipalities with high speed internet (Parry Sound is already wired). The current cost estimate for this service is on the order of $40 million to be funded federally, provincially and private enterprise. Is this a reasonable expectation? Who should be responsible for the cost? Should there be compromises when living ‘in the country’? The Smart Community can be a reality if the municipalities want to take on the cost themselves. If it’s that important a forty year bond does not seem to be that onerous especially if today’s lower interest rates could be locked in. But it’s better of course to have someone else cover that cost.
What’s more important, EMS service or high speed internet? It’s not an either/or situation but it does beg the question of what services are we as a public expected to provide for people who make a choice to ‘get off the grid’ in search of a simpler lifestyle, a closer connection to nature, or lower costs? What are the minimal services we expect everyone to have access to? Health services? Schooling? Clean air and water? Police protection? Cheap electricity? High speed internet?
A final thought – what should our expectations be with regard to policing costs? With the recent change in OPP pricing for municipalities Parry Sound will see a cut of about half in its $600 or so per residence charge, to about $300. Surrounding municipalities will see a doubling of cost from about $100 per residence to $200. The surrounding municipalities think this is unfair. But is it? Is Parry Sound really so ‘lawless’ that it deserves to be charged six-times the rate charged Seguin or Carling? Is it only Parry Sound residents who get stopped in Ride-Check programs? Pretty much all of Parry Sound could be ‘patrolled’ in less than an hour by the OPP in a single vehicle. It would take that long just to get out to and return from Seguin, Carling or McKellar. The expectation of the surrounding communities is that costs should be allocated as they always have, even if they never really were ‘fair’.
We all have expectations of others, our governments and ourselves. These expectations all come at a price. Parry Sound Council has the unenviable task of making the decisions for the whole district when it comes to emergency medical services. Better service at a higher cost, ‘uneven’ service at the same cost, or…? I’m not sure this is what they signed on for and I wish them good luck.
Even Greater Expectations? (Parry Sound in Black & White)
No comments
September 15, 2014 at 1:21 pm
why don’t we just round up all those rich free-loaders in the country and shoot them? Then we wouldn’t have to provide any EMS service for them at all! Just think of the savings!
September 16, 2014 at 7:19 am
Ryan:
I know you are being facetious, but do you have any ‘practical’ ideas? What are our responsibilities as a society to rescue individuals, at the public’s cost, who decide to go climb a mountain, find themselves ‘stuck’ and require helicopter rescue? If you or I decide to head out of country for a trip we had better take medical insurance because we will be covered only to a very small extent by our provincial health plan. Should it be the same for ‘adventurers’ who want to go for the big ‘thrill’. The same kind of logic extends to general EMS service. How much and how quickly? Where does personal responsibility start and end? Where does public responsibility start and end?
It’s a tough call that Parry Sound Council needs to make. It would be easier if it were the Argyle municipalities who were making the decision and then responsible for picking up the costs – but it’s not.
September 16, 2014 at 1:58 pm
what makes you so sure I am joking? I can think of a few people out here that need shooting!
But you are right about one thing: I do have a practical idea, the most practical of the ideas: just pay it. full level emergency service, and we just pay it.
Not that I think that’s the practical solution you are looking for, but see, I don’t offer it as a practical solution, I don’t offer it as any solution at all; that’s because I don’t see there being a problem that needs a solution. It’s only a problem from one perspective.
Your perspective is revealed by your comments. It’s a perspective you’ve shown before, and I’ve criticized it before. Your perspective comes from your starting point, and your starting point is your idea of who it is that lives out here in the provinces (as they derisively referred to the outer regions of Rome) and why they live here. You seem to assume that it is primarily the rich and well off who move out here, and they do it so that they can get a better beach access and a bigger boathouse all while lowering their tax bill. It’s the rich-playboy-provincial, in your theory, that’s the populace out here. How else, except for such an assumption, could your mind consider moving out here to be comparable with going on an exotic mountain climbing trip?
And, lest you think I’m criticizing you too harshly, it’s probably understandable that you’d have that starting point. You’ve alluded before to your previous aspirational address at one of the big ivies. Aside from a very small number of impoverished merit scholars of which it is statistically unlikely you were a member, that level of matriculation usually only comes to those raised in privilege. Just the yearly tuition alone is several times what most students will pay for their entire degree. Assuming you came from privilege, it’s therefore likely that you have sustained it – as that too is the statistical norm. And if it’s safe to assume that you are currently part of the privileged class, we can then assume two more trends that have been proven common amongst that class: first, that you yourself don’t consider yourself to be part of that class (“what, me? I don’t even have a good private plane, just an old learjet!”) and second that your primary peer group is within your own socioeconomic class (how else could you have previously posted, against all published data, that the middle class really isn’t so poor off these days? Of course you’d think that: most of the people you likely know are doing fine). What that means is that the majority of people you likely know who have moved to the provinces probably do in fact fit the model of the rich-provincial playboy: they really did move out here to get a bigger boat house and lower (even further!) their tax liability. And finally, since most humans, the maxim to the contrary, do think that the plural of anecdote is data and you are, I assume, a human, the end result is that it would only be natural for you to think it a sound conclusion that most the people who moved out here fit your starting point perception. Now, ofcourse, I could be completely mischaracterising you. It’s possible you’re the exception to one of those rules and so my entire chain of logic there collapses at some point. Possible, but not the most probable.
Now, to be theoretical for a minute, if I started at your starting point, then yes, the exotic mountain climbing or ski trip would be a good comparison to moving out here, and you would then have a good question about a good problem: to what extent should society foot the increased bill for their indulgence? And that’s a great discussion to have about things for which that starting point is valid.
But in this case, it’s not.
Come over to the other side of the tracks, and you see a different populace in the provinces. You see a different motivation for moving here. You see people who have done so out of economic necessity. People who could not have afforded a home inside the town of parry sound. People who could not have afforded the tax bill. We move out here because it’s the only thing within budget, and then you wake up every morning hoping there is not a pool of septic on your lawn or e coli coming out your tap, because not only do you not have the $15k for a new well or the $20k for a new septic bed, you couldn’t even get approved for a credit card for that much! You see people who hope that next year the income tax refund might be enough to afford some more vinyl siding, and then in the mean time you endure redneck jokes about the typar housewrap still showing on your place. That old car isn’t sitting out front because you think broken cars are great decorations: it’s sitting there because you don’t yet have the money to fix it. These are the people who make up the majority of the residents out here. They didn’t choose to skip out on their parry sound tax obligations, they moved out here because that was the only choice open to them. Economic necessity, as you know, mitigates the factor of choice.
Now, you don’t have to be a 1-percenter to know that the well-off have a long history of letting the poor eat cake. And fine, if you want to deny us fast internet because we’re too grubby to live within town limits, I guess we can deal with that. But this is more than highspeed access. Healthcare is an entitlement in Canada. And we all know that the difference between a successful medical response and a failure can often be measured in minutes. And by failure, of course, I mean death. So when you say “let’s give the provincials a longer response time” what you’re really saying is “let’s give them a higher chance of dying” and it’s hard not to hear that as “those grubbers are too poor to live anyway.” So is that really what we provincials deserve? If so, then, as I said, you might as well just shoot us and speed the process up.
But of course, that’s not what you’re thinking. You might ask valid questions about whether the playboy mountain climber can expect full medical service, but you would never, I am sure, dream of denying standard medical care to a regular citizen just trying to live their lives. And that’s why, as I said at the start, there really is no problem here, because there really is no question. There’s no question about providing standard care. It’s simply unfathomable to let people be sick or die simply because they were too poor to live within the preferred area. Not since medieval times with the walled city would we act that way, and I don’t think you or anyone would propose that today. So since there’s no option but just to pay it, then there’s really no question about it. Just that one answer: pay it.
September 17, 2014 at 11:31 am
Hmmm!
I’ll work my way from back to front on your comment.
The individual(s) who decides to take risks, be it climbing a mountain, taking their family for a round the world sailboat adventure, the drunk driver, the sky diver, the amateur pilot who doesn’t maintain their plane, are not necessarily wealthy – they are just risk takers who often don’t think about anything or anyone beyond themselves.
Back to the EMS issue. I live in Parry Sound and can reasonably expect an EMS response in 5 minutes or less. That’s pretty remarkable, but should it be the benchmark? What’s a reasonable time to expect/demand EMS arrival? I was speaking to someone who cottages on an island. They realized that they could not expect any type of rapid EMS, fire or police response. That was a risk they were willing to take for living (seasonally) out on Georgian Bay, but less so as they get older and the level of risk rises.
It’s about expectations, what individuals come to expect and what we as a society lead people to expect. In the case of EMS services in the District the expectations are really not well established. That’s why council approved spending $50K to look at the situation. Everyone would like to have 5 minute service, but what do they reasonably expect? I see people dealing with health issues that are not life threatening situations and they expect they should not have to wait a month for an appointment. But the system says that one month, or more, is a reasonable expectation. Is it? Should we just pay more to have quicker service? There may well standard expectations for EMS service – I guess that will be part of the report expected in December. We know that Seguin Council’s opinion is that the current standard of service, at the current costs to the municipalities, is acceptable and meets expectations.
I’m reasonably familiar with the challenges that families face, from financial challenges, to health challenges, to mental illness challenges, to drug abuse challenges, to ….. Life’s a bitch and then you die. It comes back to the issue of expectations. What can you, should you, reasonably expect if you are born in Ontario in the 1950’s through the 2000’s? What if you were born in the Sudan? What if you were born in the Netherlands? Many people in challenged parts of the world would willingly trade places with any Ontario resident, regardless of their situation. It’s all about expectations and who is responsible for meeting those expectations.
Concerning your insights to my perspective and my background. Two thoughts. Don’t try and make a living with fortune telling, and there is a difference in my opinion between privilege and good fortune.
Does spending grades 2 through 5 in a one room schoolhouse with seven other grades and a single teacher (then 2 grades per class) constitute privilege or the good fortune to see the real world at a young age? Does sitting on a school bus for 2 to 3 hours every day of public high school (5 years) constitute privilege or good fortune? Is living close enough to a city with a university that allowed one to live at home, stay out of trouble, and save money, privilege or good fortune? Does doing well enough in university to get a scholarship to grad school constitute privilege or good fortune? Does having parents who never took on debt constitute privilege or good fortune? Does having parents who never took family vacations because they worked 52 x 7 x 12 constitute privilege or good fortune? Nothing is really good or bad, it’s what you make of it.
I certainly have been the beneficiary of good fortune, and good health. But privilege? That might be a stretch.
Concerning the issue of how well off we are as a society, I will concede that there is a much greater wealth spread than in the past. But even the most challenged are well ahead of where we were as a society decades ago. My wife told me about her grandmother, who was married with seven children and a husband who worked for the railways as a conductor. The challenges they faced were so severe that her grandmother and the eldest daughter shared a single pair of shoes. Her grandmother had to wait until her daughter returned from high school with the one pair of shoes so she could walk downtown to shop. And that was a family with a full time wage earner.
My parents both grew up in Europe and experienced the Great Depression, the great inflation, and World War II first hand. After immigrating to Canada they had much higher expectations of themselves than they had of what society should provide them.
It’s all about expectations isn’t it?
An aside: my first real job out of grad school was as a salesman. The national sales manager decided to take me out on my first day to ‘show me the ropes’. It was the Hamilton area and we drove around discussing the various customers and who was an alcoholic and who wasn’t. He made one quip that I still remember decades later: “Don’t assume, you make an ass out of u and me.” I hadn’t yet heard it, and it made an impression. So I am careful when I try to infer people’s motives. Better to deal with their actions.
September 17, 2014 at 6:03 pm
I could probably make more as a fortune teller. But what I hear you saying here is “what, me privileged?”
And I think there’s two possibilities there.
Either #1, you’re simply confirming one of the things I wrote, which was “we can then assume two more trends that have been proven common amongst that class: first, that you yourself don’t consider yourself to be part of that class”
or, #2, you’re confirming one of the other things I wrote, which was “Now, ofcourse, I could be completely mischaracterising you. It’s possible you’re the exception to one of those rules and so my entire chain of logic there collapses at some point. Possible, but not the most probable. ”
And if that’s the case – that you actually are the rare exception who rose from rags to the vaulted steps of the ivy league – then fine; after all, someone has to win the lottery. But that doesn’t change the fact that it was still, a priori, the most unlikely of the possibilities, and hence assuming the contrary was still the most rational thing for me to do.
But all of that is moot anyway, because I agree with your final point completely: ” So I am careful when I try to infer people’s motives. Better to deal with their actions.”
I agree.
And your actions here, in this post and in others, is to argue that the poorer segment of the population should be deprived of certain entitlements enjoyed by those privileged enough to be able to afford to live at a better address. You don’t have to realise or identify that you’re espousing text book elitism in order for it to be that all the same.