The Fire Department: A Public Option
Acton Fire Station (cc photo by stevechapman)
Tina Dupuy had a nice item in the Huffington Post yesterday noting that urban firefighting in the United States was once a private for-profit industry. Then around the middle of the nineteenth century, cities began to decide that this system was too haphazard, corruption-prone, and unfair and thus began the dread big-government takeover of firefighting:
Yet if we had to have the “conversation” about the firefighting industry today, we’d have socialism-phobic South Carolina Sen. Jim DeMint on the TV every chance he could get saying things like, “Do you want a government bureaucrat between you and the safety of your home?”
Rep. John Boehner of Ohio would hold press conferences and ask, “Do you want your firefighting to be like going to the DMV? Do you want Uncle Sam to come breaking down your door every time some Washington fat cat says there’s a fire?”
It’s a good point. Anyone who’s honest about it is ultimately going to have to admit that direct public-sector provision of services is something that can be done in a quite high-quality way. Obviously, low-quality service is also possible. The fact of the matter regarding the DMV is that even though people find DMV lines important, people also just don’t care about it very much. No lifelong Democrat has ever crossed party lines to vote for a Republican gubernatorial candidates because he’s fed up with the low-quality of the DMV and excited about injecting some new blood into the stodgy motor vehicles bureaucracy.
By contrast, people do care about crime and Rudy Giuliani was able to get elected in super-Democratic New York City. Any mayor with a lick of sense at least attempts to provide a crime control agency that performs well. I think the evidence from the UK is that NHS quality is a constant subject of political debate and politicians are forever attempting to achieve better performance. This, I take it, is the reason why the NHS is so successful at delivering cost-effective treatment outcomes. A very low budget by world standards is why its outcomes don’t look great in absolute terms.
Meanwhile, in the United States it is worth keeping in mind that public provision of health care services isn’t on the table. And we don’t need to guess what public provision of health insurance might look like; Medicare is a very large and not-at-all obscure government program. It’s not perfect, I’m not even sure I’d say it’s great, but it measures up quite well in terms of both cost and quality relative to the private sector.
44 Responses to “The Fire Department: A Public Option”
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July 31st, 2009 at 8:36 am
In my state, and a lot of others, the DMV is run by an elected official, the Secretary of state. Lines at the DMV are, or would be, a major issue in the elecction for that office.
July 31st, 2009 at 8:45 am
Recently visited both DMV & my private doctor. In and out of DMV with new picture license in 45 minutes without an appointment. Doctor kept me waiting 45 minutes after scheduled appointment and I then spent most of next hour sitting alone in exam room. All and all I spent two hours at doctor for about 15 minutes of treatment.
The private sector rocks!
July 31st, 2009 at 9:00 am
My experience at the DMV after my recent move was incredibly smooth, once I passed the test. At most an hour for the entire process, half of which was my test and paperwork. I also recently went to a public health official and was very promptly served.
My private practice doctor is good as far as they go, but I still routinely way half an hour or more for my appointment over and above my scheduled time. That’s not to say that a public health system would automatically be superior, but simply that plenty of government orgs run smoothly and when weighing the benefits of universal coverage, the debate should not always assume the inefficiency of the public sector.
July 31st, 2009 at 9:09 am
The whole DMV thing is outdated. DMV’s have been modernized with multiple ques to speed things along. And most charge counter fees to move more stuff to the mail or internet in orer to reduce wait times. Truth is right now few people have any reason to go to the DMV more than like 5 times over their entire life and so its easy to make fun of it since no one actually goes there.
Now you want a huge wait with no reason, buy a car. The dealership will slow things down to a crawl to try to upsell you on service deals, rust protection, roadside service, etc.
July 31st, 2009 at 9:10 am
Analogies are fun!
Fire departments do not deliberate about whether to put out a fire based on cost/benefit analysis, nor is there any real fire department equivalent to skimping on care because more health care will have little impact on aggregate life expectancy (I wonder how much fire protection adds to aggregate life expectancy, and whether it is ‘worth it’ by utilitarian calculations.)
Medicare may deliver high quality, but I have it on authority from the President that Medicare costs are unsustainable, so what Medicare does under the status quo is something of a red herring to this discussion.
Is there an argument anywhere that health care (apart from cases of epidemic and the like) is a public good, like crime prevention and fire protection?
July 31st, 2009 at 9:15 am
I agree that I don’t really get what the fuss is about the DMV. I mean, it’s not terribly fun to wait in line, but it’s really not so awful, and there’s plenty of private institutions where one has to wait for a long time.
July 31st, 2009 at 9:25 am
“Fire departments do not deliberate about whether to put out a fire based on cost/benefit analysis”
Oooh, sorry Aaron but that is incorrect. Fire departments have to make cost/benefit analysis on fires all the time. So try again tomorrow on “Who wants to be a Troll?”
July 31st, 2009 at 9:25 am
Back when a fire brigade would be someone one paid to put out any fire at one’s house, but was mostly paid for by fire insurance companies, and each brigade had a list of houses in a city that was theirs.
However, I don’t think that any Republicans would be against public fire departments. See this interview, the relevent part is near the beginning.
http://www.reason.com/news/show/29318.html
July 31st, 2009 at 9:28 am
The problem with the DMV (or MVA as it’s called here) is that it’s haphazard. I’ve had trips that take minutes; I’ve had others that seemingly never ended. The way I look at public health care is this: we’ll trade one set of bureaucrats who don’t care and want to say “no” (insurance company flacks) for a different set of bureaucrats who don’t care and want to say “no” (government staff).
In either case – what we have now, or what you guys want – the incentives are pretty much the same: the end consumer does not pay, and therefore has no real concern about costs (driving demand up). In the face of increased demand (and thus cost), the back end payer has no alternative other than to attempt to limit costs: rationing, long waits for procedures, etc.
In neither system – what we have now, or what you guys want, is one of of the major issues addressed: the costs imposed by ambulance chasing lawyers. The simplest and best reform we could get quickly would be a “loser pays” system. Court use isn’t free, but we treat it as if it were. Make the bringers of suits put a little skin in the game.
July 31st, 2009 at 9:39 am
7 above- would appreciate some evidence or analysis.
July 31st, 2009 at 9:44 am
James,
Actual malpractice settlements and verdicts amount to less than 1% of costs. Defensive medicine doesn’t cost much more than that. On the whole, people injured by medical mistakes are undercompensated, because most do not seek any damages at all. The cost of ambulance chasers is a myth. If there were an omniscient being doling out fair compensation for all malpractice, costs would go up, not down.
July 31st, 2009 at 9:47 am
The DMV argument is to be avoided. The Republicans will use it as a cudgel either way:
-Long lines at the DMV? Government is poor at providing services!
-Short lines and no wait at the DMV? Government is wasting money with employees sitting around doing nothing!
This is the basic dichotomy of all service jobs. The Republican argument is fraudulent and always has been. We all know why they want to privatize, and it isn’t for “efficiency”.
July 31st, 2009 at 9:53 am
Fire departments deliberate whether it is too dangerous to send firefighters into burning buildings to rescue people on just about every fire-related call they get. Sometimes, they hear the screaming, and stay outside anyway, because they know they guys would go right through the floor the moment they stepped inside.
But, yes, analogies are fun.
July 31st, 2009 at 9:57 am
First, there is the pre-fire judgement as to how many men, engines or firestations we should have, how much training there should be etc.
At the fire, they judge how many crews to bring on site to fight it. If an additional crew is of little benefit, they don’t bring it in. They make cost benefit analyses with respect to demolishing adjacent structures to contain a fire. They make judgement calls as to how much danger they will subject their personel. They make judgement calls as to when to use expensive chemical retardants – generally, even if a retardant would work better, they’ll still use water if they can. They make judgement calls as to whether they will even try to save houses from wildfires.
July 31st, 2009 at 9:59 am
At a current all-things-considered cost of somewhere in the vicinity of $1 trillion annually, the US truly “enjoys” the most efficient war-mongering imperialist tool on the entire planet, including some 865 military bases in more than forty foreign countries. In other words, we have the best of both worlds: an outfit that first starts fires and then (tries to) extinguish them — the ultimate fire department!
But spending public funds on public health at home is wastrel, smacks of socialism, of government control, of ……… ad inf.
Cut “Defense” by at least half and pay for health care and education; cut the remaining half by fifty percent and convert the industrial base thus impacted into high tech clean energy research and production facilities. Maybe then the word “defense” would assume a somewhat honorable connotation. That would be unique.
July 31st, 2009 at 10:05 am
Aaron:
Here’s a resolution from the San Francisco Fire Department to temporarily relocate an engine company due to budget cuts and redundancy. It’s based on a cost/benefit analysis of acceptable fire coverage and response times:
http://www.sfgov.org/site/firecomm_page.asp?id=107628
Total search time: 8 seconds.
To answer your other question regarding health care as a public good, you might look into the academic discipline known as “public health.”
July 31st, 2009 at 10:08 am
Njorl – the costs of malpractice suits (and the actions taken in fear of it) are as hard to quantify as the cost of the minimum wage.
What we do know is that the current system encourages frivolous suits, and causes real stupidity. I’ll give you an example:
last week I took my daughter to the allergist to get tested. She’s 15, the test was going to run 2 hours. When I was a kid, I had a test like that; my mom left me there, ran errands, and then came back.
I wasn’t allowed to do that. Now the doctor requires a parent or guardian to be present at all times – a reaction to fears that a doctor, being alone with a minor, might do something awful.
Is there a monetary cost there? Hard to quantify; I was taking a trip later that day, and the 2 hours I spent sitting in the examining room were 2 hours I didn’t spend doing something useful, like running the errands my wife wanted run before I left town.
But go ahead; keep telling yourself that the regulations (etc) that have sprung up in response to ambulance chasers are negligible. They are real, they are non-trivial, and they are highly annoying.
There is one interesting thing that will happen if we end up with a single payer system: the cognitive dissonance on the left will be very amusing to watch, when they suddenly have to start taking the legal costs in medicine seriously.
July 31st, 2009 at 10:19 am
the costs of malpractice suits (and the actions taken in fear of it) are as hard to quantify as the cost of the minimum wage.
Translation: “I can’t find any actual evidence that validates my ideology, so here’s an anecdote instead!”
Of course, most right wing “arguments” on the health care issue seem to boil down to that eventually.
July 31st, 2009 at 10:23 am
Freaky. My first thought on seeing this post was: “Hey! That looks like Acton fire station.” My second thought was: “Hey! That is Acton fire station!” I used to live in Acton, you see. Any reason you chose a photo of a random firestation in West London?
July 31st, 2009 at 10:39 am
James,
Did you ask why you had to wait there? It could easily be that doctors don’t want the hassle of dealing with a minor patient over whom they have no authority without a parent present. In all likelihood, they probably leave these test patients alone for long periods of time, and don’t trust teens. They might screw around with the supplies most doctors keep in their exam rooms, or engage in behaviours that negate the value of the test.
Even if there were some lawsuit related reason for requiring a parent to be present, you just assume it is not a good idea. Most lawsuits are for damn good reasons.
…and their costs are puny in comparisson to the problem at hand.
July 31st, 2009 at 10:50 am
I asked. It’s a Maryland State Law. When I asked how and why the law was passed, the doctor told me it was a response top legal costs. You might recall the mania that spun out in the 80’s about children at day care centers being abused, and how that ended up being a witch hunt that mostly enriched lawyers and gave attention to some people with obvious mental issues?
This is a “protection” against a non-existant problem. The liklihood of a minor being assaulted by a doctor in a crowded office is pretty small, but – because well meaning, but innumerate advocates went to work on it, it’s now a cost problem.
July 31st, 2009 at 10:58 am
Again, I’m somewhat astonished that no one seems to recall why the DMV trope was invented. It has literally nothing to do with the DMV itself. It was invented in the 1960s and 1970s as a sort of political shorthand for white resentment of the following:
a. government services explicitly being funneled away from over-providing to white populations to attempting to provide them more equally.
b. resentment that the stranglehold that lower-end white ethnics previously had over certain cushy lower-end government make-work jobs (like precisely the DMV) had (somewhat) ended.
If neither of those two factors had been at work, we’d be hearing paens sung to the efficiency of the DMV just as we heard in the 1940s and 1950s.
July 31st, 2009 at 11:07 am
I fully support the basic idea of this post. I point out though that the DMV meme is really outdated. While lines and frustration do still exist, for those situations where you have to go in person, in California it is nothing short of astonishing how smoothly interactions have become with the DMV. The online website for serving nearly every purpose is suberb — working much better than many private sector websites. Even if you have to go in, you can now make an appointment window and have only a short wait. The CA-DMV has broken the mold. The meme needs to be retired.
July 31st, 2009 at 11:29 am
James, the fact that you have to wait with your daughter at the doctor’s office has nothing to do with malpractice. That is a liability issue and it completely unrelated.
In fact, there are no frivolous malpractice suits–or rather, no frivolous malpractice suit will ever get past square one. Most states require testimony from at least two MDs to back a medical malpractice claim. The thin white line of MDs is very similar to the thin blue line of the police. Doctors really don’t like to testify against one another. Believe me, if you can get two MDs to testify that another MD committed malpractice, you can be damn sure that he did.
July 31st, 2009 at 11:55 am
The way I look at public health care is this: we’ll trade one set of bureaucrats who don’t care and want to say “no” (insurance company flacks) for a different set of bureaucrats who don’t care and want to say “no” (government staff).
One of those sets fo bureaucrats makes more money every time they say no and makes less money every time they say yes. The other set makes the same amount of money whether they say yes or no. Want to guess which is which?
July 31st, 2009 at 12:06 pm
This reminded me of the Bill Kristol meltdown on The Daily Show.
He threw out so many talking points that were never designed to be used at the same time and place that he ended up contradicting himself.
For instance, he claimed that government run health care would be “expensive” and also claimed that the medicare reimbursement schedule was too low and was therefore unfair.
Is it possible that both of these things are true?
Of course his biggest error was first claiming that government provided health care for veterans was the best possible and also expensive, but they have earned it … our troops deserve the best. The rest of us haven’t earned the right to such good health care. He then claimed that the VA wasn’t really that well run after Jon Steward pointed out that Kristol had just conceded that the federal government can provide the best possible health care.
What is interesting is how conservatives have been able to chop up the debate and only talk to a particular audience and use one talking point. Many in the media enable this limited form of argument. Jon Stewart, simply by listening and responding to what his guest was saying, forced Kristol to talk himself into a corner.
July 31st, 2009 at 12:16 pm
Good example.
In large cities firefighters retire after 20 – 25 years on the job with very generous pensions. With strategic overtime sometimes those pensions exceed their annual salaries.
Meanwhile in Bumpkinsville NC the fire department is all volunteer.
But rest assured with Healthcare we are guaranteed that the government will provide superior services at a lower cost.
July 31st, 2009 at 12:26 pm
I wasn’t allowed to do that. Now the doctor requires a parent or guardian to be present at all times – a reaction to fears that a doctor, being alone with a minor, might do something awful.
As you are probably already aware but choose to conceal, those fears result from the fact that some children *actually were* sexually abused by doctors. Does that have a financial cost? Only if they can come up with enough evidence to sue and win. But it sure as hell has a non-financial cost, whether a lawsuit is ever filed or not.
You’re counting the cost of a safety measure without counting its benefit. That’s either quite dumb (if unintentional) or dishonest (if intentional).
July 31st, 2009 at 1:01 pm
“Is there an argument anywhere that health care (apart from cases of epidemic and the like) is a public good, like crime prevention and fire protection?”
Yes, and I’ll give it to you in less than ten words. Healthy people are better at working and raising children.
July 31st, 2009 at 1:36 pm
Actually, most firefighting in the United States is privately run– by volunteers!
In addition, there is a company in the West that does private firefighting, with great customer service stories. One of their markets is Scottsdale, Arizona, and they’ve never been voted out of a market they’ve had. They also concentrate on fire prevention to a degree that public firefighting departments don’t, and they have a lower rate of fires because of this. They rank high on satisfaction surveys.
Also, Denmark sees most of its firefighting services contracted out to private vendors. They are also very happy with it.
One shouldn’t use an analogy unless they know the full story around it. The companies from the last century just didn’t have a good business model or outlook, as Denmark’s success has shown.
July 31st, 2009 at 1:47 pm
All of this gabble-gabble from the nitwits making cost arguments is just plain boring, and pointless. I look at other countries who function with single-payer and/or government-regulated health schemes and they’re doing fine on cost-containment, better than we are in fact, so don’t give me incentives and end-users driving up costs and the rest of it. Canada does fine, France does fine. End of story.
PS, a little YouTube is called for: every time I read one of these lengthy, weedy posts about the virtues of privatization, I think if this clip:
July 31st, 2009 at 1:47 pm
I searched a Maryland Law database. It wasn’t there. It isn’t anywhere in general health laws or in healthcare occupations laws. Since I know that minors may stay overnight in a hospital without a parent present, I think either you or your doctor are lying.
July 31st, 2009 at 1:47 pm
“No lifelong Democrat has ever crossed party lines to vote for a Republican gubernatorial candidates because he’s fed up with the low-quality of the DMV and excited about injecting some new blood into the stodgy motor vehicles bureaucracy.”
Fiorello LaGuardia?
July 31st, 2009 at 2:04 pm
Tomemos 29: “In economics, a public good is a good that is non-rivaled and non-excludable. This means, respectively, that consumption of the good by one individual does not reduce availability of the good for consumption by others; and that no one can be effectively excluded from using the good.”
Not everything that provides indirect benefits to non-users is a public good; nor is the primary justification for the existence of health care the fact that it causes more productive work to be done (else why would we let retirees and the relatively unproductive get health care?)
Stefan 25: The whole point of bureaucracy is that people follow rules; they don’t get to just fiendishly decide what to do. It is true that insurance companies have the incentive to deny coverage to keep costs down; but the gov’t also has budget constraints, and our President claims that gov’t will be better at denying care than the status quo.
Toady 16: I wrote “fire stations do not deliberate about whether to put out a fire based on cost benefit analysis.” That they do other things based on cost-benefit analysis is interesting, but 7 claimed that I was incorrect, which isn’t true. While it is true that a fire station is not right next to every piece of property and so some people get better service than others, the department responds to every fire by putting it out as quickly and thoroughly as it can. People really don’t have substantially different interests on the matter.
Regarding public health, it’d be good if you could give me the actual argument so that I might evaluate it.
13 Not quite sure how this is supposed to impact the argument, but I’m sure it’s true that if it means near-certain death the fireman won’t run in. Instead, he’ll stay outside and put out the fire as quickly as he can, which is really the core function of a fireman. This doesn’t really raise interpersonal utility comparison problems the way third-party health care does.
July 31st, 2009 at 2:06 pm
Sorry for the bad html, I’ll try to do better next time. Still functional, though.
July 31st, 2009 at 4:06 pm
Who do you think you are, Matt Yglesias, being all reasonable and logical and stuff?
July 31st, 2009 at 5:34 pm
Dear Matt:
Good post. Therefore, by this logic, you must be outraged by Judge Nicholas Garaufis’s decision last week requiring that the Fire Department of New York, which protects your loved ones from flaming death, lower its hiring standards.
I expect to see your post complaining about this legal decision soon.
July 31st, 2009 at 6:15 pm
“Anyone who’s honest about it is ultimately going to have to admit that direct public-sector provision of services is something that can be done in a quite high-quality way.”
So you’re basically admitting that your argument is useless.
Because one thing opponents of health reform are not is honest. (See Boehner, Demint, blue dogs, etc.)
July 31st, 2009 at 7:18 pm
“Actually, most firefighting in the United States is privately run– by volunteers!”
There’s nothing “private” about volunteer fire departments. They’re public or quasi-public authorities, primarily funded by taxes and government grants, supplemented with voluntary donations.
For example, my current home of Moscow, Idaho (pop. 20,000) has a volunteer fire department. It relies on nearly a million dollars a year in city operational funding, plus the city provides the fire trucks and finances the construction and maintenance of the station facilities.
A volunteer fire department works well in smaller towns because of the infrequency of aid calls. That said, many “volunteer” fire departments are increasingly hiring at least some full-time professional firefighters, particularly as the volume of medical aid responses increases. A VFD, obviously, does not work in a city of any major size. Nor do they work at all without government funding.
August 1st, 2009 at 2:20 am
[...] We still haven’t worked out just how exceptional we are, and Matthew Yglesias points out the obvious: [...]
August 1st, 2009 at 9:34 am
[...] The Fire Department: A Public Option – Matt Yglesias [...]
August 1st, 2009 at 7:39 pm
People talking up private industry have obviously never worked in a large corporation.
August 1st, 2009 at 11:44 pm
Damn, I lost a long and very pithy commentary on this subject, which is near an dear to my heart, but here is the Readers Digest version: LibertarianGirl – do your research, Scottsdale is a bad example as they are a municipal department now (that happened in 2006 or 2007, I think) and Rural Metro is primarily a EMS provider now. If you only considered land area, you might be right, but population base, the numbers are vastly different. And Aaron, there are vast differences in the type of services that people need from the fire department – even among individuals, the needs of a person with a 500 sq ft house are very different from someone with a 5000 sq ft house, much less those who live in apartments or industrial companies with hazardous materials or other hazards.
The analogy is very apt – I have thought this for years but I never developed the analogy like this, unfortunately.
Marc
August 2nd, 2009 at 1:56 pm
One difference between publicly and privately run enterprises is that public ones are publicly accountable. They not only have to account for costs, but also account for the way they’re serving their function in society. It’s not always as simple as calculating shareholder equity. That’s what is at the heart of the injustices in the current insurance system. It’s also the reason people support fire departments as a public enterprise. Even the volunteer ones are supported by the community, in order that they be accountable to the people they serve. It would seem the enterprises protecting the health of people might benefit from the same oversight we give enterprises that protect the buildings we live in.