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Academic Medicine:
Institutional Issues: Commentaries

2025: News from the Fire Department

Casanova, James E. MD

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Dr. Casanova, when not writing satires about the U.S. health care system, is associate professor of medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, where he regularly tries to put out fires.

It has been a long, difficult road to market-based fire protection. The political maneuvering was difficult, of course. Nonetheless, the United States has again led the way to an efficient, cost-effective solution for a basic (but increasingly expensive) human need—fire protection.

Following the classic U.S. model, fire protection is now primarily employer-based. Costs have been contained, and the individual citizen is no longer disconnected from the marketplace. No more muscular young men sitting around the firehouse playing cards and polishing chrome. No more Dalmatians lying in the noonday sun.

The genius of the pure business model has been fully unleashed. Competing companies now provide service with different levels of protection and access. Every customer is assigned to a primary fire station. Of course, it may not always be the closest station—that still depends on the specific contract. Expensive equipment such as hominoid detectors and oxygen neutralizers, equipment that previously had to be shared, is now ubiquitous and considered a marketing necessity. Problems with the system so far have served only to spawn new entrepreneurial opportunities such as a line of cement furniture, self-extinguishing mattresses, and fire-retardant pet sprays.

Landmark legislation has also created fire protection for seniors, the Pyro-Care program. The elderly must pay a per-run charge, so sometimes they do not call for small fires. The program has already been criticized for its complicated billing procedures and complex rules. Multiple-access phone numbers have confused all but the most cognitively intact individuals. One emergency call in Toledo resulted only in a pizza delivery. Pre-approval for small fires has also been a problem, since the criteria are vague and some fires tend to change quickly. Firefighters also complain about the increased pre-extinguishing paperwork.

Despite obvious problems, the system delivers fire protection to as much as 75% of the population. Efficient use of resources has been emphasized, with various providers competing for “bragging rights” regarding the least amount of fresh water used per run and the fewest number of runs per thousand members. Many investor-owned fire-protection companies have done quite well, and their stock is said to be very hot. Despite all the smoke, the system has clearly cut waste, increased personal responsibility, and diverted more monies to smoke alarms and education. Certainly these have been major accomplishments.

Other unintended consequences have also been noted. The home fire extinguisher market has grown rapidly. For the first time in memory, unemployed firefighters have become a common sight on street corners. Use of tobacco products among unemployed individuals has plummeted, and matches now come with a government warning. And for some unexplained reason, dogs have stopped noticing fire hydrants.

© 2001 Association of American Medical Colleges

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