Monday, June 23, 2008

EMS Fees May Scare Sick Into Skipping Life-Saving Treatment

Author: Nick
Category: Money
Topics: ,

comic 38 - ambulance

In an era where getting from Point A to Point B is costing more and more with each passing year, it can be reassuring to know that if you get hit by a bus and need to go to the hospital, you won’t have to pony up $4 a gallon to pay for the gas the ambulance uses to get you there. At least, it used to be reassuring.

Unfortunately for all you accident-prone and sickly individuals out there, your next ambulance trip may feel more like a taxi ride thanks to many politicians’ sudden realization that there was something they weren’t taxing. All over the country, many counties and jurisdictions are writing legislation to charge fees for Emergency Medical Services (EMS). Currently, most EMS operations get their money indirectly from taxpayers, from hospitals, or from voluntary fundraising. Under the new legislation, various fees may be charged to patients who make use of EMS. Some of the proposed fees include:

  • A basic transport fee. Need an ambulance to cart your bloody body to the nearest hospital? That’ll be $300. Or maybe $800. Or maybe more!
  • A mileage surcharge. In one county, the EMS fee proposal calls for a $7.50 per mile charge in addition to the basic transport fee. Heaven forbid you live more than a few miles from the nearest emergency room.
  • An initial response fee. Not content to charge the sick and injured for the ride, some places will charge you just for getting checked out by paramedics on the scene, even if you don’t need a trip to the hospital.
  • Charges for services provided. If the paramedics use some gauze and staples to reattach your limb en route to the ER, they’ll charge you for those items and anything else they use to keep you in one piece.

The EMS fees have some very obvious benefits. For one, it is good for EMS to have money so they can afford to keep you from dying. It would suck if the next time you called for an ambulance, they told you: “I’m sorry. Our ambulance got repossessed. We’ll have a rickshaw out to you in 30 minutes.” With tax money and hospital payments fluctuating constantly, direct billing may be the best option to ensure EMS operations can stay afloat.

Nonetheless, the drawbacks of charging for EMS may far outweigh the benefits:

  • The poor and uninsured may suffer. While some jurisdictions are including caveats to their EMS fee legislation granting waivers for financial hardship, other places will happily tax the impoverished and elderly just as much as they charge celebrities who O.D. on crack.
  • Insurance companies may be unfairly targeted. A few cities say they’ll only charge EMS fees to insurance companies, waiving the fee entirely for the uninsured. As little sympathy as most have for fat-cat insurance companies, is it really fair only to go after insurance providers for fees?
  • People may forgo necessary medical treatment. Rather than pay $1,000 or more just for an ambulance trip, some sick or injured may skip the EMS ride or find alternative transportation that isn’t meant for emergency transit. Even if only insured people get the charge, some may not understand this and worry that they’ll be on the hook for the fee if their insurance company doesn’t pony up.
  • Insurance rates will go up. Some cities are touting their EMS fee plans as having “no cost to residents” if they only bill insurance companies. But not so fast! Who pays the premiums to insurance companies? You do! And when your insurer starts getting socked with EMS fees, they’ll pass the cost right on to you, the customers.

Personally, I’m conflicted on this issue. On the one hand, I wouldn’t mind seeing all taxes based on the services people use when logistically feasible (e.g. if you send your kids to private school, you don’t pay taxes to send others’ children to public schools). On the other hand, poor people are more likely to need more assistance from EMS, and I don’t think it’s morally correct to burden them with these costs. Even limiting the charges to insurance companies still poses ethical dilemmas.

Maybe our best bet is to commercialize EMS services. When you call for an ambulance, you get to pick your service provider. Some providers will be cheaper than others, while higher-end providers will offer ambulance rides with a touch of luxury—sequined gurneys, relaxing music, and really hot nurses. And if your ambulance ride doesn’t get there in 30 minutes or less, your ride to the morgue is free!

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