# Why must people pay for 911 and ambulance service?

by moonman239
Tags: ambulance, people, service
P: 867
 Heck, if there is no direct cost, why would anyone bother with a primary care physician? If you have a sore throat, just call up your local ambulance (limosine?) service and they'll drive you to the emergency room, saving you the effort and gas money, not to mention a week's wait for an appointment.
That is exactly what happens in civilized countries where these things are not an issue. Yep, you nailed it. Same thing that happens in those same countries where unemployment benefits are perpetual - everyone loafs about and takes advantage of the government. That's why all those countries have 100% unemployment and massively inflated health care expenses.

Oh wait. That's right, we're the ones with the massively inflated health care expenses, not them. However could that be.

 You can't even support one pilot for $5,000 a day (that's 24 hours of pay, benefits and insurance) Oh really? So pilots have benefits + pay packages exceeding 1.8 million dollars per year? Well, now we know why the "free market" is ridiculous at these kinds of services.  So that's the error people are making: they are focusing on the cost of the ride itself and ignoring the cost of the existence of the ambulance (and air ambulance) service. These things would be significantly cheaper if everyone were paying for them. That's the whole point of society: a collective sharing of resources for the betterment of all. Even if an ambulance does cost a thousand dollars per day, that's infinitesimal if paid for by ten thousand people. P: 1,745  Quote by mkarger For example, in the US, health insurance has a 30% overhead. Not mine; it's also less than 10%. Of course, % overhead is a spectacularly bad measure of efficiency, so we can all stop caring about it right now. P: 867  Quote by Locrian Not mine; it's also less than 10%. Of course, % overhead is a spectacularly bad measure of efficiency, so we can all stop caring about it right now. How about per capita health care expenditures?  P: 1,745 Also bad; you're just looking at input without looking at output and value. It's probably better than the % admin values you see tossed around, though. Those are just awful.  P: 867 How about per capita health care expenditure in relation to infant mortality and average life expectancy?  P: 1,745 Sure, grab Getzen's Health Economics and Financing for a good overview. Infant mortality is not easily comparable across different medical systems, but average life expectancy given some initial age (e_x) can be useful. Kinda wandering off topic, I guess. P: 12  Quote by Angry Citizen That is exactly what happens in civilized countries where these things are not an issue. Yep, you nailed it. Same thing that happens in those same countries where unemployment benefits are perpetual - everyone loafs about and takes advantage of the government. That's why all those countries have 100% unemployment and massively inflated health care expenses. Oh wait. That's right, we're the ones with the massively inflated health care expenses, not them. However could that be. Oh really? So pilots have benefits + pay packages exceeding 1.8 million dollars per year? Well, now we know why the "free market" is ridiculous at these kinds of services. These things would be significantly cheaper if everyone were paying for them. That's the whole point of society: a collective sharing of resources for the betterment of all. Even if an ambulance does cost a thousand dollars per day, that's infinitesimal if paid for by ten thousand people. Couple things if my simple napkin math is correct to have a helicopter on stand by 24 hours a day 365 days a year you would need 10 pilots on staff (5 teams of pilot/co-pilot) and maybe a 6th not knowing what restrictions there are on time off for pilots. Thus$5,000 a day would give you and average salary plus benefits and matching taxes of $182,500 per pilots with 10 on staff. That does not sound crazy to me but my assumptions may be wrong. Second how many ambulances do you think are needed per 100k in population? Lets use your number$1,000/day/10,000 people equals 10 cents a person lets assume that you actually mean per person and not per tax payer so a family of 4 pays $0.40 cents a day for ambulance service. That makes 146 dollars a year for a family of 4 sounds great but we only have 1 ambulance per 10,000 people so you better hope its not already transporting somebody from a Hospital to Hospice care when you have your car accident. I think we need a few more ambulances per 10,000 People but maybe that's just me so lets say 5 that would be 730 dollars a year for a family of 4 if you use the ambulance or not. Then again 5 may still not be enough. For example the "Downtown" Pittsburgh EMS service has 13 units with I do not know how many ambulances each they service 178 calls per day and the "downtown" area has a population of 308,000. This does not include any of the hospital run or third party ambulance services or any of the suburbs that is just the city run ems service. The Yellow pages have 90 other listings for ambulance services. Plus the fleets run by each hospital. http://www.pittsburghpa.gov/ems/ambulance_division.htm So then when we are all paying every year and you do not have to pay when you actually use the ambulance will you complain when you need one and none is available? No you will say at least the people using the ambulance can at a reasonable rate although if it were for profit we would have more ambulances available to all who may need them at a slightly higher cost. Sharing resources does not always mean the betterment of all. The tax payed ambulance service would certainly have a union and the cost would not stay at$1,000 dollars a day for long. We all end up with less service but at least its fair.
P: 12
 Quote by Angry Citizen How about per capita health care expenditure in relation to infant mortality and average life expectancy?
Infant mortality has a different definition in nearly every country. Some places count until 2 years old others count only the first six months. Some places include still births others only count death after a live birth. Some include premature babies...you get the point

US stats AFAIK are as all inclusive as possible plus with our facilities we try to save many pregnancies with c-section and delivery of far more premature babies then any where else in the world skewing our statistics even further.

It's like poverty everyone has a definition and nobody has the same one thus making comparison a waste of time.
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P: 22,300
 Quote by mkarger No one here is trying to argue that there is no cost to ambulance and emergency service operation.
I didn't say anyone said "no cost". The wording I used was "hidden from view" and "no direct cost" meaning no cost at the point of sale. This has an impact on who is paying and impacts choices on what services to get.
 What we are arguing is that the cost is excessive. And, in many cases, prohibitive.
There are several different lines of discussion going on, one of which was that it doesn't really cost $5,000 a day much less$30,000 a trip to fly someone helivac someone. $5,000 a day is definitely low,$30,000 a trip is probably high. But some issues:
 Whether or not the market cost of flying me 20 miles was 30,000 dollars, I cannot afford to pay 30,000 dollars. Fortunately, I had insurance. But roughly 50 million Americans do not. In any other industry, the costs reflect what consumers can bear. Because medical care is not really voluntary (meaning you can't go without it), the costs can be inelastic. And health care providers know that.
The purpose of insurance is to spread the cost based on the low probability and frequency of using the services. While I agree that the cost is inelastic, it is only mandatory insofar as we have decided it is. But as the anecdotes people have posted in this thread show, if the cost hits you directly, the services become very, very voluntary. Socializing the cost - removing it from the point of sale - allows us to pretend we can pay whatever it costs, but that is only pretend and that is part of the reason why the cost is inelastic. We're lying to ourselves about the cost when we do that, we make it more expensive by doing that and ultimately that is going to come back to bite us, as I'm discussing in another thread. We have chosen, for example, to make health care/insurance more mandatory than police protection in some contexts. And based on Europe's lead, we're going to go further down that road. Eventually we will either go bankrupt or we'll have to start deciding that total healthcare isn't quite as "mandatory" as other government services.

However, much of that is off topic because while I believe that some of the cost of ambulatory services should be borne at the point of use in order to deter abuse, the real cost of the service is so high, use so rare and jurisdiction so broad that most of it should be administered by government via taxes. We had a similar thread about voluntary fire department fees and I am against that concept as well.

That goes against my moral beliefs, but sometimes in politics my pragmatism > my moral beliefs.
 The only real way to solve such an issue is through nationalizing healthcare so that it is not for profit. Around the world, there are nationalized systems that are not only better at treating the population, they have significantly lower overhead costs. For example, in the US, health insurance has a 30% overhead. In Canada, it's less than 10%.
This, I strongly disagree with. As the anecdotes show us and the logic tells us, nationalizing the healthcare makes some contributors to the problem worse, in that eliminating the direct cost reduces the incentive to self-triage and encourages abuse. By the same token, making healthcare non-profit will help, but as with many discussions on corporate profits, I think you are overestimating the impact of that. Regardless, if we lower our costs by 20% but don't fix the rising cost trajectory, it will remain too expensive and just be worse again in a couple of years.

And "better" is, of course, a matter of what you measure and how. Logically, if nationalization doesn't change the quantity and quality of doctors, ambulances and hospitals, all it can really do is even-out the level of care by rationing it. I don't understand why people overlook this Law of Conservation of Doctors as I will henceforth call it.

For example, one of the primary measures that people have of "better" is, as you noted, fewer people uninsured. But the Law of Conservation of Doctors requires that if you provide a doctor for someone who didn't used to have one, you have to deprive someone who did. This manifests as substantially longer wait times for treatment in many countries with socialized medicine. You increase one person's access to a doctor and reduce another's. That's "better" for one, "worse" for the other.
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P: 22,300
 Quote by Angry Citizen ....
Please drop the attitude, propaganda techniques and read and respond to the posts as given. What you are doing there bears no relation to what I said and is not acceptable.
 Oh really? So pilots have benefits + pay packages exceeding 1.8 million dollars per year? Well, now we know why the "free market" is ridiculous at these kinds of services.
Whatever is causing your attitude is also causing you to not understand this simple issue of math (and one slightly less simple): since people typically work 40 hours a week, but medivac service must be staffed for 168 hours a week, having one pilot available at all times actually requires a staff of about five pilots (assuming these pilots work 40 hours a week and sometimes take vacations). That's the obvious one.

Less obvious is the fact that what people see on a paycheck is a small fraction of what their companies have to pay to employ them. Taxes, benefits, insurance, etc. amount to probably an additional 25-50% and that's before you even look into overhead such as administration and facilities. As an engineer who gets nothing but a small cubicle and has a very small administrative support staff (about 1/5 of a secretary), I know based on my billing rate that my personal total overhead is about 110%. Assuming similar overhead (again, this doesn't include the helicopter), puts a pilot in the $175,000 a year range. After doing that math, that's actually probably a lot closer to actual than I realized. So sure, I'll modify the statement:$5,000 a day will support about one pilot at a time, including his ready-room, workstation and (shared) secretary, but nothing else. It will not support a helicopter for him to fly, nor a mobile emergency room to carry and staff in the belly of the helicopter.

Nor, for that matter, all of the other emergency support personnel who have to assist with the landing, such as the fire department. I'm not sure if they show up as a separate line-item in the bill or not though.

I worded that line very specifically (I said "support one pilot....24 hours a day") and you weren't paying attention when you read it.
 These things would be significantly cheaper if everyone were paying for them. That's the whole point of society: a collective sharing of resources for the betterment of all.
Not my society. The founding point of my society was freedom from government intervention. Collectivist principles are relatively recently conceived, not well established experimentally and not universally agreed-upon.
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P: 22,300
 Quote by Oltz Couple things if my simple napkin math is correct to have a helicopter on stand by 24 hours a day 365 days a year you would need 10 pilots on staff (5 teams of pilot/co-pilot) and maybe a 6th not knowing what restrictions there are on time off for pilots.
Just for clarity, I was bouncing back and forth in my thought process, but the way I worded it I didn't consider a two-pilot team. This math also allows for zero redundancy which wouldn't be how a real medivac unit would have to operate.
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P: 17,322
 Quote by AlephZero Their TOTAL operating costs are only about $5000 per day, which pays for flying several missions. I'm going to call BS on this. Do you have a reference?$5k/day seems impossible, but I am not in that business.
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P: 17,322
 Quote by Locrian This was the one and only response needed to the OP. People must pay for it because the personel won't work for free and the manufacturers of the necessary equipment won't work for free. It's that simple.
I echo this comment too, the costs are real costs. The fact that someone's life depends on it doesn't make the real costs dissapear. The same is true of any medical cost.

There is no medical service fairy, nor is there a medical equipment fairy. The relationship between drugs and fairys is not as clear
P: 23
 Quote by Locrian Also bad; you're just looking at input without looking at output and value. It's probably better than the % admin values you see tossed around, though. Those are just awful.
And that's not even the only input! For average life expectancy you'd also have to look out for other factors that effect the health of your population (obesity, genetics, ect.)
P: 64
 Quote by DaleSpam I'm going to call BS on this. Do you have a reference? $5k/day seems impossible, but I am not in that business. London Air Ambulance costs roughly 2000 dollars a patient on average. It flies about 5 missions a day on average. That's 10,000 dollars a day. P: 64  Quote by russ_watters I didn't say anyone said "no cost". The wording I used was "hidden from view" and "no direct cost" meaning no cost at the point of sale. This has an impact on who is paying and impacts choices on what services to get. There are several different lines of discussion going on, one of which was that it doesn't really cost$5,000 a day much less $30,000 a trip to fly someone helivac someone.$5,000 a day is definitely low, $30,000 a trip is probably high. But some issues: The purpose of insurance is to spread the cost based on the low probability and frequency of using the services. While I agree that the cost is inelastic, it is only mandatory insofar as we have decided it is. But as the anecdotes people have posted in this thread show, if the cost hits you directly, the services become very, very voluntary. Socializing the cost - removing it from the point of sale - allows us to pretend we can pay whatever it costs, but that is only pretend and that is part of the reason why the cost is inelastic. We're lying to ourselves about the cost when we do that, we make it more expensive by doing that and ultimately that is going to come back to bite us, as I'm discussing in another thread. We have chosen, for example, to make health care/insurance more mandatory than police protection in some contexts. And based on Europe's lead, we're going to go further down that road. Eventually we will either go bankrupt or we'll have to start deciding that total healthcare isn't quite as "mandatory" as other government services. However, much of that is off topic because while I believe that some of the cost of ambulatory services should be borne at the point of use in order to deter abuse, the real cost of the service is so high, use so rare and jurisdiction so broad that most of it should be administered by government via taxes. We had a similar thread about voluntary fire department fees and I am against that concept as well. That goes against my moral beliefs, but sometimes in politics my pragmatism > my moral beliefs. This, I strongly disagree with. As the anecdotes show us and the logic tells us, nationalizing the healthcare makes some contributors to the problem worse, in that eliminating the direct cost reduces the incentive to self-triage and encourages abuse. By the same token, making healthcare non-profit will help, but as with many discussions on corporate profits, I think you are overestimating the impact of that. Regardless, if we lower our costs by 20% but don't fix the rising cost trajectory, it will remain too expensive and just be worse again in a couple of years. And "better" is, of course, a matter of what you measure and how. Logically, if nationalization doesn't change the quantity and quality of doctors, ambulances and hospitals, all it can really do is even-out the level of care by rationing it. I don't understand why people overlook this Law of Conservation of Doctors as I will henceforth call it. For example, one of the primary measures that people have of "better" is, as you noted, fewer people uninsured. But the Law of Conservation of Doctors requires that if you provide a doctor for someone who didn't used to have one, you have to deprive someone who did. This manifests as substantially longer wait times for treatment in many countries with socialized medicine. You increase one person's access to a doctor and reduce another's. That's "better" for one, "worse" for the other. I'll let the facts do the talking...  According to recent statistics gathered by the World Health Organization, the United Nations, and the OECD, the United States ranks 37th in the world for quality of health care behind nations like France, Canada, the UK, Japan and the Netherlands. The United States ranks 46th in the world for infant mortality; with a death rate nearly twice as high as France and aproximately 1.5 times higher than the UK and Canada. The United States ranks 36th in the world for life expectancy. The average American citizens lifespan is 2 years lower than a French or Canadian citizen and nearly 5 years lower than the Japanese. Our mortality rate for children younger than 5 years of age is twice as high in the United States when compared to France and Germany and more than 2 and a half times as high compared to Sweden. The United States has a maternal mortality rate roughly 5 times higher than Sweden, 3 and a half times higher than Germany, 3 times as high as France and twice as high as the UK. We have an obesity rate 3 times higher than countries like France, Sweden, Denmark and two times higher than Canada. Yet, the United States spends approximately 30% more per capita on medical care as a portion of GDP than countries like France, Germany, Sweden and the UK . The general population receives better treatment at a lower cost per capita. And emergency services are rendered just as quickly. Non-emergency services are doled out according to who's first in line. Which makes sense.  P: 79 Here's another thing to consider. Nobody ever has to pay for ambulance service. As far as I know, there's no penalty for nonpayment -- other than possibly ruining your credit rating. But if you owe, say,$10k for prior ambulance rides they'll still respond to your 911 calls and take you to the nearest hospital if you're in urgent need of medical assistance. It's really a pretty good system, albeit somewhat overpriced, imo.
P: 64
 Quote by nanosiborg Here's another thing to consider. Nobody ever has to pay for ambulance service. As far as I know, there's no penalty for nonpayment -- other than possibly ruining your credit rating. But if you owe, say, \$10k for prior ambulance rides they'll still respond to your 911 calls and take you to the nearest hospital if you're in urgent need of medical assistance. It's really a pretty good system, albeit somewhat overpriced, imo.
You realize that your assets can be seized if you fail to pay your debts, right? It doesn't just disappear because you're broke. You can negotiate the price down during bankruptcy or directly with the ambulance service. But you cannot just make it go away.

The number one cause of bankruptcy in the United States is debt from healthcare.

If the standard of service rendered is "well at least they don't let you die," then I think we need to seriously reevaluate our standards.

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