News Why must people pay for 911 and ambulance service?

[moonman239]

Funding? That's what income tax and sales tax is for.

 

[Evo]

Funding? That's what income tax and sales tax is for.

No, ambulance service is locally provided. How much you pay depends on your insurance coverage. If you have no insurance, then you will have to work something out with the ambulance company.

Pay for 911?? Explain what you mean. I believe that landline providers (former RBOCS) pass on a tiny monthly phone surcharge, is that what you are referring to, because calling 911 is free.

Why would you make a post without knowing anything about the subject?

 

[Astronuc]

In our area, emergency ambulance service is provided by the fire department and that is covered by a separate tax, which is part of our property tax.

Sales tax covers other local and state government functions/services - courts, roads, parks, public works (water, sewer), . . . .

Income tax is mostly at the federal level for all the programs and services, but some states have income tax, and some cities (e.g., NY City) have income tax.

 

[BobG]

In most communities, emergency medical service is considered a hospital emergency room on wheels. So the same policies that apply to hospital emergency room service applies to ambulances, as well.

I think the original poster may have been commenting on the fact that most communities charge patients whenever EMS responds; not just when they transport the patient to the hospital. The charge is usually much less, however.

Charges for driving a patient to the hospital can be five times greater (or more) than the charges just to respond to a potential emergency medial call. Doesn't make a lot of sense, cost wise, since actually driving the patient to the hospital is probably the cheapest part of the service. But many communities send out an EMS team if there's even the possibility of their being needed - the patient doesn't really have control over whether EMS personnel show up or not. I think the difference in cost is so a patient doesn't get hit with a huge bill simply because their neighbor decided from across the street that that skateboard wipeout has to be serious enough to require an ambulance.

For example, when I was a teenager, I witnessed a person drive his car into a brick house one night. From 40 feet away, the driver looked unconscious to me so I told the first person to come out of their house to call an ambulance. It was probably a good decision, but there was no way I could have possibly known how serious he was hurt from so far away and I definitely wasn't going anywhere near that car to actually find out. I was kind of freaked out by what I just saw. Even though it didn't turn out that way, it surely could have been possible that the driver was fine and not even really unconscious. He would have been charged for the response even if he didn't need it.

In actuality, it was hard to tell whether the driver was semi-unconscious from the accident or semi-passed out from the alcohol since his injuries were basically a bloody, perhaps broken nose. But he definitely wasn't coherent when someone with a little more confidence did check to see what first aid he needed. And the ambulance did cart him off to the hospital just to be sure.

But the policies for EMS is decided by each local community, so it would be hard to say how one single community figures out what the charges should be for emergency service (especially an unknown single community).

 

[Alfi]

If I call 911 for me, I don't mind paying.

If you call 911 for me, I may object to paying.

If I call 911 for you and you are charged, I don't care.

If I call 911 for you, I mind being charged.

 

[Evo]

If I call 911 for me, I don't mind paying.

If you call 911 for me, I may object to paying.

If I call 911 for you and you are charged, I don't care.

If I call 911 for you, I mind being charged.

Are you confusing 911 with ambulance service? They are not the same thing. What you just wrote makes no sense.

So is what you are trying to say is if you are seriously injured, you do not want to be saved?

 

[Alfi]

Are you confusing 911 with ambulance service? They are not the same thing. What you just wrote makes no sense.

So is what you are trying to say is if you are seriously injured, you do not want to be saved?

my error in not being specific.

911 = emergency response. They are the same here.
First question asked = Fire, police or paramedics?

The question was, Why must people pay for 911 and ambulance service?
I ignored the fire and police aspects of the 911 call.

 

[Evo]

my error in not being specific.

911 = emergency response. They are the same here.
First question asked = Fire, police or paramedics?

The question was, Why must people pay for 911 and ambulance service?
I ignored the fire and police aspects of the 911 call.

I don't know what country you live in, but in the US, if you call 911 (emergency dispatch), you are not sent a bill just for calling them.

Ambulance service costs will vary from town to town depending on services offered, how much is subsidized by the city/township, etc... and your ability to pay. For very poor people, there are usually services available to them to cover expenses.

Here is an example from Washington D.C..

http://fems.dc.gov/DC/FEMS/About+FEMS/Ambulance+Billing/ci.Ambulance+Billing+Questions.print

 

[BobG]

I don't know what country you live in, but in the US, if you call 911 (emergency dispatch), you are not sent a bill just for calling them.

Ambulance service costs will vary from town to town depending on services offered, how much is subsidized by the city/township, etc... and your ability to pay. For very poor people, there are usually services available to them to cover expenses.

Here is an example from Washington D.C..

http://fems.dc.gov/DC/FEMS/About+FEMS/Ambulance+Billing/ci.Ambulance+Billing+Questions.print

The actual phone call is free. The phone call is all that is free.

If Fire Dept paramedics, or contractor paramedics, or an ambulance service show up at the scene (in other words, if your phone call actually results in some kind of action), then there may be charges, depending on the city you live in.

I'm pretty sure this thread is about 911 response; not the cost of the phone call.

Sacremento charges $275 or $96 (depending which fire dept responds) for responding, even when the patient doesn't require transport to the hospital.

http://www.anaheim.net/article.asp?id=372 charges $350 per response, even when the patient doesn't require transport to the hospital. Or, an Anaheim resident can pay an annual fee of $36 via their utility bills (in addition to whatever city taxes they pay).

So, you're in a car accident - say you slide into a telephone pole because of icy conditions. An observor on the sidewalk calls 911 and a fire dept paramedic responds (although the paramedics stationed at the fire dept probably aren't actually part of the fire dept). No one in the car accident actually needs medical care. You can still be charged.

This varies city by city. It's becoming popular with small communities due to their smaller budgets. It's also starting to spread to at least a few larger cities (mostly in California) as a way to reduce costs for the city.

(Not only is this becoming common for medical response, but is becoming common for fire response in rural communities, as some might remember from a past thread about a fire dept that let a house burn down because those residents hadn't paid the fee.)

Stuff costs money. If tax money from residents don't cover the cost, then community governments either have to reduce services or charge individuals for the services they receive.

 

[mkarger]

I was in a motorcycle accident and attempted to get up once I heard a passerby on the phone with 911 telling them it was serious and that an ambulance was needed.

I knew how much emergency services cost and even with insurance I did not want to foot the bill. I figured I was okay.

Due to my disorientation, I ended up back where I was face down on the asphalt half conscious with people running up telling me to lay still.

Due to the fact that it was a motorcycle accident and in the 911 call the caller felt I was in serious condition, 911 dispatch automatically called in Medivac services to take me to a trauma 1 center.

I told the EMTs that I could not afford Medivac services. Because they feared I had broken my back, they chose to ignore my request (I don't blame them at all by the way. They must always assume the worst when treating a patient). The ambulance took me from the scene to the waiting helicopter that was about 1/4 of a mile away. The helicopter then flew me about 20 miles to the hospital.

It was a 5,000 dollar helicopter ride after insurance (uninsured it would have been roughly 30,000 dollars). And even though the ambulance service drove me only a thousand feet or so, that was another 1000 dollars. The cost of medical care to the average citizen in this country is absolutely insane. Why we haven't switched to a single payer or socialized system is beyond my understanding. I believed that before my accident and I believe it even more now.

 

[Angry Citizen]

I was in a motorcycle accident and attempted to get up once I heard a passerby on the phone with 911 telling them it was serious and that an ambulance was needed.

I knew how much emergency services cost and even with insurance I did not want to foot the bill. I figured I was okay.

Due to my disorientation, I ended up back where I was face down on the asphalt half conscious with people running up telling me to lay still.

Due to the fact that it was a motorcycle accident and in the 911 call the caller felt I was in serious condition, 911 dispatch automatically called in Medivac services to take me to a trauma 1 center.

I told the EMTs that I could not afford Medivac services. Because they feared I had broken my back, they chose to ignore my request (I don't blame them at all by the way. They must always assume the worst when treating a patient). The ambulance took me from the scene to the waiting helicopter that was about 1/4 of a mile away. The helicopter then flew me about 20 miles to the hospital.

It was a 5,000 dollar helicopter ride after insurance (uninsured it would have been roughly 30,000 dollars). And even though the ambulance service drove me only a thousand feet or so, that was another 1000 dollars.


The cost of medical care to the average citizen in this country is absolutely insane. Why we haven't switched to a single payer or socialized system is beyond my understanding. I believed that before my accident and I believe it even more now.

I absolutely agree. When I was in diabetic ketoacidosis and about to die, I seriously considered not going to the hospital partially because of the ambulance bills. I only went because I had a roommate who was willing to take me. Saved my life.

 

[AlephZero]

It was a 5,000 dollar helicopter ride after insurance (uninsured it would have been roughly 30,000 dollars). And even though the ambulance service drove me only a thousand feet or so, that was another 1000 dollars.

The cost of medical care to the average citizen in this country is absolutely insane.

Those "costs" are completely insane compared with the UK, where all air ambulances (except in Scotland) are funded by charitable donations. My local one covers an area of about 3,000 sq miles so flights of 20 miles are not uncommon. Their TOTAL operating costs are only about $5000 per day, which pays for flying several missions.

(Scotland is in a different situation, because on the islands an air ambulance servcice to the mainland is pretty much the ONLY ambulance service, unless you want to spend several hours on a ferry).

 

[nanosiborg]

Funding? That's what income tax and sales tax is for.

As far as I know there's no cost associated with calling 911. As for ambulance services, they're provided either by municipalities or private companies licensed by municipalities, as far as I know. And yes, the prices are ridiculously high. Just another example of wacked out healthcare costs. What can be done about this? I have no idea.

 

[trueo]

In my country, ambulance and any emergency services are costly applied to all calls. For fire alert: you pay the price we ask, we will come; or stay there enjoy your fire otherwise; For ambulance, we will come to you but later you must pay what price we ask, all is scaled on our defined prices...
I think people should pay for a particular service that they use, the higher they pay, the better they are serviced. Certainly we always want to avoid paying any and still love to be serviced well by any means. Is this the right thing to do ? Is it because many do, so do I ? It is ridiculous of me to refuse paying e.g $50 per my monthly income as of my duty for services I am using.
If 50 is too cheap then I am prepared to increase it up to 100. Why not ?

 

[AlephZero]

As for ambulance services, they're provided either by municipalities or private companies licensed by municipalities, as far as I know. And yes, the prices are ridiculously high. Just another example of wacked out healthcare costs. What can be done about this? I have no idea.

You could start by finding out how much profit those private companies make. It sounds like a pretty good business model to provide a service that people are not going to refuse, and then charge whatever you like (and for costs recovered through health insurance, people don't even know in detail what they are paying for). Whether it's a good model for affordable healthcare is a different question.

 

[russ_watters]

Ok, so I think most people would agree that it sucks to get socked with a large fee for a helicopter ride or ambulance ride and it would be nice if these things are tax-supported, but:

Several people just proved through their own anecotes that if the costs for these things are hidden from view, people will use them more, whether they need them or not. 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's one of my main practical criticisms of socialized medicine, that hiding the cost leads to over-use and abuse. So I ask:

What can/does a socialized medicine system do to reduce abuse of these services if they have no direct cost?

Also, regarding the cost. Cost is not as simple as it may seem and in these discussions, people tend to vastly misunderstand why it costs what it costs.

First, there is an issue of market forces involved in setting the cost and the fact that it might cost $5,000 or $30,000 depending on when and how you pay for it is not necessarily indicative of profitteering. The insurance company provides a known customer base that is useful for planning, guaranteed payment, economy of scale and the ability to negotiate collectively. A similar issue exists with airline tickets, where the same seat may cost $200 or $800 depending on when and how you buy it.

But how much should it cost on average? $5,000 for an entire day's worth of air ambulance service is impossibly low. You can't even support one pilot for $5,000 a day (that's 24 hours of pay, benefits and insurance), much less actually run a helicopter or the mobile emergency room (and its staff) contained in it. Yes, we're all just making guesses, but $5,000 a call seems reasonable to me for an average.

Ambulances are similar. You're not just paying $1,000 for a 1000 foot ride, you're also paying part of the ownership cost of the ambulance and the equipment and you're paying the crew (if it is a professional crew) to nap and watch movies in a ready-room for hours while they wait for your phone call. The gas and salaries of the crew for the time of the ride (whether 1/5 mile or 5 miles) is a tiny fraction of the cost of the ride. 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.

 

[Locrian]

Stuff costs money.

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.

It almost sounds in the OP that they think that if you pay for it through taxes, people aren't paying for it. Surely they must not believe that though, it defies reason.

 

[mkarger]

Ok, so I think most people would agree that it sucks to get socked with a large fee for a helicopter ride or ambulance ride and it would be nice if these things are tax-supported, but:

Several people just proved through their own anecotes that if the costs for these things are hidden from view, people will use them more, whether they need them or not. 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's one of my main practical criticisms of socialized medicine, that hiding the cost leads to over-use and abuse. So I ask:

What can/does a socialized medicine system do to reduce abuse of these services if they have no direct cost?

Also, regarding the cost. Cost is not as simple as it may seem and in these discussions, people tend to vastly misunderstand why it costs what it costs.

First, there is an issue of market forces involved in setting the cost and the fact that it might cost $5,000 or $30,000 depending on when and how you pay for it is not necessarily indicative of profitteering. The insurance company provides a known customer base that is useful for planning, guaranteed payment, economy of scale and the ability to negotiate collectively. A similar issue exists with airline tickets, where the same seat may cost $200 or $800 depending on when and how you buy it.

But how much should it cost on average? $5,000 for an entire day's worth of air ambulance service is impossibly low. You can't even support one pilot for $5,000 a day (that's 24 hours of pay, benefits and insurance), much less actually run a helicopter or the mobile emergency room (and its staff) contained in it. Yes, we're all just making guesses, but $5,000 a call seems reasonable to me for an average.

Ambulances are similar. You're not just paying $1,000 for a 1000 foot ride, you're also paying part of the ownership cost of the ambulance and the equipment and you're paying the crew (if it is a professional crew) to nap and watch movies in a ready-room for hours while they wait for your phone call. The gas and salaries of the crew for the time of the ride (whether 1/5 mile or 5 miles) is a tiny fraction of the cost of the ride. 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.

No one here is trying to argue that there is no cost to ambulance and emergency service operation. What we are arguing is that the cost is excessive. And, in many cases, prohibitive.

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 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%.

 

[Angry Citizen]

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.

 

[Locrian]

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.

 

[Angry Citizen]

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?

 

[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.

 

[Angry Citizen]

How about per capita health care expenditure in relation to infant mortality and average life expectancy?

 

[Locrian]

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.

 

[Oltz]

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 let's 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 let's 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.

 

[Oltz]

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.

 

[russ_watters]

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.

 

[russ_watters]

...

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.

 

[russ_watters]

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.

 

[Dale]

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.

 

[Dale]

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

 

[boomtrain]

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.)

 

[mkarger]

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.

 

[mkarger]

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.

 

[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.

 

[mkarger]

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.

 

[nanosiborg]

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.

I think that not letting people die is about as good as it's ever going to get. Fortunately I haven't yet had to call an ambulance, so have not had to deal with the exorbitant prices.

I agree that a serious reevaluation of standards and values is in order, but I doubt that that will ever happen. We're locked into a greed based system. One must learn how to manipulate it to one's advantage or simply be one of the disadvantaged.

 

[russ_watters]

I'll let the facts do the talking...

A ranking by the OECD is not a useful "fact", it is a collection of individual facts, with a weighting attached to them by the OECD. The OECD has its own politics and measures "quality" based on its opinion on what matters. Based on previous investigation of the OECD's poverty measurement, I suspect that this largely reflects the OECD confusing equality with quality. But I'd love to see how the OECD comes to that conclusion.

And an anecdote on cost:
My father buys his Zocor from Canada because it is much cheaper there. This fact has nothing to do with socialized medicine and everything to do with patent law and lobbying and
1. It wouldn't necessarily change if healthcare was nationalized and
2. It could be changed without nationalizing healthcare.

In addition, profit may be a dirty word that equals exploitation and waste to people who prefer socialism to capitalism in certain areas, but profit is also a motivator for fiscal responsibility. Lacking it, I fear our government would just do more of what it is doing already; funding its promises with borrowed money and pyramid schemes.

 

[Oltz]

I'll let the facts do the talking...




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.

See my previous comment about statistics and base line definitions this conversation has been had before about those very OECD stats they are using the data collected by each government without any adjustment for different definitions.


If you dig nearly every one of these "Independent third party" evaluations have similar flaws.

 

[D H]

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.

London Air Ambulance doesn't operate its helicopter service 24/7/365. It only flies during daylight hours, and weather permitting. Around the clock operations (weather permitting) would require more pilots and at least one more helicopter.

 

[Locrian]

As a side note, I've done a bit of research, and it's actually really hard to show that air ambulance services really do benefit the patient over ground ambulance service. There are some studies that show they do, and some studies that show they don't.

Suprisingly (shockingly! amazingly!) studies that show they do tend to be done by universities with air ambulance programs, and studies that show they don't. . . well, the opposite.

 

[AlephZero]

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.

The $5000 per day I quoted was based on the air ambulance charity website's statement of the funds they need to raise (not for the London area, but a factor of 2 isn't important compared with the US figures that were quoted).

 

[AlephZero]

London Air Ambulance doesn't operate its helicopter service 24/7/365. It only flies during daylight hours, and weather permitting. Around the clock operations (weather permitting) would require more pilots and at least one more helicopter.

Those factors don't necessarily affect the cost per flight, which is what the US figures quoted. There is no point in providing a 24 hour cover unless it is actually going to be used 24 hours per day. (The UK service already operate 365 days/year).

The basic restriction to daylight operations is the JAR regulation that night time takeoffs and landings are only permitted at "class 1" landing sites, which would exclude most emergency locations, and (at least in the UK geography) transfers by a combination of land and air transport don't have much advantage over land-only.

 

[russ_watters]

Those factors don't necessarily affect the cost per flight, which is what the US figures quoted. There is no point in providing a 24 hour cover unless it is actually going to be used 24 hours per day. (The UK service already operate 365 days/year).

That's fine, but it is misleading to say it costs a certain amount of money per day if it isn't available all day while other services we are comparing it to are. In fact, I completely lack comprehension as to how it can be that useful if it doesn't operate 24 hours a day. Night-time service is probably just as important as daytime service, as people drive drunk more often at night than during the day. It seems like a pretty severe limitation in service to me.

Also, the fact that it requires a certain amount of money in donations doesn't necessarily indicate that the donations are the only source of funding. Could you (and mkarger) please cite the source of the information so we can look at it ourselves? For example, this link says "relies heavily on public donations" which means it also relies on other sources. But it doesn't say how much:
http://www.londonsairambulance.co.uk/donate

However, that website also says the service runs 24/7 so I'm not sure if we're talking about the same service.

In any case, the "staff" page lists 5 doctors, 5 pilots and 5 paramedics, which together make up about 2/3 of the staff of the company, for this particular service.

[edit] Oh, it does have a wiki page which says (after exchange) that it costs $3.6 million a year to run, or about $10,000 a day... which is less than I would have expected for a service with a full-time doctor onboard.

 

[D H]

At night they use "Rapid Response Cars" in lieu of their helicopters.

 

[russ_watters]

At night they use "Rapid Response Cars" in lieu of their helicopters.

Who, London Air Ambulance? That's misleading! [goes back to the wiki site] I see. Ok, so $10k a day gets you 8 hours of helicopter service and 16 hours of a car service.

Er...its late and I should go to bed. I apparently stopped reading halfway through this sentence:

ased at the Royal London Hospital and founded in 1989, the service is unique in that it operates 24/7, with the helicopter running in daylight hours and rapid response cars taking over at night.