News Why must people pay for 911 and ambulance service?

[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.