Your House Fire Comes to $41,655. Cash or Credit?

Oh, your taxes?  That was just in case you needed us.

Montgomery County, Maryland, is one of the richest and most educated counties in the United States.  Their 2013 approved fire/rescue budget is $196.6 million, an increase of $16.6 million over FY 2012.  Just what does $197 million dollars get you?  Apparently not a ride to the hospital if you are sick or injured.  That, my friends, will cost you extra.

The Washington Post reports that County residents and others unfortunate enough to require medical transport will soon be paying $300 to 800 for the privilege.  Perhaps for the $300 fee you have to get into and out of the ambulance on your own.  In addition, you will only have a choice of the two closest hospitals and there will be an additional fee if you insist on a trauma center.

Ambulance

 

Now for $800, the cot will be wheeled to your bedside, you have a choice of any hospital, including MedStar, music of your choice will be played en route, and if your medical condition allows, light hor d’oeuvres will be served.

It turns out that the County’s volunteers have fought the fee in the past but reached an agreement with the bosses where they will receive a 15% cut of the $18 million annual take.  Now they are on board.

Residents are exhorted to remain calm as no one will actually have to pay. “County officials said that in nearly all cases, private insurance companies, Medicare and Medicaid would cover the cost of ambulance service…”  In a county where every other person has a post-graduate degree they are to ignore the fact that the costs of health care are skyrocketing and that Medicare and Medicaid are under attack.  Ignorance is bliss.

This brilliant economic model where taxpayers fund the emergency service to the tune of $196 million dollars but have to pay if they actually need it, should be extended to fire operations, as well.

If you call the fire department because you think you might have a fire, but you don’t, there will be a standard $2500 consulting fee as they have a look around and find nothing.

Fire Truck

If you actually have a fire, a matrix will be used to determine the cost based on the water used and the number of hoselines, and ground ladders deployed.  The use of master streams and aerial devices is not covered in the  matrix and are charged separately.  For example, the deployment of a standard rear-mount aerial for use under five floors will cost $1500.  Tillers and platforms are more.

County officials are exploring a “Diamond Plate Plus” program where any property owner, for an annual fee of $5,000 will be covered for one EMS call and one two-alarm fire per year.  This should not be confused with the annual tax bill because taxes are paid just in case.

(Source:  WP, Patch, Wiki, MC)

14 Comments

  • Larry Osborne says:

    Years ago, one of our astute IAFF Local 122 (Jacksonville, Fl) presidents went to a heavy equipment rental and service company, to find out what it would cost to rent numerous pieces of heavy equipment and crews, comparable to fire crews needed for a working residential fire, as well as greater alarms. Needless to say, it looked a lot like the remarks in this article.

    The recent NIST studies, as well as long-standing standards for the adequate deliveray of both fire and EMS services would seem to refute this “fee for service” approach to EMS.

    What is no longer heard from public officials is any reference to the “common good”, on which paid, organized fire departments and EMS services were built.

  • Eric Lamar says:

    You are so right. Thanks, Larry.

  • Fred Johnston says:

    A candiate in a Florda Congressional race commented that he is not a politician, but a businessman who will bring a business mentallity to government. So be it, maybe Fire and EMS will take a turn in history as the public garbage collection has in many parts of the country. How many tax dollars are now going toward garbage collectrion and storeage as compared to days past when a city or county provided such service?

  • alan says:

    Why would anyone choose to live in Montgomery County!?

  • Jeff Zack says:

    To answer Alan’s question: because it’s a great place to live and raise a family.

    Let’s get this out of the way real quick — full disclosure: I am not a fire fighter. But as a County resident, I am for the fee. And as an employee of the IAFF, I support IAFF Local 1664’s work to get the fee enacted.

    My tax dollars pay for the service provided by Mo Co Fire & Rescue, fee or no fee. I don’t contribute $197 million, but I pay my share.

    To be clear, ambulance service was provided before the fee, and it will be provided after the fee is enacted without a single change in SOPs by the fire department – so no one will be denied a ride now if they were going to get a ride before the fee was enacted for whatever ails them.

    The core of the question in the blog seems to be that health care costs are rising fast and this is just throwing fuel on the fire. While I don’t have a post-graduate degree, I do understand basic math. And if my County can get a few bucks from a for profit insurance company or for an allowable fee under Medicare or Medicaid from the federal gov’t, I expect them to go get that money so that my local tax dollars go farther in serving my family at home.

    The resistance to the fee from the volunteers in B-CC was never about people getting or not getting, or people not calling for rides when they need them. The volunteer company’s resistance was about their ability to raise money if the fee was enacted – they thought they would lose some funding streams. The fact that the new “15%” deal seems to quell their concerns for the patients tells the real story.

    I’m curious, though, why the blog chose to single out Mo Co? The Wash Post also says, “By enacting the legislation, the county again joins the vast majority of local jurisdictions that have the fee. Prince George’s, Fairfax and Prince Williams counties have similar fees…”

    I also strongly disagree with Mr. Osborne. Calling this a “fee for service” is inappropriate. Unlike the infamous fire in Tennessee not long ago where the local volunteer fire department stood and watched as a house burned to the ground, no one will be denied ambulance service under the new law. That makes the term “fee for service” not applicable in this case. I submit that it can appropriately be called a “getting-some-money-back-to-the-County-from-the-rip-off-artist-insurance-companies-fee,” instead.

    And finally, the recent NIST studies (which, ironically, were executed with the strong support and service of fire fighters and paramedics from Montgomery and Fairfax counties, which both now have this ambulance fee) proved a lot about the resources needed for appropriate fire and EMS response. Those do not refute what Mo Co is now doing. On the contrary, the studies were clear: in a time when cutting fire/EMS in response to budget issues is prevalent, marshalling every resource available so a jurisdiction is able to provide the proper equipment and staffing to ensure the safety of not only the residents but the fire fighters and paramedics who do respond is not a matter of opinion, it in fact must be a priority. I’m proud to say, as a resident of Montgomery County, my County is adhering to those principles and is keeping emergency response strong even in a time of budget troubles.

    • Eric Lamar says:

      Jeff-

      Your premise is incorrect: “The core of the question in the blog seems to be that health care costs are rising fast and this is just throwing fuel on the fire.”

      My belief is that County managers, including fire chiefs, should provide the service they receive tax dollars for. If you cannot provide EMS service, the KEY, number one function of the department within the budget, you are not doing your job. It would be like the IAFF charging dues and then asking a local to cough up another $10K for the most basic technical support. In the IAFF’s case, they are far more likely to GIVE money to a needy local then ask for more.

      To be sure, I think billing Medicare, Medicaid or a private insurer for hospital transport is kicking the can down the road and fiscally irresponsible. We will all pay for it in the end. You have adopted the classic view of out-of-sight, out-of mind.

      And you said: “so no one will be denied a ride now if they were going to get a ride before the fee was enacted for whatever ails them.” True perhaps, but they WILL have to pay for it, or so says the Post:”…but there were still some out-of-county patients who would pay.” And, I am sure that in-county residents, especially seniors who are ill-equipped to deal with it will be bombarded with paperwork and notices about a medical bill they should never have received in the first place.

      You asked, “Why the blog chose to single out Mo Co?” Because that is who is creating a fee. I have a long history of writing about the absurdity of fees in Fairfax, FDNY, etc.

      Throwing in the NIST study is an act of desperation that in fact, cheapens the study results. Nothing about NIST says that local governments should charge a fee for service for their most basic and core objective. That’s what the taxpayer dollars are for.

      Thanks for writing.

      Eric

  • Jeff Zack says:

    Eric, I clearly disagree with your suppositions and hypotheticals, so we will, then, continue to disagree on the fee.

    But not sure why would take it one step further and throw in that “act of desperation” line. When Larry used it to make his point, you gave him kudos. I don’t want kudos, but the ad-hominem attack seems unwarranted.

    • Eric Lamar says:

      J-

      You spent 153 words referencing the NIST study, including this sentence:”Those do not refute what Mo Co is now doing.” If that’s an endorsement, we are in all trouble. I breezed over Larry’s NIST reference and I will say categorically that I do not think that it works here.

      The use of “act of desperation” was a rhetorical device the usefulness of which would clearly be in the eye of the beholder. In the context of our “conversation” it falls far short of a personal attack and was certainly not meant as one.

      When you get a chance, read, in the comments section, John’s second sentence and Jim’s final paragraph. They reference the 800 LB. gorilla. From Jim: “Why should MontCo (or anyone else) have a monopoly, charging whatever they want and providing a level of service that may or may not be any good?”

      If you are charging a fee, maybe it’s time for a little competitive bidding to make sure the taxpayer is getting the best deal.

      E

      • Jeff Zack says:

        I read yours and Jim and John’s comments. I tend to side with John on this one. Providing and continuing to provide the service is a political game IAFF locals play everyday. Finding the revenue to do it right, and having the political where-with-all to continue to increase the revenue while fending off attempts to privatize is a never-ending battle.

        It would be nice if the county council in Mo Co would step up and just raise our taxes to provide the right service. But until they get a spine, I’m for Local 1664 finding ways to keep the service strong and the ff jobs secure.

  • John says:

    If I am paying for health insurance, and my insurance co. is willing to pay for that service, why should the provider of that service forgo payment? I’m sure a private EMS company would send a bill, so why shouldn’t the FD?

    The EMS fee is helping subsidize the provision of fire, rescue, tech rescue, hazmat, and numerous other services, thereby reducing the local taxes I would pay to maintain that level of service. The private EMS company is providing a one dimensional service, for a profit. I would much rather have 20 crosstrained FF/Medic/Hazmat/Tech rescue people on duty that 12 FFs and 6 private EMTs.

  • Jim says:

    I remember a time when an IAFF local president and the president of the volley Chiefs Association in a particular county (not demographically like Montgomer) teamed up to stop a “fee for service” proposal for ambulance service. In MontCo the volleys have been fighting it for years, but they finally caved…

    My own view is that local goverments that tax people for a service and then charge them to actually use it do so at their own peril. Tying your funding to private insurance carriers and/or various Federal programs is a slippery slope. At what point will, as a hypothetical example, somebody like Anthem or Kaiser say, “You know what, you’re charging too much. We’re going to have our own ambulances under contract and pick up our insureds ourselves” Or, when as part of health care cost containment HHS starts telling an EMS agency what they can do and not too, what kind of vehicles they can have and, most importantly, what they can charge?

    And one other thought: If you are going to charge a “customer” for using your service, why shouldn’t that same customer have a choice? Why should MontCo (or anyone else) have a monopoly, charging whatever they want and providing a level of service that may or may not be any good? I know, that’s a bit much for most people, but think about it… If you don’t like a restaurant or a grocery store or a dentist or doctor you get to vote with your feet.

    • Rick says:

      Perhaps you don’t like the way our Founding Father’s created our nation? Thomas Jefferson specifically said that we should tax those with more and those who have little or nothing should not be taxed. He was talking about land taxes at that time because it was the only kind without state or federal income taxes but progressive taxes should apply to all forms.

  • Bill Hand says:

    The City of Houston has been charging a fee for ambulance service for years, but collecting those fees is another issue. Only the people who have insurance pay, which subsidizes the fees that are not collected from others. It works just like medical care in general. Those with insurance pay for those who do not. Kinda works like income tax where those who actually pay, pay for those who don’t pay. I am not sure there is a “fair way” to tax people, but the way we are doing it now ain’t working!

  • Jim says:

    Interesting comments. I’ll throw this out: If you are going to charge for the service…whether it is the individual that pays or the insurance company or the government, then don’t give the fire department the legal monopoly to offer the service. Collecting taxes to provide a service for the community at large and for “the common good” is one thing. Sending someone a bill that they’re supposed to pay, regardless of how much it is and regardless of whether they got the kind of service they were supposed to is quite another. That’s one of the reasons I said it is is a slippery slope in my prior comment. Do I want or need to pay for a “cross trained/dual role firefigher paramedic” with all of the cost attendant with that because I need to go to the hospital? Do I need to pay for a big $250K medium duty mega ambulance when a Sprinter van might suffice? Is the only way to provide me with the appropriate level of care is to take me to the nearest hospital? I could go on with the questions, but the key thing to remember is that once you start charging (as opposed to providing a service to the community for taxes collectd) you open yourself to some real questions as to why you are doing what you are doing (or not doing) and what it really costs relative to what it could. Expressed differently, while I think fire departments can be effective in delivering EMS service, I don’t know that economic efficiency is our strong suite, nor do I think it is scrutiny we want to subject ourselves to.

    I also want to make a couple comments about the NIST studies. I agree that NIST and ambulance fees aren’t really related. And would anyone realistically think that a NIST (NIST is part of the Department of Labor) study undertaken during the most public employee/labor friendly administaation in modern history (and cosponsored by the IAFF) would conclude that less firefighters is better than more? Of course not. 4 is better than 3. 5 is better than 4. 6 is better than 5. The bottom line is that studies like that are always going to be colored by the fact that labor in not prone to suggest less labor as opposed to more, nor should they be.

    And for those who think we in the fire service are immune from scrutiny, I’ll leave you with the names of 2 cities… Las Vegas and San Jose, to name but 2.

    My one final point has to use of the terms “adequate” or “appropriate” relative to service levels. We need to start adding one more “a” word into the mix – affordable. There is no sense in talking about adequate or appropriate in a vacuum, unless it is affordable and there is a limit as to how much (individually and collectively) a community is willing and/or able to pay – even for important services like fire/EMS.

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