EMS Fees Redux: Quacks Like a Duck

The Insurance Scheme


A recent post here detailed the upcoming plan for Montgomery County, Maryland, to join other Fire/EMS departments in charging those in need of EMS care.  All-in-all it was a bit of a love fest as management, labor and the volunteers are all on board with the plan.  Money does have a tendency to smooth the way.

Apropos of these fees, there was a story in the news recently about a City of Los Angeles incident where good Samaritans, helping at a car accident, died of electrocution and suffered the apparent double miss fortune of catching a final ride to the hospital, for which, they will be charged.

According to Yahoo, “City fire officials say they do not have the power to circumvent municipal codes and waive the mandatory paramedic fees, even in cases during which a citizen is accidentally injured or killed.”

I said previously that it is those least equipped who wind up getting shafted by such fee schemes:  the frail, the elderly, the mentally incompetent. To that list we can now add grieving families.

Frankly, it is nothing more than a government run insurance monopoly.  The Fire/EMS department charges you a “premium” in the form of taxes in exactly the same manner as you pay a premium for auto or homeowners insurance, whether you use it or not.  Then, if you actually need the “coverage” you are subject to a deductible, in this case the fee.

Mr. Monopoly

If Fire/EMS departments are going to be in the business of selling “EMS Insurance” they should invite other providers to bid on the provision of the service to ensure that citizens are receiving the best care for the lowest cost.  This will be anathema to some but it is the price to be paid for selling your services.  You should be forced to compete for the market share.

A. Philip Randolph

Labor should be especially ashamed as they are historically the presumed protectors of the little guy.  A. Philip Randolph, the famed labor organizer, said, “The labor movement has been the haven for the dispossessed, the despised, the neglected, the downtrodden, the poor.”  Well, not anymore.  Labor is lined up to levy a charge on a service that has already been financed by public revenue.

The plain truth is that health care dollars are in short supply and if those dollars are used to pay for a service that has already been paid for under the guise of “cost recovery”, the “little guy” loses in the short term and everyone loses in the long one.  Critically, labor loses the most as they forfeit their commitment to fairness on the altar of faulty and dubious profit, the very thing they say they hate about management.

Sources: Yahoo, Hasbro


  • Jim says:

    You are the man!

  • Mike McEvoy says:

    I take a different view. Tax dollars, in my opinion, pay for the preparation to respond (personnel, apparatus, supplies, medicatons, radios, stations, etc). Tax dollars come from municpal taxing authority, usually the same authority having authorization to provide EMS care and treatment. That care and treatment (i.e., the actual response) has an additional cost (fuel, vehicle wear and tear, mileage, supplies, insurance, etc). The cost is so predictable that is is built into all of our health care insurance plans as planned expenditure (and mind you, a very miniscule one). So, if you are going to be a responsible government official, would you not wish to offset the taxes your citizens pay by collecting the user fees allocated and budgeted for by user health insurance companies? I think you would, and as a taxpayer, I frequently call out on the carpet government officials who do not avail themselves of every possible source of revenue to offset the taxes I pay.

    I see none of the insinuated “double dipping” here. Reliance on insurance reimbursements alone would not allow an EMS service to survive. It must be supplemented by tax dollars. Those tax dollars then, pay for the preparation to respond. Users of the the service reimburse the additional costs of the services they utilize through their health insurance. Taxpayers should not be shouldering this additional burden.

    Mike McEvoy
    EMS Editor
    Fire Engineering magazine

  • Bob says:

    Nonsense – it is a user fee. Why should I pay higher taxes for the service if I do not need it? My taxes pay for the “stand-by” portion of the service i.e appartaus, equipment, and personnel on stand-by. User fees are common in EMS and also are used in many municipalities in other areas such as fire inspections and certain training such as fire extinguishers. Yes, I know, a user fee is really a “tax” but they exist for good reason – they tax the people that use the service.

  • Smitty says:

    Stories like these remind me how important it is that we reject the idea of the business model for government. EMS should not be a profit center. Government is mission-driven with elements of being a service industry. That doesn’t mean we should be profligate or ignore the importance of balancing budgets, but we need to be focused on what’s important and who we serve, and we need to be creative and innovative in delivering services. Thanks, Eric, for another fabulous post.

  • Anonymous says:

    It is a response to a reality. Municipal government revenues are tied to home values, and have therefore taken a huge hit in the past four years. At the same time, costs are increasing for many programs due to higher oil prices and countless other reasons. Specific to fire/rescue, our apparatus is not getting any less complex or cheaper to buy or to maintain. We all want to ensure we have well-staffed apparatus, and the latest in safety gear. Many state governments are offloading expenses for certain programs onto the municipalities, further increasing the cost side of the budget. The reality is that it is politically unpopular to increase taxes to fund these increases.

    As long as the funding from these fees is directed back at the fire/rescue service and not to the general fund, then it is effectively a user fee as many have stated. It allows an increase in the fire/rescue budget at a time when it might otherwise be impossible.

    Specific to the Montgomery County situation, the agreement specifically directs funding towards the volunteer corporations. Second, I always encourage people to actually read the text of laws they wish to criticize. The Montgomery County bill now only collects from those with insurance that covers the fee, regardless of whether they live in the county or not (which differs from the original bill). No, I don’t believe the claim that this won’t have any impact on premiums (that makes no logical sense), but the article’s author is completely incorrect in stating that the bill will collect from those without means are not protected.

  • Jim Breslin says:

    As long as the insurance companies say they will provide reimbursement for ambulance fees, the municipalities would be remiss not to collect them.

  • Thomas says:

    Jurisdictions applying these fees have in place a waiver clause for folks who cannot afford the fee. It has had no impact on 911 calls that I know of.

  • Brooks says:

    The same model applies to most government services, regardless of fee structure. Or, put another way, if an EMS system with a transport fee is a government monopoly insurance company with a deductible, why isn’t an EMS system with no fee a government monopoly insurance company with NO deductible?

    We use tax money to run universities, and charge tuition. We use tax money to build public parking garages, and charge parking fees. We use tax money to build public hospitals, and make hospital charges. We use tax money to build bridges, and charge tolls. This model is not going away, and it’s not a bad model. The glorious free market may not support a decent cardiac hospital in my county, but I don’t mind my tax money going to build one so that I *might* have access to it. I don’t see the need for tax money to make it free to every user, though.

    You do have one thing right — government services need to be aware of the cost of doing business, and how likely the private sector could step up to the plate. When it comes to things like real estate (parking), externalities (a highly educated workforce), or public goods (an emergency response-in-readiness), the ‘free market’ fails at properly assessing a price.

    There are good advantages to Fire-based EMS transport; the personnel are multifunction and can be ‘forward deployed’ at neighborhood fire stations, where they can provide critical first-four-minute interventions in the case of fire or medical emergency. The EMS taxes and fees can subsidize the fire response at fires, and the fire taxes can subsidize the EMS responses.

    This falls apart when the EMS system becomes ‘congested’. EMS becomes a different sort of economic good. The personnel are no longer available to subsidize Fire responses, and potential users are unlikely to benefit from the existence of an EMS system. It’s very likely that private sector resources can be added more cheaply than additional public sector resources, especially when the private sector resources will be highly utilized, and therefore more profitable.

    The economics change with the territory. In low density areas, public EMS makes economic sense. As taxpayer and demand density increases, the proportion of time EMS units sit idle on standby costing money decreases, and the proportion of time the EMS units are profitably transporting increases.

Leave a Reply

Your email address will not be published. Required fields are marked *