Ambulance tax?

Ambulance companies in the United States are funded one of two ways: They either operate exclusively off of donations or they send the patient / his insurance a bill. Donation-based operations have an inherent degree of instability because the ambulance company is left at the mercy of the overall economic climate and the individual community's altruistic inclination. If donations go down for whatever reason, i.e. national economic woes, EMS operations will be affected, possibly severely. The need for timely and effective EMS response, however, remains the same.

A fee-for-service model (billing) isn't the cure-all either. Anyone who has received an ambulance bill knows that it is not cheap. All too often patients--especially those who have received ambulance transport in the past--balk at receiving transport in the present in order to avoid a three- or even four-figure bill. The desire to avoid incurring costs is understandable, but it should never obscure the patient's health and safety. Billing patients for procedures performed and equipment expended also tempts providers to make treatment decisions based on financial considerations instead of the patient's condition. This temptation is resisted in an overwhelming number of cases, but the door is nevertheless left open.

Fire departments on the other hand receive a large percentage of their funding from the public. Most towns levy a "fire tax" on their residents, which finances fire department operations. There is no analog of the fire tax for EMS, but I think there should be. EMS is a public service just like the fire department, the police, the library and the school system. Each of those is primarily funded by taxes no matter how much or how little citizens use those services, and EMS should be no different.

Every household pays the fire tax even if they never have to call the fire department. Every household pays school taxes whether they have no kids or have sent a dozen through the public school system. So why doesn't EMS receive tax funding? Not everyone will call for an ambulance in his lifetime, it's true. But when you do need one, you want it to show up, and after it does, you don't want a huge bill. If each household contributed a small amount of money to the local ambulance corps, the corps would be able to remain afloat without levying massive bills or reducing its operational capability to cut costs.

Ambulance companies could still bill patients, but only to recoup fuel and supply expenditures from that call only. This way the patient is only paying for what he actually consumes and expenses like vehicle maintenance, equipment purchasing and personnel salaries would be covered by the ambulance tax. After all, the knowledge that a well-equipped and -staffed ambulance will respond to an emergency offers comfort and peace of mind to the public as a whole, so it is only right that they should help foot the bill. An ambulance tax is the most reliable and evenly distributed way of funding EMS and ensuring its longevity.

What do you think?

First week of work

I started work on Tuesday at a nearby ambulance company. It's a neat company; they do 911 service for nine towns as well as interfacility transfers for both adults and neonates. The veterans have been very friendly and willing to teach, and even after just three days I'm already learning a ton. And driving the ambulance is a very cool experience!

I'm back in Chappaqua for the weekend. Horace Greeley had their graduation Sunday, and while I didn't make it to the ceremony, a hearty congratulations to the HGHS class of 2009! I'm sure we'll be hearing of their accomplishments and exploits for years to come.

In other news, the Yankees just lost two out of three against the Florida Marlins, which was disappointing. There was a silver lining, though: Throughout the series there were frequent chants of "Let's go Yankees." You've gotta love the home crowd cheering for the visiting team!

Graduation!

I graduated from Dartmouth College this morning. This special place has been my physical, intellectual, emotional and spiritual home for the past four years and walking across the graduation stage was predictably surreal but also surprisingly natural. Absent were all feelings of trepidation and anxiety. Instead I feel energized and enthusiastic; I am so excited to see what God has in store.

Now that I'm done with college, I get one day to rest and then I begin work at a nearby ambulance service on Tuesday. It'll be nice to get some more experience under my belt this summer before paramedic school begins in August. The Upper Valley is a beautiful place to be in the summertime, and living with my pastor for a month will be a terrific experience. Add to that staying near Ellen and the summer is looking pretty good.

This blog should be updated regularly, so I encourage you to leave a comment and stay in touch!