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?