Taxes and ambulance billing

First of all, happy New Year! May your 2012 be happy, peaceful, and safe.

The Journal of Emergency Medical Services ran a feature on their website today detailing the Derry, NH Fire Department's proposal to raise the rates for their ambulance service. Derry FD is asking for "an approximately 10 percent increase in its ambulance fees," according to the article. This request has precipitated, predictably, a whirlwind of support and opposition. And that's a good thing. The debate over how to fund / pay for EMS is an important one to have, and it will hopefully lead to better public understanding over what EMS is and how it fits into the civic and social fabric in the United States.

One popular objection, which Derry Councilor Janet Fairbanks raises here, is that since Derry FD is a municipal department, it is funded by tax dollars and charging residents for ambulance service is "double-dipping." This is an understandable, but flawed, position. The fact is that tax dollars provide only that an ambulance and a properly trained and equipped crew will show up at your door. Tax dollars do not cover service you receive once the EMS crew enters your home (Chuck Hemeon, the Emergency Services Director for Derry, makes a similar point in the article).

The analogy of utilities is helpful here. The residents of Derry--or any town--all pay the same rate for their electricity. This is a flat fee, universally levied, that provides them with the availability of a service. But each household pays a different amount each year on their electric bill based on how much, or how little, they used that service. In the context of municipal departments, EMS is the same way. Your tax dollars mean there will be an ambulance available if you need one, but that does not automatically translate to free healthcare.