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Morning Lineup – January 24

2 comments

Yesterday we posted an article about a county in North Carolina that is taking measures to collect up to $14 million in past-due charges for emergency ambulance service calls (HERE).

This policy of charging people for emergency care on a per-call basis is sweeping the country these days.  More and more governmental entities see the dollar-sign rainbow appearing over the ambulance bay.

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Personally, I have always been troubled with this practice of charging hard money to people who are in distress and call us for help.  For decades FD’s and rescue squads answered the calls and did what they could to help without regard of who was in trouble or whether they even lived in the area when they suffered their accident or illness.  There were no follow-up charges levied against them.  It was part of the cost of running a civilized society and has been funded by the local residents.

In some places the funding is provided from tax collections and in others it is raised by innovative fund-raising projects like a Bingo game or Saturday morning pancake breakfast parties.  But now we have a new method…. taking directly from the poor soul who called because they were unable to take care of themselves at the moment.

I know, I’ve heard the arguments justifying this policy.  In their way, they are valid arguments.  But there is also an argument as to whether this is morally justified.  How did Forsyth County find that those people “owed” it all that money?  Simple.  They merely passed a law decreeing it.

Where is the limit to this?  Isn’t emergency care supposed to be part of the common welfare duties of the locality?  What’s next, then?  If somebody breaks into your house, will the gov’t. charge your homeowners insurance for the cost of taking a police report?  And higher charges if they actually open up an investigation and attempt to catch the burglar?

Back in the 19th century, police departments in the bigger cities wouldn’t begin to investigate a crime unless the station officers (and detectives) were bribed by the aggrieved citizen.  Fire companies would watch your house burn unless you had paid in advance for “protection.”  And now we are seizing people’s money because we showed up and kept them alive when they were desperate and helpless.  That’s not progress.  We are regressing.

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Now let’s get the equipment checked.  I’ll make sure the coffee’s ready.

Posted by on January 24, 2008 • Filed under: morning lineup
  • Frank

    I enjoy the site but have to take exception to the generalization that agencies who charge for EMS see a “rainbow of cash”.

    We are a tax-funded, primarily volunteer organization, with four career members and six part time members supplementing our weakest staffing periods, and we almost always have several members on duty in our five-station district 24/7. In my state, a law was approved by the voters around 2002 that restricts our annual budget increases from the county to 1% of the previous year’s budget. Our budget does not reflect the skyrocketing home values and sprawling growth, all that extra income goes to other things – schools, libraries, the arts, whatever was not singled out in the 1% annual increase.

    On the local level, last year, the residents of our district rather surprisingly voted down a long-standing EMS levy that covered all EMS services rendered in our district, including ambulance transport by our neighboring ALS FD.

    It has been pretty much impossible to survive annual budget increases of 1% with equipment and fuel and other expenses increasing somewhere like 6-8% each year, and the loss of this EMS levy was brutal. State law also requires us to operate financially in the black. We were forced to start billing for our EMS calls to stay afloat. Because we are required to operate in the black, our only other realistic options to remain in compliance with state law were to lay off employees (and likely miss some responses), sell equipment or apparatus, sell stations/property, or simply refuse to respond to EMS calls.

    This same levy paid for ambulance transport by the aforementioned neighboring FD. They are also now forced to bill for services, and at a less than 50% collection rate, their hand is also being forced. They too must operate in the black, but they also have an obligation to their own citizens first, their city cannot be expected to subsidize transport services for a portion of the county that simply voted to stop paying. If the levy is not restored at the next election, they will be forced to withdraw from our service territory. The next closest provider, a private EMS provider, has not shown any enthusiasm nor made assurances that they will stretch to cover our area, and the next-closest provider after them is a small county EMS system from the next county over 30 minutes away and is not equipped or staffed to assume our district anyway.

    Let me tell you, it breaks my heart to bill customers. We all feel crappy about it, but we have no choice if we are to survive. Even in our situation, our empathy drives us to forgive many of our bills and fudge the billing paperwork to the benefit of our patients.

    Regarding the tax lid, we have a lid lift election coming up next month where we will ask our residents to approve an increase above the state law’s 1% limit, which will merely restore our tax rate to the level it was from 2002 with no increases to reflect inflation since then. If this does not pass, we will be forced to lay off all part time staff this year, and one full time staff member per year afterwards until we are once again a fully volunteer agency with uncertain staffing patterns. If, after this, we still cannot operate in the black, once again, we either must sell equipment/real estate, discontinue all EMS services, or simply cease to exist. By state law, something has to give.

    We are on a thread, barely surviving. It’s just great that we might have a moral obligation to provide “free” EMS, but we also have strict and inflexible legal requirements to meet. It is a classic example of an unfunded government mandate, and the victims are the residents of our district.

    So, please, cut those of us some slack, who see not a rainbow of cash, but a grim and lousy timy-consuming chore necessary for the survival of our agency and the continuation of those services we are still able to provide with the diminishing funds the voting taxpayers have left us with.

  • Frank

    I enjoy the site but have to take exception to the generalization that agencies who charge for EMS see a “rainbow of cash”.

    We are a tax-funded, primarily volunteer organization, with four career members and six part time members supplementing our weakest staffing periods, and we almost always have several members on duty in our five-station district 24/7. In my state, a law was approved by the voters around 2002 that restricts our annual budget increases from the county to 1% of the previous year’s budget. Our budget does not reflect the skyrocketing home values and sprawling growth, all that extra income goes to other things – schools, libraries, the arts, whatever was not singled out in the 1% annual increase.

    On the local level, last year, the residents of our district rather surprisingly voted down a long-standing EMS levy that covered all EMS services rendered in our district, including ambulance transport by our neighboring ALS FD.

    It has been pretty much impossible to survive annual budget increases of 1% with equipment and fuel and other expenses increasing somewhere like 6-8% each year, and the loss of this EMS levy was brutal. State law also requires us to operate financially in the black. We were forced to start billing for our EMS calls to stay afloat. Because we are required to operate in the black, our only other realistic options to remain in compliance with state law were to lay off employees (and likely miss some responses), sell equipment or apparatus, sell stations/property, or simply refuse to respond to EMS calls.

    This same levy paid for ambulance transport by the aforementioned neighboring FD. They are also now forced to bill for services, and at a less than 50% collection rate, their hand is also being forced. They too must operate in the black, but they also have an obligation to their own citizens first, their city cannot be expected to subsidize transport services for a portion of the county that simply voted to stop paying. If the levy is not restored at the next election, they will be forced to withdraw from our service territory. The next closest provider, a private EMS provider, has not shown any enthusiasm nor made assurances that they will stretch to cover our area, and the next-closest provider after them is a small county EMS system from the next county over 30 minutes away and is not equipped or staffed to assume our district anyway.

    Let me tell you, it breaks my heart to bill customers. We all feel crappy about it, but we have no choice if we are to survive. Even in our situation, our empathy drives us to forgive many of our bills and fudge the billing paperwork to the benefit of our patients.

    Regarding the tax lid, we have a lid lift election coming up next month where we will ask our residents to approve an increase above the state law’s 1% limit, which will merely restore our tax rate to the level it was from 2002 with no increases to reflect inflation since then. If this does not pass, we will be forced to lay off all part time staff this year, and one full time staff member per year afterwards until we are once again a fully volunteer agency with uncertain staffing patterns. If, after this, we still cannot operate in the black, once again, we either must sell equipment/real estate, discontinue all EMS services, or simply cease to exist. By state law, something has to give.

    We are on a thread, barely surviving. It’s just great that we might have a moral obligation to provide “free” EMS, but we also have strict and inflexible legal requirements to meet. It is a classic example of an unfunded government mandate, and the victims are the residents of our district.

    So, please, cut those of us some slack, who see not a rainbow of cash, but a grim and lousy timy-consuming chore necessary for the survival of our agency and the continuation of those services we are still able to provide with the diminishing funds the voting taxpayers have left us with.