Vermonstrous writes, "ambulance fees. DC has 'em. Alexandria and Arlington have 'em. Montgomery is considering them. Supporters of these fees say they are only charged to those whose insurance pays -- functionally giving the jurisdictions free money from insurance companies. They also say the fees haven't discouraged people from calling 911. How they can say, on one hand, that taxes and fees -- on cigarettes, environmental impact and the like -- can change behavior while at the same time arguing that ambulance fees do no such thing is beyond me. What say you?"I'm going to put aside the issue of whether I think ambulance fees are a good idea or not (I haven't thought about it much nor read the relevant literature) and simply explain why the fees don't discourage 911 calls. Basically, there are two reasons, and they demonstrate something important about health care:1) We're insulated from health care costs. To take the cigarette example, imagine if your work paid for your cigarettes. In fact, you never even saw the price tag on the pack. Rather, you went in, flashed your smoker's coverage card, and got your cancer sticks. Would you care if the legislature raised prices a dollar a pack? Of course not. You don't really see how you're paying. Of course, in the end, you are paying, because your employer is taking that money out of your wages or passing it in to consumers. But that's very indirect, or at least feels very indirect. In the short-term, the smokes might as well be free. So too with ambulances, and ambulance costs, for folks with insurance. While the uninsured may be somewhat price sensitive, for the insured, calling an ambulance doesn't much change their insurance bill. So why not make the call? After all, your insurer is paying for it.2) You don't comparison shop from a hospital gurney. In any economic transaction, the consumer's leverage is her ability to walk out of the store and either go without the good or find a better price somewhere else. Consumers don't have that distance when pain is lancing through their chest and every moment of delay may mean the death of more heart muscle. Too much delay could mean brain damage, or even death. When those are the stakes and the time constraints, you don't have the ability to not call the ambulance. You don't have the time to comparison shop. Folks having a health emergency go to the doctor first and figure out the pricing later. A good credit rating, after all, isn't much good if you're dead. ASSIGNMENT DESK: AMBULANCE FEES.
Vermonstrous writes, "ambulance fees. DC has 'em. Alexandria and Arlington have 'em. Montgomery is considering them. Supporters of these fees say they are only charged to those whose insurance pays -- functionally giving the jurisdictions free money from insurance companies. They also say the fees haven't discouraged people from calling 911. How they can say, on one hand, that taxes and fees -- on cigarettes, environmental impact and the like -- can change behavior while at the same time arguing that ambulance fees do no such thing is beyond me. What say you?"I'm going to put aside the issue of whether I think ambulance fees are a good idea or not (I haven't thought about it much nor read the relevant literature) and simply explain why the fees don't discourage 911 calls. Basically, there are two reasons, and they demonstrate something important about health care:1) We're insulated from health care costs. To take the cigarette example, imagine if your work paid for your cigarettes. In fact, you never even saw the price tag on the pack. Rather, you went in, flashed your smoker's coverage card, and got your cancer sticks. Would you care if the legislature raised prices a dollar a pack? Of course not. You don't really see how you're paying. Of course, in the end, you are paying, because your employer is taking that money out of your wages or passing it in to consumers. But that's very indirect, or at least feels very indirect. In the short-term, the smokes might as well be free. So too with ambulances, and ambulance costs, for folks with insurance. While the uninsured may be somewhat price sensitive, for the insured, calling an ambulance doesn't much change their insurance bill. So why not make the call? After all, your insurer is paying for it.2) You don't comparison shop from a hospital gurney. In any economic transaction, the consumer's leverage is her ability to walk out of the store and either go without the good or find a better price somewhere else. Consumers don't have that distance when pain is lancing through their chest and every moment of delay may mean the death of more heart muscle. Too much delay could mean brain damage, or even death. When those are the stakes and the time constraints, you don't have the ability to not call the ambulance. You don't have the time to comparison shop. Folks having a health emergency go to the doctor first and figure out the pricing later. A good credit rating, after all, isn't much good if you're dead. 
