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Posted at 8:31 AM ET, 10/ 7/2010

Ambulance fees would burden the poor

By editors

By John T. Bentivoglio
Chevy Chase

The Oct. 4 editorial “The case for ambulance service fees” dismissed several troubling aspects of such fees and ignored evidence that they could risk lives and have unintended consequences. Your readers deserve a more careful analysis of the facts.

First, studies and surveys demonstrate that medical costs, including ambulance fees, contribute to delays by people in seeking emergency care for heart attacks and other life-threatening medical events. Such fees run counter to three decades of effort by public health officials to lower barriers to calling 911. Anecdotal experience confirms that some patients probably would refuse transport if fees were charged.

Second, in the case of proposed fees in Montgomery County, the threshold for waivers would leave many working poor subject to the fees, and some of those who are eligible, such as immigrants, might be leery of asking for a waiver. So while the “majority” might not feel the impact, fees of $300 to $800 would fall on the poor, uninsured and underinsured individuals, and the elderly. Have we grown so callous that we should ignore these groups when help is needed most?

Finally, The Post dismissed concerns about insurance-rate increases. Does The Post really believe that insurance companies, facing millions in new costs, won’t pass these along in higher premiums? Why haven’t fee proponents offered evidence from insurers or regulators that rates won’t rise? Perhaps The Post has forgotten the important lesson that there is no free lunch.

Ambulance fees are bad public policy, and the Maryland Court of Appeals was right to give Montgomery County residents a say on this important issue via a referendum in the November election.

The writer was the lead attorney in the lawsuit challenging the rejection of the ambulance fee petition.

By editors  | October 7, 2010; 8:31 AM ET
Categories:  HotTopic, Montgomery County  
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The most important job of government is to provide for the safety and well being of its citizens. Charging for ambulance service is uncalled for. That is what people pay taxes for (police and fire protection).

Posted by: sfcret | October 7, 2010 12:07 PM | Report abuse

So, the solution is to give them a free ride by demanding, at gun point, that I pay instead?

Posted by: illogicbuster | October 7, 2010 12:10 PM | Report abuse

I contribute to my volunteer fire department every year, thinking that if I need them they will transport me free. Guess not!

Posted by: mbrumble | October 7, 2010 1:57 PM | Report abuse

I am a county employee who works for the Department of Public Libraries, and we have seen firsthand the effect of the budget cuts that were enacted in July. If the ambulance fee doesn't go through, where will that continuing source of revenue come from? No one wants to pay higher taxes and the County Executive will not jeopardize the County's AAA bond rating by dipping into the reserves, so that just leaves cutting funding to programs that provide services to all County residents, including the elderly and at-risk youths. Take a look at Leggett's memo to the Council and see exactly what is going to be cut if this ambulance fee is revoked: (click on the link on the right under "What's New"). After you read that, then decide whether you think you can live without library services, programs for seniors, and subsidies for the poor who can't afford to pay their heating bills.

Posted by: librarygal | October 7, 2010 3:36 PM | Report abuse

Maybe these so-called 'poor', who get plenty of 'assistance' from coerced, protection rackets run by criminal governments, perhaps these 'poor' should take better care of themselves so they won't need another freebie, paid for by everyone else. And while they're at it, perhaps they should upgrade their personal skills so they could get better jobs, then they might be able to afford paying for things instead of just sitting there, whining.

Posted by: RichTheEngineer | October 7, 2010 3:54 PM | Report abuse

Hi there.

I, for one, need more data about how ambulance fees impact different groups (uninsured vs. insured, chronically sick vs. those hit with one-time emergencies, etc.) and whether/how certain groups purportedly overuse/abuse "free" ambulance service ("frequent flyers," the homeless, hypochondriacs, etc.).

Are people dropping like flies in other areas that charge ambulance fees because they're deterred from dialing 9-1-1?

Posted by: FedUpInMoCo | October 8, 2010 11:19 AM | Report abuse

Take a look at the memo that MoCo Fire Chief Richard Bowers sent to the County Council this spring that discusses in detail the studies that opponents to the ambulance fee have cited as being proof that the fees are a bad idea, and you can see for yourself that there is no real evidence to support the assertion that the fees will keep people from calling for an ambulance when they need help:

Posted by: librarygal | October 8, 2010 12:13 PM | Report abuse

In response to the last post, the County's analysis is superficial and dismissive at best. Here's an except from an April 2010 study in the Journal of the American Medical Association:

"Results Of 3721 patients, 2294 were insured without financial concerns (61.7%), 689 were insured but had financial concerns about accessing care (18.5%), and 738 were uninsured (19.8%). Uninsured and insured patients with financial concerns were more likely to delay seeking care during AMI and had prehospital delays of greater than 6 hours among 48.6% of uninsured patients and 44.6% of insured patients with financial concerns compared with only 39.3% of insured patients without financial concerns. Prehospital delays of less than 2 hours during AMI occurred among 36.6% of those insured without financial concerns compared with 33.5% of insured patients with financial concerns and 27.5% of uninsured patients (P<.001). After adjusting for potential confounders, prehospital delays were associated with insured patients with financial concerns (adjusted odds ratio, 1.21 [95% confidence interval, 1.05-1.41]; P=.01) and with uninsured patients (adjusted odds ratio, 1.38 [95% confidence interval, 1.17-1.63]; P<.001).

The report concluded: "Lack of health insurance and financial concerns about accessing care among those with health insurance were each associated with delays in seeking emergency care for AMI [acute myocardial infarction -- heart attack]."

Additional studies, along with anecdotal stories, can be found at

If ambulance fee supporters are so confident fees won't be a deterrent to calling 911 when help is needed most, why don't they come forward with well-controlled studies supporting their position? Not just assertions (e.g., about the experience in other jurisdictions -- which, by the way, have done no studies to see if fees are a barrier) but actual research and analysis.

The studies support the common-sense notion that if you charge a fee $300 to $800 per transport, it will be a barrier for some people, particularly those without insurance and others who are financially strapped.

We've spent three decades trying to convince people to call 911 at the earliest sign of a heart attack or stroke -- yet ambulance fees send exactly the opposite message.

I respect (but disagree with) those who say we need the revenue so badly we should accept such risks. But we can't wish the risks away -- they are real and well documented.

Posted by: jbentivoglio | October 11, 2010 3:08 PM | Report abuse

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