Ambulances for All, You Scoundrels!

If you call 911 and the fire department comes, you will generally pay nothing. In virtually all cities, fire departments operate as a public service financed by local government, usually via property taxes.

But if you call 911 for an ambulance, you could face a huge bill, even for a short ride. Ambulances typically don't operate as a free public service. In many states the average balance due runs over $1,000.

Having health insurance does help, but deductibles and exclusions can still leave you with a huge bill. A medical emergency that requires an ambulance can easily drive you into debt.

People sometimes beg not to be put in ambulances, even in situations where they clearly need them. One Boston resident, her gashed leg caught between a subway train and the platform, pleaded with worried fellow passengers to forego any call to an ambulance service.

"I have terrible health insurance," she explained.

But things could be worse. Imagine if we had privatized fire departments. We would then see a "fire-fighting insurance industry" emerge. Your insurer would receive a bill from the fire-fighting company that put out your fire. These bills would be high, in part because fire companies would have trouble getting poor people to pay them.

You would also likely have a giant deductible, and that would leave fires, even for the insured, extremely costly. Many people would become reluctant to call for help. They would try instead to put fires out by themselves, making desperate cost-benefit analyses in a moment of extreme stress instead of just calling the fire department to get their fire extinguished quickly and safely.

A privatized fire-fighting system would create ludicrous situations. Saner voices would quickly demand that we return to public fire departments and have everyone, once again, get their fires extinguished for free.

Some among us, of course, would likely protest against "creating" still another "costly" public service. They would lodge against public fire departments the standard conservative arguments against left-leaning health care plans.

So you actually trust, these critics would argue, the government to put out your fires? People deserve a choice about how to finance extinguishing the flames that are burning down their houses. And many people like their private fire insurance. You want to take it away from them! You want to eliminate jobs in the private firefighting insurance industry? You want to raise taxes and hurt the economy?

Tax-funded fire departments, the argument would continue, put us on a slippery slope to collectivism.

My own belief? Ambulances should be close to free, with perhaps a $50 fee to prevent over-use. Based on three million ambulance rides a year, nationwide, the cost of providing this ambulance access would only take about $4 billion a year in new spending, frankly just a rounding error in federal health budgets.