# Start Here > Guest Forum >  How would ambulance service work?

## Unregistered

If the medical system is totally private, how would local ambulance service work?

Example:  I'm out in public somewhere, I have a heart attack, become unconscious, and if I'm not brought to a hospital within 30 minutes I'll die.  Onlookers call 911.  Ambulance services get the call.  An affordable no-frills ambulance service that's a mile away would only charge me $500 to take me to the hospital.  However, a luxury 5-star ambulance service happens to be only a couple blocks away and gets to me first.  They charge $2000.  Since I'm unconscious, I can't turn away the ridiculously expensive luxury ambulance service when the no-frills ambulance service will do just fine.

How's that going to work so I don't wake up and get another heart attack after I get the ambulance bill?

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## pcosmar

> If the medical system is totally private, how would local ambulance service work?
> 
> Example:  I'm out in public somewhere, I have a heart attack, become unconscious, and if I'm not brought to a hospital within 30 minutes I'll die.  Onlookers call 911.  Ambulance services get the call.  An affordable no-frills ambulance service that's a mile away would only charge me $500 to take me to the hospital.  However, a luxury 5-star ambulance service happens to be only a couple blocks away and gets to me first.  They charge $2000.  Since I'm unconscious, I can't turn away the ridiculously expensive luxury ambulance service when the no-frills ambulance service will do just fine.
> 
> How's that going to work so I don't wake up and get another heart attack after I get the ambulance bill?


How did it work before 911 was invented?

If you need an ambulance,, call an ambulance.

If you call 911 you will get police and fire depts,, and one of them may call an ambulance. If you are lucky the police will not arrest the firemen.. and won't shoot you for failing to comply with their commands.

And when the cluster$#@! is over you will be charged,, or your survivors will be charged for the unnecessary resources.

Never call 911.

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## Root

This is why you have medical insurance.  Plus, it wouldn't be a free-for-all.  You will get  the closest capable available unit.

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## Root

> How did it work before 911 was invented?
> 
> If you need an ambulance,, call an ambulance.
> 
> If you call 911 you will get police and fire depts,, and one of them may call an ambulance. If you are lucky the police will not arrest the firemen.. and won't shoot you for failing to comply with their commands.
> 
> And when the cluster$#@! is over you will be charged,, or your survivors will be charged for the unnecessary resources.
> 
> *Never call 911*.


Qft

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## Voluntarist

xxxxx

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## amy31416

We're libertarians...we'll shoot 'em for trespassing.

Seriously though, there are plenty of private ambulance services out there.

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## fisharmor

First, if you even HAVE a $500 option, you're already better off than in the current system.

Second, in a private system, people would also start to notice some other absolutely horrifying aspects of the current system.

On Monday I got to witness a high-speed accident involving a woman on a motorcycle.  I had the wife call it in and got out to make sure there wasn't something I could do.  I tried to keep her still and make sure there weren't any jets of blood coming out of her, and by the time that was done *two* nurses had stopped and were administering first aid.

I was at her within ten seconds of her stopping her roll and the nurses were on her within twenty seconds after that.  There already was private help for her.

Secondly, as we got off with 911 and I realized we were third wheeling and in the way, I left.
*As I was walking back to the van, the first cop showed up.*
*As I was driving away, the second cop showed up.
*
Maybe in a private system, someone would stop to consider that for a second.
Does anyone seriously think they were there to help?
Or did they smell blood in the water, and a good opportunity to write some tickets?
Why am I even asking those questions when I know the answer?

ETA the point I forgot to add is, I don't know WHEN the ambulance showed up.
I've been scouring google for the last four days trying to find out what happened to her.  She might have died.
But at least two cops got there within five minutes.

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## oyarde

> If the medical system is totally private, how would local ambulance service work?
> 
> Example:  I'm out in public somewhere, I have a heart attack, become unconscious, and if I'm not brought to a hospital within 30 minutes I'll die.  Onlookers call 911.  Ambulance services get the call.  An affordable no-frills ambulance service that's a mile away would only charge me $500 to take me to the hospital.  However, a luxury 5-star ambulance service happens to be only a couple blocks away and gets to me first.  They charge $2000.  Since I'm unconscious, I can't turn away the ridiculously expensive luxury ambulance service when the no-frills ambulance service will do just fine.
> 
> How's that going to work so I don't wake up and get another heart attack after I get the ambulance bill?


 Ambulance service is private business where I live.There are about three ( businesses )in the two counties most of my properties straddle . Works fine . You call them , they will do there best to get you there alive for about $550 , or you can drive yourself .They will not bill you for a few weeks and then you have a few weeks to pay.

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## oyarde

I would not use a govt ambulance , first of all , it would cost more  , worse service ( no accountability ) lazier , less efficient employees, so , model of inefficiency . Where I am , there are volunteer fire dept.'s ( model of efficiency , run off of donations ) , caring , hard working people. Or , just drive to the Menonite or Amish Dr.'s offices  .......

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## oyarde

Do not worry , by next yr , the IRS will run your ambulance  service .

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## acptulsa

Once Tulsa had private ambulance service by a company called Central.  The owner was all the time feuding with the politicians, probably over the size of their kickbacks.  It was great--until the politicians won.

Only Central was inspected and approved to do emergency runs.  That small portion of the population who were unable to speak for themselves when an ambulance was called for them got Central.  Others could say they weren't an emergency, and they wanted Brand X instead.  Any Brand X company could do any patient transfer.  And the government could take the contract from Central and appoint another company if Central got too cocky to do the job right (which they never did).

Now we have an Official Government Boondoggle.  If we don't use their overpriced services, we don't use an ambulance at all, because their overpriced asses are now the monopoly.  The monopoly was set up because in spite of the price hike, the government-run boondoggle couldn't make ends meet without having transfer patients forced to use their overpriced services.  And now we pay the fire department to respond on all ambulance calls so they can keep patients alive until the boondoggle can get around to getting there.

They have so little faith in their paramedics their dispatchers have to be paramedics.  So, few if any of their dispatchers know the city at all, and we're all the time waving ambulances down and helping them find their patients.

How did ambulance service work here?  A damned sight better forty years ago than now, that's how.  And thanks for asking--that was a good question.

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## NorthCarolinaLiberty

Speaking of competing ambulances and the like--should I buy the movie Mother, Jugs, and Speed?  Would it be good nostalgia with those actors, or would I be wasting my 75 cent at Good Will?

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## mosquitobite

It is a private/public partnership here and when you call 911 you get the ambulance service that has the CONTRACT with 911.  Quite lucrative as the ambulances are private entities and the governments go by speed and accuracy on the call versus cost.  

I had never thought about calling an ambulance company directly.  Not even sure how that would work here as the contracts essentially make it so any smaller service can't compete.

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## mosquitobite

> Once Tulsa had private ambulance service by a company called Central.  The owner was all the time feuding with the politicians, probably over the size of their kickbacks.  It was great--until the politicians won.
> 
> Only Central was inspected and approved to do emergency runs.  That small portion of the population who were unable to speak for themselves when an ambulance was called for them got Central.  Others could say they weren't an emergency, and they wanted Brand X instead.  Any Brand X company could do any patient transfer.  And the government could take the contract from Central and appoint another company if Central got too cocky to do the job right (which they never did).
> 
> Now we have an Official Government Boondoggle.  If we don't use their overpriced services, we don't use an ambulance at all, because their overpriced asses are now the monopoly.  The monopoly was set up because in spite of the price hike, the government-run boondoggle couldn't make ends meet without having transfer patients forced to use their overpriced services.  And now we pay the fire department to respond on all ambulance calls so they can keep patients alive until the boondoggle can get around to getting there.
> 
> They have so little faith in their paramedics their dispatchers have to be paramedics.  So, few if any of their dispatchers know the city at all, and we're all the time waving ambulances down and helping them find their patients.
> 
> How did ambulance service work here?  A damned sight better forty years ago than now, that's how.  And thanks for asking--that was a good question.


Oh man, I have similar stories here.

We used to have a third vendor, but the rumor is that one of the other companies had someone on the 911 dispatch that would regularly send that other service to the wrong address.  (123 Main St could be in two cities - oops! you went to the wrong one!) Then the ambulance service would get dinged for it.

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## Nirvikalpa

> Where I grew up (a rural area) we had a volunteer fire department and a volunteer rescue squad (ambulance). They were quite effective - but also had the ambiance of a social club. I can remember the fundraising for when the rescue squad building and ambulance was being sought (thermometer-style billboards at the entrances to town indicating how close we were to the goal). The property had been donated.
> 
> Of course that was back in the 1960's I think it's all tax funded now.


Nah, private ambulances still do have fundraising and we have to.  Supplies aren't cheap, most aren't reusable, and ambulances aren't cheap - and ambulances 7+ yrs old are considered old and out of date.  Good stretchers (Stryker) are expensive too.

-----

Some private ambulances will charge a fee to bring a patient to the hospital, however I've worked for one who did and one who did not - never had a problem collecting payment with the one who did, and we always set aside money donated to us to help ease the burden for individuals who struggled to pay, and we "took care of" a lot of people.  The hospitals around here know they're dealing with a large population of homeless, elderly, sick, and needy.  

My private companies (all emergency call, no transports) kept their EMTs trained, too.  Every month we'd have a training session that was fun and educational that focused on a medical call that we may have during that season.  That's the difference between private, volunteer, non-profit and government-run.

Anyway, long story short my one private ambulance service (my town's) was shut down and the local FD took us over.  It was a long time in the making and we fought valiantly (as did the entire city behind our back, knowing we would go from a combined 8 ambulances to 1).  They have 2 ambulances now (took them a year before they got the additional rig) and constantly are calling for mutual aid.  I moved ambulance corps (to another volunteer squad three towns over, ~20min ride away) and got a mutual aid call from them.  

And it's not bad on the EMTs/Firemen who are understaffed and do 24-hour at minimum shifts, it's bad on the big boys who were the ones fighting for this merger (if you want to call it that, although no one 'merged' and all of us in the private sector lost our jobs) who also have the cushy $120k jobs and sit behind their desks all day and don't even go on calls.  My town has anywhere from 12-20 medical calls a day... it's too much.




> We used to have a third vendor, but the rumor is that one of the other companies had someone on the 911 dispatch that would regularly send that other service to the wrong address. (123 Main St could be in two cities - oops! you went to the wrong one!) Then the ambulance service would get dinged for it.


On one of my last calls for my private company before FD took us over, this situation happened for us too.  For medical calls an ambulance and a truck (firetruck) would dispatch out... we had a call for a street name that had both "St" and "Rd" in our town... we realized one of us had to hear it wrong when we passed each other on the main road, going in two very opposite directions.  Turns out we had it right

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## pcosmar

> Speaking of competing ambulances and the like--should I buy the movie Mother, Jugs, and Speed?  Would it be good nostalgia with those actors, or would I be wasting my 75 cent at Good Will?


Buy it.. Worth the laughs at twice the price.

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## oyarde

> Speaking of competing ambulances and the like--should I buy the movie Mother, Jugs, and Speed?  Would it be good nostalgia with those actors, or would I be wasting my 75 cent at Good Will?


Get it for a dollar or less .

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## Unregistered

No one has really answered my question.

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## Unregistered

> How did it work before 911 was invented?
> 
> If you need an ambulance,, call an ambulance.
> 
> Never call 911.


That would be a little hard to do since I'm unconscious as I gave in my example.

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## MelissaWV

> No one has really answered my question.


Actually, several people have answered, particularly as there are many private ambulance companies out there right now.  

To get more to the heart of your hypothetical, in a free market things would not continue to be as different as they are in the example.  That $2000 fancy ambulance would not make much money trolling the regular streets.  Private pay individuals would not pay their whole bill, and would end up settling it way down the line if they paid it at all.  Insurance companies would not pay $2000.  Media would love this sort of story (charging four times as much to take you to the hospital).  So it's really not a good business model to charge 400% of what others do, and this would become an issue over time.  Likewise, if the "no frills" company were operating at a huge loss to the point that donations and payments could not keep them in business, they would eventually no longer be able to offer the $500 transport.

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## Unregistered

> This is why you have medical insurance.


Isn't that partly why health care is so expensive as it is, insurance will pay for ridiculously over-priced goods and services and pass the cost by raising people's premiums?  




> Plus, it wouldn't be a free-for-all.  You will get  the closest capable available unit.


That sounds like a free-for-all to me.   The closet available unit in my example was a ridiculously over-priced luxury ambulance service.  I'm just wondering in a free-market health system, how do people not get stuck in that situation because I can't see communities tolerating that.

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## Unregistered

> Actually, several people have answered, particularly as there are many private ambulance companies out there right now.


Actually, you're the first person who's really tried to answer my example, but regardless.




> To get more to the heart of your hypothetical, in a free market things would not continue to be as different as they are in the example.  That $2000 fancy ambulance would not make much money trolling the regular streets.


Maybe not regular streets, but most likely in upper-class areas where they know people have money and I can see the luxury ambulance service advertising they hire top-notch EMT's to make people feel their emergency service is the best qualified, partly justifying their high price.

What if I happened to be passing through one of these rich areas when I have my heart attack?




> Private pay individuals would not pay their whole bill, and would end up settling it way down the line if they paid it at all.


So after dealing with the stress of my heart attack, now I have to deal with the stress of haggling the price down after the fact?  Doesn't sound too appealing to me.




> Insurance companies would not pay $2000.


They do now!  They just pass the premiums on to the payers.




> Media would love this sort of story (charging four times as much to take you to the hospital).  So it's really not a good business model to charge 400% of what others do, and this would become an issue over time.  Likewise, if the "no frills" company were operating at a huge loss to the point that donations and payments could not keep them in business, they would eventually no longer be able to offer the $500 transport.


I understand the principal of the free-market keeping prices more in check as you describe, but you would agree with my example that in richer areas, prices will be higher and that is going to lead to problems when poorer people have the misfortune of needing an ambulance in a pricey part of town.

But let's say the ambulance company is greedy and doesn't care about bad press, if you need ambulance assistance and are incapacitated to refuse the service of a sleaze-ball ambulance service, who's going to protect the injured person who's unable at the time to refuse being picked up by them?

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## MelissaWV

> Actually, you're the first person who's really tried to answer my example, but regardless.
> 
> 
> Maybe not regular streets, but most likely in upper-class areas where they know people have money and I can see the luxury ambulance service advertising they hire top-notch EMT's to make people feel their emergency service is the best qualified, partly justifying their high price.
> 
> What if I happened to be passing through one of these rich areas when I have my heart attack?
> 
> 
> So after dealing with the stress of my heart attack, now I have to deal with the stress of haggling the price down after the fact?  Doesn't sound too appealing to me.
> ...


You should already deal with haggling prices down after the fact.  Appealing or not, that is the best way to get your bill down in any case, whether it be a credit card bill, and particularly a medical bill.  

The insurance companies do not pay full price, and they will pay according to a fee schedule.  If it is usual and customary for the other ambulance company to charge $500 (and these prices are arbitrary for the sake of the example), let's say a 15% discount.  Your insurance company will pay $425 for an ambulance.  They do not care if you used a frilly super fancy ambulance service, that is what they will pay.  Either the frilly ambulance service will accept that as a contractual write off, or they will charge the patient for the difference.  This once again puts the patient and the company in a pretty bad spot.

However, I think you missed part of the point.  Most people who will pay extra for a special type of ambulance service would have some sort of indication that they would do this.  You having just lost consciousness precludes you being able to make a choice, but even in well-to-do neighborhoods the ambulance company cannot assume that everyone will pay 400% of the expected rate for their services.  Those companies are more likely to enter into private contracts with the ultra rich, hoping to differentiate their product and attract a more reliable revenue stream.

Barring all of that, you could take the ambulance company to court if they carted your unconscious body off and charged you at a rate you were not in your right mind to agree to.  It would then be up to a court or arbitrator to decide what restitution is owed to which party.  I would think in many cases the injured party would just be responsible for the usual and customary cost of an ambulance ride (in your example $500).

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## Danke

If you didn't sign a contract, how are they going to collect for an involuntary act?

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## Unregistered

> If you didn't sign a contract, how are they going to collect for an involuntary act?


Then why would someone start an ambulance service if no one would be forced to pay?

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## Danke

> Then why would someone start an ambulance service if no one would be forced to pay?


Where did I imply no one would pay?  I was just using your example of being over charged for a service someone else requested on your behalf.

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## MelissaWV

> Then why would someone start an ambulance service if no one would be forced to pay?


As I stated earlier, there are a number of bills that would be paid in full.  Insurance companies will pay usual and customary rates.  Even people will privately pay what they feel is reasonable.  There will inevitably be cases, though, where someone is charged four or five times that usual rate, and they will protest loudly about it.  Then there will be those who grumble but do not want to negotiate a price, and pay it anyhow.  There will also be those that do not pay anything at all.

A business has to figure out how to balance all of this.  Those "forced" to pay in these industries are usually at the other end of the Collection Agency cycle, and those agencies take their cut from everything they collect as well, so there's always a bit more loss as things advance.  The easiest way to avoid most of that is to price  yourself within range of your competitors, or to change your business model to ensure you keep afloat in some other way.

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## Unregistered

> You should already deal with haggling prices down after the fact.  Appealing or not, that is the best way to get your bill down in any case, whether it be a credit card bill, and particularly a medical bill.


Do you really think the voters of a town are going to be OK with this system of having to haggle?  I don't see it passing in too many towns. 




> The insurance companies do not pay full price, and they will pay according to a fee schedule...This once again puts the patient and the company in a pretty bad spot.


That's kinda the whole point of my question.   I just see a hole in a free-for-all health system in terms of ambulance service.  




> Those companies are more likely to enter into private contracts with the ultra rich, hoping to differentiate their product and attract a more reliable revenue stream.


Sounds like you're saying they won't bother to rescue poor injured people.




> Barring all of that, you could take the ambulance company to court if they carted your unconscious body off and charged you at a rate you were not in your right mind to agree to.


Again, do you really think the voters of a town are going to be OK with that kind of system?  I'm just being realistic.  Doesn't matter how good a system is in theory, it will eventually have to be approved by the voters or town's politicians.


I think a free-for-all ambulance system would never fly as far as I can see.  I think the closet system would be a town would set a certain criteria for an ambulance service to operate in the town and hopefully the town wouldn't limit how many ambulance services could compete in the town as long as they meet their minimum criteria and hopefully the town's minimum criteria isn't set to keep capable low-cost ambulance services out of their market.  That's the most realistic system I see happening.  There is still the problem of how to handle those needing ambulance service who are too poor to pay anything.

Hopefully a free-for-all system would prove me wrong.

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## Unregistered

> Where did I imply no one would pay?  I was just using your example of being over charged for a service someone else requested on your behalf.


You just said how would the ambulance company be able to force you to pay.  If no one was forcing me to pay, I sure wouldn't.

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## Henry Rogue

> We're libertarians...we'll shoot 'em for trespassing.
> 
> Seriously though, there are plenty of private ambulance services out there.


Yes, we still have a private ambulance service in my community and a lot of the surrounding communities. Original poster makes it sound like some far fetched nonexistent fantasy. I can answer the OP's question from personal experience. The last time I needed an ambulance,  they showed up, they took me to the hospital,  they sent me a bill in the mail for four hundred dollars. I didn't have insurance at the time, I paid the bill. Another time  I refused transport.

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## NorthCarolinaLiberty

> So after dealing with the stress of my heart attack, now I have to deal with the stress of haggling the price down after the fact?  Doesn't sound too appealing to me.


Your government proposals don't sound appealing to me.  Perhaps you should take care of yourself, not have a heart attack, and stop demanding that society be responsible for you.

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## Danke

> You just said how would the ambulance company be able to force you to pay.  If no one was forcing me to pay, I sure wouldn't.


Oh, you're a Democrat.

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## Cleaner44

Here is a private ambulance company that exists and is doing business in AZ right now:
http://www.ruralmetro.com/

Do does this ambulance service work?

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## Danke

> I can answer the OP's question from personal experience. The last time I needed an ambulance,  they showed up, they took me to the hospital,  they sent me a bill in the mail for four hundred dollars. I didn't have insurance at the time, I paid the bill. Another time  I refused transport.


You need to lay off the Meth.

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## Cleaner44

> You just said how would the ambulance company be able to force you to pay.  If no one was forcing me to pay, I sure wouldn't.


It's no wonder that statists want to have the government use force against everyone, because they can't see people doing right by each other in a voluntary way.

Why be a deadbeat?  Why not pay your bills without the force of violence?

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## Unregistered

> Original poster makes it sound like some far fetched nonexistent fantasy.


People don't get into emergency situations where they are unconscious and need to be taken to a hospital in your world?




> I can answer the OP's question from personal experience. The last time I needed an ambulance,  they showed up, they took me to the hospital,  they sent me a bill in the mail for four hundred dollars. I didn't have insurance at the time, I paid the bill. Another time  I refused transport.


In my example, how would I refuse transport if I'm unconscious?

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## Unregistered

> Your government proposals don't sound appealing to me.  Perhaps you should take care of yourself, not have a heart attack, and stop demanding that society be responsible for you.


lol, that compassionate response is going to bode well with the voters.  What if I have a genetic condition which my heart is a ticking timebomb?

How about this example:  I'm riding my bike.  A driver not paying attention hits me, knocking me unconscious.  I'm bleeding out and will die if I don't get to a hospital within 30 minutes.

Tell me your ideal scenario of how this example would go in a free-for-all system.  Mind you that the reason I'm riding a bike is that I'm too poor to afford a car and would have trouble even paying a $500 ambulance bill.

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## MelissaWV

> lol, that compassionate response is going to bode well with the voters.  What if I have a genetic condition which my heart is a ticking timebomb?
> 
> How about this example:  I'm riding my bike.  A driver not paying attention hits me, knocking me unconscious.  I'm bleeding out and will die if I don't get to a hospital within 30 minutes.
> 
> Tell me your ideal scenario of how this example would go in a free-for-all system.  Mind you that the reason I'm riding a bike is that I'm too poor to afford a car and would have trouble even paying a $500 ambulance bill.


The person who hit you would pay.  If not, the hospital's charity fund likely would since you are indigent.  Have you actually had to do any of these things?  I work with people in these scenarios every day and it's not complicated.

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## Unregistered

> Oh, you're a Democrat.


Are you resorting to name-calling?

I'm not a dem btw.  Are you a republican?

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## acptulsa

I ride a bike to keep my heart from becoming a ticking time bomb.

You know, there are jurisdictions where the cops call certain wreckers for accidents and jurisdictions where the cops put the call out and whoever shows up first gets the job.  Both have advantages and disadvantages.  In each case the owner of the car is liable not to be able to refuse service (in this case because the car is in the way of traffic).  So, none of this is new.  Of course, in those cases the state determines the rates that can be charged--and they're usually higher than normal for the area so that wrecker drivers will be motivated to make everyone else wait and go take care of the emergency.

So, there's nothing new in this.  Nirvikalpa, who is in the business, has described how some people make this work.

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## pcosmar

> That would be a little hard to do since I'm unconscious as I gave in my example.


Do you really expect to have everything done for you?

So you were unconscious,, you didn't call the ambulance. It would be the responsibility of the person who called to pay for it.

Myself,, I don't want an ambulance. I do not want to be taken to a hospital. Period..

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## Danke

> Are you resorting to name-calling?
> 
> I'm not a dem btw.  Are you a republican?


Being a Democrat is "name-calling?"

No, I am not a Republican.

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## MelissaWV

> Do you really think the voters of a town are going to be OK with this system of having to haggle?  I don't see it passing in too many towns. 
> 
> 
> That's kinda the whole point of my question.   I just see a hole in a free-for-all health system in terms of ambulance service.  
> 
> 
> Sounds like you're saying they won't bother to rescue poor injured people.
> 
> 
> ...


Do you realize your entire post is predicated on asking "mother may I?" on each and every point?

People haggle over their bills right now.  There are negotiations, payment plans, cost reductions, charity assistance, and a dozen other things that happen to change the stated cost.  




> Sounds like you're saying they won't bother to rescue poor injured people.


Those particular companies that want to make oodles of money will not rescue random people on the street at all.  There are some ambulance companies that basically service a select neighborhood where there are elderly rich folks, or retirement communities that sprawl across areas of this country.  They are more expensive and largely privately paid, but they are also patrolling the area and ready to pick people up at the drop of a hat, with the understanding that their supplies and personnel should specialize in geriatrics.  Those are your "$2000" companies.  

And yes, you can sue right now.  You don't need permission from your town to do so.  If you are unconscious and you believe that unreasonable extra care was provided, or extra charges tacked on, or both, then you can dispute that very thing.  Let's say you've been struck by that car.  You wake up in the hospital with a manicure.  Are they allowed to charge you for "cuticle improvement"?  You laugh, but that has happened already.  People are given a haircut, a shave, a treatment for some perceived condition unrelated to the injury that brought them to the ER, and then they are charged for it, and if they do not dispute it, it stands.  This is now.  Right now.

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## NorthCarolinaLiberty

> lol, that compassionate response is going to bode well with the voters.  What if I have a genetic condition which my heart is a ticking timebomb?


So you don't even care enough about yourself to address your ticking bomb on this forum, but now I'm uncaring because I don't buy into your demands that society be attentive to that exact issue?





> How about this example:  I'm riding my bike.  A driver not paying attention hits me, knocking me unconscious.  I'm bleeding out and will die if I don't get to a hospital within 30 minutes.


It's the other driver's fault, so you're not paying.






> Tell me your ideal scenario...


So you concede that your genetic heart condition, your poverty, your bike riding, etc. are not ideal scenarios, but you expect everyone else to build an ideal society to address all of these things?

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## NorthCarolinaLiberty

> People don't get into emergency situations where they are unconscious and need to be taken to a hospital in your world?
> 
> 
> In my example, how would I refuse transport if I'm unconscious?




If your that concerned about your heart, your bike riding, your strolls on the rich side of town, etc., then perhaps you should carry documents instructing medical personnel for such contingencies.

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## Unregistered

> It's no wonder that statists want to have the government use force against everyone, because they can't see people doing right by each other in a voluntary way.


How was it voluntary that I was taken to the hospital by ambulance unconscious?




> Why be a deadbeat?  Why not pay your bills without the force of violence?


If the average ambulance rate was $500 and one company charged me $2000 cause they offered a 5-star ambulance experience even though I was unconscious and had no choice in the matter, I'd be a deadbeat in that instance and I reckon a lot of other people would be too if put in the same scenario.

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## MelissaWV

> •For patients without health insurance, ambulance service cost typically depends on location, whether the trip is for an emergency or scheduled transport, how many miles the patient travels and whether basic life support or advanced life support is needed. The cost can be nothing out-of-pocket in cities where services are covered by taxes, but usually ranges from less than  $400 to  $1,200 or more plus mileage. For example, in Lima, OH, taxes pay for any ambulance services not covered by insurance, so residents do not receive a bill. The city of LeMars, IA, charges  $375 for non-emergency basic life support service up to  $600 for emergency service with advanced life support. The city of Urbana, OH, charges  $650. The city of Nichols Hills, OK[2] , offers a membership plan for  $2.50 per month for ambulance rides at no out-of-pocket cost, but non-members pay  $1,100 plus  $9 per mile for ambulance service. Woodburn Ambulance Service in Woodburn, OR, offers a membership plan, but non-members pay  $1,220 plus  $20 per mile per trip.





> •Some providers will negotiate a discount of up to 20% or more for uninsured patients who pay cash or pay within a certain timeframe. For example, Lincoln County Ambulance Service[4] in Kansas offers a 20% discount for payment within 30 days and a 10% discount to uninsured patients. And Woodburn Ambulance Service in Oregon offers a 10% discount for payment made within 30 days of service.





> •The American College of Emergency Physicians Foundation[5] offers a guide to when to call an ambulance in an emergency. In a 9-1-1 emergency, the ambulance provider that services that location will respond; in some locations, there is more than one provider and it might be possible to request a certain provider.





> •Medical supplies -- for example, sterile gloves, needles, IV supplies, catheters, and saline -- used during the trip can add hundreds or even thousands of dollars to the final bill. For example, providers in Los Angeles County[3] can charge  $24.75 for an oxygen mask, as well as for bandages, dressings ice packs; they can charge  $45.25 for a burn kit or obstetrical kit; and can charge  $80.25 for an infusion pump or pulse oximeter.
> •If a critical care nurse or respiratory therapist is required during an ambulance ride, it can add hundreds of dollars to the cost.


So right now, to recap, there ARE private ambulances, there CAN be different ones that come to your rescue when called, there ARE different prices for different patients based on location, method of payment, severity of injuries, use of supplies, and any number of other things.

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## acptulsa

We sure are long on 'if' and short on acknowledgement that we've really tried to address your questions--and provided a lot of good information, including from a professional in the medical billing field and a known EMT...

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## Unregistered

> The person who hit you would pay.


Yes, I just realized that.  I'll go back to my amended example that I have a genetic heart condition and now matter how healthy I eat or exercise I get, my heart is a ticking timebomb from being born with a bad heart.

Of course in my bike scenario, I hope the person who hit me has insurance or money.

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## Henry Rogue

> People don't get into emergency situations where they are unconscious and need to be taken to a hospital in your world?
> 
> 
> In my example, how would I refuse transport if I'm unconscious?


I live in the same world you do with the same economic principles. You wouldn't refuse transport. The ambulance crew would take you to the hospital and bill you. They don't ask for the money up front at least they didn't thirty years ago, before subsidation drove health care prices into the stratosphere. 

Market prices move towards equilibrium.   It is doubtful that competing ambulance services would have a large difference in price, if there even is more than one ambulance service. If an ambulance service has a monopoly in a community and decides to quadruple the price they charge, competitors move in to take advantage of the pice boom. Competition drives the price down. But even in a market where there is only one ambulance service, the price would likely be in tune with what the community can afford.  If you owned an ambulance service, you could charged a million dollars per transport,  but if none of your customers could afford it, you would have a hard time collecting your fee and you would soon drop your price or go out of business as no one would call you.  
The problem is (apart from government subsidation, price fixing and barriers to entry) insurance subsidizes the cost among many insurers (who may never have the need for an ambulance), this allows the price to rise beyond what the community can afford on their own.

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## Unregistered

> Do you really expect to have everything done for you?


Um, if I became unconscious, I really wouldn't have a choice, would I?




> So you were unconscious,, you didn't call the ambulance. *It would be the responsibility of the person who called to pay for it.*


Really?!  That's how your ideal system would work?!!

I can just see the headline:  "Man dies because onlookers didn't call 911 to foot ambulance bill"

Good luck in passing that kind of system through the voters.




> Myself,, I don't want an ambulance. I do not want to be taken to a hospital. Period..


Well hate to tell you friend, but in the real world if you're out somewhere and get in an accident and become unconscious, you're going to be waking up in a hospital.

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## NorthCarolinaLiberty

> ...I have a genetic heart condition and now matter how healthy I eat or exercise I get, my heart is a ticking timebomb from being born with a bad heart.


So you've totally absolved yourself from the bad hand you've been dealt and every possible scenario to address it, yet you expect everyone else to address it through every contingency you can list on this thread?

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## Henry Rogue

> You need to lay off the Meth.


I'm not even sure what meth is, I know it is some kind of drug that people make at home, but that is about it. I had a few accidents when I was in my twenties. Two ambulance rides and an air-ambulance ride.

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## NorthCarolinaLiberty

> Really?!  That's how your ideal system would work?!!


So it's okay for your personal situation of bad heart, bike riding, poverty, etc. not to be ideal, but you expect the societal response to all of this to be ideal?

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## Unregistered

> If you are unconscious and you believe that unreasonable extra care was provided, or extra charges tacked on, or both, then you can dispute that very thing.  Let's say you've been struck by that car.  You wake up in the hospital with a manicure.  Are they allowed to charge you for "cuticle improvement"?  You laugh, but that has happened already.  People are given a haircut, a shave, a treatment for some perceived condition unrelated to the injury that brought them to the ER, and then they are charged for it, and if they do not dispute it, it stands.  This is now.  Right now.


My example is more like the luxury ambulance didn't do anything a no-frills ambulance service wouldn't do to get me to the hospital.  I'm just wondering how people are going to deal with the sticker shock of having the misfortune of becoming unconscious and needing to get to a hospital closer to a luxury ambulance service than a low-cost ambulance service.

You're haggling the ambulance bill with the company and potentially getting the courts involved is probably not going to be too appealing to the voters, definitely not with me.  At this point, I would be more likely to vote for the ambulance system I described earlier.

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## Root

Do these so-called "luxury ambulance" services even exist?  I was an EMT for many years for a few different companies and all the ambulances were basically the same.  

The same standard of care applied to all of them.

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## Danke

People need to pay for services I use by force of violence.

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## MelissaWV

> Do these so-called "luxury ambulance" services even exist?  I was an EMT for many years for a few different companies and all the ambulances were basically the same.  
> 
> The same standard of care applied to all of them.


They do under the circumstances I described (private/exclusive areas with specialization).  One could call the helicopter a luxury ambulance, as well.  Mostly, though, there is variation within the field and yet we are not all lying in the street dying of our wounds.

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## Henry Rogue

> Um, if I became unconscious, I really wouldn't have a choice, would I?
> 
> 
> Really?!  That's how your *ideal system* would work?!!


No, you wouldn't have a choice and you would be responsible for payment of the bill. 
This post wasn't directed towards me, but I'm going to answer it anyway. 
I don't have an ideal system. Markets aren't a system they are a process,  and markets (even a Free one) are not perfect, but a Free market is simply the best of all the choices. Although a completely Free market may not be attainable, the freer a market is, the better it functions.

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## pcosmar

> Well hate to tell you friend, but in the real world if you're out somewhere and get in an accident and become unconscious, you're going to be waking up in a hospital.


I doubt it.
 I avoid cities,, and live far from any.
In fact,, if my health were to deteriorate to the point that I can no longer continue,, I will take a long walk in a wilderness area.
If my body is found,,veterans affairs can stick it in the ground somewhere. I will have no further need for it.

If I am taken to a hospital anywhere, It will be against my will,, and I will have no intention to pay any extortion.

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## NorthCarolinaLiberty

> My example is more like the luxury ambulance didn't do anything a no-frills ambulance service wouldn't do to get me to the hospital.


If the market really is a free market, then the luxury ambulance service is not going to deal with people who can't pay anyway.  Plenty of other places around the world where this model plays out in real life.  If you live there or adopt that system, then you'd get your no frills ambulance.

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## Nirvikalpa

> My example is more like the luxury ambulance didn't do anything a no-frills ambulance service wouldn't do to get me to the hospital.


EMS is a complicated business, that varies at the state and local level.

It's nearly impossible to give you the answer you want (and I think you know this).

Do some ambulances charge, and are others free?  Yes.
Are some ambulances private, and some tax-funded and associated with local FD or municipalities? Yes.
Do some private ambulances have paid staff?  Yes.
Do some ambulances have older supplies, and others have new, top-of-the-line equipment (can they all generally do the same thing: yes)?  Yes.
Are there extra charges for ALS (paramedics [EMT-P], advanced life support) vs BLS (basic life support, EMTs)?  Yes.




> Sounds like you're saying they won't bother to rescue poor injured people.


Sigh.

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## bunklocoempire

> People need to pay for services I use by force of violence.


Indeed.

Because *every* consensual relationship on earth has been exhaustively tried already.  Get the government gun, this individual is too unpopular with his fellow man and must resort to force.

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