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Want to really understand what the rest of the world thinks of the US health care system?

ABC News has a shocking article about how Fire Departments are charging homeowners for the cost of the fire trucks and personnel used to fight their house fires — and how residents are “horrified” when they receive a bill for sometimes tens of thousands of dollars after their home burns down.

What does this have to do with health insurance? Humor me for a minute.

The article is full of interesting quotes. The “shocked” homeowner who received a bill for $27,989 responds “That’s what taxes are for.” Other quotes accuse local governments of “double dipping” — taxes and usage fees — for the same service. My favorite quote is from an insurance company institute spokesperson, who says “You don’t want to be thinking ‘can you afford it’ when your house is on fire.” Other people who received bills say “We don’t have any way to know if the charge was low or high or accurate.”

In the article, everyone except for the company that collects these debts for the fire departments (and gets a healthy cut) thinks charging homeowners for fire services is despicable and barbaric, to say the least.

And yet, Americans seem to accept a health care system where getting sick or having an accident can bankrupt you, even if you have health insurance. Where all but the richest people have to worry if they can afford it before they go to the hospital. Where seniors have to choose between health care and paying the rent. Where hospitals and doctors charge arbitrary (and huge) amounts of money and there is no way to know if the charges are accurate.

I’ve lived in several other countries, and I can tell you that most people look at our health care system as not only despicable and barbaric, but completely crazy, since their systems provide far better care for much less money. When will we wake up?



  1. ebdoug wrote:

    To live in a more simple world: Our fire and ambulance are still volunteer. They have a neat club house to sit around and gather and drink. We make yearly donations, fund drives, and cases of beer.
    They take great pride in their equipment. They are there on the spot. Must be 20 fire trucks showed up when my neighbor had a chimney fire. Very colorful on back country rounds at 11 p.m. where we have no street lights.
    Fortunately our weather is too bad for anyone to want to live here.
    And, to stick to the subject, our doctors still make house calls.

    Sunday, February 7, 2010 at 7:17 am | Permalink
  2. starluna wrote:

    Shocking. But at the same time, there was a good point made at the end of the article about the people (either directly or through their elected representatives) putting caps on what municipalities can raise through property taxes, so this is one way of raising needed revenue.

    I wonder whether the municipalities that are doing this are those whose residents have voted against raising property taxes, or encouraged their reps to place caps on their taxes.

    Sunday, February 7, 2010 at 4:51 pm | Permalink
  3. Iron Knee wrote:

    Well, there is that irony of people who claim to want small government and vote for tax reductions, but then want all their government services anyway, but I was trying to make a different point in this post. Besides, if you bring that one up, you might get an argument from someone that governments strapped for cash are cutting only those services that they know will cause people discomfort, so they can convince them to raise taxes. It is a complicated issue.

    But there is nothing complicated about the irony that we instinctively think that it is horrible for someone whose house is burning down to have to also have a huge bill to pay afterward, but seem to not notice that health insurance does the same thing to people who get seriously ill or have an accident.

    Sunday, February 7, 2010 at 6:26 pm | Permalink
  4. The fire truck charges are just another form of regressive taxation. It is not intended that people pay for them personally, rather that realising the potential for these charges they increase their home insurance premiums so they are covered. Now everyone has an additional tax to pay, yet they pay it to their insurance company rather than the state government. Making the insurance agency into a tax-collector-by-proxy is really stupid economics as it is vastly inefficient.

    Sunday, February 7, 2010 at 9:04 pm | Permalink
  5. Good post. And may I say, the comments on this site have been fantastic lately.

    Monday, February 8, 2010 at 8:04 am | Permalink
  6. starluna wrote:

    I get you. I once heard the argument that municipalities are shutting down fire departments and laying off EMTs just to make a point. It was then pointed out that most municipalities would have to stop providing public schools (which they legally can’t), or fire everyone who works for the municipality, including the teachers, if they want to restore the emergency services. Even if your mayor or police chief makes more money than he/she “should”, it doesn’t compare to the costs of maintaining adequate emergency response systems.

    Or in short, the people who make that argument are uninformed ideologues whose positions are only logical if they believe that the roads are magically paved by road fairies when they are asleep.

    I do believe that both points hold. The same people who are offended by the health insurance company denying them care, or increasing insurance premiums, or requiring higher co-pays and deductibles, are also the most opposed to health insurance reform. They don’t believe they should have to pay more out of pocket because “that’s what health insurance is for.” These are the same people who get hot under the collar when they are told that their insurance premiums are going to cover the cost of paying for the care to the uninsured. The sentiment is not very different than the offense taken at charging someone for emergency services because, “that’s what taxes are for.”

    Monday, February 8, 2010 at 12:04 pm | Permalink
  7. ettucat wrote:

    They think our healthcare is despicable? Is that why they all come here for their emergency care, or complex care that they can not get in their own countries? And, it is DESPICABLE that private sector citizens are being charged to receive the very services we supposedly pay taxes for. What has happened is, our taxes are going to provide the big paychecks, 95% pensions for government worker retirees, and 100% guaranteed lifetime healthcare benefits for government workers. When did it become more desireable to be a government worker? They get 30% more in their paycheck than does the private sector worker for comparable work, it is impossible to fire them for incompetence and even for corruption or criminal acts, they work only 30 years to get that scrumptious pension which means they can continue to work another 20 years for a second pension from the private sector, or double dip by getting another gov’t job, and WE PAY THEIR HEALTHCARE FOR LIFE. I would say H1N1 didn’t target the right people, and it wasn’t deadly enough.

    Friday, February 26, 2010 at 9:12 pm | Permalink
  8. Iron Knee wrote:

    Ettucat, you must be new here. If you are going to spout things and pretend they are facts, please back them up with references. Otherwise, you’re just pissing in the wind.

    Friday, February 26, 2010 at 11:06 pm | Permalink
  9. Dreadhead wrote:

    Only rich people come to America for healthcare. Also, rich Americans go to other countries for healthcare. For instance, Farah Fawcett came here to Germany for more holistic treatment for cancer.

    Saturday, February 27, 2010 at 9:13 am | Permalink
  10. CSCornette wrote:

    @Ettucat, I’m a government employee, and I’m trying really really hard to find ANY accuracy in your post, but I can’t. A few obvious things: NOBODY travels internationally to receive emergency health care – I suggest you grab a dictionary and look up the word emergency. Secondly, the larger the government paycheck, the SMALLER it is in comparison to the compensation for a comparable civilian position. Compare the President of the US salary with that of ANY large corporation CEO to get an idea of what I’m talking about. Thirdly, gov’t employees don’t get free healthcare for life, plus 95-100% pensions are incredibly rare, and it most certainly is NOT impossible or even uncommon for a gov’t employee to be fired for substandard performance. Fourth, you CANNOT receive multiple gov’t pensions – if you take a second gov’t job, your initial time in service is adjusted to include your previous service and you forego the first pension until final retirement. Finally, are you suggesting the H1N1 was targeting somebody?

    Saturday, February 27, 2010 at 11:44 pm | Permalink