Monday, November 2, 2009

Ambulance Chasing Irish Style

What Happens in Ireland When You Need an Ambulance:

Yesterday, our neighbor's son Paul came charging to our door. The poor kid was scared to death; his 13 year old chin was quivering like Jello: "You have to come now! My Mum has collapsed!" So, of course, that's exactly what we did. My wife and I ran next door to discover our wonderful neighbor Paula lying inert on her stair's landing. She was breathing, had a strong pulse, but she was absolutely comatose.

At which point my good wife sprung into action. "Call 999!" she yelled. ("999" in case you didn't get it, is the Irish equivalent of 911.) "We need an ambulance! Right now!" And the young neighbor's son, Paul, did exactly that. Without hesitating, he ran to the phone.

And while we made Paula confortable, we took comfort in the knowledge that a local ambulance - complete with its crew of EMT specialists - was steaming toward us, blue lights blazing, weaving in and out of traffic on its way to rescue a favorite friend.

Now - before moving on - I should explain the following: Paula and her family don't have health insurance. At least not the type that many US citizens have. And yet, my wife, Paula, or her young son didn't think twice about calling for an ambulance.


The cost to Paula and her family was exactly... (wait for it)... ZERO!

What Happens in the US When You Need an Ambulance:
If you're not insured, all hell breaks loose. Two weeks ago, I had the pleasure of visiting Kernville, California. In case you didn't know it, Kernville is located about 2 and a half hours NNW of Los Angeles, and maybe an hour or so from Bakersfield. Located in the arid corners of the Sierra Nevada mountains, and maybe 3 hours from Death Valley, I was struck by the beauty of the spot. The Kern River curls around the town, its tumbling energy attracting trout fishermen (or is that fisher-people, if I'm to be PC?) from all over the Western US.

Kernville has also become a fairly popular destination for retirees. Housing costs - at least by California standards - are relatively reasonable. And the location is everything you would want if you're the type to enjoy the outdoors.

But there's a problem. For you see, Kernville is a good 60 miles from the nearest hospital. And that, of course, means an Ambulance trip if you get into trouble.

I was made aware of this fact - and worry - while having a beer at the local tavern. A retired Viet Nam vet was bitching and moaning about this sad state of affairs over his bottle of Coors: "I love Kernville. But I get worried about medical costs," he said. "Recently, my friend's wife got sick. They called the ambulance to take her into Bakersfield. He was the one that almost died when he got the bill. Just transporting her from here to the hospital was over two thousand dollars. He doens't have insurance, of course."

I've been gone for too long because I almost choked on my Miller.

When I got back, I did a bit of research. Many US ambulance companies charge by the mile. And if you don't have insurance, you get stuck with it. So what does one do in California...or Maine, Florida, or Utah if - like Bernie and I - your neighbor's kid rushes to the door and his Mom needs an ambulance, and the family doesn't have insurance?

Pay through the nose, I guess.

The Pros and Cons of Socialized Medicine
Ireland, of course, has socialized medicine. That's why the ambulance bill was zero. Of course, somebody has to pick up the cost, and that someone is the taxpayer. Remember, please, that Ireland has some of the most onerous taxes in the western world. We're taxed on almost everything: salaries, of course. But we also pay a 21.5% sales tax on almost all goods and services; additional taxes when we buy cars, houses, and investment or summer houses; and tax levies on almost anything that you can imagine...television programming, credit cards, check writing... It's a horrible state of affairs, and means that many people take home less than 50% of their gross pay.

BUT, and it's an important least if we want to order an ambulance we know that it won't break the bank. Nor will Irish citizens have to declare bankrupcy if they're uninsured and need a hip replacement, or triple bypass, or require a kidney transplant.

The downsides of socialized medicine are immense: the Irish government is ultimately responsible for the levels of care that we receive. To that end, they've developed a huge, cost-inefficient bureacracy - our Health Board - to oversee national medical care. Recently, and due to the current economic mess - a variety of interest groups have analyzed the costs of that care. And the results have proven eye-opening: huge amounts of waste - particularly within administrative levels - have gone unreported, and undetected, for years. Which means, of course, that Irish taxpayers have not received the sort of cost-effective care that they are entitled to.

As a confirmed fiscal conservative, such waste bothers me deeply. And as I watch Obama's health care proposals move through its various stages, I can only feel sorry for Americans as they ponder the consequences of a national health program ultimately run by bureaucrats. Deciding pro or con on such legislation will be difficult.

While I am not totally convinced of the efficiency of national health programs, all I can say is this: when we rang for an Ambulance to help Paula, we didn't think twice about the cost.

For more stories on living in Ireland, consider Tom Richards book A Survivor's Guide to Living in Ireland, available at


  1. I had no idea that the sales tax alone in Ireland was so high.

    I hear horror stories out of Canada about waiting up to a year or more for non-emergency surgery (such as knee replacement or torn rotator cuff). Is it as bad in Ireland? Is the care generally good? And what about dentists? Can you get in easily or is it a long wait?

    As an unemployed American I am thinking we NEED insurance that is not linked to being employed (and to buy insurance as an individual is cost prohibitive)... but from stories I hear from people who live in places with socialized medicine I am concerned that it won't solve anything either.

  2. Hi Hazel. And to answer your Q's:
    a. Waiting lines ("queues" over here) can be pretty horrid. However, and depending on the problem, most patients are seen fairly quickly;
    b. The care is GOOD. I trust these guys with my life! Har!
    c. Dentists - I have a great guy who charges fairly and does good work. And yes, getting in to see one is simple and easy.
    Hope this helps - Tom

  3. Tom:

    Yes, it gives me an idea of how healthcare is in Ireland. Because of the recent/current healthcare hullabaloo here I am very interested in how other countries work. We always hear the horrors of Canada and England, rarely the good points, and of the rest of the world and their healthcare systems we are woefully ignorant. I sometimes think that we are purposely not informed of stellar systems -- such as found in Sweden -- lest we demand the same! Thank you for answering my question.

  4. Hi Tom,

    I have scary stories about what can happen when you don't have insurance in this country....but most recently my husband broke his ribs in a football accident and was rushed to the hospital because he was coughing up blood. He had to stay overnight, saw a few doctors who were very worried, but he left the next day. Total bill: $16,000

    He said, if I was at home, it would have all been free.

    I'm not sure if we are ever going to pay it or not, but it doesn't really matter for various reasons. (i.e. they have no contact info) Even though I know I will not keep most of my income, it is nice to know that if something catastrophic ever happened, we would be taken care of without immediate burden.

    I appreciate your honesty and ability to share the pros and cons. I guess it just depends on if you like seeing your money go...or not. When we pay taxes, I suppose we don't really know sometimes what it was ever like to have the money because it left us before we saw it. When a bill like that arrives in your mailbox, it's just so shocking.

    By the way, move date: Dec. 15th. I already have a few private students lined up and people are trying to help me get a university position teaching voice and music! Exciting!

    Hope all is well! Is your neighbor okay then!?


  5. Hi all. And to answer Diana's question (and thanks for asking): yep, neighbor is now just fine, thanks be to God!

    This thread of a discussion has obviously struck a chord: obviously, no one likes to pay taxes. However, no one likes to pay huge and unexpected medical bills.

    There are pros and cons for socialised medicine. What I like about it is the obvious, and as stated: you're not going to go bankrupt if you suffer a football accident and need your ribs fixed (per Diana's example above). Too, and contrary to those scary stories in the press regarding the Canadian medical system (not that I live in Canada): talking to Irish that live in Canada, the system there is not too bad at all. Yes, they do have waiting lines for some procedures, but all and all it works. Same goes in Ireland: yes, we do have waiting lines for some things. And yes, things can be a mess. And occasionally (very rarely) you hear of an incompetent who has ignored a patient in dire straights, which can lead to extreme problems (read: Death!) But all in all, we get pretty good care over here.

    The downsides are fairly onerous, however. In that the entire medical system is run by bureaucrats and civil servants, it is - like many 'federal programs' a system hallmarked by bloat and excess. Millions of euro are wasted each year in excessive salaries and unnecessary administration. This 'bloat' has come to light recently, as the government looks to save money within a dire economy. This next year is sure to be a year of discontent as the government attempts to whittle down costs, resulting in possible wage cuts to doctors, nurses - and of course, those 'administrators' mentioned above.

    Other public servants including teachers, firemen, police, and prison officers are going to face the same fiscal knife. The result will possibly be a broadly based series of strikes within organisations that we depend upon.

    In my experience, the public sector has never been motivated by efficiency. That is the downside.

    But they are motivated by a willingness to serve. That is the upside.

    So pick your poison. High taxes, reasonable services, but horrible fiscal waste... OR ... private sector policies that provide exceptional services to those that can afford it.

    Surely, there has to be a mid-point in which care can be provided to those that can't afford it, but using a 'fair' system that also ensures fiscal responsibility?

    Perchance, perhaps that path is too difficult for our policy wonks to consider.... Hah!