Welcome to Debate Club! Please be aware that this is a space for respectful debate, and that your ideas will be challenged here. Please remember to critique the argument, not the author.

Can you call an ambulance for somebody without their consent?

13

Replies

  • tennisdude2004
    tennisdude2004 Posts: 5,609 Member
    I went to the gym to spend my lunch hour swimming laps. As I was getting ready to turn into the plaza parking lot, somebody was coming down the sidewalk, about to cross the driveway. His leg was in a cast and on a walker. He stopped to let me go first, but he had the right of way, so I waved him to go. He did, or started to, a car came way too fast out of nowhere and hit him hard. I heard a terrible crunching noise.

    I left my car where it was and ran to help the guy. People behind me lost their *kitten*, because they to go around.

    The guy was obviously in shock. It wasn't obvious whether he was injured or not. To me, the only thing to do is go to the hospital, and that seemed really clear. But not to him. He struggled to get up, I had to lift him to his good foot. The driver was beside herself with remorse, she was real helpful too. I've been hit by a car on my bike, I know what it is to be hurt and confused and not understand what's happening, and I could see it in his face.

    He just wanted to go home. I kept telling him he needs to see a doctor, they'll do x-rays, they'll have pain medicine, you might feel ok now but you'll want it in an hour. I offered to go pick up his wife or girlfriend or anyone else and bring them to to him. I took his phone, added my number as a contact with the name "witness."

    I managed to talk him into going to the hospital. The lady that hit him drove, so he wouldn't have to wait for the ambulance to arrive (or pay $1,000 for the ride).

    In the moment I didn't feel like I could call 911 without his permission. But it was clear that he wasn't able to make that decision at the time. I really hope I never see anything like this again, but, if I do, can I just call the ambulance immediately?

    Do you get charged for using and ambulance?
  • happytree923
    happytree923 Posts: 463 Member
    I might chime in....

    I am American and proud to be an American. But, I find it somewhat funny that we are worried about "legal issues" with this type of situation. And, then on top of that, civil liability.

    The OP did the right thing. Absolutely. I mean, you never know and there could be internal injuries that we can not see/readily identify. And we all have likely seen someone in shock before....they can NOT make any decisions. How badly would you feel if you did nothing and something bad happened to that person, something that *could* have been avoided?

    I am admittedly ignorant as to the laws here (in North Carolina) as to who pays for what but I have seen - three different times - a person faint or pass out and someone did the right thing and called 911 and the Police and EMT came and - in each event - the person denied service. Their reason (in all three cases): I ain't paying that bill!

    So, is this a medical system issue or a legal issue? Or, both?

    I don't have that answer. Or, any answer, for that matter. I am more conservative in nature *BUT* I did live in Germany for several years. Not sure. I just find it a bit silly that we are worried about legal responsibility here. And, not picking on the OP. Absolutely not. She absolutely did the right thing. To me, that should not even be a question as to what to do (you call 100 times out of 100 - without hesitation or being prompted to do something....seconds can make a difference).

    So, this is a very interesting thread to me.

    I grew up in California and I know of a lot of EMT Service Providers that go out of business because no one ever pays. Not siding with them....just sharing that information.

    I really and truly look forward to other's comments....

    I really think that Americans get so scared of legal liability BECAUSE our healthcare costs are so high. If someone breaks your rib doing chest compressions, but you live in a country with a single payer system, that broken rib costs you almost nothing as far as medical care. If you also have paid sick leave how on earth are you going to claim financial damage from the chest compressions?
  • happytree923
    happytree923 Posts: 463 Member
    CSARdiver wrote: »
    CSARdiver wrote: »
    You absolutely have the right to activate emergency response, but in this case the patient went to the hospital on their own. You did well - please continue to do so.

    People in accidents (or any traumatic event) are rarely in their right minds due to the body's response to trauma. Blood to the extremities is limited, so people lose peripheral vision, hearing, cognitive thought, fine motor skills, and all higher reasoning.

    Most Local/State laws have some manner of Good Samaritan laws in place to protect civilians from liability from taking reasonable actions to aid the injured. Need to check with your area to see what your laws are.

    You need laws for this? :o

    YES! People have been sued for doing chest compressions/rescue breathing and Heimlich.

    Jeez......!

    Sad but true - this is one of the primary drivers of healthcare costs in the US as 40-60% of a frontline healthcare professional's income goes to liability insurance.

    Where did you find those statistics? Unnecessary care in the form of defensive medicine certainly is a problem but 40-60% of salary is definitely NOT the average cost of physician malpractice insurance.
  • 2BeHappy2
    2BeHappy2 Posts: 811 Member
    No, you don't need his permission. Once on the scene, the patient can refuse the trip to the hospital, and if the EMTs feel comfortable releasing him, they will. He doesn't have to pay for the ride to the hospital. But they might find evidence of trauma that a lay person can't tell, so they are the best people to evaluate and make that call. So if something like that happens, no, you don't need permission. Call.
    Why would he not have to pay? When I fell after having had surgery and needed to call, I was billed.

  • nutmegoreo
    nutmegoreo Posts: 15,532 Member
    2BeHappy2 wrote: »
    No, you don't need his permission. Once on the scene, the patient can refuse the trip to the hospital, and if the EMTs feel comfortable releasing him, they will. He doesn't have to pay for the ride to the hospital. But they might find evidence of trauma that a lay person can't tell, so they are the best people to evaluate and make that call. So if something like that happens, no, you don't need permission. Call.
    Why would he not have to pay? When I fell after having had surgery and needed to call, I was billed.

    I assume she meant, he wouldn't have to pay if he refused the ride.
  • 2BeHappy2
    2BeHappy2 Posts: 811 Member
    nutmegoreo wrote: »
    2BeHappy2 wrote: »
    No, you don't need his permission. Once on the scene, the patient can refuse the trip to the hospital, and if the EMTs feel comfortable releasing him, they will. He doesn't have to pay for the ride to the hospital. But they might find evidence of trauma that a lay person can't tell, so they are the best people to evaluate and make that call. So if something like that happens, no, you don't need permission. Call.
    Why would he not have to pay? When I fell after having had surgery and needed to call, I was billed.

    I assume she meant, he wouldn't have to pay if he refused the ride.
    Aaahh, gotcha!

  • AnvilHead
    AnvilHead Posts: 18,343 Member
    Funny video related to this topic: https://www.youtube.com/watch?v=0HAGMb_jAdU

    "Did you see this mechanism of injury?!?"
  • VUA21
    VUA21 Posts: 2,072 Member
    Yes you can. They have the right to refuse treatment, but that doesn't mean you can't call for medical help.
  • heybales
    heybales Posts: 18,842 Member
    Was that show reading our topic?
  • comptonelizabeth
    comptonelizabeth Posts: 1,701 Member
    ceiswyn wrote: »
    Having read this thread in increasing horror and disbelief, I’m just going to sit here quietly for a while and really appreciate the NHS.

    Yup, me too.
  • RGv2
    RGv2 Posts: 5,789 Member
    ceiswyn wrote: »
    Having read this thread in increasing horror and disbelief, I’m just going to sit here quietly for a while and really appreciate the NHS.

    Amen to that.

    Meh, I do alright with my healthcare.

    I had a stroke 4 years ago, ran up over $150K in medical bills and ended up paying a total of $1,800 (and a free 45 min ambulance ride :smile: ).
  • deannalfisher
    deannalfisher Posts: 5,600 Member
    RGv2 wrote: »
    ceiswyn wrote: »
    Having read this thread in increasing horror and disbelief, I’m just going to sit here quietly for a while and really appreciate the NHS.

    Amen to that.

    Meh, I do alright with my healthcare.

    I had a stroke 4 years ago, ran up over $150K in medical bills and ended up paying a total of $1,800 (and a free 45 min ambulance ride :smile: ).

    mine wasn't that bad - but thyroid surgery in 2014, followed by radioactive iodine treatment - i paid $1750 out of pocket - that included surgery, anaestethic, hospital room, radiology etc - that was employer offered blue cross blue shield insurance where i paid 40% and they paid 60% out of my paycheck
  • RGv2
    RGv2 Posts: 5,789 Member
    RGv2 wrote: »
    ceiswyn wrote: »
    Having read this thread in increasing horror and disbelief, I’m just going to sit here quietly for a while and really appreciate the NHS.

    Amen to that.

    Meh, I do alright with my healthcare.

    I had a stroke 4 years ago, ran up over $150K in medical bills and ended up paying a total of $1,800 (and a free 45 min ambulance ride :smile: ).

    mine wasn't that bad - but thyroid surgery in 2014, followed by radioactive iodine treatment - i paid $1750 out of pocket - that included surgery, anaestethic, hospital room, radiology etc - that was employer offered blue cross blue shield insurance where i paid 40% and they paid 60% out of my paycheck

    I have BCBS as well. They have really...really good affordable coverage. I don't think we're 40-60 though, pretty sure it's closer to 20-80 or 30-70.
  • soufauxgirl
    soufauxgirl Posts: 392 Member
    We pay $140 a year ambulance cover for all family members. If you dont have it then costs start from $550 and upwards for ambulance to hospital and I think an additional cost per km/mile. We pay it over quarterly payments. A very small price to pay and we have had to use the ambulance once already so such a relief to have it.
  • SuzySunshine99
    SuzySunshine99 Posts: 2,989 Member
    I went to the gym to spend my lunch hour swimming laps. As I was getting ready to turn into the plaza parking lot, somebody was coming down the sidewalk, about to cross the driveway. His leg was in a cast and on a walker. He stopped to let me go first, but he had the right of way, so I waved him to go. He did, or started to, a car came way too fast out of nowhere and hit him hard. I heard a terrible crunching noise.

    I left my car where it was and ran to help the guy. People behind me lost their *kitten*, because they to go around.

    The guy was obviously in shock. It wasn't obvious whether he was injured or not. To me, the only thing to do is go to the hospital, and that seemed really clear. But not to him. He struggled to get up, I had to lift him to his good foot. The driver was beside herself with remorse, she was real helpful too. I've been hit by a car on my bike, I know what it is to be hurt and confused and not understand what's happening, and I could see it in his face.

    He just wanted to go home. I kept telling him he needs to see a doctor, they'll do x-rays, they'll have pain medicine, you might feel ok now but you'll want it in an hour. I offered to go pick up his wife or girlfriend or anyone else and bring them to to him. I took his phone, added my number as a contact with the name "witness."

    I managed to talk him into going to the hospital. The lady that hit him drove, so he wouldn't have to wait for the ambulance to arrive (or pay $1,000 for the ride).

    In the moment I didn't feel like I could call 911 without his permission. But it was clear that he wasn't able to make that decision at the time. I really hope I never see anything like this again, but, if I do, can I just call the ambulance immediately?

    Do you get charged for using and ambulance?

    It depends...my husband needed an ambulance ride from our house and the local fire department took him free of charge because we are residents and pay taxes here. But, when he needed an ambulance ride from the next town over (same distance to the hospital), we were charged $1600 because we were not residents there. Our insurance paid half of that.
  • Max_Adams25
    Max_Adams25 Posts: 64 Member
    Cant believe you have to pay to use ambulance. Crazy country
  • kimny72
    kimny72 Posts: 16,011 Member
    I went to the gym to spend my lunch hour swimming laps. As I was getting ready to turn into the plaza parking lot, somebody was coming down the sidewalk, about to cross the driveway. His leg was in a cast and on a walker. He stopped to let me go first, but he had the right of way, so I waved him to go. He did, or started to, a car came way too fast out of nowhere and hit him hard. I heard a terrible crunching noise.

    I left my car where it was and ran to help the guy. People behind me lost their *kitten*, because they to go around.

    The guy was obviously in shock. It wasn't obvious whether he was injured or not. To me, the only thing to do is go to the hospital, and that seemed really clear. But not to him. He struggled to get up, I had to lift him to his good foot. The driver was beside herself with remorse, she was real helpful too. I've been hit by a car on my bike, I know what it is to be hurt and confused and not understand what's happening, and I could see it in his face.

    He just wanted to go home. I kept telling him he needs to see a doctor, they'll do x-rays, they'll have pain medicine, you might feel ok now but you'll want it in an hour. I offered to go pick up his wife or girlfriend or anyone else and bring them to to him. I took his phone, added my number as a contact with the name "witness."

    I managed to talk him into going to the hospital. The lady that hit him drove, so he wouldn't have to wait for the ambulance to arrive (or pay $1,000 for the ride).

    In the moment I didn't feel like I could call 911 without his permission. But it was clear that he wasn't able to make that decision at the time. I really hope I never see anything like this again, but, if I do, can I just call the ambulance immediately?

    Do you get charged for using and ambulance?

    Yep, if you actually take a ride in it. I passed out at my nephew's baseball game (turns out it was dehydration and heat exhaustion because I'm an idiot). Folks called 911 and the EMTs checked me out and couldn't find anything wrong but strongly suggested I go to the hospital. I turned down the ambulance and had to sign a waiver, then had someone else drive me to the ER. Was charged about $900 for using the ER and getting an EKG, my insurance paid half so it cost me $450. Wasn't charged for the EMT's but the ambulance ride would I believe be another $500 at least, from what I've heard. In general, I would not turn down medical care, but considering the EMT said my vitals were fine, and the hospital was only 10 mins away, it did my health better to save the extra money!
  • deannalfisher
    deannalfisher Posts: 5,600 Member
    RGv2 wrote: »
    RGv2 wrote: »
    ceiswyn wrote: »
    Having read this thread in increasing horror and disbelief, I’m just going to sit here quietly for a while and really appreciate the NHS.

    Amen to that.

    Meh, I do alright with my healthcare.

    I had a stroke 4 years ago, ran up over $150K in medical bills and ended up paying a total of $1,800 (and a free 45 min ambulance ride :smile: ).

    mine wasn't that bad - but thyroid surgery in 2014, followed by radioactive iodine treatment - i paid $1750 out of pocket - that included surgery, anaestethic, hospital room, radiology etc - that was employer offered blue cross blue shield insurance where i paid 40% and they paid 60% out of my paycheck

    I have BCBS as well. They have really...really good affordable coverage. I don't think we're 40-60 though, pretty sure it's closer to 20-80 or 30-70.

    I’d have to check for sure but if it’s offered BCBS is my go-to; had friends with other companies and heard horror stories;
  • tennisdude2004
    tennisdude2004 Posts: 5,609 Member
    kimny72 wrote: »
    I went to the gym to spend my lunch hour swimming laps. As I was getting ready to turn into the plaza parking lot, somebody was coming down the sidewalk, about to cross the driveway. His leg was in a cast and on a walker. He stopped to let me go first, but he had the right of way, so I waved him to go. He did, or started to, a car came way too fast out of nowhere and hit him hard. I heard a terrible crunching noise.

    I left my car where it was and ran to help the guy. People behind me lost their *kitten*, because they to go around.

    The guy was obviously in shock. It wasn't obvious whether he was injured or not. To me, the only thing to do is go to the hospital, and that seemed really clear. But not to him. He struggled to get up, I had to lift him to his good foot. The driver was beside herself with remorse, she was real helpful too. I've been hit by a car on my bike, I know what it is to be hurt and confused and not understand what's happening, and I could see it in his face.

    He just wanted to go home. I kept telling him he needs to see a doctor, they'll do x-rays, they'll have pain medicine, you might feel ok now but you'll want it in an hour. I offered to go pick up his wife or girlfriend or anyone else and bring them to to him. I took his phone, added my number as a contact with the name "witness."

    I managed to talk him into going to the hospital. The lady that hit him drove, so he wouldn't have to wait for the ambulance to arrive (or pay $1,000 for the ride).

    In the moment I didn't feel like I could call 911 without his permission. But it was clear that he wasn't able to make that decision at the time. I really hope I never see anything like this again, but, if I do, can I just call the ambulance immediately?

    Do you get charged for using and ambulance?

    Yep, if you actually take a ride in it. I passed out at my nephew's baseball game (turns out it was dehydration and heat exhaustion because I'm an idiot). Folks called 911 and the EMTs checked me out and couldn't find anything wrong but strongly suggested I go to the hospital. I turned down the ambulance and had to sign a waiver, then had someone else drive me to the ER. Was charged about $900 for using the ER and getting an EKG, my insurance paid half so it cost me $450. Wasn't charged for the EMT's but the ambulance ride would I believe be another $500 at least, from what I've heard. In general, I would not turn down medical care, but considering the EMT said my vitals were fine, and the hospital was only 10 mins away, it did my health better to save the extra money!

    That’s a lot of money. So what happens if you need an ambulance but you don’t have health insurance and don’t have enough money ?
  • kimny72
    kimny72 Posts: 16,011 Member
    kimny72 wrote: »
    I went to the gym to spend my lunch hour swimming laps. As I was getting ready to turn into the plaza parking lot, somebody was coming down the sidewalk, about to cross the driveway. His leg was in a cast and on a walker. He stopped to let me go first, but he had the right of way, so I waved him to go. He did, or started to, a car came way too fast out of nowhere and hit him hard. I heard a terrible crunching noise.

    I left my car where it was and ran to help the guy. People behind me lost their *kitten*, because they to go around.

    The guy was obviously in shock. It wasn't obvious whether he was injured or not. To me, the only thing to do is go to the hospital, and that seemed really clear. But not to him. He struggled to get up, I had to lift him to his good foot. The driver was beside herself with remorse, she was real helpful too. I've been hit by a car on my bike, I know what it is to be hurt and confused and not understand what's happening, and I could see it in his face.

    He just wanted to go home. I kept telling him he needs to see a doctor, they'll do x-rays, they'll have pain medicine, you might feel ok now but you'll want it in an hour. I offered to go pick up his wife or girlfriend or anyone else and bring them to to him. I took his phone, added my number as a contact with the name "witness."

    I managed to talk him into going to the hospital. The lady that hit him drove, so he wouldn't have to wait for the ambulance to arrive (or pay $1,000 for the ride).

    In the moment I didn't feel like I could call 911 without his permission. But it was clear that he wasn't able to make that decision at the time. I really hope I never see anything like this again, but, if I do, can I just call the ambulance immediately?

    Do you get charged for using and ambulance?

    Yep, if you actually take a ride in it. I passed out at my nephew's baseball game (turns out it was dehydration and heat exhaustion because I'm an idiot). Folks called 911 and the EMTs checked me out and couldn't find anything wrong but strongly suggested I go to the hospital. I turned down the ambulance and had to sign a waiver, then had someone else drive me to the ER. Was charged about $900 for using the ER and getting an EKG, my insurance paid half so it cost me $450. Wasn't charged for the EMT's but the ambulance ride would I believe be another $500 at least, from what I've heard. In general, I would not turn down medical care, but considering the EMT said my vitals were fine, and the hospital was only 10 mins away, it did my health better to save the extra money!

    That’s a lot of money. So what happens if you need an ambulance but you don’t have health insurance and don’t have enough money ?

    I would assume you try to work out a payment plan and eventually if you don't pay you end up dealing with a collection agency. Luckily I've always been able to afford at least crappy insurance and had a little money saved so I haven't experienced that, but I used to work for a debt management company and lots of collection agency accounts are old medical bills.
  • deannalfisher
    deannalfisher Posts: 5,600 Member
    kimny72 wrote: »
    I went to the gym to spend my lunch hour swimming laps. As I was getting ready to turn into the plaza parking lot, somebody was coming down the sidewalk, about to cross the driveway. His leg was in a cast and on a walker. He stopped to let me go first, but he had the right of way, so I waved him to go. He did, or started to, a car came way too fast out of nowhere and hit him hard. I heard a terrible crunching noise.

    I left my car where it was and ran to help the guy. People behind me lost their *kitten*, because they to go around.

    The guy was obviously in shock. It wasn't obvious whether he was injured or not. To me, the only thing to do is go to the hospital, and that seemed really clear. But not to him. He struggled to get up, I had to lift him to his good foot. The driver was beside herself with remorse, she was real helpful too. I've been hit by a car on my bike, I know what it is to be hurt and confused and not understand what's happening, and I could see it in his face.

    He just wanted to go home. I kept telling him he needs to see a doctor, they'll do x-rays, they'll have pain medicine, you might feel ok now but you'll want it in an hour. I offered to go pick up his wife or girlfriend or anyone else and bring them to to him. I took his phone, added my number as a contact with the name "witness."

    I managed to talk him into going to the hospital. The lady that hit him drove, so he wouldn't have to wait for the ambulance to arrive (or pay $1,000 for the ride).

    In the moment I didn't feel like I could call 911 without his permission. But it was clear that he wasn't able to make that decision at the time. I really hope I never see anything like this again, but, if I do, can I just call the ambulance immediately?

    Do you get charged for using and ambulance?

    Yep, if you actually take a ride in it. I passed out at my nephew's baseball game (turns out it was dehydration and heat exhaustion because I'm an idiot). Folks called 911 and the EMTs checked me out and couldn't find anything wrong but strongly suggested I go to the hospital. I turned down the ambulance and had to sign a waiver, then had someone else drive me to the ER. Was charged about $900 for using the ER and getting an EKG, my insurance paid half so it cost me $450. Wasn't charged for the EMT's but the ambulance ride would I believe be another $500 at least, from what I've heard. In general, I would not turn down medical care, but considering the EMT said my vitals were fine, and the hospital was only 10 mins away, it did my health better to save the extra money!

    That’s a lot of money. So what happens if you need an ambulance but you don’t have health insurance and don’t have enough money ?

    You work out a payment plan - I had one fresh out of college when I was in a car accident (because they took me to a civilian hospital tricare didn’t want to at, I fought 6mths before I gave up) - I basically paid back $5-10 a paycheck for like year - thankfully interest free
  • RGv2
    RGv2 Posts: 5,789 Member
    RGv2 wrote: »
    RGv2 wrote: »
    ceiswyn wrote: »
    Having read this thread in increasing horror and disbelief, I’m just going to sit here quietly for a while and really appreciate the NHS.

    Amen to that.

    Meh, I do alright with my healthcare.

    I had a stroke 4 years ago, ran up over $150K in medical bills and ended up paying a total of $1,800 (and a free 45 min ambulance ride :smile: ).

    mine wasn't that bad - but thyroid surgery in 2014, followed by radioactive iodine treatment - i paid $1750 out of pocket - that included surgery, anaestethic, hospital room, radiology etc - that was employer offered blue cross blue shield insurance where i paid 40% and they paid 60% out of my paycheck

    I have BCBS as well. They have really...really good affordable coverage. I don't think we're 40-60 though, pretty sure it's closer to 20-80 or 30-70.

    I’d have to check for sure but if it’s offered BCBS is my go-to; had friends with other companies and heard horror stories;

    Ya...the last company I was at had BCBS then after getting bought out they made us switch to Aetna...awful. Glad to be at another company and back to BCBS (at about 1/2 the price of Aetna)
  • ccrdragon
    ccrdragon Posts: 3,374 Member
    I have BCBS and I am very thankful. We also have an HSA, which the company jump-starts with half of our deductible. Saved my *kitten* this year... my wife had a brain aneurysm 4 months ago followed by a minor stroke afterwards (no lasting effects from either, thank god). The total bill for both was north of 500K, I paid nothing out of pocket because we had enough in the HSA to pay the deductible. Oh, that did include a 20 minute ambulance ride from the local hospital to a stroke center in the next town - $1600 for that ride.
  • T1DCarnivoreRunner
    T1DCarnivoreRunner Posts: 11,502 Member
    Yes, you can call 911 without anyone's consent. That is what it is for.

    Those of us with medical training have a process to determine whether a patient is legally able to consent to care. If/until a patient is not able to consent, they get treated under "implied consent."

    I know I've had hypoglycemic issues a few times in the past where I first became aware with medics around me. They always have asked the right questions and I know that as soon as I can show a LOR of A+Ox3, then I can refuse care.... and I do in those cases. I've already been treated by then under implied consent and have reached a level where I can care for myself, so I don't need them. Only once did I never reach that level and had to be taken in to the ER. Every other time, I have just taken over care on my own. Usually, the medics carry a form for me to sign saying I refuse care and I know the risk, etc. etc.
  • T1DCarnivoreRunner
    T1DCarnivoreRunner Posts: 11,502 Member
    In regards to payment, our healthcare insurance companies all have something called a "subrogation" dept. This is the dept. that looks at injury claims and tries to find out if someone else is liable. In this case, his health insurance company would seek to recover money from the driver's car insurance company.
  • tennisdude2004
    tennisdude2004 Posts: 5,609 Member
    CSARdiver wrote: »
    Cant believe you have to pay to use ambulance. Crazy country

    You're still paying for it. It's just taken out in advance.

    Out of sight out of mind.

    Technically yes, but if you've not been fortunate enough to earn the money to pay in through your taxes you still have full access.
  • RGv2
    RGv2 Posts: 5,789 Member
    edited July 2018
    CSARdiver wrote: »
    Cant believe you have to pay to use ambulance. Crazy country

    You're still paying for it. It's just taken out in advance.

    Out of sight out of mind.

    Technically yes, but if you've not been fortunate enough to earn the money to pay in through your taxes you still have full access.

    So do people in the states....

    It's not like they run your insurance and do a credit check before you go. If you honestly can't pay, that will usually end up going to the state in some way/shape/form.