The blog mentions it, but it’s one of those obvious things that somehow isn’t solved yet and blows my mind every time it comes up.
We hope to set the rates such that folks won't have to pay at all if they have insurance or will only have to pay the gap amount insurance would have covered.
I'm collecting the data to figure out how many residents, how many businesses, and how many college students there are in the region and match that to the call volume for those same categories so that each group pays a fair share.
We're basing the legal structure in the MESA group from Lancaster PA. Public fee hearings with residents hopefully start this Fall, and then we're hoping to go live Jan 2027.
I will say I've been surprised how extremely expensive it is to run EMS. Even with 25% of our responders being volunteers, the costs are staggering. Insurance, equipment, medicines, payroll, billing, fuel, building maintenance, heating and cooling.
The vehicle maintenance would turn your hair grey. We have a vehicle in the shop almost every single day. And we have two volunteer mechanics trying to do fixes in house. But these ambulances just are absolutely beat to hell 24 hours a day. My partner is one of the mechanics, and she sometimes gets a half dozen vehicle maintenance reports a day! And we only have 7 vehicles!
And then you have to factor in deprecation on an asset that effectively drops to $0 after 5 years. And costs $300k to replace.
We pinch every penny we can think of, but the end effect is that we're trying to provide a service that's extremely expensive and so we hope this model will diffuse those costs across the whole population (which we expect will turn out to be something like $100/year per family).
Cross your fingers because this feels like our best option
The thing about unfettered private health is that it finds "profit centers" and pumps them ruthlessly. But the problem when scheme/scam gets reigned in (say out-of-plan doctors), another appears (out-of-plan ambulances) and there's no end to the situation. Only actual state sponsored health care can end this.
Tangentially (think in systems), much of the US exists off of volunteer emergency services (fire and emt), which is rapidly evaporating. Average age of these volunteers is mid 50s.
https://www.nfpa.org/news-blogs-and-articles/nfpa-journal/20...
> For generations, volunteers have formed the backbone of the nation’s emergency response system. Roughly half of the U.S. population, some 170 million people, live in areas primarily served by volunteer departments. Unpaid firefighters comprise more than 60 percent of all U.S. firefighters, and more than 80 percent of the country’s fire departments are either all or mostly volunteer.
https://www.ruralhealthresearch.org/publications/1596
> 4.5 million people lived in an ambulance desert (AD); 2.3 million (52%) of them in rural counties. Four out of five counties (82%) had at least one AD. Rural counties were more likely to have ADs (84%) than urban counties (77%). Areas with the highest share and number of people living in ADs include the Appalachian region in the South; Western states with difficult mountainous terrain; coastal areas across the U.S.; and the rural mountainous areas of Maine, Vermont, Oregon, and Washington. Eight states had fewer than three ambulances covering every 1,000 square miles of land area (the Western states of Nevada, Wyoming, Montana, Utah, New Mexico, and Idaho; and the Midwestern states of North Dakota and South Dakota).
There are some good points above, but I think this one is a distraction. Many of those states on that list have low ambulance densities because they have low population densities.
Have you ever driven through Wyoming or Montana? They have less than 10 people per square mile on average. There are a couple clusters of cities and then miles of empty land.
These statistics need to be based on cities, or at least have population density taken into account. It doesn't compute to set a threshold for ambulances per square mile when the population density differs so much from state to state.
Choosing to live far away from others is also choosing to live far away from help.
If a service is highly variable cost dependent and is unaffordable for the average individual to pay out-of-pocket it is unaffordable for the aggregate individual as well.
There _should_ be some ambulance deserts.
But also because Postal Service is much cheaper than an ambulance service?
Trying to frame it as a choice also misses a lot. It technically is, but you have to recognize there's a huge cost in uprooting your entire life and moving to a new location.
It is not the government’s job to “take care of” anybody.
Everything has a cost, staying has a cost, leaving has a cost. The question is how much should the public be taxed to pay for individuals suboptimal decision-making? Or conversely, why am I subsidizing some billionaires remote horse ranch to have daily Postal Service and an ambulance standing by?
Can I move to the wilds of Alaska and then demand the same level of service as New York City? No that would be ludicrous.
That is literally the only job of government. The entire reason we have a government is to serve the citizens in some fashion or another.
Even for most libertarians, they'll view the government in having a role resolving disputes. That is "taking care of" citizens by resolving conflicts.
Subsidizing farmers so citizens continue to have cheap and consistent access to food is a great thing. Right up there with providing clean drinking water, sewage services, and building roads.
The government needs to balance the interest of the public with the interest of the individual. It is not intended to “take care of “people regardless of their asks.
Otherwise, what if I am only “taken care of” if I have a beachside penthouse in Malibu and also a pony?
The government is not taking care of people if it allows the average expenditure per person to eclipse the average tax revenue per person. The economics need to be roughly sustainable at the national state and even rural area level.
That's a false equivalence.
We aren't talking about giving people penthouses. We are talking about providing EMS. Heck, I can even grant "degraded EMS" maybe we don't ensure an ambulance is stocked with the latest and greatest tech because you are rural. Maybe the ambulance is a hand-me-down from a larger city.
But it's not a huge ask to say that rural communities deserve at least some level of emergency health medicine. Less people means less health incidents. That's the primary reason why so many rural locations today are able to get by with volunteer EMS (Something my family participated in. Calls happened roughly once a month at most in my town of 300).
> The government is not taking care of people if it allows the average expenditure per person to eclipse the average tax revenue per person. The economics need to be roughly sustainable at the national state and even rural area level.
I agree, it's smart to make sure the government isn't over spending on frivolous things. I just don't think "EMS" is frivolous. Everyone might need it, it doesn't ultimately cost that much to provide (especially if it were actually ran by the government and not private entities), and it's services buy a lot of good will with citizens. Additionally, it creates economic output. Someone dying or getting a lifetime disability because EMS wasn't available is someone that's not adding to the economy.
What happens when half of government acts is bad faith purely to poison the well, one half of government and an entire political party make it so that the numbers don't work (and via the fiscal policy they intentionally inflict/structure/design) purely so that they can promote their policy position of 'the numbers don't work'?
How many unfunded tax cuts have we had recently? Those aren't acts of nature. The numbers you speak of not matching aren't acts of nature. They are intentionally designed to 'starve the beast' in the 1980s Republican way, and in newer ways the party has come up with since. All so the exact argument you gave can be made.
In the rest of the state there are volunteer Ambulance services subsidised by state and federal government and a fleet of Royal Flying Doctor air ambulances.
RFD(WA) comes in at ~ $80 million AUD / annum in state support (for better or worse - https://www.abc.net.au/news/2024-07-24/rural-gp-slams-royal-... )
They assert to have a "value" to the state of $4.1 billion AUD over 30 years - https://www.flyingdoctor.org.au/wa/
Every day, the Royal Flying Doctor Service in Western Australia retrieves 29 people.I am all for flight for life as we call it here, but that is different than saying we should have a network of ambulances across massive swabs of mostly empty terrain.
I am willing to hazard that the Australian airlift response is slower than your average ambulance response in Sydney.
Dunno about that, there be weeds. Not to mention the US clown car demolition derby is still in office.
Still, the coronavirus pandemic and associated policy responses led to the largest deterioration in the Australian Commonwealth Government’s fiscal position since the Second World War. That was 2021.
The forecast national net debt has looked pretty shitty since then, but the arc has been one of improvement - last years 2025-26 National Fiscal Outlook has been claimed to be overly grim by the most recent KPMG assessment of the 2026–27 AU Budget and backs the estimates that the Federal Government net debt servicing will return to pre COVID levels by 2029-30.
Yeah, it's f-obvious it takes longer for a plane to cross 600km than it takes an ambulance to cross a Sydney suburb.
Any other insights?
That is actually the only legitimate function of government.
--- Says far too many people, always.Seriously? How many conversations have you been in where people were bragging about how good their health coverage is and trying to one-up each other? The extent I've experienced is stuff along the lines of "thank god I had my health plan, because otherwise it would have cost [6 figures]", but it didn't give the impression that they'd be mad if everyone didn't have to suffer that fate.
Do imaginary conversations in the shower count?
And this is exactly why those same people do NOT want universal healthcare.
Healthcare is not a flex, and it my experiences on the west coast, it's an inverse correlation to wealth. :/
The one to which I was responding was capricious. The one you cited has reasoning, even if you disagree with it.
And that was the whole point of my comment. That by reducing the other side to a farcical strawman, you diminish your own argument. It just becomes a yelling match.
I would rather debate the person you cited than sit complacently with the cynic to whom I responded.
Evil is often very reasonable; pretending otherwise is a 'farcical strawman' of your own.
About 65% of the more than one million firefighters in the U.S. are volunteers, with nearly 19,000 fire departments being run completely by volunteers.
In rural Australia most of the fire, ambulance, and emergency response service are volunteer manned and (locally) run, with federal and state assistance for equipment and costs.
Costwise AU Ambulances are either free (if you're a St. John's member - cheap per annum OR if covered by private / work insurance) or (a decade out of date number) a flat fee of $500.
There's no cost for ambulance treatment and transport for Queensland residents. This includes treatment and transport that takes place in other parts of Australia.
If you don’t live in Queensland, you’ll be charged for ambulance treatment and transport. If you have ambulance cover in another state it may cover the cost for you.
I volunteer to give blood. No one is paying me, and yet, someone's life is saved by that.
Some folks believe (in fact, this is the thesis statement of much of anarchist theory) that people would largely volunteer to care for one another if their basic needs were met.
Not everything has to be transactional, you can have a government setting up a scaffold that supports and encourages and organizes volunteers and run an effective service.
For my city of Ann Arbor, Michigan from https://www.a2gov.org/media/4glhvywf/2025-aafd-annual-report...
FY2026 budget: $20,810,234 Structure Fires: 58 Cooking Fires: 75 Vehicle Fires: 30
So should we somehow recover roughly $127,000 from the victims of each fire?
Of course not. I and my neighbors pay taxes to maintain the Fire Department and have it ready when needed. Many may argue that we pay too much, but those unfortunate enough to actually need its services would probably say they got a great deal.
The US also has decent EMS response times. If you adjust for population density, the US has fantastic response times.
I.e. I was responding to the original "in 'most of the world' EMS quality is ass.", trying to say that you only get that outcome if you compare apples and oranges (developed vs developing)
8-10 minutes in urban areas is pretty much universal (for the developed world). Rural areas are where differences come in, and even there standards for the developed world are somewhat on the same level.
- If you’re comparing to developed nations (or some non developed ones with functioning agencies), the argument doesn’t hold true.
- If you’re comparing to the bottom of the barrel EMS (quality being ass like you said), you’re still not going bankrupt for an ambulance ride.
They were super lucky that someone from the hospice just happened to be leaving at the same time they flipped the bed.