[DoesntMatter22]

I think the answer is very simple. Regulation. If there was no regulation or very little then anyone could open up an ambulance service and the cheapest costs and the best service would win.

Unfortunately that’s not the case. It’s like day care. Day care is expensive because the government mandates it to be expensive. Otherwise you’d have grandmas down your street would gladly watch your kid but it’s generally not allowed for more than a couple kids.

Same thing with houses. I have half an acre. Could easily put 2 affordable tiny homes on it. Good income for me, cheap rent for someone else, but, unfortunately it’s legally blocked

[Georgelemental]

When you are bleeding out on the street, you don't have time to shop around for the best deal

[DoesntMatter22]

Wont matter because nobody is going to be paying 12k for a ambulance ride if there are people doing it significantly cheaper.

[Georgelemental]

Again, if you are busy dying, you (or, more likely, the bystander who calls EMS on your behalf) do not have time to check how much the bill will be, or who has the best response time to your location at that moment, or the best equipment, or the best training.

[DoesntMatter22]

Again, if people are doing it cheaper, how could a 13k per ride company stay in business? 911 services would have to be steering them to an insanely bloated expensive company. That wouldn't happen. Competition brings better service and much cheaper prices, always does, without exception.

[Georgelemental]

There's a distinction between 911 emergency ambulance service (respond to people calling 911) and interfacility transfer service (transfer stable patients between hospitals and medical facilities).

When you are an ordinary person calling 911, you can't meaningfully shop around in that emergency situation. The competition that exists is between the possible organizations you local government could contract to run the system. The safety regulations and medical standards they set are part of them choosing what they feel is the best "deal" for their population. (In some places, all 911 calls are run by public fire departments; in others, the government contracts with private companies.)

At the IFT level, again it's not generally possible for patients to choose their service, because (as explained in the article) ambulance services inherently need extensive infrastructure with large fixed costs at every location they serve. You're not going to fit 20 ambulances from 20 competing companies in one hospital's ambulance bay, and those 20 competitors aren't going to be able to afford to pay employees to sit around for hours at that hospital on the off chance that maybe today patients will pick them and not the other guy. The costs for the ambulance company are not primarily per-call, most of the expense is to stand ready for a call whether it happens or not. Instead, competition generally happens when the hospital chooses which ambulance service(s) to contract with.

[DoesntMatter22]

Again, as I keep explaining, if companies were free to compete then even 911 is not going to redirect you to a 13k ambulance service. Why would they unless they are getting payoffs. It doesn't cost anywhere near that to transport you.

[Planktonne]

The idea that everything gets better if we remove all regulation is one we know doesn't work. It's the model we've tested repeatedly, before each piece of regulation, and it always leads to negative outcomes.

[hackeraccount]

So the argument is that any piece of regulation will always lead to a positive outcome?

How is that possible?

[DoesntMatter22]

Can you name some?

[lokar]

I would absolutely not tolerate and unregulated ambulance responding to my emergency.

[DoesntMatter22]

You don’t have to. You do what you want. I’d prefer to hire a company where the workers make more money. Right now they make a pittance.

[duskwuff]

Someone who's having a medical emergency is certainly in no position to go comparison shopping for ambulance services.

[DoesntMatter22]

You would do it before hand of course

[fragmede]

Let me just schedule in plans for my future heart attack and car accidents.

[DoesntMatter22]

Yes because you don’t have health insurance until you have a heart attack right? You never pick that before hand do you?

[yamillove]

When you get your bill, you could just double that as a tip.