David Anderson, writing about his experience in Current Affairs:
The private ownership model for ambulances is fundamentally at odds with its own purpose. In the beginning they were useful insofar as they were an ad-hoc option in a society that gave no thought to whether or not speed was important in treating an illness or injury. However, this jumble of organizations across the nation creates big problems beyond figuring out billing logs. A key problem is the cost of doing business. A single ambulance can cost somewhere in the $500,000 to $1 million range, so any ambulance company’s first priority is to reduce overhead as much as possible... They want to get the cheapest gear, the cheapest ambulances, and the cheapest workers. You will see EMS personnel make fast-food level wages, for what is ostensibly an extremely important job. Paying people by the hour in addition to having prohibitively expensive equipment means EMS corporations need to maximize the workload for a workforce that they keep as small as is feasible.
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The irregularity is just one reason that health problems are rampant in EMS. Overworked EMTs have random meal schedules, eat unhealthy food often, and are too tired to exercise.About 1/3 of EMTs work more than 40 hours a week, and the Bureau of Labor Statistics confirms that they have “one of the highest rates of injuries and illnesses of all occupations.” … No wonder, then, that your average EMT lasts about two years before experiencing “burnout,” the psychological exhaustion that irreversibly damages your performance.
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The usual justifications for free markets fail completely when it comes to ambulances, since there’s no practical way for “consumer choice” to improve services. When you’re bleeding to death, it’s hard to comparison shop—not that you’re even offered a choice. As Harvard Law School’s Shailin Thomas wrote, ambulances function as monopolies, because “the patient faces a market with exactly one option.” Thus even though the ambulance industry itself is actually “quite diverse,” consumers have approximately zero power in the market. Moreover, the company that transports you is usually determined by the contract they strike with the town/city government, not you. You take whatever ambulance the dispatcher sends, and they already got the council to agree to what constituted an “acceptable” transportation fee.
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If we were to design a good EMS system, it would be fully tax-funded, and each town EMS department would be run by the EMTs themselves. They would either act collectively to optimize the place or elect officers to dictate orders. Ideally, to combat fatigue, they would only ever work 4-6 hours a day, 5 days a week. That would require a lot of manpower for 24/7 coverage, but better pay and reasonable hours would lure many highly capable people to the job. Of course, it would cost far more than the current system. But the current system is disastrous, and getting profit out of emergency services means no more thousand-dollar one-mile rides.
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Good emergency medical services are going to be expensive and unprofitable. The sheer cost of operating an emergency response service is why firefighting was ultimately turned into a public utility. In the beginning week of firefighter training, students learn that the Great Chicago Fire was the turning point that led to the extinction of private fire companies and the beginning of fire services as a widespread public utility. Chicago’s fire businesses found it far too expensive to keep and maintain the equipment and people necessary for a massive disaster, which they saw as too rare an occurrence to justify budgeting for it. The same could be said for ambulances…