If you call 911 and the fire department comes, you will generally pay nothing. In virtually all cities, fire departments operate as a public service financed by local government, usually via property taxes.
But if you call 911 for an ambulance, you could face a huge bill, even for a short ride. Ambulances typically don’t operate as a free public service. In many states the average balance due runs over $1,000.
Having health insurance does help, but deductibles and exclusions can still leave you with a huge bill. A medical emergency that requires an ambulance can easily drive you into debt.
People sometimes beg not to be put in ambulances, even in situations where they clearly need them. One Boston resident, her gashed leg caught between a subway train and the platform, pleaded with worried fellow passengers to forego any call to an ambulance service.
“I have terrible health insurance,” she explained.
But things could be worse. Imagine if we had privatized fire departments. We would then see a “fire-fighting insurance industry” emerge. Your insurer would receive a bill from the fire-fighting company that put out your fire. These bills would be high, in part because fire companies would have trouble getting poor people to pay them.
You would also likely have a giant deductible, and that would leave fires, even for the insured, extremely costly. Many people would become reluctant to call for help. They would try instead to put fires out by themselves, making desperate cost-benefit analyses in a moment of extreme stress instead of just calling the fire department to get their fire extinguished quickly and safely.