Why an ambulance ride can cost $12,873 – blame the hearse

For most of the twentieth century, if you needed an ambulance in America, a funeral home sent one — the only vehicle built to carry someone lying flat was the hearse. David Oks traces the whole expensive mess back to that arrangement: funeral homes ran cars that carried patients and coffins alike and barely charged, because "the family that called you for the ride to the hospital was likely to also call you for the funeral."

Then CPR, portable defibrillators, and trained paramedics turned a giveaway into a capital-intensive business, but Medicare kept paying per ride, as if standing ready cost nothing. The result, Oks writes, is "the exact opposite of how insurance is supposed to work." One San Francisco man was billed $12,873 for a six-mile hospital-to-hospital transfer.

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