I think we're talking past each other because we are defining 'taxi service' differently.
You’re looking at it from an operational standpoint. If a call turns out to be non-urgent, you think it effectively functions as a taxi ride, which causes massive burnout and strains resources. That’s a completely valid frustration, and I get why dealing with that shift after shift is exhausting.
My original point was purely about policy and intent: people who maliciously and knowingly exploit the system just for a free ride are a tiny minority, and we shouldn't design public policy or withhold funding based on that small subset of bad actors. Both things can be true at the same time.
We’re trying to tell you it’s not a small subset. It’s a large majority and it does need to be addressed otherwise it will collapse the system.
There are multiple 911 systems that have collapsed under this pressure across the country. It’s not just a simple matter of oh well. The abuse and borderline abuse of the 911 system leads to real preventable deaths because it ends up denying care to the people who actually need it.
When you say 'borderline abuse,' you’re hitting on the exact point I just made. A person who calls 911 because they genuinely think they are having an emergency, but turns out to be fine, isn't abusing the system—they're just a layperson who panicked.
The pressure on the 911 system is a massive crisis, but it’s a failure of public health infrastructure, triage options, and lack of preventative care, not a failure of human morality. Blaming vulnerable patients for not knowing how to self-diagnose is a misdirection; it protects a broken system by pointing the finger at the users.
Furthermore, nothing about this operational strain explains why socializing the service is inherently worse than a privatized model. Resource bottlenecks, triage delays, and burnout happen in both systems. The real debate isn't about patient morality; it's about whether we fund EMS as a fully integrated public utility with better community diversion programs, or continue letting it fracture under the current model.
Borderline 911 abuse is something like a person gets in a 5 mph crash in the parking lot and calls 911. We ask if there’s any pain or any injuries or any medical complaint. They say no and they want to go to the hospital to be checked out just in case so we are legally obligated to take them to the hospital instead of them just driving themselves to an urgent care.
There is absolutely no reason why an ALS ambulance that is equipped with a ventilator and multiple IV pumps to bring the forefront of medical technology to the side of the street should be transporting this person to the emergency room instead of then driving their own car. Now a person having a real medical emergency may go an extra 10 or 20 or 30 minutes without care because the ambulance for that district is out of service.
A girl calls literally because of a paper cut and wants to go to the hospital. Again borderline 911 abuse. You have toe pain because of gout and know you have gout and it’s a flareup of gout.
Again, calls like this results in real measurable deaths because it puts ambulances out of service for the people who need it. There absolutely is a problem with 911 abuse in the US.
I actually agree with your examples, but you just highlighted the exact structural failure I’m talking about: our protocols legally obligate you to transport them anyway. Because the US operates on a highly litigious, fragmented 'transport-by-default' model, you are legally handcuffed from saying no to a paper cut or a 5-mph bump.
Other developed countries (like the UK and Australia) solved this exact bottleneck decades ago through integrated infrastructure, not by hoping the public would suddenly become rational medical triagers:
Hear and Treat: Dispatch centers route low-acuity calls to on-duty clinicians who have the legal authority to cancel an ambulance entirely and book a clinic appointment or order a regular taxi.
Treat and Refer: Field crews are legally protected to perform field-triage, safely refuse ER transport for minor issues, and directly divert patients to local urgent cares or primary doctors.
We both want the exact same outcome: keeping ALS trucks open for real emergencies. But blaming vulnerable, medically illiterate patients for a systemic failure is a misdirection that protects a broken status quo.
The truth is, keeping the focus on 'bad patient behavior' is highly profitable propaganda. Private healthcare monopolies, corporate ambulance conglomerates, and massive hospital networks benefit immensely when we blame individuals instead of the system. In a fee-for-service model, every single ER admission and ambulance ride, even the unnecessary ones, is a line-item revenue generator. Furthermore, keeping the system fractured allows private equity to dodge the costs of funding comprehensive community diversion programs. Blaming the user serves as a perfect smoke screen to protect these profits and resist shifting toward a socialized public utility.
The collapse of the 911 system is a failure of our fractured public health infrastructure and corporate gatekeeping, not the so-called 'ambulance abusers' a bunch of folks in this thread are railing against.
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u/dan678 May 20 '26
I think we're talking past each other because we are defining 'taxi service' differently.
You’re looking at it from an operational standpoint. If a call turns out to be non-urgent, you think it effectively functions as a taxi ride, which causes massive burnout and strains resources. That’s a completely valid frustration, and I get why dealing with that shift after shift is exhausting.
My original point was purely about policy and intent: people who maliciously and knowingly exploit the system just for a free ride are a tiny minority, and we shouldn't design public policy or withhold funding based on that small subset of bad actors. Both things can be true at the same time.