Very much so. We could fix this. We continue to choose not to, and will for some time into the future.

Tangentially (think in systems), much of the US exists off of volunteer emergency services (fire and emt), which is rapidly evaporating. Average age of these volunteers is mid 50s.

https://www.nfpa.org/news-blogs-and-articles/nfpa-journal/20...

> For generations, volunteers have formed the backbone of the nation’s emergency response system. Roughly half of the U.S. population, some 170 million people, live in areas primarily served by volunteer departments. Unpaid firefighters comprise more than 60 percent of all U.S. firefighters, and more than 80 percent of the country’s fire departments are either all or mostly volunteer.

https://www.ruralhealthresearch.org/publications/1596

> 4.5 million people lived in an ambulance desert (AD); 2.3 million (52%) of them in rural counties. Four out of five counties (82%) had at least one AD. Rural counties were more likely to have ADs (84%) than urban counties (77%). Areas with the highest share and number of people living in ADs include the Appalachian region in the South; Western states with difficult mountainous terrain; coastal areas across the U.S.; and the rural mountainous areas of Maine, Vermont, Oregon, and Washington. Eight states had fewer than three ambulances covering every 1,000 square miles of land area (the Western states of Nevada, Wyoming, Montana, Utah, New Mexico, and Idaho; and the Midwestern states of North Dakota and South Dakota).

▲ Aurornis 4 hours ago | parent | next [-]

> Eight states had fewer than three ambulances covering every 1,000 square miles of land area (the Western states of Nevada, Wyoming, Montana, Utah, New Mexico, and Idaho; and the Midwestern states of North Dakota and South Dakota).

There are some good points above, but I think this one is a distraction. Many of those states on that list have low ambulance densities because they have low population densities.

Have you ever driven through Wyoming or Montana? They have less than 10 people per square mile on average. There are a couple clusters of cities and then miles of empty land.

These statistics need to be based on cities, or at least have population density taken into account. It doesn't compute to set a threshold for ambulances per square mile when the population density differs so much from state to state.

▲ pclowes 4 hours ago | parent | prev | next [-]

I don’t think it is reasonable to expect to have ambulance coverage across the entire United States. There is a lot of land with very few people.

Choosing to live far away from others is also choosing to live far away from help.

If a service is highly variable cost dependent and is unaffordable for the average individual to pay out-of-pocket it is unaffordable for the aggregate individual as well.

There _should_ be some ambulance deserts.

▲ cogman10 4 hours ago | parent | next [-]

It's very often not a choice. But also, those rural areas are often the breadbaskets of the united states. Taking care of our farmers is important.

Trying to frame it as a choice also misses a lot. It technically is, but you have to recognize there's a huge cost in uprooting your entire life and moving to a new location.

▲ pclowes 4 hours ago | parent [-]

We give our farmers absolutely insane subsidies already.

It is not the government’s job to “take care of” anybody.

Everything has a cost, staying has a cost, leaving has a cost. The question is how much should the public be taxed to pay for individuals suboptimal decision-making? Or conversely, why am I subsidizing some billionaires remote horse ranch to have daily Postal Service and an ambulance standing by?

Can I move to the wilds of Alaska and then demand the same level of service as New York City? No that would be ludicrous.

▲ defrost 4 hours ago | parent | next [-]

W.Australia has a land area three time that of Texas with the bulk of the 2.9 million in population clustered about the capital city Perth.

In the rest of the state there are volunteer Ambulance services subsidised by state and federal government and a fleet of Royal Flying Doctor air ambulances.

RFD(WA) comes in at ~ $80 million AUD / annum in state support (for better or worse - https://www.abc.net.au/news/2024-07-24/rural-gp-slams-royal-... )

They assert to have a "value" to the state of $4.1 billion AUD over 30 years - https://www.flyingdoctor.org.au/wa/

  Every day, the Royal Flying Doctor Service in Western Australia retrieves 29 people.

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pclowes 3 hours ago | parent [-]

Australia is also going bankrupt just slightly faster than the United States. Looks like deficit spending and debt levels are only trending the wrong direction there as well.

I am all for flight for life as we call it here, but that is different than saying we should have a network of ambulances across massive swabs of mostly empty terrain.

I am willing to hazard that the Australian airlift response is slower than your average ambulance response in Sydney.

	▲	defrost 2 hours ago \| parent [-]
		> Australia is also going bankrupt just slightly faster than the United States. Dunno about that, there be weeds. Not to mention the US clown car demolition derby is still in office. Still, the coronavirus pandemic and associated policy responses led to the largest deterioration in the Australian Commonwealth Government’s fiscal position since the Second World War. That was 2021. The forecast national net debt has looked pretty shitty since then, but the arc has been one of improvement - last years 2025-26 National Fiscal Outlook has been claimed to be overly grim by the most recent KPMG assessment of the 2026–27 AU Budget and backs the estimates that the Federal Government net debt servicing will return to pre COVID levels by 2029-30. Yeah, it's f-obvious it takes longer for a plane to cross 600km than it takes an ambulance to cross a Sydney suburb. Any other insights?

▲ jjav 4 hours ago | parent | prev | next [-]

> It is not the government’s job to “take care of” anybody.

That is actually the only legitimate function of government.

▲ _DeadFred_ an hour ago | parent | prev | next [-]

Sweet, open the borders then. It's not the government's job to take care of that (we had government long before we had 21st century style closed borders, so it's definitely not a requirement of government). More people = more money coming in.

▲ cogman10 4 hours ago | parent | prev [-]

> It is not the government’s job to “take care of” anybody.

That is literally the only job of government. The entire reason we have a government is to serve the citizens in some fashion or another.

Even for most libertarians, they'll view the government in having a role resolving disputes. That is "taking care of" citizens by resolving conflicts.

Subsidizing farmers so citizens continue to have cheap and consistent access to food is a great thing. Right up there with providing clean drinking water, sewage services, and building roads.

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pclowes 3 hours ago | parent [-]

I think what I’m saying is being misinterpreted. I should have been more clear. Everybody’s definition of “taken care of” is different.

The government needs to balance the interest of the public with the interest of the individual. It is not intended to “take care of “people regardless of their asks.

Otherwise, what if I am only “taken care of” if I have a beachside penthouse in Malibu and also a pony?

The government is not taking care of people if it allows the average expenditure per person to eclipse the average tax revenue per person. The economics need to be roughly sustainable at the national state and even rural area level.

	▲	cogman10 2 hours ago \| parent \| next [-]
		> Otherwise, what if I am only “taken care of” if I have a beachside penthouse in Malibu and also a pony? That's a false equivalence. We aren't talking about giving people penthouses. We are talking about providing EMS. Heck, I can even grant "degraded EMS" maybe we don't ensure an ambulance is stocked with the latest and greatest tech because you are rural. Maybe the ambulance is a hand-me-down from a larger city. But it's not a huge ask to say that rural communities deserve at least some level of emergency health medicine. Less people means less health incidents. That's the primary reason why so many rural locations today are able to get by with volunteer EMS (Something my family participated in. Calls happened roughly once a month at most in my town of 300). > The government is not taking care of people if it allows the average expenditure per person to eclipse the average tax revenue per person. The economics need to be roughly sustainable at the national state and even rural area level. I agree, it's smart to make sure the government isn't over spending on frivolous things. I just don't think "EMS" is frivolous. Everyone might need it, it doesn't ultimately cost that much to provide (especially if it were actually ran by the government and not private entities), and it's services buy a lot of good will with citizens. Additionally, it creates economic output. Someone dying or getting a lifetime disability because EMS wasn't available is someone that's not adding to the economy.
	▲	_DeadFred_ an hour ago \| parent \| prev [-]
		Since the 1980s the Republican party had adopted a position of starve the beast, of screwing up these very numbers so that people can make exactly the argument you have. What happens when half of government acts is bad faith purely to poison the well, one half of government and an entire political party make it so that the numbers don't work (and via the fiscal policy they intentionally inflict/structure/design) purely so that they can promote their policy position of 'the numbers don't work'? How many unfunded tax cuts have we had recently? Those aren't acts of nature. The numbers you speak of not matching aren't acts of nature. They are intentionally designed to 'starve the beast' in the 1980s Republican way, and in newer ways the party has come up with since. All so the exact argument you gave can be made.

▲ skinfaxi 4 hours ago | parent | prev [-]

Why should there be ambulance deserts but not postal deserts?

	▲	pclowes 4 hours ago \| parent [-]
		Directionally, I am also fine with postal deserts or at least different delivery expectations for very rural areas. But also because Postal Service is much cheaper than an ambulance service?

▲ darth_avocado 4 hours ago | parent | prev | next [-]

There is no reason why this should be a blocker to solving the problem though. 80% of the population still lives in an urban area. You could create a system that works for the majority of the country’s population and then can figure out the rest.

▲ rconti 5 hours ago | parent | prev [-]

We choose not to, because most consumers of ambulance services don't have to pay for it. So those of us who pay out of pocket for an ambulance, like I did ($1700 to go 3/4 of a mile last year) are a tiny minority.