the reverse side of that medal is that in 'most of the world' EMS quality is ass.

US EMS quality isn't exactly something to be proud of. It's been private equityified. Just recently (last winter) I nearly lost an aunt because of our stellar EMS system literally doing a transfer from a hospital to a hospice. The company had only one person working, they parked the ambulance next to a snow bank, tried to wheel my aunt up the snow bank, and had her and the bed flip on them trapping them in the snow.

They were super lucky that someone from the hospice just happened to be leaving at the same time they flipped the bed.

I think this argument is very disingenious for two reasons:

- If you’re comparing to developed nations (or some non developed ones with functioning agencies), the argument doesn’t hold true.

- If you’re comparing to the bottom of the barrel EMS (quality being ass like you said), you’re still not going bankrupt for an ambulance ride.

If you limit it to say the top 20 developed countries how does it look?

Haven't yet seen a developed nation do worse than the US. If you prefer to compare against developing countries only, sure, winning by lowering the bar to the ground is an option.