This is what I meant in "Humble Heroes" when I said that it is very difficult for people today to understand just how open the free market was up until the 1960's. The "cost" of ambulance service today is hidden from most people, because the current EMS system is socialized to a great extent. If you, like most people, have tax supported ambulance service, you're paying for your occassional use of the EMS system, and you're also paying for your neighbor who calls 9-1-1 for an ambulance trip for everything from a stomach ache to a gunshot wound. Some private services in the 1970's had 25% collection rates, and that's why so many went out of business. Most funeral homes operating ambulance service were subsidizing the ambulance business through their income from funerals. Credit cards and cash payment at time of service may sound tacky in our modern world, but the guys operating private ambulance services were expected to pay wages, insurance, all the overhead, and if they had a 25% collection rate, they were going hungry. In the 1970's the federal government added the burden of applying the Fair Labor Standards Act to ambulance services (overtime payment, paying for "on call" time), and at the same time added minimum staffing and equipment requirements, which increased overhead substantially, and pretty much killed the "mom and pop" ambulance service.