John Oliver explains why U.S. ambulances cost so much while EMTs are paid so little

"Ambulance crews clearly play a critically important role across the country, so it is no wonder that during the height of the pandemic last year, they were among those who got an outpouring of gratitude and nightly applause," John Oliver said on Sunday's Last Week Tonight. "People clapping and giving pizza in appreciation was very nice, but it wasn't a substitute for the things that they actually needed, like a living wage and health benefits." In fact, he said, "EMS workers around the country are shockingly underpaid, which is kind of amazing, especially when you consider how prohibitively expensive taking an ambulance can be."

"Tonight let's take a look at our emergency medical services — specifically how they function, why they can be so expensive, and what we can do to fix things," Oliver said. The first thing to know is that when you talk about emergency medical services, "you're actually talking about 19,000 locally run EMS providers with wildly different structures," so "if you have seen one EMS setup, you've seen exactly one EMS setup." He moved on to the "absolutely incredible fact" that in 39 states, "EMS is not considered an essential service, meaning local governments don't have to provide it to their citizens — which, as a practical matter, means EMS generally has much less access to government funding. This is a huge deal."

With little federal or local funding, some EMS services turn to GoFundMe campaigns to fund themselves, especially in rural areas, and you know the system's messed up "when patients and providers are relying on the same crowdfunding platform," Oliver said. "And the fact they are so underfunded starts to explain why they can cost so much," to recuperate losses. Also, many EMS services get paid only if they transport people to the hospital, setting up a perverse incentive system, he explained. "Instead of all of us paying a little bit all the time for ambulances, we have a system where some of us pay an awful lot all at once when we have a terrible emergency." And it gets worse, thanks in part to vulturous private equity firms

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"Look, last year everyone was anxious to show just how much they supported EMTs," Oliver said. "Well, now is the time to f---ing prove it and make big changes on their behalf." There is NSFW language and cartoon imagery throughout.