Why is EMS the only major emergency service in America that bills the people it rescues? In this episode of EMS Evolution, we continue our series featuring chapters from Donnie Woodyard's book, The Dark Ages of Emergency Medical Services: How America Created, then Forgot, Its Early Emergency Medical Legacy.

Chapter 6 tackles what may be the most uncomfortable question in the profession: Is EMS fighting the wrong fight?

For decades, the profession has campaigned for higher reimbursement from CMS — and the grievance is real. But what if the reimbursement rate isn't the actual problem? What if Medicare is already paying close to what an insurance payer should pay for a clinical encounter — and the real crisis is that no one is funding the 85% of EMS costs that exist before the first call of the day is ever dispatched?

Police departments don't bill crime victims. Fire departments don't invoice homeowners. Yet EMS loads the full cost of 24/7 readiness onto the patients who happen to need help on any given day — disproportionately the elderly, the uninsured, and the chronically ill — and then wonders why the model is broken.

This episode traces how we got here: a jurisdictional contest between federal agencies in the 1960s, a self-sufficiency mandate in the 1973 EMS Systems Act, and the collapse of federal EMS funding in 1981. It compares how hospitals fund readiness — Hill-Burton grants, tax-exempt bonds, facility fees, philanthropy, and tax exemptions — against the zero equivalent mechanisms available to EMS. And it asks whether the profession has spent decades sending its lobbyists to the wrong address.

Some of what you hear may challenge long-held assumptions. Good. That's the point.

📖 Get your copy of The Dark Ages of Emergency Medical Services on Amazon for $9.99 🔗 Learn more: ems-history.com