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There are some things that ordinarily, the taxes people pay to the state ought to cover; such as ambulance service. I strongly believe ambulance service should be free, given that people pay tax. But not only is it not free, it is so expensive too. Why?
How much it cost is dependent on where you live. If you live in an area where you pay taxes that support an ambulance service, then it is free. They will still charge your insurance, but if you do not have any, no bill. If you live in an area where some services are covered by local taxes, you will get a bill, but it will be at a reduced rate.
If you live in an area where the ambulance service receives no tax money, you will be responsible for the whole bill. If you have insurance, it will cover a portion of the bill.
Now, irrespective of what area you live in, the cost to operate are similar. An ambulance stocked with all the equipment cost about $300,000 on average. You have trained providers on there who expect to be paid. Most departments have stations that need to be purchased or rented and maintained. When you call 911 for help, someone has to be there to answer the phone and to dispatch the appropriate units. Someone has to work in the office to do billing. Someone has to run operations, training, scheduling, etc. All these people will get paid.
It’s expensive to maintain an ambulance, crew and training. A lot of ambulance services are private. They are for profit businesses. They are not run by the state you live in. When you call 911, the ambulance that shows up may be run by a private firm. Insurance in the US doesn’t pay for everything. You get to pay for a lot of the service. Private firms, especially, will go after you for every cent of the bill that the insurance company doesn’t pay them. If you are out of network or the private company doesn’t have an agreement with your insurance group, then you pay more. That is how it works.