Some ambulance systems aren't tax supported and aren't even exactly contracted to the municipality. In our town the BLS EMT's are volunteers (paramedics are paid) who take a ton of training, a ton of ongoing training, they go on runs, and THEN they stand on corners with a boot to raise money. That's (a) dedication on their part and (b) abusive on the part of the community. And patients still pay $2k for the ride. IMO if you live and work somewhere, some of your taxes should go to 911 to make it work right.
That's how it worked in my hometown, but I don't think the bill was 2k as it was essentially ran by the county.
Everything was basically either payed for by donations from a local business or funded by fundraising. Primarily because the county didn't want to have a tax to run the system properly. Same thing happened with my hometown's fire department. Though in that case you could effectively buy fire insurance from the county (and of course, some people decided not to buy that insurance).
Both are a bad way to run critical services, especially since my hometown was surrounded by a lot of farm and state owned land where lightning strikes causing a fire wasn't uncommon. I don't have a big issue with the volunteer portion of it, it was a small town which the county would otherwise not want to service. But the funding portion was just bad. Fire, famously, spreads. And giving people the ability to opt out is dumb because it makes a big problem if a fire starts on their property and spreads to someone else's.
