Are you wondering why your taxes are going up?

Editor's note: Want a good insight into how private equity firms are ripping off American municipal governments when they purchase ambulances and fire trucks? Private equity–driven consolidation of the fire truck industry, led by American Industrial Partners rolling multiple manufacturers into REV Group (they monopolized the market) has sharply increased prices and delivery times for fire equipment, leaving departments like Los Angeles with aging, broken-down fleets they can't afford to repair or replace. As costs for trucks and parts have surged and wait times stretched to years, fire departments have been forced to operate with fewer working vehicles and tighter budgets. This is contributing to reduced capacity during major wildfires, demonstrating how greed is undermining essential public services. The same comparable ambulances with Ford or Mercedes chassis manufactured in China can be purchased for between $30,000 to $60,000 (including all medical equipment) with delivery times up to 90 days. Imagine that? A half million dollars (the cost of manufacturing an ambulance in the US increased faster than inflation at 300 percent) for one fucking ambulance in the US that you will be lucky to receive in a couple of years. At this rate private equity firms are going to force communities back to horse-drawn water carriages with bucket brigades to put fires out. It's not a supply chain problem, it's a greed problem. Have your water buckets ready...and eat crow as your cities burn...

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Emergency Prices: How Private Equity Captured the Ambulance Market

Emergency service costs have been going up for years, frustrating city officials. One reason seems to be private equity, which bought up ambulance makers and raised prices.

By Matt Stoller and Dan Geller | April 11, 2026

In 2023, the city of Evanston, Illinois raised its ambulance fee from $1500 to $2000, with a $15 mileage charge tacked on. Like many municipalities, city officials and taxpayers have gotten used to ever-increasing prices for basic services, all bucketed under the "cost of living" crisis we're dealing with. In fact, yesterday the Michigan University consumer sentiment indicator hit the worst reading it has ever recorded, going all the way back to 1961. The endless increases in prices for all sorts of random necessities is a key reason.

But these cost hikes don't just 'happen,' as if it's some sort of natural event. Markets are a function of law. There are companies and dealers and financiers behind every industry, so we can actually try to understand why they are happening. In this case, Evanston chalked up the hike to, among other things, the increasing of "cost of equipment and vehicles used for emergency responses." The ambulance market, once a decentralized set of family owned firms, has been rolled up into a consolidated industry run by private equity. And the price hikes followed.

This story isn't unusual. In early 2025, BIG traced a roll-up of fire trucks and fire apparatus, leading to a crisis in that sector. It turns out that something similar seems to have happened here, with some of the same players.

Let's go back to Evanston. In 2011, the city purchased an ambulance for $148,000, an International MedTec used as a reserve vehicle to back up the rest of its fleet. The average ambulance is designed to last 5-7 years based on normal wear and tear. "Emergency response miles are a lot harder on a vehicle than routine traveling to work miles," said one fire chief. But Evanston kept this one for more than 13 years, spending as much as the original purchase price on repairs to keep it going. In 2024, Evanston finally buckled down and got a new one for half a million dollars. In thirteen years, the price increased by 337% — 297% above inflation. And these vehicles are often on long backorders; in the case of Evanston, the ambulance they ordered "won't be delivered for at least two years because of production backups."

In 2025, North Olmsted in Ohio had a similar experience.

City Council is expected to approve the North Olmsted Fire Department’s request to purchase a new $495,000 ambulance…

The expenditure -- which is coming out of the general fund -- marks quite an increase since the fire department's 2021 ambulance purchase price of $353,000.

"We’re seeing that across the board with not just med units but all kinds of fire equipment,” he said.

That's not the only bad news associated with the new ambulance purchase.

“They're telling us delivery ETA is 925 to 950 days from the date of order," he said. "Our lead times are long now, quite a ways out. That would be 2028, so it's gonna be a while.

"The days are gone when you could just call up a manufacturer and say you need one by the end of the year. That doesn't happen anymore."

We at BIG have tracked ambulance prices as best we can through public news reports, and have found that the experience of these two cities tracks the overall trend.

Please go to substack to continue reading.

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Again, we see another "congressional hearing" blowing smoke up your ass pretending to do something while nothing has changed in the past seven months since this hearing took place: