I would absolutely not tolerate and unregulated ambulance responding to my emergency.

You don’t have to. You do what you want. I’d prefer to hire a company where the workers make more money. Right now they make a pittance.

Someone who's having a medical emergency is certainly in no position to go comparison shopping for ambulance services.

You would do it before hand of course

When you get your bill, you could just double that as a tip.