Source: Thebignewsletter
PE-backed ambulance operators have transformed emergency transport from a municipal service into a high-margin revenue extraction play, with firms like AMR (owned by Global Medical REIT) and Rural/Metro raising base fees 30–40% while layering on mileage surcharges that penalize distance. Municipal governments have limited alternatives once they've outsourced operations, and patients facing cardiac episodes don't price-shop, creating captive demand that rivals airlines for aggressive yield management. The pattern extends to other "boring" infrastructure monopolies—parking meters, toll roads, ambulances—where PE targets locked-in pricing power by converting public goods into financial assets with predictable extraction mechanics.