Medically Emerent vs Convenient   

The BS transfers are what pay to make the aircraft available for when it's really needed.

Exactly. Something like three-quarters of scene flights are no-pays.

The IFTs are generally reviewed with compensation in the process. The patient can die in the original facility as well as some 'higher care facility'; and it's cheaper if that happens.

You want government healthcare? I don't, I was raised as a military dependent and I can say that's when the healthcare was good, it was as good as any. But when it was bad, one had no choice but make the best of it. That's pretty much what you're advocating.

If you want actual medical necessity as the defining criteria, you're going to have to accept a government body over-seeing flight requests, not medical experts.