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When I flew EMS (2006) the numbers are actually closer to 75%, not 55%. Unless that many more people are getting seriously injured and meet the "Life, Limb, or Eyesight" criteria.

Those flights that don't truly require HEMS are the ones that pay the bills for those for whom the HEMS is truly a benefit. Most of those trauma/emergent medical cases are no-pays or pay a very small percentage of actual costs.

The "American health care system" is well and truly fecked by being overly dependent on 'health insurance', primarily paid for indirectly through employer provided benefits. Even if you have 'cafeteria plans' available they are provided with advantage to those responsible, which are not you or yours.

As I understand it, your employers group demographics determine the plan structure and benefits available to you. Your actual benefit is very limited by the fact that YOU do not directly select options to maximise utility- you choose from the 'menu of limited options' available through your employer and it's contracted insurers. My opinion is that pilots, being a group of selected health risks by the professional requirement to meet pilot physicals should not be lumped in with the broader general demographics.