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I am saying that I have encountered people who don’t want to go to the emergency room because they don’t have insurance or haven’t met their deductible. I am not saying this should necessarily be a consideration, just that it happens. If hatzolah bills those people will be less likely to call. Sometimes their not calling will lead to bad medical outcomes. The example you have is am extreme one but a subtle chest pain can be a heart attack. Hatzolah is built on the premise that even if one life is games it is with it too have the whole organization. If when one yiddeshe neshama is lost it is not worth implementing a something that will cause it.