In Mexico City, the government run hospitals employ just 45 ambulances for the care of the city’s 9 million-plus residents. It is a healthcare crises. This has led to a number of ambulance services to begin operating privately to meet the demands of the population. The only problem is that they are competition to the government’s state-run health services are thus illegal. Director Luke Lorentzen captures this in his documentary, Midnight Family. Here he films the plight of the Ochoa family, who run one such ambulance service, who struggle to make ends meet financially while running this service, and also try not to compromise the health of those they provide services to.

With demand far outpacing supply, an underground industry for EMT care has developed in Mexico City. The Ochoa family takes pride in their ambulance, working hard to do things the right way. After a pick-up, they take the patient to the hospital of their choosing, often to a private hospital or urgent care facility. When it comes time for them to bill the patient, or their next of kin, they are often stiffed. No one seems to have any money. As we watch the Ochoas working their midnight shift, they at one point go three days with no payment. Yet they are having to replace the supplies they use on these patients, pay for gas, eat, and try to earn some profit to take home after what they must pour back into the business.

Living in Houston, Texas, a large city of over 5 million citizens in the greater metroplex, I likened the competition of these ambulance drivers in Mexico City to tow-truck drivers here in my town. Here, tow-truck drivers wait, parked under underpasses and bridges, listening to police-scan radios for news of an accident. When they receive word, they take off at break-neck speeds, weaving in an out of traffic. The first one on the scene gets the job. The Ochoa’s business operates much the same way. Monitoring the emergency-band radio, they race through the city streets, jockeying for position against the other private ambulances trying to get there too. If a state-run ambulance arrives, it will get the job automatically, but given their track record, they can take hours to arrive. The private industry, therefore, becomes pure raw competition. The first ambulance on the scene gets the the opportunity to transport patients and provide care.

The film captures the exhilirating race to get to the scene, as well as the down time spent waiting, or restocking inventory. Through the dialogue of the family with one another, or through phone calls they make to others, we get a sense of the struggle they face. Each call they take could lead to them being arrested, which we do see. Police make sure they provide these illegal business ventures opportunity to operate, as they are desperately needed, but not without taking their cut. Bribes are happening all over the place. Any money the Ochoas, and other operators, make is greatly lessened by what they must pay out to the police.

There is also a mountain of regulations for private companies to become recognized by the state so that they can operate more freely. As we see in Midnight Family, the goalposts are always being moved. One such requirement is the age of the ambulances. They are not allowed to be older than a 2008 model vehicle, but the Ochoas lament that there is not one state-run ambulance newer than that. What is required by private vendors to operate legally, is not required by the state-run services which are a de facto monopoly. The fees for licenses, the amount and type of equipment that must be on the ambulance, are all cumbersome requirements compared to the state-run services.

Midnight Family never really preaches. It does not interview its subjects, but rather observes them. Any message that is felt is the view of things solely from the point of view of the Ochoa family. Simply following them around, the viewer will get a reasonable sense of how things are run in Mexico City. The need for EMT services is great, but often, the government is the biggest obstacle to meeting the needs of its own people. For those watching this film, it is certainly a good primer when discussing the practical struggles countries have when providing state-run health care to such a large population. The Ochoas ask for their fair fees for services rendered, but because they are a private entity, they can only push so hard for payment without worrying about jeopardizing their ability to operate. It is here that free market principles of health care shine brighter than the centrally-planned model we see in operation in the film.

Midnight Family is an interesting conversation starter on a topic that has been more and more a part of the United States political debates. During an election year, the issue of privatized verses government-run healthcare is bound to resurface. Like Canada to our north who often see long wait times for services and who reluctantly look the other way so that private-run businesses (who operate illegally) can pick up some of the slack, Midnight Family demonstrates a similar phenomenon in Mexico’s largest city. There are no solutions provided, but there is enough empathy provided for people like the Ochoa family who deeply care about the patients they serve, but who also need to be paid to help their own family meet their needs.

Midnight Family is now playing in select theaters.