It’s a quandary that leaves our island state with very little recourse — other than to repeat, early and often: “Do the right thing.”

That’s the message to air ambulance company Air Medical Group Holdings (AMGH) Inc., which is buying the only other air medevac company in Hawaii, American Medical Response (AMR), in a $2.4 billion deal. Concerns over a monopoly — and higher prices — loom large. But since states are prohibiting from regulating medevac fees under federal airline rules, air carriers can charge what they want. And research has shown AMGH charges thousands more; in one Hilo-to-Oahu example, AMGH charged $70,580, while calculation of AMR rates showed the same flight would’ve cost about $20,000.

Improving and having more ER care on each island would decrease reliance on medevacs — but of course, that’s easier said than done.