It all depends on the level of care that you are willing to pay for and the things that the breed of dog may have a pre-disposition for. One of the hardest things that gets dealt with at a vet clinic is a client who can’t afford the level of care that their pet needs. Nobody wins with that one.
One of the veterinarians at our clinic has Spot pet insurance, which has helped her immensely with her Great Dane pup who has had two different instances of GDV. Even with taking radiographs and doing an exploratory at our clinic, she still wound up bring him to an emergency clinic for overnight care just so she could get some sleep and know that he was getting the best care possible. For her, the health insurance has already paid off even before year 1.
Convinced us to get coverage for our shepherd, at least until we can rule out any need for hip replacement and as a precaution for ACL. As with any insurance, there is a cost-benefit to it on premium vs saving for it.
Small animal clinics are shifting away from providing 24hr emergency services and relying upon dedicated emergency clinics. Cost, employee retention, and hiring are all reasons. Generally a trip to an emergency clinic is at least a $1K bill.