Ambulances for the Ample

Ambulances for the Ample

Ambulances for the Ample

Science, technology, and life.
Oct. 23 2009 8:59 AM

Ambulances for the Ample

Everywhere you look, fat people are being charged extra. More for plane seats . More for health insurance . More, in the form of reduced incentive payouts, under proposals for  Medicare and Medicaid .

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William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

Now, more for ambulance service.

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We've talked about ambulances before. Along with toilets and coffins , they're part of a global size upgrade for bigger bodies. And it's expensive. Heather Hollingsworth of the Associated Press does the math :

Transporting extremely heavy people costs about 2 1/2 times as much as normal-weight patients. It takes more time to move them and requires three to four times more crew members, who often must use expensive specialty equipment. ... [One] unit in Topeka recently spent about $10,000 to retrofit an ambulance with equipment that accommodates patients weighing up to 1,600 pounds. Ambulance services with helicopters also are creating larger patient compartments and adding stronger gurneys. Sales of specialized lift systems nationwide are expected to reach $193 million by 2012, up from $75 million in 2004, according to EMS Insider , an industry newsletter. The sale of specialized stretchers is expected to nearly double to $50 million in 2012.

Now there's a movement to pass on the costs. Hollingsworth reports:

Ambulance companies say it's time for insurance providers, Medicaid and Medicare, or patients themselves to begin paying the added costs, which are cutting into their razor-thin profit margins. In the past, ambulance companies often absorbed the extra expense of serving the obese. Now they are adding charges similar to those already imposed on intensive-care patients, people requiring multiple medications and patients on ventilators.

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The surcharge is significant. In several cities, ambulance services are billing nearly double for anyone over 500 pounds. In raw numbers, that's around $500 to $700. Fat-rights activists say the extra fees are discriminatory. The president of one group tells Hollingsworth, "Ambulance services are a critical public service and should accommodate the needs of all of those who require them at a fair cost."

I don't have a quick answer to this problem, but maybe we can start to think it through. First, we need to decide whether privately operated ambulances are, as the fat-rights spokesman says, a public service. It seems pretty clear, for example, that private airlines can make you pay double if you don't fit in a seat. Do ambulances have to play by nicer rules because medical services are inherently public? If so, shouldn't the public reimburse them?

Second, to the extent that fat is an issue of personal responsibility , does that really apply to ambulance service? Nobody's going to lose weight so they can save $700 on their next ambulance trip. To the extent that motivation can overcome obesity, the reason people are going to lose weight is to stay out of the hospital altogether.

Third, if you think fat people should bear the extra cost of transporting them, what does that say about your overall views on insurance for preexisting conditions? The health-care reforms being debated in Congress would bar insurers from excluding people with pre-existing conditions. The argument is that people aren't responsible for such conditions and shouldn't be priced out of the insurance market on account of them. Therefore, we would socialize their extra cost. Is that OK with you? If so, to the extent that obesity is genetically or environmentally induced , shouldn't we treat it the same way?