http://www.slate.com/blogs/blogs/humannature/archive/2009/10/23/ambulances-
for-the-ample.aspx

Ambulances for the Ample
Posted Friday, October 23, 2009 8:59 AM | By William Saletan
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.

Now, more for ambulance service.

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.

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?