So the other option would be to blame the government for mandating that ambulances are required to transport regardless of ability to pay then?

Though get ready because a dozen welfare or human rights groups or whatever will go all rabid on you if you say this :P

So let's start fresh again
150k for the vehicle and equipment
2 man crew 24/7 would result in a bit more than 4 sets assuming 40~ hour work weeks. but taking into account holidays and such you probably need 5 sets, so @ 40k per year for 3.5 years that'd be 1,400,000 ... which is QUITE a difference from your 280,000 estimate.
You'll probably need at least one support personnel of some sort for paperwork and such, so let's add another 40k for 3.5 years = 140k
Then you consider insurance costs for the vehicle, equipment and personnel
Insurance for an ambulance vehicle is about 10k/year (At least that's what i saw on a random article somewhere... you're free to dispute this if you have a source you can quote since I don't) I
So that's another 35k
I have no idea what the insurance on the equipment would be so let's assume its included in the vehicle insurance
Now for the personnel, according to this link I got from google [stillwater.org]
Its about 14.5k per year for each ambulance personnel, so for 3.5 years that's about 507.5k
For the support staff it's prob around the 1k for avg adults so let's just round that to 510k
so now its 150k+1400k+140k+35k+510k = 2235k
Now I'll just use your 400k for gas repairs and supplies and we're already at 2635k

Now let's look at the 3832.5 revenue you estimated, you'll probably get about 2/3 of that due to 1/3 of it being unrecoverable. So that puts it at 2555k
Gee.... lots of profits we have here... a whole 2555-2635=-80k!
Maybe I overestimated the loss due to the unrecoverable calls... but I'm going off of what someone else mentioned, you're free to debate this number with whoever mentioned it. Though this doesn't include other costs like legal costs due to the lawsuit happy nature of America :P

Yup, sure profitable.

@rpm773:

other have said it, but i'll say it too.

the ambulance charges by the mile.

i was in a car accident back in late march of this year, and the ambulance drove me (and my sister) to the hospital. it was 10 miles away. my sister and i both got the bill and they even laid out a fuel surcharge of about $9/mile to each of us. we shared the damned ride, and they charged us twice for the same gas and vehicle.

I think one thing should be stated, most other countries offering their own health care don't have a population close to our size. There are 33 million people in Canada, the entire population of Ireland does not even equal Boston. We have 300+ million people...the logistics are a bit different. I'm not saying it couldn't or shouldn't be done, just that to compare us to countries with 1/10th the population is not really fair.

@zibby: Lol! Hopefully it ends when the person can no longer afford the lifestyle and resulting medical costs, if not before. That is, unless the rest of the population is forced to subsidize it, and then it ends when we all are out of money.

FWIW my service sends 2 units on patients over 300lbs. There is an extra charge for that but Im not sure what it is. One crew cant safely move someone over that size.

This is no different than having to buy 2 plane tickets if you are a large person

$500 x 6 calls per day x 365 days = $1,095,000 a year (note I'm using low estimates for cost and calls)

at 3.5 years is about $3,832,500

with a total investment of $150,000 in equipment

and $280,000 for a two man crew at $40,000 a year for 3.5 years

Throw in another $400,000 for gas, repairs and supplies?

That's a profit of $3,002,500?

So the ambulance owner can look forward to making 1 million dollars a year on one ambulance? Sign me up!

@razremytuxbuddy: Good points, but you need to be fair - fat people are already soending more money on Chee-tos and Ding Dongs, and now people want them to spend more for an ambulance ride too? Where does it end?

@BuyingPowerTools_GitEmSteveDave: Damn. Someone just wrapped their high-school logic course. Glad you resisted the temptation to throw a red herring in there - everybody loves that one.

when young & dead broke (2 jobs each & full time school each), my husband & i were having a helluva a time keeping food on the table. we choked down our pride & went to DES for food stamps. same song & dance - you pregnant? too bad. if you were here's a list of all we can do for you.

how can that be justified? i mean there we were - stating we can't feed ourselves and being told to have a kid?!?!?!?!

[instruct.westvalley.edu]

Harrison Bergeron by Kurt Vonnegut (1961)

read it.

what needs to change FIRST is the corporate dominance of every aspect of life. That is what destroys the ability of most folks to attempt, never mind succeed, the necessary balance of work & life to be healthy.

only so many hours in the day - if most are at work or traveling to/from - not a whole lot left for healthy lifestyles.

The upcharge is cost recovery. Period. If you haven't noticed, America is getting fatter. And ambulance services have to equip and staff for those people. We routinely pick up people who are over 500 pounds. Two people can't lift that much, so that means you have to take two trucks out of service to lift the patient in and out of their home.

Regular stretchers can hold 600 pounds, but are narrower than an airline seat, so most obese people won't fit on them. Bariatric stretchers will hold 1200 pounds, and and much wider but won't fit in a small Type III van. That means the providers have to buy a large type II box ambulance, equip it with the stretcher, and add ramps and a winch to safely get the patient in and out.

All of that costs money. Bariatric stretchers are $10K a pop, a box ambulance starts at $150K, the modifications for bariatric patients add $15K to the base cost, then you need another $50k to equip the truck.

All that money for a truck that will be used on a half dozen transports a week, a third of which the company will never collect a dime on.

This is robbery in the first degree. Simple.

@BZMedia: Reading the comments in here is like a testament to the complete lack of knowledge of the general public in the way EMS works.

First of all, there is no ambulance in the world that would cost you "upwards of $10,000", and I doubt highly that the total ambulance bill was 1/10th of that, unless you were taken by aeromedical, and that's a different beast in and of itself. I like the last bit you posted. THAT'S THE REASON IT'S CALLED EMERGENCY MEDICAL SERVICES. We don't exist to take you to the hospital because you have a cold, and if we do, expect a bill.

@@chatterboxwriting: So let's see, you had a syncopal episode that could have many different etiologies, you were treated appropriately, a differential diagnosis was determined and you were taken to a facility capable of rendering you definitive care? I'm sure they did more than check your sugar and put you on oxygen, and if not then that's one lazy medic.

@katstermonster: It's already been addressed here, but let's just say that your friend lacerated her liver. Fairly easy to do, actually, depending on the mechanism of injury. It would be negligent of that crew to take that person to a local, non-trauma center, who would not be capable of rendering the right care, than to take them to a trauma center where they can get the surgery needed to recitfy any serious injury. Ambulances don't have X-Rays. Mechanism of injury is sometimes more important than presenting symptoms - better safe than dead, IMO.

@Matthew Berkhan: That wouldn't work. IANAL, but how was she supposed to know she wasn't injured? Paramedics are not doctors, and cannot make that determination, when presented with a serious mechanism of injury. It would have been much worse for them legally to have just dropped her off at the local hospital.

Now that I'm done replying, I can get to the meat of my coment here. Yes ambulances are expensive. So is the training to be an "attendant" (EMT Basic or Paramedic). So is the insurance, for the liability and the vehicle. Ambulances are in excess of $100,000 and most only have a 5 year lifespan. Equipment can add another $50-100,000. Employees are expensive, health insurance for those employees is expensive. If you want to make a real change, and solve the problem, make it a mandatory service, like fire suppression. Force municipalities to provide EMS coverage and then they can recieve the proper state and federal funding like the fire departments do, and then you will see per-person costs start to lower because there is more funding available. EMS is a new concept, relatively speaking, and there's a learning curve when it comes to where the money is found. Or we can all just complain about how our lives aren't as important as our flaming belongings. When was the last time you heard of a bill, exhorbitant or not, for putting a fire out?

@icantreplyright:

Given your very,very high risk of osteo as a thin runner, what about heavy folks paying extra for the hip fracture you're almost certainly going to get in your 60's? Your spinal compression fractures? That joint replacement surgery in your 50's because you've blown your knees? The long term effects of the kidney, intestinal and pancreatic damage you sustain during a marathon?
many lifestyle choices come with downsides.

I also think there should be tax breaks or other incentives for fitness programs. You can what-if that notion to death too, but a regular fitness routine is cost effective and a proven preventative measure.

It's incongruous to say that someone who works at maintaining a healthy lifestyle is trying to make it easier on him/herself. It takes effort and discipline to live a healthy lifestyle, and it's a self-worth thing; you have to think you're worth it. The rewards are cheaper grocery bills, fewer medical bills, more energy, and generally feeling good all the time. It's not a matter of being "comfortable" with the fact I'm not obese. It's that I work at not being obese, and it's unfair that the growing obese population expects me to subsidize their unhealthy lifestyle while they don't take responsibility for their own health.

Are there days when you give more than 100% at work? I'm sure there are, and I'm sure you resent picking up the slack for anyone who sits there and only gives 50%, or who calls in sick all the time. It's the same with healthy living. I'm not willing to pay premiums or taxes to cover those who don't do their part.

The reason I'm so passionate about it is that the cost of the obesity trend is going to hurt us all, beyond comprehension. Our state is now 27% obese, and we aren't the worst state in that regard. I remember in grade school when there used to be one "fat kid" in class. Now 1 out of 3 kids are obese. The growing obese population is passing that lifestyle on to their children. I don't know how these 1 out of 3 children who've never known any different lifestyle, will ever find their way out of obesity, or even understand why they should try. And so the trend will continue--until it becomes unaffordable.

@veronykah: You sound like someone desperately in need of a Baconator.

@razremytuxbuddy: But it's not the only one.

Would you add cost for people who chose to eat meat, because of the added risk of colon cancer?

What about people who live on more than 1200 calories a day? There are proven health benefits to living on an extremely calorie restricted diet... you're cold all the time and you look like a skeleton (literally... google this) but it's a much healthier lifestyle. Perhaps we should add cost for anyone who chooses not to limit caloric intake in this fashion.

There are countless decisions that individuals make that impact their health... Obesity is the "Largest" (sorry for the pun) issue right now (smoking would have been 20 years ago) but it's only one of many. You can start with extra costs for the fatties but I suspect you're more comfortable with this because you're not overweight. Were the crosshairs focused on a habit/choice that you engage in you might not be so quick to pipe up in favor of variable charges.

@Radi0logy: I'd like to see some statistics on that that didn't come off of the side of your frosted flakes box.

But that will never happen, because that would make healthcare more affordable for everyone. It might mean people are less dependent on health insurance or government programs, and would give government officials and pundits less to fight over. The Left doesn't want it, because what they want is to build as large a constituency as possible which is dependent on government largesse. The Right doesn't want it, because they won't be able to use the fear of "socialized medicine" like a firebrand to keep their rabid followers in line.

So long as we're locked into the false dilemma of "keep things as they are, or socialize healthcare," nothing will improve. The REAL solution, as I said, is to do NEITHER ONE. It is, instead, to LOWER THE COST OF HEALTHCARE.

By all means, let's keep up the fallacious "black and white" thinking. Let's all purposely avoid seeing the (potentially many) alternatives.

Nothing keeps the middle class (shrinking as it is) in line like torturing the poor.

Another bizarre cost-shifting method is what is charged to the uninsured compared to other patients. Thinking of two medical bills I have faced over the past few years: In one case the provider's 'retail' charge was $1400 and the negotiated insurance rate was $450. In another case, 'retail' was $2250 and the insurance paid $880.

So, in both of these cases the provider agreed to perform a service for the insurer for at least 60% less than their 'list' price. Since these are negotiated rates I'm assuming the providers aren't losing money on the deal. Meanwhile, I can't think of a better way to herd the working poor and lower middle class uninsured into personal bankruptcy.

Cost: $20,000. Yes. Twenty. Thousand. Dollars. If she had been uninsured, that would have been it for her financially, at age 22. As it were, she was stuck for a few thousand. I had to pick my jaw up off the floor when she told me the cost.

It is the spreading out of individual costs that in each instance don't mean much but taken as a whole end up costing us more. I think if drug companies and medical equipment manufacturers had to ask individuals to pay without insurance companies the dynamics would be much different and they would not be able to charge as much as they due. It is not a conspiracy, but it has the same effect, as they all benefit from the market the way it is- to all our detriment(as long as we are not a part of the industry!)

Raz said that it's inexcusable to raise a child in that "eat more and not take care of yourself" lifestyle. Not that fat people are bad parents.

Now, you take that ambulance, park it on a corner and wait for someone to get sick or injured. In a big city, on a busy day, that rig might do 12 calls. Sounds promising, doesn't it? It is, right up until you realize that you'll never collect a dime on 1/3 of those calls. That means the other 8 people will have to cover all the costs.

And when there's only 6 calls in a day, that's even fewer people to spread the costs around.

Do ambulance services make a profit? Yep. But it's not nearly as much as you would suspect from looking at your bill.

The crew probably took her to the trauma center, rather than the community hospital based on what they perceived to be the mechanism of injury ie the car was "severly smashed up."

Just because someone is up and walking around doesn't mean they're fine. I've had plenty of people walking and talking to me one minute and then crump on me the next.

The ambulance crew did what was in your friend's best interest. If they had taken her to the local facility, which isn't equipped to handle major trauma, and she then crumped, you, her family, and her friends all would have been calling for the ambulance crew's heads.

Instead of bitching, you and your friend should be thanking the crew for looking out for her best interest.

And statistically, homosexuals DO have a much higher rate of AIDS/HIV infections per capita

Is it expensive? Yes... Is it a ripoff? Probably not...

BTW, it does cost quite a bit to roll and ambulance and run an IV, not to mention the costs of the health-care providers insurance and training.

If I'd been unemployed for that same period, the hospital/doctors items would be covered but I'd have been out about $300 (2 puffers, 3 months of pills and the dentist visit.)

And I have to point out my employer pays for that extra coverage so one could say I'd be paid more if they didn't - if you wanted to look at it that way.

@TechnoDestructo: I'd love to hear your plan for making that happen.

We're not limited to a single hospital but, of course, it helps if you do as all your records would be in one spot. When I first moved to this small, fictional city, I used to go to the French hospital out of convenience. When I found a new family doctor, she works out of the English one so now I go there.

It's not a perfect system, I'll give you that, but it's pretty darn close.

If people posted here insisting that all black people eat watermelon or every gay person spreads AIDS, they'd be disemvoweled and/or banned from the site. Way to go, Consumerist. Another fat-people bashing fest is yours.

Drinking, smoking, and eating to excess all tend to cost (more) money to the individual and the system.

If you reread what i said, people with inherent health problems would be automatically covered as would the healthy. It's those who *choose* an every day lifestyle that places them at risk they might not otherwise experience, that should bear some responsibility for the extra cost they impose on the system.

If the person imposing extra risk to themselves and paying into the system falls ill, they have at least gone some way to mitigating the costs.

But many Canadians complain about the cost of buying things because of the high tax. You may think it is a fair trade-off- but there is a cost.

The cost-passing goes both ways. Medicare covers people private health insurers won't touch (the elderly...well, they won't touch them unless they're subsidized by medicare) because they cost too much. Basically the private health insurers cherry-pick the lowest-cost customers, passing costs onto the government, who then pass costs back to the private health insurers.

You're right about what the problem is, but I think you were giving the impression that it only goes one way.

There's nothing like an ex-anything to bring out the hatred against anything. Ex-fat guy, ex-smoker, ex-catholic, ex-mormon, ex-LARPer...anything.

While you're pondering that, consider this classic tale of real-life sadness and horror:

[sprott.physics.wisc.edu]

We have developed some really unhealthy infrastructure that individuals CANNOT correct. There is not enough room for everyone to live in the few walkable cities the US has, and the fact that people continue to live in places like Phoenix is taken by developers as a cue that there is continued demand for such places.

That that's only considering people who aren't limited by their jobs in where they can live.

The single worst thing about the American lifestyle is NOT a matter of personal choice. Blame the Streetcar Conspiracy and Eisenhower.

If it meant fewer people had diabetes go untreated, there would be fewer 350 pound people to begin with. (Being fat doesn't just increase your risk of being diabetic...being diabetic can make you fat.)

@Bathmat: In almost all psych (or potential psych, such as yours) cases online medical command will order EMTs to take the patient to the hospital for examination. Additionally a police officer can 302 (involuntarily committ) someone on a psych call if (s)he believe the patient is a threat to himself or others. Under both of these circumstances, the EMTs are required by law to bring the patient to the hospital.

@katstermonster: It is baed off of a combination of perceived injuries and damage to vehicle/machanism of injury. As an example, in my state a fall from height greater than 3 times the persons height requires a trip to a level one trauma center. Additionally when multiple criteria such as "spidering" of a windshield, airbag deployment or significant (>6") intrusion of a body panel into the passenger compartment are criteria for a trip to a trauma center. If a patient presents with significant injuries, a EMT or Paramedic can also elect to go to a trauma center.

That's more or less what happens in most countries. Third level education is either free or heavily subsidised in European countries (I paid 600 euro a year; if I'd been from a disadvantaged background I'd have been paid to go to college). Doctors who work exclusively in the public system don't require insurance, because if something goes wrong, the state pays (the doctor may still be struck off by the Medical Council after a trial, of course). Those who work in both systems (the most common case in Ireland, which has a peculiar medical setup) have their insurance somewhat subsidised by the state. Those who work exclusively in the private sector get to pay their own insurance (to a non-profit semi-state), which goes some way towards explaining why few doctors work exclusively in private hospitals.

And strangely, even with all of this, all European companies spend a lower percentage of GDP on healthcare (and in many cases, that's a smaller GDP per capita than the US), and all rank better in most international rankings of medical treatment (in large part because preventative care is far more commonly taken advantage of, because it is free or cheap). Go figure, eh?

VERY slippery slope, this taxing of voluntary health risks.

@QquegChristian: Agreed. I know a person who's lwo income housing provides basic cable and internet. Only thing she pays is an electric bill and like 45 a month which her baby daddy's child support takes care of. I think thats how I'll retire. I'll just keep saving cash in a safe and then quit my job and go part time and live on the governments dime.

@QquegChristian: It's not just a matter of being poor. When I was about 19, I worked at a grocery store and made $6/hour (85 cents above min. wage then, I think). I had lived with a roommate for a while, but she moved out and I couldn't afford the rent on my own. After looking around for another place I realized I really couldn't afford any rent on my own, so I looked into subsidized housing. I went to the only such apt. complex in my town and handed my application to the lady in the office. She glanced at it and said, "You don't have any children. Are you pregnant?" When I said no, she replied, "That's too bad. We could have gotten you in if you were pregnant." I've gotten pretty much the same response trying to apply for Medicaid. So I have a feeling that your hostess friend may well have gotten pregnant and then qualified for assistance, in that order. They don't really seem to care much about poor people without children, which I think is really, really funny. The stereotypical welfare poster child is generally a single mom with about twelve children. People look down on such a person for being so irresponsible as to have so many children and then they, the taxpayer must pay for her and her brood-- But ultimately I think it's entirely possible that that person may have that many children precisely because that was the only way to get assistance. She was merely being practical. This is why the system doesn't work, because the system discourages responsibility.

As for the comments people make about your weight (also, thin and healthy are not the same thing. McDonald's is bad for everyone)? Maybe you need to examine the way you treat other people. Karma's a bitch.

As for charging overweight people extra for the extra services they require, that seems fair enough. If you're going to charge individually for medical care, then it should be based on the individual.

Given that most of the rest of the world manages to be skinnier, America is either somehow the land for the people with fat genes, or they have developed some really bad habits they themselves are responsible for correcting.

Maybe health care should be free for those who pursue a healthy lifestyle (determined via checkups and blood samples), or have a proven disease or genetic condition, while those who choose to smoke, gain weight, or do other things to their bodies that are unhealthy, should be billed for insurance on a gradually increasing scale depending on risk factor. You're never going to be totally fair, and people are going to try and con the system, but it might provide some incentive. If the money is deducted from their paycheck, then they can't dodge the issue - unless they are unemployed. In which case they are automatically enrolled in a "volunteer" position. Which leads to another topic for another time.

You have the right to give (or withhold) consent, until you are unable to do so, and then the default goes to consent for treatment.

Funding and some standards are passed down federally, but each province administers it's own health care system. Some do it better than others. For example, despite hefty oil revenues, more often than not, the province of Alberta (acknowledged within Canada as being the most like the US with regards to it's Reaganesque policies) is known for shutting down facilities, limited specialist services, and long waits, while British Columbia next door fares better. BC has had to enact a number requirements to prevent Albertans from coming over to get care in that province.

It's because I eat too much and don't work out enough! Ding Ding Ding!

Both of those are conscious decisions I've made.

Really? You look at a plate of food, and you're all "Gee, I guess I'm going to have to force it down, to make sure I keep my spare tire!"

I think it's a lot more accurate to say that eating too much is an unconscious decision. Yes, it's one that people need to take ownership of, which is hard. It's like an addiction, I think. The same way smokers unconsciously reach for another cigarette, overeaters unconsciously keep reaching for more food.

And I think you'll find that the vast majority of people hate themselves for it.

Too bad! I got a ride to the hospital, which left me alone in a silent room with nothing to do for 2 hours (talk about going crazy...), regardless of my actual mental state. The hospital subsequently sent me home with no treatment.

Cost for driving me less than a mile to a hospital down the block: 800 dollars. I seriously considered billing my ex for that crap.

And yet when rich Canadians need advanced non-critical medical procedures, they still come to America to do them immediately, rather than wait.. Huh. Go figure...

There, I fixed it for you.

@Andrew Farris: You mean the same way Americans routinely go to Mexico? No healthcare system in the world is perfect. If the US healthcare system crashed, the biggest loss would undoubtly be the ability to do procedures that other countries simply do not have the facilities and/or specialists required to preform them.

Firstly, while most stretchers are rated to 500lbs they are far too narrow for a large patient to comfortably sit on. This is where the oversized or bariatric stretchers come in as well as winch systems.

Secondly, when faced with a large person the amount of manpower needed can easily rise from 2 to 6-8 personnel. In order to safely lift and extricate a larger person from their home (and it's always inevitably the back room of a home with small corridors) an ambulance crew typically has to enlist the help of the Fire Department. In some municipalities the FD is unwilling to help and therefore a second (or sometimes) third ambulance must be summoned to assist in safely moving the patient.

Lastly, there is the human cost. I treat all of my patients with dignity and would never discriminate on the basis of weight, race, or even a sour attitude. However, it is a fact that moving large patients greatly increases the chance of injury for the caregiver. It makes sense that attempting to take a 500lb patient down stairs and through their yard greatly amps up the chances of a back/knee/other injury. These injuries cost EMS systems millions of dollars a year. If a paramedic blows their back out it is typically the end for them. The system they work for therefore is on the hook for rehabilitation as well as disability in attempting to find that person a job with less demanding physical requirements. I would like to see this overweight patient charge put into a fun that would be used to assist medics who are injured in the course of performing their daily functions.

Also, the vast majority of US doctors, even extremely expensive ones that cater mostly to the "outpatient elective" crowd, take medicare patients. It simply makes economic sense - only a small minority of their patients are able to pay out-of-pocket, and in some cases, seeing a % of medicare is a stipulation in their contracts.

However, my disagreement with you is that you seem to have the opinion that medical care is a right, not a service. If that's the case, let the government pay the massive cost of physicians' education, certifications, licensing, and insurance. In many cases, the cost of malpractice insurance alone is 40% of what a doctor makes. (The ridiculousness of our litigious US society is another argument for another time)

I just spoke to a friend of mine who's a physician in Michigan. He informed me that his base cost to perform a certain procedure is around $2500, and when he performs that surgery for medicare, he's reimbursed less than $1900. Now, he could be lying through his tennis-playing, sports-car driving teeth, but that situation doesn't seem "fair" to me either.

Canada's doctors, while limited in compensation, are still very highly paid and respected.

If the government paid for the outstanding balances and then went after the non-payers with their collection power(like the IRS and Sallie) there could be lower costs for all. This method would mean most would be able to pay the much lower costs and those that couldn't would not have such a big bill and could pay the Federal Gov slow enough to make it palatable. Not THEE answer but a start.

(and bless Mrs Slocombe -- the halo will ride up with wear.)

GENERALLY speaking if you weigh more than 350 pounds, you are fat. Sorry to break it to you.
I have 2 friends one is 6'7" one is 6'8", neither of them weigh over 350, not even close.
I'm 5'11" and you could DOUBLE my weight and I wouldn't weigh over 350, by a long shot.

. . .oh, wait.

On the other end of the spectrum I do see a real problem with the current situation. When a person gets dropped by their insurance company because they get sick we have a real problem.

I think one course for at least the middle class is concerned is make it affordable for normal care to be out of pocket and allow for a catastrophic policy. When I went for a cut finger it costs around $600 dollars(I didn't even need stitches)because I didn't have insurance. If I had insurance the clinic would have charged around 200. I need insurance just to not get screwed.

The bari equipment is not cheap in any ways, there is increased risk to EMT's carrying a bari patient, and generally they require additional manpower to load, unload, etc. I think it's fair to charge these patients more.

And I agree--obesity is a visible effect of an unhealthy lifestyle. But then it also becomes the cause of further health problems.

I foresee some problems in the classification, but it also seems reasonable to me that different equipment costs different amounts.

Note, this is not only the case with this added bariatric-patient charge. It happens with virtually every other healthcare procedure. In virtually all cases, Medicare/Medicaid pays healthcare providers MUCH less than they would otherwise charge ... and all of that is made up elsewhere by other patients and, usually, their insurance companies.

It's a form of cost-passing which is making healthcare financing more inefficient, and thus more costly for those actually paying the bills, than it needs to be. If it costs more to move a bariatric patient, then it costs more to do it ... period ... and that cost does not change based on who pays his/her bill. So why do we bill for it as though it does matter?

The system is broken. The sooner we admit that, the sooner we can find a way to mend it.

How about a massive health tax on internet connections, videogames, alcohol, snack foods, and fast foods?

@mrsultana: agreed. I'm sick of people blaming the EMTs and other first responders who are in the business of saving lives and trying to do their jobs for the state of health care.

There, no more obesity problem.

(/sarcasm)

@BZMedia: Wow, you really don't want the EMT's to follow the rules that were laid down to keep people safe, do you?

I remember when Liam Neeson's wife died and there were people saying that the EMTs should have taken her to the hospital after she refused, because she ended up dying anyway. If the patient ends up being OK, the idiot, meddling, overcharging EMTs should have minded their own business. If the patient ends up dying, then those lazy bums didn't do their jobs.

/wife of an EMT.

The excuses we make and it not being PC to state the obvious are all contributing factors to our society not being able to deal with these situations.

You see, a $1000 bill looks much better at $333.

I was resented by some previous overweight roommates for this. Always scoffing when I got up early to run or didn't go on the late night McDonald's runs. Even more fun was when people complemented me on my figure they'd say "Oh she's so lucky, she doesn't have to do anything to be thin". Excuse me?!

But on the subject of this article, I think it's completely fair. If you need extra services because of your large size you should have to pay for it.

On another note, I remember now why she was forced to go to the Level 1 trauma...her door was smashed up and her seatbelt was stuck, so they had to cut her out of the car. Makes some more sense...but still, the price is obscene.

Shut up.

I could get a low income apartment almost identical to my normal income apartment. Medicare with all the free ambulance rides I can eat. My wife and I could have a baby for free. Then we could feed it for free.

Trust me, I'm not saying it's a glamorous life... but I find it truly disappointing that I could have something so innocuous as a broken bone happen to me and almost go bankrupt. A few broken and I probably would. The crazy thing would be that the $10,000 hospital bill subtracted from my income would actually make me eligible for Medicare. So I end up with less of an income after that than the people actually on Medicare?

Last year, my wife and I couldn't afford to have a baby and our job did not offer health insurance. Outside of our job is a little more complicated because of pre-existing conditions (asthma that hasn't shown symptoms in 15 years!) Yet a hostess at our serving job has no problem having 2 babies back to back, because she makes very little money. After that, of course she needs more money to support them, so she moves up to server. She now shares the same income as us... but had her kids for free?

So when we pay through the nose for the insurance to have a baby, I'll think about that one comment up above that said that they have to inflate prices to make up for how little they get from Medicare.

At least I don't work in a friggin' restaurant anymore.

So, you're happy with a system that allows "I'm the best kidney person in Miami. I'm doing HIS operation first because he'll pay 20 grand and, if I have time before my tennis game, I'll deign to look at that welfare schmuck dying in the basement somewhere. Lucky they put him near the morgue, eh?"

You know, there was a long period of time when being obese was in fashion and admired, because it meant you had money. I'm sure there were people then that resented the fat people.

1: You are clearly under the influence of drugs or alcohol. This generally requires a consult with a ER Physician before we are permitted to compel a patient.

2:You are a threat to yourself or others as determined by the ambulance crew, police officers, or ER physician based upon a call made by the ambulance crew.

3: You have a significant head injury, are not completely alert and oriented (person, place, time, event).

In the ambulance I volunteer for we are required to contact online medical command (ER physician by phone) before compelling a patient.

As for the "outrageous" billing mentioned above, in the area my company serves, we collect the total amount billed on approximately 1/3 of our calls, another 1/3 we collect nothing (typically because the patient has no insurace and cannot afford the bill) and on the last 1/3 we only collect >10% of the billed amount from Medi-Cal/Medicare patients because those programs will only pay an amount that they have set, regardless of what we bill. As unfair as it may be, the high cost of treatment and transport is used to cover the losses from the unpaid and Medi/Medi patients.

Our company charges per mile but the first 4 are already included in the bill, so anything longer than 4 miles begins to incur an additional fee. I don't know how other companies operate but maybe this will shed some light on the matter from the ambulance companies perspective.

Why don't YOU gain some weight? Clearly, you are making a conscious decision to be that skinny. It probably isn't healthy to be that skinny- some fat is necessary for the body. So I really think that you should gain some weight and stop being so skinny. Eat some more! Clearly, the only reason you are skinny is because it is a personal choice.

As another person considered small by today's standards, I'm shocked when someone puts me down for that, and scoffs at the fact that I'm a runner. Somehow those good habits have gone from being admired to being resented as making obese people feel bad about themselves.

It's because I eat too much and don't work out enough! Ding Ding Ding!

Both of those are conscious decisions I've made.

"In 2006, 1 in 9 Canadian-educated physicians practiced in the United States. Collectively, this is equivalent to having 2 average-sized Canadian medical schools dedicated to producing physicians for the United States."

Also,

"The results of the study highlight the lure of larger physician salaries in the private market-based U.S. medical climate, versus the government-run Canadian system, where physician salaries are limited to what the government will pay in compensation."

That seems problematic to both physicians and patients in Canada, if you ask me.

You don't see a problem with that statement at all?

The sad part is, they might charge this but, for most it will never be a fee that is never collected. I just don't see state wellfare or Medicare paying for the extra charge and I doubt many of these patients have the ability to pay. The ambulance service is compelled to transport regardless of ability to pay and, the hospital is compelled to care for these patients regardless of ability to pay. So good luck collecting this extra fee. I don't see the insurance company, state wellfare or Medicare paying regardless of what the service wants to charge.

Yeah, I tried that. Because I didn't exactly have $10k in my budget for unplanned trip to the hospital. They don't care. You get billed, rebilled, and sent to collections. Just like anything else. At no point did anyone ask me "can you afford this?"

@bohemian: i don't have a problem with charging people over 350 lbs. there really is no reason to be that heavy regardless of height or bulk. to compare, i looked up shaq who is 7-1 and 325 lbs. if he is not over the 350 lb mark then there really is no reason for anyone else to be

Pharm costs are my co-pay - the plan absorbs the rest and, oh, yeah, meds supplied in the hospital for the procedures are paid by the province.

So, that leaves me out of pocket $45 plus the cab ride back from the hospital.

Canucks pay both federal and provincial tax (calc'd separately on the same form, my blended tax rates about about 16% federal and about 13% provincial)

My employer's plan is funded by them. I don't pay any extra premiums.

Granted, if I lost my job, I'd have to pay retail for drugs and dental - but the doctor, specialists visits and the hospital procedures would continue to be free as they would if I weighed 500lbs.

Now, explain to me why this is bad??

BTW, thanks for volunteering. You guys don't get enough credit.

I would like to know why fat people think it is okay to make "Thin" comments to me (being 125 lbs). Fat people telling me "you need to eat more" is deemed to be fair game. But if I say "Stop eating that, lard ass" people get angry. I am healthy. They are not. Why the double standard?

HAPPY 4th!

We've also had to, in one instance, bring our truck to an EMS call(100' platform), cut out the person's 2nd story wall, and use the platform to bring them down to ground level because they no longer fit through their doorways.

But oh wait! They can't take her to the hospital 5 minutes down the road! This is a "serious accident"! Note: her car got the worst of it, and she was up, walking, talking, perfectly fine. Nope, they had to take her to the bigger hospital, 30 miles away. And -- you guessed it -- she got charged for every mile.

She arrived at the larger hospital. They told her to move her limbs. They told her to go home. No joke. No Tylenols, no checking for whatever hidden problems the medics were convinced could have been caused by the "serious accident." She got charged over $1000 for the ambulance ride ALONE. She hasn't even gotten the ER bill yet.

But whatever the reason IF it costs more it is "fair" to charge it.

Maybe I am just cranky because I spent 4 hours last month sorting through one of our kids medical bills. I found multiple errors and a fraudlent claim to our insurance.

What really burns me is that drugs are insanely expensive. Drug company profits are coming before theraputic benefit at the clinic level in the way doctors prescribe. Our health insurance is the second most expensive monthly bill only smaller than our mortgage. Yet we still get sunk for a huge chunk of money for out of pocket and medications. The system is a total failure. We don't need reform. We need a new system.

I know it is mean to wish someone has something bad happens to them. But I wish all these idiots spreading disinformation about the current system would fall ill and get to experience it for themselves. It is about the only thing that would wake them up to reality.

@BZMedia: I agree. In March, I had to call the ambulance because I blacked out after being ill for several hours. They charged me $953 for a 1-mile ride to the hospital. They took my BP and blood sugar and put me on oxygen. That's it.

It turned out that I was only dehydrated and just needed IV fluids, but because I have severe hypertension and chronic kidney failure, I couldn't chance staying home and seeing if I felt okay after blacking out. The hospital bill was "only" $2,953 - why should a one-mile ride cost 1/3 of a 5-hour hospital stay, x-rays, lab work, medication, and nursing care?

Why are we still subservient to corporations that don't give a crap about anything besides the almighty dollar? At least the government is somewhat more accountable than some corporation.

So step back from your shrine to Ronald Reagan and please stop trying to derail anything decent.

(Also, screw most of the Democrats for capitulating to special interests and the Republicans. We need more Kucinichs, Feingolds and Sanders and less Baucuses and Dodds)

I think the ambulance services and hospitals in general WAAAAAAAY overcharge for what they provide. So now they're charging more? Not surprised. One trip to the hospital in an ambulance, a couple of Tylenols, a few hours in the building, and no insurance can very easily run you upwards of $10,000. I know this because they did it to me. The healthcare system in the U.S. is severely broken, and I don't see it getting fixed during my lifetime. The next time I visit a hospital or ride in an ambulance, it will be when I'm dead.

I only weigh 130. Can I get a discount?