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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?
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Look who's flirting with animal rights.
In recent days, the New York Times has published two in-house commentaries on Spain's move to legislate rights for apes. "We like to think of these as absolutes: that there are distinct lines between humans and animals," Donald McNeil, Jr., wrote Sunday. "But we're kidding ourselves." Yesterday, Adam Cohen added that "showing respect for apes would elevate humans."
I agree with my human colleagues. But that agreement is the beginning of a huge mess.
The mess starts when we abandon an old religious idea. "Ten years ago, I stood in a clearing in the Cameroonian jungle, asking a hunter to hold up for my camera half the baby gorilla he had split and butterflied for smoking," McNeil recalls. He remembers the words his guide spoke at the time: "A gorilla is still meat. It has no soul." This, McNeil notes, is the position of Spain's Catholic bishops: Humans have souls; animals don't.
Secular humanists reject this dogma. We understand that there's something wonderful and uniquely worthy of respect in the power, richness, and subtlety of the human mind. But to us, the soul doesn't explain these wonders. It describes them. That's one reason why the destruction of human embryos doesn't torment us the way it torments pro-lifers. We don't believe in ensoulment at conception. We believe in the gradual development of mental capacities.
This puts us in an awkward position. We call ourselves egalitarians, yet we deny the equality of conceived humans. We believe that a woman deserves more respect than a fetus. A 26-week fetus deserves more respect than a 12-week fetus. A 12-week fetus deserves more consideration than a zygote. We discriminate according to ability.
This is also why ape rights appeals to us. It's not a claim of equality among all animals. It's a claim that apes resemble us in ways that insects don't. It's a kind of discrimination. Cohen observes that Peter Singer, the philosopher behind the ape rights movement, believes that "species should be evaluated on a case-by-case basis." And McNeil reports:
In an interview, Mr. Singer described just such calculations behind the Great Ape Project: he left out lesser apes like gibbons because scientific evidence of human qualities is weaker, and he demanded only rights that he felt all humans were usually offered, such as freedom from torture -- rather than, say, rights to education or medical care.
This multi-tiered approach to species and rights isn't just Singer's position. It's your government's position. As Cohen points out, chimps get special protection under the Chimpanzee Health Improvement, Maintenance and Protection Act. McNeil adds:
Even animal cruelty laws have a bias toward big mammals like us. For example, in a slaughterhouse, chickens are sent alive and squawking into the throat-slitting machine and the scalding bath. But under the federal Humane Slaughter Act, a cow must be knocked senseless as painlessly as possible before the first cut can be made.
In other words, as the pigs of Animal Farm put it, some animals are more equal than others. And if that principle applies to other animals -- discriminating among them based on humanlike capacities -- does it also apply to us? Are some humans more equal than others?
We've already established that you accept this principle if, like me, you discriminate among preborn humans based on degree of development. And if you accept that humans and apes gradually evolved from common ancestors, then you'd also probably discriminate among born humans based on degree of evolution. As McNeil observes, the archaeological record of human bones "suggests that some of our ancestors exited this world as stew." Were the ancestors who gnawed those bones truly human?
We don't like to face such questions. Like creationists, we ridicule anyone who lumps us together with other primates. Cohen says animal rights activists "come off as loopy" when they say things like, "I am an ape." But according to the U.S. government, that statement isn't loopy. It's fact. All of us are great apes.
If preborn and prehistoric humans are less worthy of respect, what about born, living humans who seem functionally subhuman? McNeil says we're kidding ourselves when we imagine that "certain ‘human' rights are unalienable." He mentions a terrorist who beheaded a reporter. Is it possible, he asks, to forfeit your human rights for subhuman behavior?
On the other hand, if we deem some people less human than others, does it lead us back to the bad old days of racism? McNeil raises this question in the context of his African guide's comment about the butchered gorilla: that it was just "meat" because it had "no soul." The comment, he writes,
was an interesting observation for a West African to make. He looked much like the guy on the famous engraving adopted as a coat of arms by British abolitionists: a slave in shackles, kneeling to either beg or pray. Below it the motto: Am I Not a Man, and a Brother? Whether or not Africans had souls -- whether they were human in God's eyes, capable of salvation -- underlay much of the colonial debate about slavery.
To say the least, that's a controversial analogy. People for the Ethical Treatment of Animals made a similar comparison three years ago and was charged with racism. "They're comparing chickens to black people?" an NAACP spokesman protested at the time. Cohen offers the same objection, faulting PETA for "boneheaded moves, like the ad it ran juxtaposing photos of penned-up animals with starving Jews in concentration camps." He doesn't mention his own paper's juxtaposition of gorillas with Africans a day earlier.
Not that I should be throwing stones. I've got my own contradictions to sort out: that it's wrong to eat animals but not meat; that it's wrong to compare mistreatment of blacks to mistreatment of animals; that it's wrong to "predict the criminal propensity of unborn children based on the color of their skin"; that we should "prepare for the possibility that equality of intelligence, in the sense of racial averages on tests, will turn out not to be true"; and that it's pernicious "to group people by race and compare averages."
I'm still working my way through the puzzle of equality as we learn more about human and animal biology. So are McNeil, Cohen, and others. It's a communal dialogue between morals and science. Where it will lead, I can't say. But what strikes me at this point in the conversation is that equality and discrimination are intricately related. What we often call equality -- sorting creatures into biological groups and treating each group member as identical to the others, but different from members of other groups -- is also discriminatory. That's the paradox of "human rights."
Each of us mixes the two in our own way. Spain extends its "community of equals" to gorillas but not gibbons. Catholic bishops demand rights for zygotes but not chimps. PETA equates racial with interspecies equality. The NAACP discriminates between discriminations.
For my part, I've come to suspect that the first problem to deal with isn't inequality. It's indiscriminateness. Discrimination in the best sense means seeing each individual as she is. It takes effort. You have to look past the surface of things. It's easier to assign individuals to groups and judge them that way. But it's also, to the same extent, unfair. The unfairness arises not from inequality, but from how we organize it. Inequality, at the biological level, is mostly nature's fault. Indiscriminateness is ours.