ABLEnews Extra

                    Taken for a Ride

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The San Jose City Council again is likely to put off its decision
whether to take over ambulance service in the city or to continue as
part of the Santa Clara County ambulance system. That's good news. If
the council went ahead with a vote Tuesday as planned, there'd be too
much chance of making the wrong decision.
   
For months now, the city and the county have been trying to work out a
compromise to keep San Jose in the county system. The idea is for the
county's private ambulance contractor, American Medical Response West
(AMR), to reimburse the city for the cost of putting paramedics on its
fire trucks. The city wants to do that because the trucks get to
ambulance calls before ambulances, and paramedic firefighters could
save more lives.
   
Negotiators hit an unexpected snag last week, so there is no
compromise ready for the council to approve on Tuesday. But the
alternative, having the fire department go into the ambulance business
in order to pay for the paramedic firefighters, carries a huge
financial risk for San Jose.
   
City administrators say San Jose can make money on ambulance service.
Maybe it could now, but not for long. The costs of an expanded fire
department would mushroom, while payments for ambulance services are
likely to plummet. Insurance companies are trying to cut costs, and
some hospital systems, like Kaiser, are thinking of operating their
own ambulances.
   
Today, the private ambulance contractor takes the risk when bills go
unpaid. Under a public system, taxpayers would be on the hook.
   
Ironically, the same uncertainty that makes a city ambulance takeover
a bad idea has caused the snag in the alternative plan. The county
says because the future is so murky, it can't guarantee reimbursement
levels beyond the term of the AMR contract, which ends next year.
There are ways to get around this--extending the contract, or
requiring new bidders to live up to the same agreement--but not by
Tuesday.
   
On top of that, the city and county are still about $500,000 apart on
what AMR can pay for paramedics on fire trucks and what the city says
the program will cost.
   
The city council probably will decide Tuesday to begin training
paramedics. While the council can't approve a firm funding plan, it
can do two things:
   
-- Tell city negotiators they're expected to work out a compromise.
   Firefighters desperately want to run their own ambulances.
   Negotiators need to know it's not a realistic option.
   
-- Order an audit of its own paramedic plan. Ernst and Young did an
   objective audit of AMR's books. Somebody should do the same for the
   city plan, which seems unrealistic on revenue and top-heavy on
   supervisors. An independent audit might find a way to close that
   $500,000 gap.
   
Putting paramedics on fire trucks is a good idea. The city needs more
time to find a way to pay for it without getting into the risky
ambulance business.
   
[Paying for Paramedics, editorial, San Jose Mercury News, 4/10/95]

CURE Comment: Those familiar with managed-care and insurers'
              care-cutting mania will view their intentions with a
              healthy skepticism. Obsession with cost-cutting in
              getting you to the hospital or  treating you once there
              could take you on your last ride--via checkbook
              euthanasia.

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