Ambulance fee, finally

Baltimore County's political establishment has long had a chronic case of anti-tax and anti-fee fever. The property and income tax rates sit frozen in amber for close to a quarter-century like those ancient mosquitoes that provide the crucial dinosaur DNA in "Jurassic World." And when it comes to education spending and improving schools, the county can be just as parsimonious — rarely offering more for the annual operating budget than is needed to qualify for state aid under the so-called "maintenance of effort" formula.

But here's where the county really set the bar for fee-a-phobia: For years, Baltimore County has refused to charge a fee for ambulance rides even as most every jurisdiction in the state — and much of the nation — has increasingly chosen to bill health insurance for that service. On Monday, it was announced that era will finally come to an end as a $700 or $750 bill (higher for the most advanced life support) plus $10 per mile will be submitted to private insurance companies, Medicare, Medicaid or, in the case of passengers who don't live in the county, the patients themselves.


What took so long? Baltimore has charged a similar fee for 26 years. Twenty-six years. Counties with highly conservative and all-Republican leadership in Western Maryland and the Eastern Shore charge an ambulance fee. So does every county in the Baltimore area (although Howard's is an overall fire tax, not a fee-for-service). Expecting a "free" ambulance ride is a lot like expecting a free parking space in a county-owned garage or a free driver's license from the Motor Vehicle Administration, it's just not realistic, particularly if taxpayers don't want to see property and income tax rates rise.

And here's what really makes it remarkable. Hardly anyone will even notice that fee. As Chief John J. Hohman noted, not a penny will come out of the pockets of county residents. Since so many jurisdictions now seek reimbursement for medical transport, the cost is already baked into insurance premiums regardless of where you live. If anything, the fee is saving county taxpayers money — at least to the extent that it reduces the pressure to seek more revenue out of taxpayer pockets to balance the county budget. It's the closest thing to finding free money on the table, and it was foolish for Baltimore County to resist this long.


It's not exactly pocket change either. County officials estimate that the fee will generate $26 million annually (less $1 million for the private billing firm to collect the money). Those are dollars that could be spent to put more medics on the street, upgrade equipment, lower response times and save lives. Or (and this may come closer to how the money is actually used), it may simply be gobbled up by the county's general fund and help guarantee that County Executive Kevin Kamenetz and the County Council won't have to cut services or raise taxes for the remainder of this term.

In a statement, Mr. Kamenetz suggests he was swayed by the increasing number of people who are insured under the Affordable Care Act. But that's a bit suspect. Other counties didn't need that extra incentive, and with the "soft billing," county residents, insured or uninsured, won't see any difference, Obamacare or not. More likely, it was a matter of optics and the strong desire not to be seen raising fees of any kind in Baltimore County without providing a new service, even if those fees are paid by insurance companies.

If there is a criticism to be made, it's that the fee ought to be more closely aligned with the county's actual costs and the revenue dedicated to fire protection and emergency medical services. When fees have a one-to-one relationship with a service, residents are more apt to accept them — much like the cost of any private sector fee-for-service. When you pay for someone to mow your lawn or coat your driveway, you know the money is going for lawn care or sealant or the labor involved with those chores, not to fix the next-door-neighbor's dishwasher or trim his hedges.

Still, the county's fee is not out of line with those charged by its neighbors and, as the state's gambling revenue-for-education ploy has demonstrated, most government revenue is fungible anyway. The wonder is not that the county is charging for ambulance rides but that it took this long to accept what has become a standard practice — perhaps a sign that even policies frozen in time can be defrosted once in a while.