08.30.10 Ambulance Fee Debate: Not So Black & White

The following is cross-posted with Washington Post’s All Opinions Are Local.

In Sunday’s Post, Montgomery County Council Member Phil Andrews (D-Gaithersburg-Rockville) decried the recent Board of Elections ruling against a November referendum to overturn the county’s new ambulance fee [“To the Montgomery elections board, your legal signature isn’t good enough,” Local Opinions, Aug. 29]. I agree completely with Andrews’s outrage at the ruling itself: The new rules for what constitutes a valid signature are absurd and anti-democratic. More on that another time.

I was surprised, though, to discover how passionately Andrews opposes the fee, something he touched on only briefly in his column. (Full disclosure, my family and Andrews’s are friends, but I had never previously discussed this issue with him.) I assumed, given his fiscal conservatism (read this as “fiscal responsibility” – Andrews was grappling with the unsustainability of the county budget before practically anyone else) that he would be in favor of the $12 million to $14 million in revenue the fee would produce for county coffers.

Boy, did I have that wrong. When I spoke with Andrews about his article, he called the charge for ambulance transport “immoral and dangerous.” He warned that a significant number of people in need of emergency transport would avoid calling 911 and drive themselves to hospitals, endangering themselves and others on the road. He went on to dismiss the fiscal arguments of fee supporters.

Responding to proponents’ claims that insurance companies will pick up the cost of the fee, Andrews said, “There’s no free money here — insurance companies will get the money back by raising rates.” He also said that the amount of revenue produced by the fee is not significant in a multi-billion-dollar budget and could be compensated for by spending cuts elsewhere.

Finally, he is concerned that the fee will loosen the bonds between communities and their volunteer firefighters, whose engagement, he says, saves the county over $20 million annually.

When the council voted on the fee in March, it passed 5-4 with a rather unusual alignment of members: In addition to Andrews, Roger Berliner (D-Potomac-Bethesda), Valerie Ervin (D-Silver Spring) and Nancy Navarro (D-Eastern County) were in the minority. Duchy Trachtenberg (D-At Large) switched her vote from 2009 to become a supporter this year. I asked her why she changed sides, particularly given her self-proclaimed role as a leader on health-care access for disadvantaged populations. Her response was all about budget math: In a year that required excruciating cuts to services, she had made a deal with Council President Nancy Floreen (D-At Large): If Trachtenberg agreed to support the ambulance fee, Floreen would drop proposed cuts to the health and human services budget.

Council member George Leventhal (D-At Large) is unambivalent about the fee. He points out that only a tiny number of ambulance users will see the fee at all: noncounty residents without insurance. Insurance will pay the fee for all who are covered, while county residents without insurance will have the fee waived. Furthermore, says Leventhal, Montgomery County can no longer afford to forgo a source of revenue used by all other jurisdictions in the metropolitan area. He is critical of Andrews’s stand, saying, “You can campaign against particular tough choices, but that’s not being a responsible public official.” He also blames volunteer firefighters for “scaring [his] constituents” about the fee and, in effect, creating the hesitance to call 911 that Andrews warns about.

For his part, Berliner says his opposition to the fee is all about supporting the volunteers, who have a particularly large presence in his district. Berliner expresses dismay that a compromise was not found when the moment was ripe at the beginning of the year. He says that once the brief opportunity was lost, attitudes hardened on both sides, making compromise impossible.

The ambulance fee is one of those non-black-and-white issues made black and white by the stubbornness of those involved. No doubt, some small number of emergency cases will forgo treatment out of misguided fear of a fee that will pale in comparison to the total cost of their care. No doubt, contributions to volunteer firefighters will drop off by some percentage because of the fee.

But this is a time of painful choices. No revenue source or spending cut is insignificant under the circumstances. The county is out of cash. It hardly seems unreasonable to ask ambulance users (who won’t actually pay personally) and volunteer fire departments to bear some part of the burden. It’s a shame when politics comes down to squabbles like this, but count me a reluctant supporter of keeping the fee.

©2010 Keith Berner

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