Writings and observations

The difficulty of controlling the explosive costs of medicine by half-steps came clear this morning in the Oregon House Health Policy & Public Affairs Committee, which was hearing testimony on a simple – one page! – bill that on its surface would seem to provide for modest cost reduction and avoidance of fraud. And maybe it would. But as an insurance company lobbyist (yeah, that’s right) pointed out, the matter is more difficult than that.

The measure is Senate Bill 651, sponsored by Senator Ted Ferrioli, R-John Day, and co-sponsored with 14 other senators (of both parties) and two representatives. Its summary states its point clearly: It requires insurers to “make check for payment for health care services payable jointly to provider of health care services and enrollee if provider has not contracted with enrollee’s health benefit plan to provide health care services.”

At present, checks from insurers cut to pay for medical services often are made out to the patient; the idea is that the patient will then sign it over to the doctor or other provider, such as an imaging clinic. Many do. Quite a few others do not, instead either holding the check for a long time – what’s the incentive to hurry? – or in quite a few cases, cashing it and never paying the provider. Thereby, in the end, driving up the cost of business, and so the cost of medical care.

The bill, which is backed by a number of medical providers (notably clinics), would make the check jointly payable so it could be sent straight from the insurer to the provider. Which seems to, maybe does, make good general sense.

But as so often in these things, there’s a catch.

We’ll admit to being less than poised for acceptance as we watched the Blue Cross lobbyist open his stack of papers and sounding every inch the insurance company guy, eager to protect that bottom line. But his point was sound:

Insurers like his engage in negotiations over cost of services with medical providers, and reach agreements with some of them, resulting in lowered costs, and not with others. Those negotiations can have a real impact on the overall cost over medical care.

By requiring insurers to directly pay providers, whether they’ve negotiated a deal or not, the bill would undercut those negotiations – render them all but irrelevant, from the providers’ standpoint – and maybe drive costs back up.

The point seemed to impact on the committee, which almost looked a touch deflated – damn, another idea for containing health costs that doesn’t quite do it.

The committee’s chair, Representative Diane Rosenbaum, D-Portland, did refer during the discussion (the committee did not formally act on SB 651 today) to her efforts to develop certificate of need legislation, to curb medical-related spending that isn’t needed. A larger point seemed to emerge there: In the area of medicine, small half-measures simply don’t seem to do the job, however well-intended they may be. You have to look toward more global approaches.

It’s a blob of mercury. A thumb won’t contain it; you need something larger.

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Our weekly reminder, that our regular Wednesday chat is on for tonight at 6 pm Pacific, 7 pm Mountain, accessible off this page. (Scroll down to the right to the “nickname” box, enter your name, click the button, and you’re in.) It lasts about an hour; feel free to jump in or out any time.

So far we’ve had enjoyable discussions with an eclectic group of people. Greg Smith, a co-founder, should be back on board this evening. Along with, well, who knows who.

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We’ve had a bunch of reaction to the former Idaho journalists list (accessible through a page on the subject), and because of a slug of additional information, it’s be expanded by almost half again.

And if you have more suggestions/updates/corrections/clarifications/whatever, pass them on and we’ll update again.

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Anderson Ranch Dam reservoir
Anderson Ranch Dam reservoir

The decision by the Idaho Supreme Court in the groundwater v. surface water case – American Falls v. Idaho Department of Water Resources – awaited for so many months with such trepidation, turned out to be an anticlimax.

And a good deal more limited in immediate application than a lot of people probably figured.

The case was set up as a showdown between the older (senior) water right holders, who had rights on the main surface water sources in southern Idaho, and the newer (junior) groundwater pumpers. The lower court decision, by Judge Barry Wood (a former presiding judge over the Snake River Basin Adjudication), was taken to have sided mostly with the surface water users, and the Supreme Court ruling, which overturned Wood’s core conclusions, was thought to side mostly with the ground water people.

But it’s a lot more convoluted than that, and the key participants in the case generally, on both sides, seem to have been wise enough to withhold their celebrations.

The decision more simply means that the state’s established process for determining the relationship between surface and ground water, and the approach to regulating it, can go forward . . . to the extent it is able.

The decision offers plenty of room for interpretation and legal challenges of various sorts. And in some underlying ways, it was less a reversal of the Wood decision than some might think. If you doubt that, take a look at pages 7 and 8 of the decision, in which the justices (in an unusual gesture) said they appreciated much of Wood’s logic, and added, “While this opinion does not reach those same conclusions, we nevertheless accept large parts of the district judge’s analysis and attempt to use his analysis to clarify our interpretation of the CM Rules.”

More to come.

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John McKay
John McKay

Representative Doc Hastings may have some explaining to do: Was he pressuring the U.S. Attorney’s office, then led by later-dismissed attorney John McKay, into doing partisan dirty work?

This might seem to come out of nowhere except for the context. A string of U.S. attorneys around the country (mainly around the west) were fired late last year; the one of the group from the Northwest was John McKay of western Washington, who was well-regarded locally. No explanation for the dismissal was given, either to McKay or publicly, and some weeks passed even before confirmation that in fact he was fired.

Since then, reasons for dismissal of several of the attorneys has surfaced, and they haven’t been pretty. In New Mexico, for instance, firee David Iglesias said he felt “leaned on” by Senator Pete Domenici and Representative Heather Wilson to go ahead with prosecutions that would reflect badly on Democrats before than after the last general election. Other comparable stories have been emerging.

This morning, McKay, Iglesias and two counterparts from California and Arkansas testified before the Senate Judiciary Committee, which is reviewing the dismissals. They prefaced by saying, “Recently, each of us was asked by Department of Justice officials to resign our posts. Each of us was fully aware that we served at the pleasure of the President, and that we could be removed for any or no reason. In most of our cases, we were given little or no information about the reason for the request for our resignations. This hearing is not a forum to engage in speculation, and we decline to speculate about the reasons.”

But details of fact emerged anyway.

McKay’s testimony included a recount of communications, after the election of 2004, from Hasting’s office. A Republican, Hastings and his staff were, with everyone else, watching the convoluted election recounts after the super-close gubernatorial election that year.

Seattle Times: “McKay told the Senate Judiciary Committee that [then-Hasting staff chief] Ed Cassidy, who now works for Republican Minority Leader John Boehner, called him ‘some weeks’ following the 2004 election, and after a third re-count had determined that Democrat Christine Gregoire had narrowly defeated Republican Dino Rossi.”

When, McKay recalled, Cassidy asked him about future prosecutions concerning the recounts, “I stopped him and I told him I was sure that he wasn’t asking me on behalf [of Hastings] because we both knew that would be improper. [Cassidy] agreed it would be improper and he ended the conversation in a most expeditious manner.”

Cassidy hasn’t denied or acknowledged the conversation.

Hastings hasn’t shown up on this in the public records. But don’t expect that the recent chair of the House Ethics Committee will remain out of view for long.

UPDATE More on this that should be noted.

The Seattle Times now has Hastings saying that “Tom McCabe, the executive vice president of the Building Industry Association of Washington, which backed [losing Republican gubernatorial nominee Dino] Rossi, did contact his office in July 2005 to ask that Hastings urge the White House to fire McKay. ‘I flat out refused to do so, which Ed Cassidy told him in the bluntest of terms,’ Hastings said.”

The Talking Points Memo blog, which has been tracking the U.S. attorneys case closely, remarked (a tad snarkily), “So, Cassidy gets a call from a Rossi backer (Rossi’s the failed gubernatorial candidate) asking that Hastings ask the White House to can McKay. Then Cassidy calls McKay asking for an ‘update’. Clearly McKay’s subsequent firing is a coincidence.”

Also: Video of a key part of McKay’s testimony today.

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There is a clear career path for journalists in Idaho – straight outta journalism. Is it more true in Idaho than most places? Our first impulse is to say yes (although that’s a point we want to explore more fully.)

And so we’ve compiled a list of Idahoans who worked in Idaho newsrooms once, but now work (in Idaho) doing something else. We’ve compiled a list of these former journalists – those we know about, to which will be added others brought to our attention. And it’ a long list.

More on this page

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This is, logically, an apt time for reflection among Oregon Republicans, months after important reversals at election, and months ahead of the 2008 campaign season. Where to go from here?

The attendees at the Dorchester Conference at Seaside last weekend are not a perfectly representative group of Republicans – they are activists, funders and the heavily-involved – but they do provide a rough measure of thinking. And, in a series of votes at the conference, they did express some opinions.

Their presidential preference was former New York Mayor Rudy Giuliani – he took a clear lead (he won 60). Second (with 34) was former House Speaker Newt Gingrich, who isn’t in the race; and third was former Massachusetts Governor Mitt Romney. Whither Arizona Senator John McCain?

More significant were the attendees’ take on issues. They proposed (121-73) amending the Oregon Constitution to ban the state lottery and related games. They overwhelmingly (204-36) supported the recent troop increase level in Iraq. They supported (119-105) strictly tying school funding to performance on No Child Left Behind tests.

Leaving aside the merits of those positions, they look from here like an improbable agenda for regaining political clout in Oregon.

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With days left till the big viaduct vote in Seattle, Times columnist Danny Westneat reports on something useful: A walk along and underneath the Alaskan Way viaduct, describing in some detail what (and who) he finds there.

He winds up where a seemingly growing number of people do, with the idea that the viaduct, or at least the most critical 10 blocks or so of it, could usefully be turned into a street-level expressway, a move that might make for some substantial spinoff inprovements in one of the least well-developed sectors of the city’s downtown core. He makes one of the clearest cases yet for voting a double-no on the ballot barely a week away.

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For your amusement – or as an argument stopper, or starter – the National Review rundown of “liberal” and “conservative” rankings for all the members of Congress.

Readers of this site will recall our frequent argument that both terms of political philosophy have been so twisted and abused by the politics of the last generation that both are meaningless as a practical matter. As a loose descriptor of where these members fit into the policy picture, though, it’s worth a look (and maybe as a case in point of our point). These are, we should note, reviews of 2006 voting; this year’s activity isn’t factored in.

Northwest overall, on the liberal side, the highest numbers went to Washington Representative Jim McDermott, with second place to Senator Patty Murray. Top conservative numbers regionally went to – you were expecting Idaho to show up here, right? – Washington Representatives Cathy McMorris and Doc Hastings, respectively. All of the Oregon and Idaho members ranked in between.

All depends on how you count.

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Two sides will run politically on the question of how well Oregon Senator Gordon Smith latest stances astride parties – mainly on Iraq, but also to some extent on cigarette taxes – will play. One is, to what extent does he pick up support from the middle, from independents? That answer will await another day. But we have some feedback on the other issue: How well will Smith’s fellow Republicans, whose support he has been able to rely on up to now, accept it all?

For an early answer, we go to reports from the annual Dorchester conference, already in progress.

The well-connected Republican blogger I Am Coyote (Ted Piccolo) said he missed the Smith speech last night owing to a card game, but afterward, “I did some asking around to find out the general consensus as to how Sen. Smith was received. In general most people were still angry and growling about him. Although he did receive points for at least showing up.”

Jeff Hazen, a Republican who is a commissioner at Clatsop County who attended, said “It was interesting to watch the people in the crowd and you could certainly tell who was angry with him about the stance against the president on this matter. They would not rise during one of the standing ovations. Personally, I admire him for his conviction.”

All this seemed to match with the Oregonian piece on the speech and its reaction, which led: “U.S. Sen. Gordon Smith defended his rapidly changing stance on the Iraq war to a roomful of Republicans on Friday night, drawing cheers but also some harsh questions at the annual Dorchester Conference. Won’t pulling back in Iraq only cause more violence? Don’t your words demoralize the troops? Aren’t you empowering Democrats?”

Early indications. Primary anyone?

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