Writings and observations

trahant MARK


Idaho’s Rep. Mike Simpson, a Republican, asked a critical question Tuesday. It’s one rarely asked, let alone, answered. The question: Does more government money work?

Specifically, Simpson, the chairman of the House Interior Appropriations Subcommittee on Interior, Environment, and Related Agencies, was asking if recent increased funding for the Indian Health Service has made a difference.

Dr. Yvette Roubideaux, director of the IHS, went through the numbers at an oversight hearing. IHS appropriations have increased 29 percent since 2008 which, she said, is “making a substantial difference in the quantity and quality of healthcare we were able to provide to American Indians and Alaska Natives.”

For example: Contract Health Service dollars, money spent to purchase medical services outside of the Indian health system, has been increased by 46 percent since 2008. “Four years ago, most programs were funding only Medical Priority 1, or ‘life or limb’ referrals. Now, Dr. Roubideaux reported, “the increased CHS funding means that almost half (29 out of 66) of Federal CHS programs are now funding referrals beyond Medical Priority 1.”

That means that there is now money, at least some money, for preventative services such as mammograms and colonoscopies. “The increased CHS money also means that the IHS Catastrophic Health Emergency Fund, which used to run out of funding for high cost cases in June, now is able to fund cases through August,” Dr. Roubideaux said.

Simpson said: “You can get sick now up to August?” To which Dr. Roubideaux replied, that the phrase, “Don’t get sick after June,” has been incredibly effective describing the problem of what it means for a health care delivery system to run out of money.

Clearly more money in the contract health care (soon to be labeled in the next budget as “purchased and preferred care”) program is making a difference and most likely saving lives. But what about in other program areas? There the data is convincing as well. The Improving Patient Care program, a team based approach to care, has increased the number of sites to a total of 127 (adding 89). This has resulted in both quantity (empanelling 261,180 active patients in a primary care team up from 85,079) and quality (IPC sites show patient satisfaction increasing from 55 percent in April 2011 to 72 percent currently.)

IHS has provided more women mammograms, up from the low to mid-40 percent range to more than 50 percent.

No one thinks that there is enough money in the Indian health system. But in this one subcommittee there is bipartisan agreement that more government spending does indeed work and that the Indian Health Service could use more. This is dangerous talk in DC, the very words that strike fear, government spending is effective.

Indeed, Rep. Tom Cole, R-Oklahoma, asked what else Congress could be doing to make the IHS even more efficient, beyond appropriations. He asked about removing bureaucratic obstacles or better definitions in the law. “We know we need to do more,” Cole said.

Navajo Nation Vice President Rex Lee Jim, speaking for the National Indian Health Board, agreed there have been recent improvements that followed the funding resulting in “small, but real gains.”

But what now? The federal budget sequester will reduce the ability of the agency to provide patient care, a cut of $220 million, meaning 3,000 fewer inpatient admissions and 804,000 fewer outpatient visits.

“Any budget cuts, in any form, will have harmful effects on the health care delivery to American Indians and Alaska Natives and its true cost will be measurable in lives as well as dollars,” Jim testified. “This must change. If this Congress cannot avoid sequestration through alternative methods of deficit reduction, the National Indian Health Board implores this Congress to make IHS exempt from this process.”

Nearly everyone thought that the Budget Control Act would have limited the impact of the sequester on the IHS (as it did many medical-related spending). But one of the Congressional authors forgot to include specific language — as has been the case in the past — protecting IHS (as well as another larger agency, the Health Resources and Services Administration) from the across-the-board cuts.

Simpson was blunt. “Blame me as much as anybody,” he said. “I should have caught that.”

If Simpson’s subcommittee had all the keys to Congress this problem would be solved going forward. And in a process with Republicans and Democrats working together. It’s exactly how Congress is supposed to work.

But let’s be clear about this: The budget challenge ahead for the IHS with the sequester is going to be rough. Next year’s budget outlook will remain difficult. But there is also a promise: The Affordable Care Act beginning in 2014 opens up new revenue streams that could substantially increase funding. (More about that in future posts.)

What’s significant about this hearing is the narrative itself; the story that was told. For so long the story about the Indian Health Service has been one of failure. But this is a story about success, about how a government agency can execute a policy, and when given more resources, it can improve the delivery of health care.

Mark Trahant is a writer, speaker and Twitter poet. He lives in Fort Hall, Idaho, and is a member of The Shoshone-Bannock Tribes. Join the discussion about austerity. A new Facebook page has been set up at:

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GENETIC FOODS BILL It’ll be a little hard, in the end, to stop a bill that proposes to inform consumers about the food they eat. That’s the core of the bill to require notification about food products that have been genetically altered, and it may turn into a big issue at the Oregon Legislature – which might become the first in the nation to require such labeling. There is the point that genetic-based modifications in foods go back thousands of years; but the new laboratory-based modifications are (most people probably understand) a new kind of creature. The political fault lines, if they develop, could be fascinating.

PERSONAL PROPERTY TAX How many ways can you slice a tax proposal? Quite a few, as the increasingly complex debate over the Idaho personal property tax shows. The center of gravity seems to be toward a partial shift, cutting the tax on low-end items (which would eliminated a lot of paper work), but the battle rages.

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ridenbaugh Northwest

The whole question in health care of who gets the money – which relates directly to how much money is in the system – hasn’t yet gotten near enough attention. But all it would take is the asking of a few pertinent questions.

Here’s a press release (in e-mail, from the Oregon House majority) about an Oregon bill that poses some of those questions. If it now passes the state Senate and is signed into law, it could turn into one of the more consequential measures of the session in its reverberative impact.

A bill that will provide equal pay for Nurse Practitioners and Physicians Assistants who perform the same services as physicians passed the House today.

HB 2902A would help build the skilled and workforce that Oregon needs in order to meet the diverse healthcare demands throughout the state.

“Oregon is shifting toward a healthcare system that focuses on preventative and community-based care,” House Majority Leader Val Hoyle (D – Eugene) said. “Providing equal pay for equal work will help us grow Oregon’s healthcare workforce and improve access to care for more Oregonians.”

HB2902A would require insurers to pay health practitioners the same rate for the same services and reimburse based on an unbiased coding system.

“If two people are trained to perform the same procedure and it’s within their scope of work, they should receive equal payment,” Representative Mitch Greenlick (D – Portland), Chair of the Health Care Committee said. “This bill solves one problem within our healthcare system by following the fundamental principles behind equal pay for equal work.”

House Bill 2902A passed the House 39 – 20 and now heads to the Senate.

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Oregon Reading Uncategorized

rainey BARRETT


The saddest people I know at the moment are my Republican friends. The ones who watched the CPAC convention last week. Eager to again be proud of the good ol’ Republican brand, they were looking for some hint – some small clue – that all this talk of recognizing the Party’s recent electoral failures and the expected new efforts to heal the badly wounded elephant would result in some good GOP news for a change.

What they saw was a parade of the same oft-rejected faces living in another time and certainly another world. They heard the same old mantras voters have ignored before. Looking for substance that Republicans at the national level were hard at work banishing defeated voices of the past while offering a glimpse of a new, more positive future, they saw time-warp presentations of same-old, same-old. All harbingers of more time to come in the political wilderness.

Thinking Republicans were treated to three days of ample evidence that those who control the GOP administration and the nominating process nationally are more committed than ever to a course of public destruction. Even with the heavily gerrymandered congressional districts and Republican-sponsored voter restrictions we’ve witnessed in many states, 2014 looks even more promising for Democrats. If the many threats heard at CPAC about challenging Republican incumbents from the far right are carried out, that’ll be the cherry on top.

I came away from the CPAC experience with such an unworldly, disconnected feeling of political fantasy, I came up with some of my own.

Suppose – just suppose – the Koch Brothers, Foster Freize, Adeleson and the other billionaires were – gasp – life-long Democrats. What if they had bankrolled the other side of the aisle 30 or 40 years ago when they began to surreptitiously worm their way into the political woodwork of a national party? What if they’d poured those hundreds of millions of dollars into candidates and causes representing the poor, educational improvements, new energy development, climate change, a redesigned military for today’s conditions, veteran’s care, mental and physical health research and … well … many other things?

If those uber-rich guys – with their vast resources – had been behind people and movements devoted to those and other important issues, would we be in the mess we are in Congress right now? With all the terribly important problems that need to be addressed in the House and Senate, would the Republican angst be as high as the one emergency national issue they’ve complained about the most? Discontinued tours of the White House?

Had that fantasy been reality for several decades, we would be living in a far different country. As a nation, we’d be working on those and many other issues. And, when people are working, they do a lot less bitching and become part of the team. And, with more people working, deficit reduction is less a fantasy and broken political promise and more a reality.

If you really looked and heard the craziness and otherworldly activities of CPAC last week, you know – you KNOW – cooperation, working together, dedicating national resources to facing and whipping our most important problems had no place in the discussions. You saw absolute resolve to repeat past failed experiences with the same failed faces and their rejected arguments. You heard lies trotted out as fact.

You heard messages of division and exclusion. You heard false messages of “change” and “inclusion” while attendees deliberately dis-invited some of the best people the GOP has to offer. Excluded people they need to make “change” and “inclusion” more than feel-good, happy talk.

The reason why the failure of CPAC to offer anything new and positive is so terribly disappointing is that this crowd represents who you’ll see on the ballots in many states in 2014. Many of these crazies control the nominating procedures in their states. Those who “think” like they do will be the names offered you’ll see in too many cases.

Rather than “change” and “inclusion,” they want purity. Winning is less important than adhering to deeply flawed tenets which have produced too many deeply flawed officeholders. CPAC offered no immunization from past political sickness. It was simply an over-ballyhooed booster shot for continued ailments.

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trahant MARK


Three words to think about as we near the next budget fight on Capitol Hill: Austerity has limits.

As I have written often, I view the austerity trend as a global one, not a national debate. That’s important to remember because other countries are further along in their austerity implementation, policies that should give the U.S. Congress real examples of what works and what’s a disaster.

Italy’s soon-to-be former prime minister makes that case. “Public support for the reforms, and worse, for the European Union, is dramatically declining, following a trend which is also visible in many other countries across the union,” Mario Monti said in The Guardian newspaper. “To revive growth and fight long-term and youth unemployment would be the best message to counter the mounting wave of populism and disaffection with the European Union, showing that Europe is listening to people’s concerns.”

Anti-austerity efforts are gaining strength in the United Kingdom and Spain.

But the dumbest austerity action came last week in one of Europe’s tiniest countries, Cyprus.

As part of a bailout deal, that country’s government agreed to a tax on the savings accounts of its citizens ranging from 6.75 percent to 9 percent. The president of Cyprus said Sunday night it was either the tax or his country would have to leave the European Union and face national bankruptcy. “I chose the least painful option, and I bear the political cost for this, in order to limit as much as possible the consequences for the economy and for our fellow Cypriots,” Anastasiades said in The Global Post.

So the people of Cyprus rejected that policy and began withdrawing money as fast as they could before any such tax could be imposed; a classic run on the banks.

Cyprus and EU politicians are now looking for a Plan B, showing that austerity has its limits. (The Cyprus parliament postponed a vote on the bailout as a result.)

Of course all of this has nothing to do with the Congress — and the tribal governments across North America. Except that we are riding the same wave of austerity where governments are scrambling to balance competing ideals. On one hand, other countries, banks and investors want the money back that governments have borrowed. On the other hand hand, the people, the citizens, want their government to live up to the promises it has made (and, by the way, just don’t charge too much in taxes either).

Decades of congressional promises to tribes, to seniors, to other nations, now exceed the country’s political will to pay for those promises. The United States has treaty obligations to tribes that have been reduced to ordinary appropriations and, as a consequence, funded at levels that would not meet the test of an ordinary contract.

This week, the Senate’s version of a Continuing Resolution, money to fund the government for the rest of the year, will be released. According to Politico, this 587 page document has become a “magnet for scores of amendments” ranging from restoring specific sequester cuts (such as school constructionfunding for the Bureau of Indian Education) to foreign policy initiatives.

But consider what has to happen: The proposal itself must win enough bipartisan support to pass the Senate (60 votes, please). Then each amendment. Then that package has to reconcile against a very different House package. And then pass both Houses. And be completed by March 27.

The best solution might end up being a continuing resolution of a continuing resolution of the current continuing resolution; a temporary fix of a few more days or weeks. (The alternative being a government shutdown.) In other words: The Congress will take a long time to make up its mind. Then it will really move slowly.

Mark Trahant is a writer, speaker and Twitter poet. He lives in Fort Hall, Idaho, and is a member of The Shoshone-Bannock Tribes. Join the discussion about austerity. A new Facebook page has been set up at:

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idaho RANDY
The Idaho

No one living in Idaho or in other states should be unaware how the cost of health care, and insurance for it, has ballooned in the last few decades, driving people into individual ruin and straining businesses and other organizations (and economic recovery). A brush with a hospital is flirtation with bankruptcy – and it has meant bankruptcy for many. That’s true even for the insured, who find their protections eroding each year. And the number of uninsured sits at about 16 percent of all people nationally, 18 percent in Idaho (21 percent among those 64 and younger). This is an enormous problem.

There is no one cause and no one answer. One tactic intended to help, one that makes use of a marketplace, is an insurance exchange: An organization allowing buyers of insurance to shop around, compare costs and benefits and get assistance, in a way they haven’t been able to. Such a plan was built into the 2010 Affordable Care Act, and in it states were given the option to set up exchanges.

That’s the background for House Bill 248, which would establish by the state of Idaho an exchange aimed at helping consumers of health insurance to locate and buy appropriate policies. Alternatively, the feds would establish one in Idaho. The bill passed 41-29, after more than seven hours of debate.

You might suppose that long debate, one of Idaho’s longest legislative debates in decades, would have centered on the problems and costs of health care and insurance. You would suppose wrong.

The bill’s stated “purpose and intent” begins, “It is the public policy of the state of Idaho to actively resist federal actions that would limit or override state sovereignty under the 10th amendment of the United States constitution. Through this legislation, the state of Idaho asserts its sovereignty …”

That framing overwhelmed the debate. The need of Idahoans for affordable health care and insurance, whether the exchange was a good solution, whether this specific model might be improved upon: These were touched upon almost not all. The course of debate suggested the health (in effect, the safety) of Idaho’s people wasn’t of significant interest. Maybe the closest graze came from the conservative Representative JoAn Wood, who aptly noted the absence of strong consumer protections in the bill. The “sovereignty” of Idaho seemed the lone general concern – that, and taking potshots at anyone federal.

There were a few somewhat contrary voices on sovereignty, such as Representative Frank Henderson of Post Falls who noted how local governments often work with federal requirements without much trouble. And Representative Neil Anderson, R-Blackfoot, who delivered one of the most courageous debates in the Idaho Legislature in years by declaring “We are still the United States” and that the federal government should be seen as a partner, while instead “we’ve almost wound up in this adversarial role.” (Will he be thrown out of the House Republican caucus for that heresy?)

In those hours of debate, talk of wolves and roadless areas (in the context of federal and state control) roamed free. The only health-related specific subject was abortion, more precisely abortion-related “freedom of conscience” (for people opposed to abortions, not those seeking to have them).

Health care? Crushing financial catastrophe? The well-being of Idahoans and their ability to live in some measure of financial security? Evidently, not the Idaho Legislature’s concern.

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Idaho Idaho column

stapilus RANDY

The View
from Here

A couple of thoughts about the Senator Rob Portman/gay marriage story, tangentially about the issue involved but mostly about the way Portman arrived at his reassessment.

The story is that the Ohio Republican senator, who until this week has been firmly opposed to allowing same-sex marriage, has changed his mind. He told CNN, “I’ve come to the conclusion that for me, personally, I think this is something that we should allow people to do, to get married, and to have the joy and stability of marriage that I’ve had for over 26 years. That I want all of my children to have, including our son, who is gay.” Learning about his son’s orientation and life preferences, he indicated, was central in his thinking.

A lot of people have changed their minds over the years on this subject. 15 years ago, polling showed that just over a quarter of Americans thought same-sex marriage should be allowed; back then, I was among the majority who thought not. In the last decade especially, opinions have moved drastically, and now a majority around the country thinks it ought to be allowed; and once again, I’m in the majority having changed my mind too.

What changed, what caused that change, is something worth exploring. In my case, the evolution started with a general acceptance of a broadly understood norm, that marriage was between a man and a woman, period. Until not too many years ago, the subject wasn’t much publicly debated, and – for many people – not deeply thought about.

It moved to the front burner partly, I suspect, in response to two things. One is that more people have tended to become more open about homosexuality, bringing more people into contact with the impact of policies including those concerning marriage. (The don’t ask don’t tell military debate was part of that too.) And, a then-pointless political opposition to same-sex marriage, pushed as a political wedge issue about a decade ago, wound up exposing the emptiness of the argument against: Simply, the case against seems awfully thin compared to the case in favor, in which actual people are demonstrated actual and easily corrected damage to their lives.

The shift of attitude among Americans probably relates, to some degree, to those two factors (much as they may overlap). Some people, and I would be one of them, considered the arguments pro and con over a period of years, and changed point of view after considering them. You could call this the legislative approach, since it involves weighing the pros and cons of a policy.

The other reason for the shift may be personal, and this is where Portman comes in. Probably like many other people (former Vice President Dick Cheney, for another), he changed his mind after direct exposure, in his own family, to the consequences of the policy. You could call this the personal approach.

So, at base line, this measure of criticism for Portman: It took a personal case, involving a person very close to him, to persuade him of the need to make the change. That’s not a legislative approach, because most issues around us – and most issues facing members of Congress – don’t allow for that kind of direct, personal, intensive involvement.

For most Americans, there’s no real implication in that. For a member of Congress (much less a senator), there’s a real implication: What conclusions should we draw about Portman’s ability to make meaningful, informed judgments in cases where simply a weighing of the evidence is involved? He surely knows no more about the issue now than he did three years ago; all that changed was the personal factor. Is that how members of Congress should make the law?

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PRIVATE SCHOOL CREDITS The Idaho House Revenue and Taxation Committee has voted (12-4) to extend tax credits to scholarship funds specifically aimed at private schools. From a news report: “Coeur d’Alene Republican Sen. Bob Nonini said this could actually save Idaho money, because reducing public-school enrollment would also cut Idaho’s per-student funding obligation.” This seems legally problematic, however – it has the look of back-door funding for private schools – and it effectively removes funds from public schools to be funneled to private.

INSURANCE FRAUD Oregon legislators are looking seriously at Senate Bill 686 which is aimed at allowing the state (and, depending on final versions, maybe others) to sue insurance companies for fraud – such as when they convey the impression something is covered, and then decline to pay. From a statement by sponsor Senator Chip Shields: “Too many businesses, medical providers, and consumers tell me that their insurance company is driving them to bankruptcy. If your insurance company blatantly won’t pay the reimbursement that their big premiums or contracts are supposed to cover, it’s wrong. It’s time the Legislature protects small businesses and consumers by removing the insurance exemption.” This would set up in law the concept of insurance fraud running in a different direction than the one we’re most accustomed to (and comfortable for insurers).

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First Take

rainey BARRETT


Check any dictionary in any language and you’ll usually find these two definitions for the word “politician” among the several listed. One will be “a person holding political office.” The second will use the word “devious” in some way. A descriptive word you’ll never find there is “love.”

While historically an honorable profession, our recent experiences have made us use other words to define politicians. “Self-serving.” “Deceitful.” “Dishonest.” “Uncaring.” “Ignorant.” “Out-of-touch.” And worse. Too often, they are apt.

I’d like to see that word – love – used in politics more often because it can be a great “leveler.” In recent days, it publically appears so for Sen. Rob Portman (R-OH), father of a gay son. Long an outspoken conservative voice opposing gay marriage and any other homosexual recognition efforts, Portman is now getting a lot of sympathy for changing his gay marriage stance. It’s no longer just another “safe” political topic to include in speeches to his “conservative” base. It’s become a personal issue dealing with a loved one. Well, good for him. Let’s show the Portman’s – father and son – a little love. But not too much for the Senator.

Portman is only the most recent ardent Republican foe of gay marriage to seem to have a “come-to-Jesus” moment on the matter. Probably the most notable figure to be similarly affected is former VP Dick Cheney. Early in his career in Congress, neo-con Cheney’s was just another contemptible voice loudly damning the country’s gay community. Then – BANG. Suddenly he had a teen lesbian daughter who “came out.” Cheney quickly did a 180 and said marriage should be allowed for “any two people who love each other.” Very similar to the Portman “conversion.”

Except for one thing. When Mitt Romney looked around for a vice presidential running mate over a year ago, Portman’s name was right there near the top of the list. To Romney, Portman was the quintessential, very compatible candidate. Experienced. Squeaky clean. Popular with the GOP base. Represented a large swing state. Matching positions on all the major issues. Including Portman’s oft-pronounced opposition to – wait for it – gay marriage and other issues of homosexuality.

Romney’s search team called him in many months before the election. He was vetted in all possible ways. It was then – over a year ago – that Portman told Romney’s people his son was gay. He was immediately dropped from consideration. Banished.

Which is why I said hold up a bit for all that love stuff. Because Portman’s high-profile and very public voice of opposing homosexual issues has been constant all these many months. Unchanged. Until March 14, 2013. When his son’s sexual orientation became public. But Portman admits his son “came out” to him more than two years ago.

Now the Senator is making the talk show rounds – portraying himself as a loving, understanding and accepting father. Which I’m certain he is. But he’s also “deceitful” and “dishonest.” And “devious.” The other words that too often describes today’s politicians. Because – in all those months – for more than two years – he maintained his public, anti-gay positions in the public conduct of his office. His “Damascus Road” conversion came only when the family secret was suddenly media fodder. March 14, 2013. But it was something he’d known for two years.

Whatever your views on gay marriage or any other issue, they’re your views and a part of who you are. You’re entitled to them. But – if you hold yourself out for elective office – if you repeatedly try to win public support to get and keep you there – if you espouse positions on issues political and social directly contrary to your personal practices – all those negative words apply. And more.

Portman’s conduct during all that time had less to do with love and more to do with covering his political butt.

I applaud Sen. Portman for loving and supporting his son. But there’s a bit of hypocrisy here that taints the story. Given the length of time he knew of the situation – while keeping his crafted public image of being a staunch opponent of the same reality he knew at home – that undermines the media trek he’s now on.

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TOW TRUCKS Ah, the free market: Your car is towed, and to collect it and get it released, you have to pay – what? Absent rules to the contrary, you pay whatever the truckers demand. Portland has had lots of headlines over this; some of the more recent in the Puget Sound charged with an $800 tab and then, Seattle Times columnist Danny Westneat notes, “came horror stories of even gougier bills, as high as $1,400. City officials and state lawmakers vowed to cap towing rates, which in Wild West fashion could be jacked as high as the tow truckers desired.” There’s a reform bill in the legislature this session, but consider that “reform” in quotes: This is a bill the tow truckers love, because it sets state rates that are nearly as bad as the horror stories, much higher than most of the state now experiences, and four to five times higher than in places like New York. Westneat: “Well played, tow truckers. Well played.”

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First Take