Writings and observations

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This summer in Idaho is featuring some unfortunate health headlines ranging from the plague among rodents to e. coli on the beach (at Lucky Peak park near Boise).

But the really messy story is neither of these: It concerns the Saltzer Medical Group and its relationship with St. Luke’s hospitals, and the slippery state of how modern medicine deals with big money.

The story goes back a few years and iterations. Saltzer is a consortium of physicians at Nampa – the state’s second-largest city, remember – which had a large base of customers who regularly needed hospital facilities. St. Luke’s Health System, the largest hospital organization in Idaho and based at Boise – with major facilities scattered around the metro area – bought Saltzer in 2012, in a friendly takeover. Part of the justification was that if the organizations worked more tightly together, they might be able to hold down costs.

Attorney General Lawrence Wasden warned that the deal might be illegal, violating federal anti-competitiveness laws. St. Luke’s and Saltzer said the merger could be readily “unwound” if need be. That’s now being put to the test. Two levels of federal courts ordered the merger reversed, agreeing with the state (and several St. Luke’s competitors) that the mashup was anti-competitive. Now, in speaking of the un-wind, St. Luke’s attorneys were quoted as saying that what “seemed like a simple, straightforward process … has proven not to be so.”

Is everyone properly shocked . . . ?

For one thing, Saltzer isn’t now what it was: A group of what was 50 or so doctors is down in number by about a quarter, some of those departing evidently wary of getting snared in legal issues. Several specialties important to the overall group now have no practitioners. The group reached an agreement with St. Luke’s to provide those services, which has made things even more complex.

And there have been efforts afoot to sell off part or all of Saltzer to some other party.

How does all of that comport with the court’s order to, more or less, return St. Luke’s and Saltzer to where they were before their merger?

No one really knows.

There’s some talk about a court-appointed master who would have some direct authority over the situation. This might work, in theory, somewhat comparably to a trustee in a bankruptcy case. But this may be a lot more difficult for such an official to handle than would be a bankrupcty; in this case, the businesses are alive and fully functioning. Part of what has happened involved physicians quitting one employer and moving to another, or setting up independent shop. How could a master force someone to, say, continue working at Saltzer if they didn’t want to? (Not that such an effort would likely be made anyway.) Both Saltzer and St. Luke’s are active – in St. Luke’s case, you might almost say hyperactive – businesses, doing many things and making many decisions every day. Planting a special master in the middle of that could be nightmarish for everyone involved, prospectively including patients.

The legal-financial complex U.S. medicine is in may be headed for a series of smashups. Look at St Luke’s and Saltzer as a harbinger of things to come.

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Idaho Idaho column Stapilus

We’re big fans over here of direct democracy – the ability of citizens to take control of legislating, whether for ideas good or bad (and in our view, they seem to balance out). But is it ever subject to abuse. . . You can structure legislation in all sorts of ways, ways that make an ideological point without acknowledging the consequences (like cutting taxes without saying what services will be sliced, or reducing classroom sizes without saying where the money will come from). Money speaks in initiatives too: In Washington, Tim Eyman is or isn’t a factor in state politics in a given year depending on whether he has a rich guy in his back pocket. But the Tacoma News Tribune points out today another problem too: People who solicit petition signatures for initiatives or other ballot items can, and sometimes do, misrepresent or outright lie – and there seems to be nothing the state can do about it. The specific trigger for the story is a new ballot issue that would change the Tacoma city charter, though it’s being billed mainly as a term limits proposal.

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First Take

At what point did we cross the line when significant numbers of Americans thought torture was okay for us to do? It wasn’t the case a generation or two ago; in the years I grew up, it was the bad buys – and only the bad guys, whether in fact or fiction – who tortured people. (At least as far as we knew or countenanced.) The good news yesterday was that the U.S. Senate decisively seemed to share that general concept; most of the Republican caucus and all of the Democrats led the 78-21 vote to reaffirm (this is not new policy, it’s just re-upping what’s already on the books) the official prohibition on torture. So what are we to make of the 21 senators who voted against? Idaho’s two senators, Mike Crapo and Jim Risch, were the sole northwesterners (and that would include the Republicans from Alaska as well as the Democrats from Washington and Oregon and mixed delegation from Montana) to oppose the amendment banning torture. And why would they do that? Boise Weekly checked in with their offices, and got no response from Risch’s. Crapo’s statement had an on-the-one-hand, on-the-other-hand quality: “In the past he has expressed reservations about some of the things that were done, but he has been increasingly vocal about the tools that our military has at their disposal, some of the restrictions that were put in place. At the same time, he is changing his mind and his tune on when we should put our troops out there—boots on the ground, so to speak. He is less inclined to do that, but when we do it, we ought not to hamstring them in regard to what techniques they can use, and I think this follows along with that.” No. It’s not that complicated. Crapo’s vote was for saying that we’re okay with torturing people who fall into our hands. And what message, and what moral license, does that give to people who capture Americans? And what kind of moral sense can we attribute to someone who supports the use of torture? – rs

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First Take

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The most successful university president in Idaho history, Boise State University’s Bob Kustra, is rapidly approaching retirement. He is 72 years young, and has accomplished more in his 12 years than all other Idaho public university presidents combined, with the possible exception of former Idaho State University President William E. “Bud” Davis.

Many factors combined fortuitiously to generate his success, but one key is from day one Kustra understood the job is primarily one of mastering the politics. To succeed a university president must concede they are a politician—-not an academician, not a researcher, not a teacher, not a scientist.

Kustra came to his job almost straight from the jungle of Illinois politics where it is truly a contact sport riven with internecine fights and plagued with a history of corruption. He served two years in the State House, eight years in the State Senate and seven years as the Lt. Governor working with one of the few, competent, ethical and untainted governors in modern Illinois history, Republican Jim Edgar.

Kustra resigned his office in 1998 to go into higher education, a long-time secondary avocation of his (he holds a Ph.D in political science), to accept the presidency of Eastern Kentucky University and by 2003 was named the 6th president of Boise State.

Credit Kustra with understanding both the potential for dynamic growth at BSU and the importance of putting together and implementing strategic plans. As the man with a plan he quickly converted all the multiple constituencies from alumni to faculty to students. All recognized they had in Kustra a smart, tactical leader who knew how to make decisions, win over critics and unite diverse interests around goals beneficial to all.

Kustra also intuitively understood that everyone loves being associated with a winner, especially in the game of football. Boise State was already moving in the direction and had achieved real success on the gridiron but credit Kustra with understanding how crucial football success is to generous alumni giving and substantial funding from state legislators. Credit him also with ensuring that the minor sports were well supported as well as womens sports in full compliance with Title IX.

Kustra, working with his athletic director, deserves credit for elevating a fine football coach like Chris Peterson and hiring Leon Rice as head basketball coach. They took Boise State to the top tier of college football and basketball. Neither was he afraid to leave a rival like the University of Idaho, which couldn’t keep up, behind.

Credit Kustra also for hiring as his director of government affairs former House Speaker Bruce Newcomb, one of Idaho’s saviest political practitioners. Only one University of Idaho president, Tim White, working in conjunction with the Vandal’s equally adept government affairs director, Marty Peterson, could have possibly matched the Kustra/Newcomb combination.

White got fed up with continual harassment by Ed Board member Blake Hall from Idaho Falls and walked away. He landed in California where today he is Chancellor of the entire University of California Higher Education System. It didn’t take Kustra long after White was gone to not so subtly have removed from the University of Idaho’s mission statement the characterization of the U of I as the “flagship university.”

Kustra understnds the importance of perception. Too smart to appropriate that title directly, he knows today Boise State, though it describes itself as a “metropolitcan research university of distinction,” is nonetheless Idaho’s flagship university.

During Kustra’s tenure BSU has grown into the state’s largest public university. It grants over 40% of the bachelor degrees awarded in Idaho each year. Yes, the U of I for a while longer may continue to lead in research dollars and be considered academically better, but Kustra knows reality often follows perception and it is only a matter of time until BSU leads in those arenas also.

Like all successful politicians, Kustra has his detractors. He can be imperious and downright arrogant at times, and more than one person has called him a jerk when he acts less than his capability to charm. Decisive people though can often alienate those who dislike their decisions. Kustra knows success can cover a multitude of sins.

It appears the University of Idaho’s new president, Chuck Staben, doesn’t begin to understand the nature of the challenge Kustra’s aggressive leadership has created for him and his university. One example, is indicative. After being in office over a year he has yet to meet with the editorial board of the largest daily newspaper in his own backyard, the Lewiston Tribune. Vandal boosters better wake up..

When Bob Kustra hangs up his spurs he’ll do so secure in the knowledge that he is retiring as the uindisputed champion of the title “best university president,” bar none, in the history of Idaho.

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Carlson

When Donald Trump emerged to announce his run for president, the song playing in the background was Neil Young’s “Rockin’ in the Free World”. That was probably a good indicator of the judgement he’ll be using in the rest of his campaign: Young released a statement saying “Donald Trump was not authorized to use Rockin’ In The Free World in his presidential candidacy announcement. Neil Young, a Canadian citizen, is a supporter of Bernie Sanders for President of the United States of America.” (A nice little boost for Sanders there.) Not to mention that Trump must not have paid attention to anything about the song beyond its title, since it is actually a protest against practically everything Trump stands for. A minor glitch? Practically everything in his announcement speech was a glitch, from his reference to himself as “the best jobs president god [lower case] ever created,” to his self-delighted proclamation, “I’m really rich.” This act will not take him to the White House, certainly, and almost certainly not to the nomination: Such an overt expression of raw ego may sell to a sliver of a fan base but not to enough to get very far. He won’t necessarily flame out quickly, though. He’s a celeb, which is a real advantage in today’s America. He also has enough money to self-fund his campaign, well into primary season anyway, if he really wants to; he doesn’t need to court a billionaire, and he can fire shots at his competitors who do. A lot of other Republicans may desperately want him out of the race, but with his ego finally on the line – after talking about running twice but backing away – he may not be able to let it go. For quite a while.

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First Take

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This year’s legislature has been good to lower paid workers.

Sick leave? check.

Enhanced retirement options for workers who don’t have retirement plan through work? Almost check.

And now Democratic House leaders are introducing a bill that will increase the minimum wage incrementally to $13.00 hour by 2018. (inevitable check)

And lets not forget the Affordable Care Act, assuring that low income workers are able to afford health insurance.

With this increases in minimum wage, paid sick leave, more retirement options, and health insurance guaranteed, the State of Oregon, along with the feds who are supplying the subsidies for health insurance, have “negotiated” some pretty solid contracts with America’s workers.

The 2014 union rate for the US was 11.1%. In Oregon it was quite a bit better at 15.6%. But still…..15.6% is pretty low historically.

Is there correlation between the shift of income from the middle to the top a and the shift of power between capital and labor because of the reduction in the power of private labor unions? And if so, will the enhanced employment requirements passed by the State Legislature help boost the middle class workers situation? Or will the enhanced benefits required by law now remove the reason for lower income workplaces unionize in the first place?

It’s an interesting development, Oregon State is legislating compensation packages for lower paid workers that are substantially better than the typical compensation packages available in other States. It’s acting like a union of last resort. The consequences could be positive – historically higher unionization meant more for the middle class. And it’s certainly better for the lower paid worker. More income to spend in the community. Better protections for workers. Healthier workforce. More incentive to work and save for retirement.

Or could it backfire? Perhaps, besides the obvious danger of a loss of jobs as employers find ways to trim operating expenses, it could also mean that the lower paid less skilled workforce, the one that could arguably benefit most from a strong private union, no longer has a reason to unionize. Of course, unions had been struggling to unionize low wage workers for some time.

Now, if we can just elect some responsible “union” leaders in 2016.

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Harris