Posts published in “Schmidt”

There are all kinds. There are the ones with minutes or the ones on the sidewalk. There are ones with published agenda and the ones over a couple beers. I admit I don’t always like meetings, especially when I don’t think they serve a purpose.

But you can change that.

When I first got appointed to the Idaho Board of Health and Welfare, I did my research. Before accepting the appointment, I reviewed the minutes of the previous meetings. That had little to inspire me.

But then I remembered the previous H&W Board member from my district, the late Tom Stroschein. I served for six years on the Senate Health and Welfare Committee. Tom would show up every year when he came down to Boise for a Board meeting.

He was an old southeast Idaho sheep rancher, so he had an “aw shucks” manner. And he was a Democrat, now from this tiny liberal part of the state. He would stand before us, recognized by the Chairwoman, Senator Patti Anne Lodge and he would give this self-deprecating “aw shucks” two- or three-minute speech that he was just here to connect.

He just wanted the Senate committee members to know who he was, and he could talk to them about the things the Department of Health and Welfare was doing, and he was keeping an eye on things, as they should be too.

He was saying, “We’re in this together.”

My fellow committee members were answering emails as he spoke, and I’ll admit, after the second year of the “aw shucks” I got a little tired of it.

But he had a valuable point. Standing up and saying, “Let’s all work together for the people we serve” might not be popular these days. But it is worth saying.

And doing.

I only write this because the next scheduled meeting (March 20th) of the Idaho H&W Board has been canceled until after the legislative session. I understand this, but it saddens me.

Idaho DHW staff and director are busting their butts to address legislation that might affect them, and the citizens we serve.

I will admit I have not been the open and honest advocate Tom was. Last year, my only time on the board when a meeting was held during session, I got out of town quick. I did not really want to walk the marble halls and schmooze.

But that’s really what we need to be doing.

Yes, I’ve got the big yellow “D” sewn to my coat, so talking to legislators can be difficult.

But it’s what we should do.

Or is it?

Governor Little (who appointed me to the DHW Board) got 37,457 calls about the private school tax credit bill. They ran 7/1 opposed. He signed it, though the bill did not meet the criteria he outlined.

So, what is the point of this meeting?

The point is, we get to know each other.

I think our Governor heard from the 32K opponents and decided it wasn’t a deal breaker.

Have you ever had a conversation with someone and faced a deal breaker? They said something, and you had to walk away? Before you walk away, you consider the ramifications. Will I need to work with this person again? For if you do, you don’t just walk away.

Tom Stroschein was trying to open up a dialogue. That was brave and honorable.

I knew him well and talked with him regularly. But my fatigue with his appeals was because I didn’t realize he wasn’t really talking to me.

I don’t know that Tom got many folks to listen.

I have not had his courage.

But that effort, to stop someone on the street, talk to them at a town hall, listen to their perspective, share your own with humility and kindness, will make this a better union.

And that is our fundamental goal.

It appears Representative Jordan Redman has given up on his Idaho Medicaid Expansion repeal bill, HB 138. It barely passed the House and was headed to stormy waters in the Senate. You have to ask, why does this effort to get people off health insurance keep coming up?

So there’s another shot out of the cannon, HB 328. It’s complicated.

Sorry about all the details here, but it is worth your consideration.

Maybe not, if the US Congress decides to make big cuts to Medicaid to fund the Trump Rich People’s Tax Cuts. Whatever is attempted on the state level will be shriveled by the federales.

I truly appreciate all this effort. As I have said so many times, the health care swamp in this country could just be our downfall.

But cuts to Medicaid?

What does one Idahoan on Medicaid Expansion cost the taxpayer?

Keep in mind, under the current split, Idaho pays 10% of the total cost. And don’t let the big numbers thrown around confuse you.

There are many folks covered in Medicaid. There’s the most expensive with severe disabilities. They cost over $20K/ year per person.

Then there’s the kids. Children are cheap. They cost less than $3K per year.

Medicaid Expansion folks cost about $7K/ year.

So, Idaho pays $700 a year of Idaho taxpayer dollars to get them health insurance.

What does Idaho pay to get its legislators health care insurance?

I’m sure Representative Redman knows these numbers. He sells health insurance. Him and his wife and six kids get covered on our tab at over $10K per year. That’s a nice juicy benefit.

But these Medicaid Expansion losers could be scamming us. Sitting on the couch and playing video games all day and we have to pay for their doctor bills. I can see why there is the concern.

So instead of dropping Medicaid Expansion as would have happened in the first bill proposed, this new bill wants to privatize the health care coverage of this small sector of Idaho.

What’s wrong with that?

By the way, privatize has become “Managed Care” in the newspeak of this age.

We have seen how “Managed Care” has affected Medicare (Old people’s guvmint health insurance). Everybody confuses these: Medicare/ Medicaid = Mediconfusion.

Private companies can take over tax funded Medicare (old folks) health insurance and run it for a profit for their stockholders. There’s 20 years of experience. It’s clear. Profit is a powerful motivator, even in this “helping” industry of healthcare. The care is worse, the cost is more , but the profits are real.

It appears Rep. Redman and his cosponsors have decided Idaho would be better served to hand over Idaho Medicaid Expansion to the private equity folks.

At the same time, they want to abandon the effort started ten years ago to hold doctors accountable for wasteful practices.

The most powerful force in this twisted, arcane, convoluted system of health care in this very health care expensive country is, unfortunately, the doctor.

We have given this demigod the power to order unnecessary tests, perform unnecessary surgeries, prescribe harmful and unnecessary medications, and thereby spend our money. If it’s private insurance, the stockholders are pissed. If it’s public insurance, we taxpayers weep. If it’s a normal, honest citizen under this hammer, they just get smashed.

This needs to change.

Idaho started down the road to change this about ten years ago. The progress has been slow.

But throw that baby out now to the venture capitalist wolves?

I am very thankful that our state legislators are trying to reform health insurance. It could be so much better.

But why is their focus on Medicaid? That’s a small apple. Medicaid controls how much it pays. Why aren’t they looking at the big apple, their own big red benefit we all pay for?

Congressional Republicans have to come up with some good ideas fast, since the shutdown is looming in a few weeks.

One of the ideas floated has to do with cutting Medicaid. So maybe the Idaho legislature is going off halfcocked, since they have floated their own proposals in the last few weeks. Are they working together? We know for sure Democrats aren’t.

But then, who wants to stand up and defend Medicaid?

Doctors hate it since it pays them a bit more than a couple dozen eggs for what the private insurances might pay one snow tire for their SUV. That is, if they code it right.

But honestly, that is one of the strengths of Medicaid. It puts out the payment schedule and doctors can either take it or not. Doesn’t that save you, the taxpayer money?

Health insurance companies have a mixed incentive. Sure, they want to be able to compete to lower costs and thus get more subscribers. But then, if they get to charge a bit more to their enrollees, they have a little more to send off to their stockholders.

Aren’t the complexities of the healthcare market fascinating?

If we could just get it a little more complicated, maybe you all would show up at the statehouse with pitchforks. Maybe that’s the weave our President is considering.

That’s it! Trump and his congressional toadies have this plan to kick 27% of Americans currently covered by Medicaid off their health insurance so there will actually be a ground swell for single payer, simplifying this corrupt and despicable health care system we are all burdened with. Bernie must be whispering and maybe they are listening?

Let’s do some more numbers.

Nearly 60% of American children are covered by Medicaid. Maybe they will have little pitchforks.

While 51% of pregnant women deliver their babies with private health insurance, that is split amongst hundreds, thousands of insurance companies. Docs love it because these private companies pay over twice what Medicaid pays. But if you compare all the payers, Medicaid is the biggest provider of insurance for women having babies. And the sad part is that they are just getting started figuring out how to do this better.

Pregnant women shouldn’t have to carry pitchforks.

What about those really expensive patients? The severely disabled comprise just 13% of Medicaid enrollees, but the account for three times that percent of the total budget. Folks in wheelchairs with pitchforks? Wouldn’t that just tug at the Bro’s heartstrings?

The Idaho whiners who are focused on the Idaho costs of Medicaid expansion have their numbers. And they know the Idaho budget. But can they see the big picture? Will the folks with pitchforks see the big picture?

It’s not complicated. It’s a simple consideration.

We are the richest country in the world. You might want to make us great again, and I do too. But the way to do that is to confront our healthcare swamp.

You can dismantle USAID, but that’s not 18% of our GDP.

The United States, the richest country in the world, spends about twice per capita what any other country does, and we are sicker for it.

Do we need to run down the “sicker” numbers? I’m running out of space.

I don’t think Medicaid is the solution to all our problems. But it has some of the answers.

I don’t think dissolving Medicaid at the federal level justifies cutting corporate and wealthy folks’ taxes.

And here in Idaho, dropping Medicaid expansion coverage is short sighted. It would cause harm to our state.

We need elected representatives with some vision, some leadership. Maybe health care is that fulcrum. There’s not a lot of profit in this for Elon.

We should keep our pitchforks ready.

It’s a question if our (Idaho’s) Attorney General will still be in his role in a couple years. We all know he wants to be Governor.

But I’m just giving him a heads up here, not that he asked. There’s a lawsuit coming our way. I’m sure he’d be happy to fight this one. The legislature would be too, but they don’t get to go to court. They just write the checks. With our tax dollars.

Back in 2022 the legislature decided WWAMI students should come back to Idaho and practice. This requirement had been instituted by other WWAMI states. The thinking of the legislature, I guess, since no one talked to me about this, was that we, the taxpayers are subsidizing the education that gets these folks going into high paying jobs, so they owe us. And doing some time in the Potato State would pay us back some of our tax dollars.

Idaho is a low doctor state. Actually, we’re the lowest. So, the legislature’s bid to require these high earning professionals to come back here and pay us back, with their work, their taxes makes good sense, doesn’t it?

The bill requires any Idaho WWAMI graduate to come back here and work within a year after completing residency or obtaining a medical license.

This would have been a problem for me ages ago. I was in a three-year family medicine residency in Washington. I had completed my first year, so I applied for a medical license in Idaho. Idaho only required one year of post graduate education (residency) to get a license. I got an Idaho license in my second year of residency and did moonlighting ER shifts in Idaho for extra money.

But I had two more years of required training in the Washington residency. Under the Idaho law, I would have to move to Idaho to start practicing before I could complete my training. Maybe the Board of Education who is supposed to supervise this would grant me the year. As it turned out, I came to Idaho and did my service.

This scheme was not well thought out. But this would just be a minor lawsuit I’m sure AG Labrador could sort through.

Let’s get to the nitty gritty.

Let’s say I’m an Idaho WWAMI graduate who has gone into maternal fetal medicine specialty training after her OB/Gyn residency. She is learning to take care of complicated pregnancies that deal with the life of the fetus, the life of the mother. Some of these care decisions are very iffy.

The baby cannot survive. Should the woman have to carry it to term? If the mother is diabetic and her health is at risk, can she consider this?

Here in Idaho, right now, the woman and the doctor cannot consider these issues. The mother’s future health to have more children, her possible complications cannot be a consideration for terminating a doomed pregnancy.

And that is just what a maternal fetal health specialist is supposed to do.

And our laws are requiring that they come back here to “practice”?

Can you appreciate that OB/Gyn doctors who have to have these patient care conversations are leaving this state? Do you know anyone who has been in this position? I do.

So, AG Labrador, do you want to bird dog this issue to its Supreme Court decision?

Prohibiting women from having this choice might be defensible if you have that sort of perspective.

But requiring a medical professional to return to our state and then telling them they cannot care for women like most civilized cultures do seems a bit over the top. But it would be a fun debate in front of some mostly favorable Supremes, eh?

I am arguing that this is a forthcoming lawsuit AG Labrador should be drooling for. Maybe he wants to stay where he is. Or not.