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Posts published in “Schmidt”

Two Patriots Walk Into a Bar

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Alexander Hamilton was waiting for James Madison at the crowded sports bar. He sipped his pint and barely noted the many screens showing the many games. He frowned at the ring his glass had left on the counter, lost in thought.

Madison clapped him on the shoulder. “So, is it your turn or mine, Mr. Hamilton?”

“I suppose it is me, Mr. Madison, since Jay did the last one and yours was prior.”

Madison laughed. “No, Alexander, I meant who was to pay for the ale. Since you have offered, I’ll order two.” He motioned for the ale wench.

“Well aren’t you two a little late for Halloween?” she grinned at them, appreciating the white wigs and knee breeches. “What can I getcha?”

“Two pints of your best ale, ma’am. And see if you can lift this poor man’s spirits.” He again clapped Hamilton’s shoulder.

She frowned, “What is the problem, sweetheart?”

Hamilton sighed deeply. “Alas, I must convince the New Yorkers that the Senate is the proper body to judge impeachment.”

She wiped at Hamilton’s wet ring spot and asked, “So, what have you been watching, CNN or Fox?”

“Madam, I assure you, we have no time for the hunt or fishing. We are trying to save this Constitution we have fought so hard for.” He turned to Jimmy Madison. “So, will this be the 65th?”

Madison mumbled “Thereabouts” and licked his dry lips.

“Oh, I get it!” she burst into laughter. “You guys are acting as if you’re Hamilton and Madison and you are worried over writing those Federalist Papers. What a hoot!” She bustled off for the ale.

Alex and Jimmy leaned toward each other. “How did she know we were Federalists? Don’t Republicans look the same?”

“Oh, forget it. We have work. How do you propose to convince?”

Hamilton adopted his oratorical posture. “The Senate will hold the mantle since it will be the most august body of learned men, sworn to protect the Constitution and defend the Republic. They will be appointed by the legislatures and each state’s properly elected body will only choose men of the highest character, not swayed by self-interest or subject to partisan influence.”

A bearded man with a MAGA hat looked over and laughed. “I sure as hell hope not.” He raised his glass to them. “We need our President defended from those lousy Democrats. They’ve sworn to spit him out ever since he was elected. It’s the Democrats who want to overthrow our duly-elected President. It’s a coup!”

His buddy with a Seahawks T-shirt added, “You guys never heard of the 17th amendment?”

Jim and Alex shook their heads but smiled. “It gives me great comfort to know the Constitution might be so changed, tell me about it.”

“We dumped that legislative election of Senators way back. States couldn’t agree and seats sat vacant. Not to mention the rich guys buying their senate seats.” The two shared a laugh at the patriots.

The ale wench brought the two pints for Madison. “You figured it out yet? I read all those Papers in Law School.” she said with a twinkle, playing along.

Both the patriots laughed at her joke. “Ma’am, the law is no place for a woman. She is best suited for the house.”

“Or the Senate!” she laughed back at them. “You guys are a real hoot. You’ve sure got the costumes and the characters down.” Then she frowned. “Hey, why don’t you get a little relevant here? What would you guys say about universal healthcare or gun rights?”

MAGA hat and Seahawk jeered from the opposite table. “There you go with your Democrat commie talk!”

She smiled at the hecklers and asked, “Can I get you guys a refill?” Then she turned to the patriots and murmured under her breath, “Watch out for these Republicans. Alex, I mean it. Especially that Aaron Burr.” And she tilted her head back with a hearty laugh.
 

Helping out

schmidt

This last week I ran into a guy in clinic that made me thankful for Idaho voters. We were able to help him out. You should know about this. It’s not about politics or policy, just about how we were able to help out a hard-working guy.

He was in his work insulated coveralls since he had gotten in a couple hours on a chilly October morning before his appointment. He’d made an appointment with our clinic since he’d heard we offer a sliding scale fee structure.

About 16 months ago on a job he had been holding a board for a brace and another guy shot a nail into the two by four. The tip of the nail had come through the board and embedded into his left hand. He was able to wiggle his hand off the nail and it hurt like heck, but with a bandage in his glove he kept working. It got real swollen over the next week but never infected so he figured it would be ok. The swelling and pain went down, but over time the wound developed a small lump that kept getting bigger.

It was on his left hand on the thumb side of the junction of the pointer finger knuckle. It would hit on things when he grabbed them and it was now, when I saw it, the size of a marble. It felt really solid, not like a fluid-filled abscess or cyst. His finger moved just fine. He wanted it taken off. I didn’t blame him. I could see how it would get in his way and be a problem.

The trouble was, I am not the right doctor to take that lump off. Hands, especially fingers are tricky to work on. He needed to see an orthopedic doctor, maybe a hand surgeon.

“Do you have health insurance?”

He looked at me blankly, a young healthy working man. “No sir, that’s why I came to you guys (meaning the clinic with the sliding scale fees).”

“Did you file a workman’s comp claim?”

“Naw, I just kept working.”

I explained to him the delicacy of dealing with this part of his body. I could recommend a local orthopedic doctor that might see him for a reduced amount, but I expected the surgery would include hospital or operating room costs; probably thousands of dollars all added up.

The physician assistant was in the room with us looking at the bump. He asked, “Can you wait until January?”

The young man looked at him a bit confused.

“Next week you can sign up for Medicaid here in Idaho and coverage will begin in January. You’ll have health insurance.”

“Heck, I’ve lived with it this long.”

I warned him if it got red or painful or started swelling more he should come back in, but given his situation it was fine to wait.

Idaho voters did the right thing for this guy and their fellow citizens last November when they overwhelmingly passed Proposition 2, Medicaid expansion. The Idaho legislature did the right thing this last session when they were putting on all those waiver sideboards. They mandated that none of their sideboard waiver applications would delay the enrollment of those eligible under the Medicaid expansion initiative. The Idaho Department of Health and Welfare has been doing the right thing for the last ten months and preparing to enroll the newly eligible for Medicaid health insurance.

This isn’t the story of a life saved or a bankruptcy averted. It’s just a small story of how health care can be of service when a bump gets in the way. But it’s also a much bigger story of how we can make decisions to help out our fellow citizens. It made my day.
 

Vending machines

schmidt

Sometimes when you listen to people you hear the way they think. When we have a problem to solve, how we think about it, how we frame it can determine our ability to find a solution.

Many people see government as a vending machine. It’s a mysterious thing that takes our money and gives us back something we expect to be of equal value. If it doesn’t work we cuss it and kick it. If the candy bar is stale or melted, we cuss it and resolve not to put in any more quarters.

Does this image work for you? Should the services we receive from the government we elect equal the money we put into it in taxes levied?
If this is how you think government should work, then just how much is your safety worth? Government cannot ensure safety, but we expect some modicum here in the United States, don’t we? We don’t have roving bands of armed drug-lord-paid para-militaristas shooting up our town centers. Most of us live in relative safety. In fact, we are more likely to harm ourselves than be harmed by others here in Idaho.

What price would you put on justice? Or should justice just be something you get, like a candy bar, when you put enough money into the machine? On a trip to Washington DC I took a picture of the inscription above the columns of the US Supreme Court: Equal Justice Under Law. We here in Idaho are struggling to provide adequate defense for those charged with a crime and unable to afford their defense. Maybe you think they shouldn’t get the candy bar.

Do clean water and clean air have a value? I’ll bet you’d pony up more than a quarter if you didn’t have it. If you do, do you think it just comes for free?

I watch the arguments around public education in our state and the vending machine image sits right up front. If we pay teachers more will the test scores come up? If we make college more affordable will salaries rise? What will I get from this vending machine for my quarter?

Taxes are painful if you think you aren’t getting “your fair share”. I was heartened to find US citizens actually pay their federal income taxes at a pretty high rate; around 86%. And this compliance rate has been consistent for years. We beat most European countries, the UK at 78% and Italy a mere 62%. Are we suckers?

I wonder if this will change much as our faith in our government seems to be eroding. Almost 70% of Americans trusted government before the Vietnam War. Our faith rebounded under Reagan after the Nixon/Carter decline. But we have been below 25% of people who have faith in the government for ten years now. So why do we keep ponying up our quarters to this vending machine in which we have such little faith?

I think it’s because our local governments are doing a good job. We have little faith in Washington DC, but our city water systems and streets keep working. And we know our local mayor or city council. We should anyway.

The vending machine way of thinking can build distrust. One essay I read suggested government should be considered more like a barn raising. We all get together, share our different skills, energies and resources to accomplish something it would take just one of us way too long to accomplish.

So, get out and vote for your city council, your mayor, your fire district candidates. Your vote is just some of the work you can do. Don’t figure they can get this work done without all of us chipping in. Keep your quarters, raise a barn.
 

Don’t take offense

schmidt

In the middle of my career I was given a gift. The nurse I had worked with for a long time told me she would need to be leaving the office at 4PM each day to deal with family issues. She said she could arrange for someone to cover for the last couple hours of the day. I thought about it long and hard and said, OK, I will see my last patient at 4, then with finishing dictation, paperwork and hospital rounds I could be home by 5-530. Prior to this I’d get home by 630-7 on days I wasn’t on call.

But with this new schedule I was able to get home and have dinner with my wife and four daughters most nights. It was a generous gift. It cost me money, but I gained in memories and time with my family.

My oldest daughter was by then in Junior Hi School, the youngest in grade school. It was expected that we all sit around the table, pass the food and have conversation. One prolonged conversation I remember had to do with one daughter reacting to another with the loud declaration, “I am offended that you would say that!” The conversation usually stopped for a while after such a declaration.

As the pattern kept being repeated I intervened. “Taking offense is something you have control over. You are not in control over what comes out of your sister’s mouth. If you want to have a conversation, it’s fine to feel offended, but you cannot expect the person you are conversing with to guess or know what might offend you. Take control of your own offense. Share your feelings if you chose, but when you take offense and react with anger, the conversation is probably over. We can do better.”

You can imagine with school-age daughters this took some practice.

This last week we had our President’s Chief of Staff tell us all to “Get over it!” when reporters questioned him on our president seeking aid from a foreign leader for his own political benefit. In fact, he acknowledged that the president withheld appropriated military aid to incentivize cooperation, though President Trump has declared, “No quid pro quo!”

The Chief of Staff’s “Get over it!” declaration sounded like we, or the reporter might have taken offense at a politically incorrect utterance. Indeed, the Trump for President campaign now has embraced the slogan “Get Over It” with a fund-raising t-shirt.

When a conversation is the goal, it is important to “get over” one’s strong feelings to further understanding. But when one needs to be making judgements about another person’s character or indeed actions, I think of another phrase I ran across in medical residency training. Residents are new medical school graduates. We had four years of medical school and limited patient care and management but now we staffed hospital wards, emergency rooms and clinics under the supervision of teaching attending physicians. The phrase I heard that stuck with me was from good teachers who ultimately would decide whether we residents would graduate to the position of practicing physicians. It was: “Forgive and Remember”. Mistakes occur, some can be severe; forgive those mistakes, but remember them and look for patterns, because some patterns can prove to be fatal for patients when a physician is independently practicing. If these patterns cannot be corrected, the resident should not be graduated.

My interpretation of “Get over it!” was our President’s chief of staff calling for us to either dismiss shaking down a foreign leader as unimportant, or just forget that it might be an illegal bribe.

I understand that many are offended by our President’s demeanor, his tweets, his untruths, his policy decisions and actions. We should “Get Over” our feelings of offense. But we should remember his actions, his cumulative behavior, his abuse of power and then make some judgement about his fitness.
 

Social studies homework

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“You ready?” Blanche called back to Dennis. “C’mon, I want to get to Walmart. Bring your homework, you can do it there.”

Dennis came out in his sweatshirt and ball cap. He grabbed his school backpack as he passed the kitchen table.

On the way into town Blanche asked him, “You know what you’re supposed to do?”

“Yeah, remember, I told you last night. You even had me practice on you.”

“I didn’t know nothing, did I?” Blanche and Dennis laughed.

“No, you didn’t. But at least you didn’t yell at me.”

“So that’s what’s got you worried. Now if you are polite and talk to people straight, not mumble people will be polite to you. Oh, and always remember to smile.”

Dennis still seemed worried. Blanche thought it was a pretty odd homework assignment. She asked, “You know all the answers to them questions?”

He nodded. “I got an “A” on the test.”

Blanche whistled. “Ain’t you something.”

They parked in the Walmart parking lot and the early Saturday shoppers were in full force. “You know,” Blanche offered, “You could offer to help them out with their groceries and ask them the questions then.”

Dennis nodded. Blanche clapped him on his shoulder. “Well, you get at it. I’ll go shopping.”

Blanche went in the doors and Dennis got out his clipboard.

“Excuse me sir, can I ask you some questions? I have a homework assignment.”

The grey-haired man grinned as he slowly pushed his cart into the lot.

“I won’t be getting you in trouble if I help you with your homework, will I?”

“No sir, you see, that’s the assignment, to ask you some questions. It’s for my social studies class.”

“Well you go right ahead.”

Dennis started reading from his clip board, pencil in hand. “Do you live in Latah County?”

“Yup” Dennis checked a box.

“Do you vote?”

“Always” Dennis checked another box.

“Do you know who represents you in the Idaho legislature?”

“That’s a tough one. I think it’s that Risch guy and maybe there’s a new guy, I think it’s Fullmer.”

Dennis frowned and studied his sheet.

“How about who the Governor of Idaho is.”

“Oh, that’s easy, Butch.”

Dennis frowned again, not sure what to write. “Is that his last name?”

“No sonny, it’s Otter, Butch Otter.” The old man grinned. “He’s been for a long time, you know that.”

“OK, thanks. Can I help you with those bags?”

Dennis had a sheet of paper for each interview, so he slid out a new one as he approached the mom with three small kids. She was frowning so he smiled, then she did too. “Can I ask you some questions for my homework?”

“What kind of questions?”

“It’s for social studies.”

“Well, you go ahead.”

She said she didn’t vote but it turned out she knew two out of the three state legislators and three of the four Idaho congressmen. “Hope you get a good grade,” she called to him as she belted in a toddler. “You sure are brave to be out here asking questions.”

“Yes ma’am. Thank you.”

He ran into some folks from Washington so he had to excuse himself. Then he asked the older woman with a near empty cart. He offered to help her and she agreed to answer his questions.

“Oh yes, I vote, always vote straight Democrat.” She smiled absently. She couldn’t name a single representative at the state level or in Congress, but it didn’t bother her a bit. “I don’t read the paper anymore, I just watch the TV. Can you believe that Trump character?” Dennis helped her put the bags in the trunk.

Blanche asked him on the way home, “What did you learn?”

Dennis frowned. He wasn’t sure how he was going to write his report.

“It seems to me some of the folks who vote shouldn’t, and some of the folks who don’t ought to.”
 

When Will Health Care Cost Too Much?

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Most healthy people think about their health insurance about as much as they do their retirement; not much. It’s hard to value something that you don’t use regularly.

But a recent survey showed that the total cost for an employed person’s health care has risen to now be more than $20,000 a year. That includes what the employer pays as well as the individual with deductibles, copays and family premiums. The cost increased 5% this year, is expected to go up 6% next year and has been rising at twice the rate of wage growth for 10 years or more.

Since I hear so few griping about it, I find myself thinking of the frog in a pot slowly brought to a boil. Most of us aren’t jumping out.

Some are. For the first time in 10 years the number of uninsured Americans increased last year, now up to 8.5%. Before the Affordable Care Act, we were at 13.3% uninsured. I can’t blame folks for dropping health insurance when the total annual cost could buy you a pretty good car, or pay for a kid’s college costs.

But will these slow but steady increasing health care costs kill us?

I believe they already are.

Think how plush “Cadillac Health Plans” for well-paid or union workers tie them to a job. They might have an idea of a way to do this work better and want to go off on their own and build a new business. But the costly health insurance for small businesses could scare off an entrepreneur.

I believe the cost of health care is contributing greatly to our stagnating economic growth, but even more to our slow wage growth.

We hit the lowest unemployment on record recently, but wage growth in adjusted dollars, especially for the lower income earners has not changed much since the 1960’s.

But benefits have increased significantly. Wages are being eaten up by health insurance costs.

With a significant amount of our income being siphoned into health care, we ought to all be pretty healthy, huh? Let me remind you, the United States has seen a declining life expectancy for three of the last four years. This is mostly due to the striking rise in accidental overdose deaths and suicides. And we can put a lot of the blame for narcotic overdose deaths square at the feet of our medical industrial complex.

Let’s stop feeding it.

That’s what the Democratic presidential candidates who have lined up behind Bernie for the Medicare for all have in mind. Outlaw private insurance, let government starve the big Pharma, for-profit hospitals. I understand their perspective, I just don’t buy it.

I believe the market place would be much more powerful than a big government program, and would better suit our national character. Let private insurance compete against government plans, the so called “Public Option”. Such a change might be acceptable, though I can’t imagine any Republican voting for anything right now.

What is the Republican plan for this? I’ve heard the “Repeal” chant for eight years, then the “Repeal and Replace” chant for another two, but now I only hear crickets from Republicans; not even a Tweet. Maybe they have found a cool place in the simmering pot.

I don’t think so. I think we are all in this frog stew together. And the sooner we can start talking about realistic solutions, the better off we all will be.

It can start on the state level. There are many promising innovations some states have made in their Medicaid programs. Look at Missouri’s Health Homes for high cost patients. Consider Tennessee’s waiver for Money Follows the Person to move patients out of high cost nursing facilities into community care. Idaho has a similar waiver. Oregon is rolling out Community Accountable Care Organizations that put some of the risk (and reward) at the local level.

It’s time to get to work. Feel the heat.
 

Favors

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It had been a long day for Brad and Teresa touring the noodle factories of Taiwan. He pulled off his cowboy boots in the Presidential Suite in Taipei wanting to take a break before the big dinner tonight. He clicked on the TV, searching for the Vandals game figuring the kickoff was soon. Instead the airwaves were full of the Ukrainian Trump telephone conversation. Brad skipped the Fox News analysis.

“What should I wear tonight?” Teresa called from the walk-in closet.

“The black and gold dress!” Brad yelled, hoping she’d bring good luck to his Alma Mater.

She gave him “the look” and he laughed. “Go Vandals!” he retorted.

They went down the stairs before halftime and the Vandals were ahead so Brad was in good spirits.

“Governor, your table is here.”

They were escorted to the head table in the large banquet hall. Brad took off his jacket and threw it on the back of the chair, his Black and Gold suspenders complementing his wife’s dress.

As the hall filled he chatted with the Taiwan Minister of Economics. The minister asked, “Do you anticipate any tariff issues?”

“Oh, I don’t think our government would want to obstruct the free trade of agricultural commodities with Taiwan.”

The minister frowned. “Taiwan will always be a good trader and Idaho offers good wheat. We have agreed to take more. We are always willing to do favors.”

Brad laughed and clapped his shoulder. “It’s no favor. We grow good wheat. You make good noodles. We all benefit.”

The minister looked down, his frown deeper. “But surely, we can do more.”

Brad swirled his wine glass. “Well, we’ll grow more wheat.” Then he turned away as the Taiwan Minister of Security touched his elbow.

“Governor, I hope the noodle plants were to your satisfaction today. The Vandals are now down by 4 points in the third quarter.”

Brad didn’t skip a beat. “We’ll come back.”

“Maybe so.” The Minister of Security offered with a soft smile. “We have connections everywhere, but we cannot influence football games in Moscow, Idaho.”

Brad looked off, troubled by the news of the Vandal deficit. “We’ll come back.” He said again but distracted.

The Minister of Security cleared his throat and nodded his head to the man next to him who quietly moved away. “Governor, I am here to tell you if you need any favors in your state, we are here to help.”

Brad sipped the Washington Merlot and nodded. “We really appreciate all the wheat you guys buy.” He looked over to where Teresa was chatting with the wife of some Minister of Something. “Can you get your people to like potatoes more?”

The Minister of Security laughed and Brad did too. But as he started to turn away, the minister touched his arm. “We have many resources that could be an advantage to you. We know the political landscape of your state. Your primary election was very close. We study and have information. Let us know if you have any need, any need for any favors.”

Brad bowed toward the minister and the minister bowed back and before they parted he leaned in and added, “The Vandals just scored.”

Teresa gladly introduced Brad to her chatty companion, the wife of the Minister of Political Affairs. After the smiles and chatting Teresa leaned in to Brad and whispered, “Why does she keep asking me if we need any flavors?”

Brad frowned. “Maybe she has some influence on what dessert we get.”

Teresa didn’t give him “the look”, but she gave him the public look. “I think they are trying to tell us something and I just don’t get it.”

Brad nodded.
 

Another waiver

schmidt

We have tipped past the equinox so we are officially in fall season. But the passel of work the Idaho Legislature dropped on the Department of Health and Welfare this last legislative session is churning out another waiver request. So, it’s still Waiver Season.

If you’ve forgotten, after voters approved Prop 2 last November, the Idaho legislature felt the need to fix it. This same legislature which had not studied the options, had not debated any proposals for six years, decided last session they knew better than the voters about how to expand Medicaid eligibility for Idaho residents. So, they got busy passing laws, Governor Little signed them, and so our taxpayer funded agencies are doing the work as directed.

The first waiver request, Idaho Choice, is dead. It got nixed by the Feds because it was going to cost more and provide worse coverage. But since it’s what the Idaho legislature wanted, the Idaho Department of Insurance and DHW did the work of researching it, holding hearings, taking testimony, and submitting the request.

The second waiver “Work Requirements” has finished with public input. All who testified were opposed and over 90% of the 1800 written comments were opposed. It will be submitted to the feds in the coming weeks. It will be approved, then contested in court.

The third waiver now open for public comment is a head scratcher. But that is only if you don’t understand the intent. This third waiver requires all Medicaid participants who want to get family planning care somewhere other than with their designated primary care provider (PCP) to obtain a referral. This is from the same legislative body who bows before the “free market” and salutes school choice. I wonder where the Freedom Foundation is on this one.

The reason I’m scratching my head on this one is because it’s what Idaho Medicaid already does. If you enroll in Medicaid you can choose a PCP or you are assigned to one. That PCP is supposed to “manage and coordinate care”. That means making referrals when the PCP decides she needs some help from a specialist.

So why the direct reference to “family planning” for this statutory referral requirement? Most agree it’s a weak attempt to shunt money away from Planned Parenthood, where some low-income women get their care.
But as I read the waiver, there are no consequences for the PCP if they give the referral, and there are no consequences for the specialist if they provide care without the referral.

A while back a patient came in about his chronic medicines and asked me to give him a referral to a dermatologist. “Why?” I asked.

“Oh, I have these spots.” He held out his hand.

“Those are seborrheic keratoses. They are benign. You will get more as you get older. Do you want me to freeze them off? They, or others will come back. It’s OK just to watch them if they aren’t bothering you.”

“I want to see a dermatologist.”

A month later I get the letter from the dermatologist telling me the patient had seborrheic keratoses and she had frozen them off.

One way to control health care costs is to provide the most appropriate care in the lowest cost setting. If I’m going to have to fight with a patient about referrals, and believe me, it can be a fight, what’s in it for me to get all this ill will? Where’s the leverage?

As far as I know, this is the only statute on the books in Idaho about patient referrals. This sort of bureaucracy does not befit a conservative; but I guess it’s worth it to them if it hurts Planned Parenthood, even a just little bit.

If the legislature wants to get in the business of writing laws to manage health care, I suggest they do a better job. But this waiver isn’t worth arguing over. It’s a dog whistle; don’t bark.
 

Settlement colors

schmidt

Now that Purdue Pharma has filed for bankruptcy, I wonder if Idaho State Attorney General is smiling or wincing. Either way, he’s shown courage and conviction.

Purdue Pharma famously produced Oxycontin, a powerful controlled-release narcotic they marketed as a magic pain reliever that wouldn’t lead to addiction. At least that’s what I remember their well-dressed salesmen saying to me over an expensive catered lunch they provided for all our office staff. But that was in the mid 1990’s. As the body count started to climb in the early 2000’s they toned back their claims.

But this drug made a lot of money for the Sackler family who 100% own Purdue Pharma. The family net worth is estimated to be over $13 Billion. And surprise, surprise, recently discovered documents have shown they have hidden billions of assets in preparation for this planned bankruptcy.

Purdue/Sackler have already settled lawsuits with the federal government and states for hundreds of millions. Indeed, some executives plead guilty to criminal charges in federal court for misleading advertising. But a large group of states, municipalities, even tribal governments have signed onto a much larger suit that is pending.

Idaho AG Lawrence Wasden joined many other states just this last June in suing Purdue Pharma. It’s Wasden’s second dance with the drug company in court. He (representing Idaho) was a co-complainant when Purdue settled in 2007 for $19M.

Wasden isn’t just focused on Purdue. Idaho has filed lawsuits in Federal Court against many other opioid manufacturers.

But now Purdue is declaring bankruptcy. Before they filed Sunday night, they offered to settle with the long list of states and entities suing them. It is interesting who agreed to settle and who didn’t. One analyst painted a map of the states that agreed and who refused. Idaho stands out as the only Red (Republican) state that refused. I can hear the “RINO” howls already echoing against Wasden. It won’t be the first time. But Red- Blue is the wrong way to look at this.

The analyst had some interesting conjecture on the relationships between Republican AGs and a big-time lobbyist for Purdue. It seems Purdue contributed three times as much money to the national Republican AG Association ($680K) as they did the Dem AG Association ($210K). It’s hard for me to believe this colored their decisions.
Fundamentally, either Republican or Democratic, I believe an elected state Attorney General would want to pursue justice for their constituents; color me naive. Maybe the AG’s who settled were just being pragmatic and figuring the pot would be reduced dramatically when the imminent bankruptcy was filed.

So, what was Wasden thinking? His only public comment was that he did not believe the settlement was in the best interests of the people of the State of Idaho. Since we don’t know all the details of the offers, indeed, we probably don’t know where all the money is hidden, it’s hard to second guess his decision. But he didn’t take the easy off ramp. He’s got a lot of work ahead of him.

It’s tempting to look at the bottom line and just see what the dollars would have been if a settlement had been taken compared to the route AG Wasden has steered. “What’s in it for us?” Such thinking is driven by self-interest, not justice.

There is no doubt our state has suffered. Idaho’s accidental overdose death rate has tripled since Oxycontin was rolled out. And there is no doubt some people have profited greatly from that suffering.

I blame Purdue Pharma/ Sackler for misrepresenting their product. I blame my profession for falling for their lies. I blame patients for expecting life to be without pain. But all this blame gives me little sense of where justice lies.