Posts published in “Schmidt”

It was always a question for me when the House would have the guts to actually kill the Medicaid budget. Every year it would sneak though by 5-10 votes. This year, they actually killed it.

Lead by their wise Speaker, Mike Moyle, just over half the House Representatives wished away health insurance for Idahoans in poverty. It’s like spanking your stepson. What is your point? Other than to demonstrate your authority, or maybe your lack of generosity, or maybe your fealty to the Freedom Foundation?

Make no mistake, Medicaid is a Federal/State health insurance program for low-income people. The trouble is, Wayne Hoffman and most Idaho Republicans think these low-income folks don’t deserve health insurance. I can just see their bluster.

“I have health insurance because I work for it!” They thump their proud, inflated chest. Yeah, you have a ¼ time, taxpayer funded job with full medical coverage, also at the taxpayer’s expense. This stepson sees some hypocrisy.

“I voted against the Medicaid budget because we must control the costs!” comes the other cry of outrage. Well, addressing that problem will take more than a simple no vote. Does the average Idaho Republican legislator know that Medicaid annually costs the taxpayer less per enrollee than their plush state health insurance benefit? Does even the best-informed Idaho Republican legislator know the main mechanism used to control Medicaid costs is to pay hospitals and doctors less? When you take your sick legislative runny nose to your doctor, the state Insurance pays that doctor about three times what the poor person’s Medicaid pays. Do you like that method of cost control? Then I can see why you might think a “no” vote would control Medicaid costs.

Controlling health insurance costs is more complicated than motivating a sullen teenage stepson. Slapping either won’t help. It takes a lot more work than that.

Make no mistake, what we are really talking about here is poverty. I can hear Wayne, and his “vote no” minions scream, “No, it’s about preserving the American Way! People should work for what they get!”

I ask you, Wayne, and House “No” voters, do you know anybody on Medicaid? Do they work? If they don’t, I’ll bet it’s because they are a child, pregnant, a young mother, or taking care of someone. All the Medicaid patients I see are working. But, unlike my three elected Representatives, Medicaid workers don’t get Blue Cross health insurance with their part-time or low pay full-time work. Not all employers are as generous as your voters are.

Don’t complain that they are wasting your taxpayer dollars with their ER visits for runny noses. Doctors’ offices refuse to see Medicaid, where the care would be a third of the cost. Medicaid patients often have the ER as their only choice for care. Doctor’s offices refuse because you, fully insured legislator, have budgeted to pay doctors at a third of the price of what your Blue Cross Special plan pays them.

So, the House finally pulled the trigger and killed the multi-billion-dollar Medicaid budget. And what fiscally responsible substitute solution did they then come up with? The new budget looks a lot cheaper for this year, but there will be a $150M supplemental next year. Kick it down the road.

Nothing wrong with a little posturing, I guess. Maybe that’s all it’s about. Stepsons know posturing when they see it.

I’m going to relent here. There is a plan in the works to study “managed care” as a plan for controlling Medicaid costs. If anybody had been paying attention, they’d have seen the weak results many other states have had with this. I give the legislature a C- for the effort. It’s a mystery to me why Medicaid gets the slapped face, when private insurance costs have beat inflation year over year. Who’s driving this bus?

It's pretty clear the Idaho Legislature doesn’t have their hands on the wheel.

 

 

I am struggling with a plumbing problem. No, it’s not my prostate, though you’d be forgiven for assuming such, given my age and decrepitude. It’s a 350# cast iron bathtub. I asked the plumbers if they could install it. They winced and asked if this summer would work. So, I cut the holes and bought the fittings, but the darn thing just won’t hook up. Tomorrow I’m calling the plumbers. I’ll bring them cookies.

Getting professional help should not be shameful. That’s what the Office of Performance Evaluation does for the Idaho legislature and us citizens. We should all read their reports before turning to Netflix. Or maybe late at night when sleep won’t come.

The reports don’t read like romance novels, but they sure captivated me when I first got elected to the legislature. They had a trove of evaluations and recommendations for fixing our state. So, it bothers me that the Idaho Republican legislature is planning to politicize this independent, nonpartisan, award-winning office. They are working just fine. What are they trying to fix? And for what purpose? This move is unwise.

It shouldn’t surprise me. OPE has provided no studies on pornography in libraries or gender reassignment surgery or the deadly MRNA vaccines. These are the issues our Republican legislature wants to pass laws about. Fixing EMS funding, evaluating Medicaid payments and reducing prison recidivism just aren’t red meat.

The proposal is to dismantle the balanced bipartisan Oversight Committee that directs the proposals and instead leave the direction to the Majority run Legislative council. Representative Blanksma successfully got this change through the House. There were only two Republican votes against it. Her arguments were that the Majority legislative leadership can be as unbiased as a balanced bipartisan committee. Sorry, I just don’t believe it. Democrats, if they were in the majority can be just as biased as Republicans. Be careful how you build things.

However, I am pleased to compliment Representative Blanksma for addressing maternal and child health. Her proposal would expand Medicaid health insurance coverage for children up to 205% of the federal poverty level. We are currently one of two states (Idaho and North Dakota) that doesn’t cover kids at this level.

Her proposal also recommends maternal Medicaid coverage be expanded to 12 months after delivery. It currently shuts off at 60 days. We are with 13 other states with such weak support for our moms. Of course, there is a price tag for this. So I can imagine some strong Freedom Foundation opposition.

Blanksma’s bill is sitting in House Health and Welfare Committee, awaiting a public hearing.

Getting advice or recommendations from independent people who study issues in our state is not always welcome nor heeded by our esteemed legislators.

Maybe that’s why the independent Maternal Mortality Review Committee is looking at the axe. This body was established in 2019, with a sunset date of July 2023. The bill to remove the sunset date is also sitting in the House H&W committee.

It’s no wonder they might sunset. They may have delivered some unwelcome news. Maternal deaths have doubled in Idaho since the MMRC was established. Their recommendations were to expand Medicaid coverage for moms to 12 months after delivery. So, Blanksma’s Maternal Child Medicaid Expansion coverage is addressing this recommendation. Good for her. I hope she has as much success getting this health bill through the House as she did with the OPE restructuring.

I know there’s a certain unpopularity about listening to experts. It has been openly expressed in our Idaho legislature. But don’t wait for a cast iron bathtub to convince you. Experience and knowledge are valuable. Wise people don’t shun such advice.

 

Franny was nervous as the ultrasound tech chatted and booted up her machine. The warmed jelly spread over her lower abdomen and the transducer pressed. The screen was facing away, and the technician stopped her friendly chatter.

“What is it?” Franny asked.

“Nothing. I’ll be right back.” And she left the room.

A tall man entered with the technician at his elbow. “What’s wrong?” Franny, now desperate, asked.

“We’re just trying to get better pictures. We don’t want you to worry.” He murmured in a quiet soothing voice.

“Oh, good. I was getting worried. What do you see?”

There was a long bit of silence as the tall man moved the transducer with more force, pressing uncomfortably on her full bladder. He looked up at Franny, then back at the screen and said,” It looks like you have a case of beucephaly.”

“What’s that?”

He paused again. “We can see the heart beating, and the head well formed, but your baby has four legs and a tail.”

“What?”

“It seems you have a horse, maybe a pony growing inside you.”

“Oh,” said Franny. “Will it live?”

He frowned. “We don’t often see cases like this. I recommend you talk with a high-risk pregnancy specialist.”

“Can I see it?”

He spun the monitor screen toward her. The black and white fuzzy screen showed the image of a little, folded up pony. Franny smiled. She had always liked horses.

“Let me see if I can get Dr. Barford to come in. She’s just down the hall.”

Franny listened to the swishing of the heartbeat and studied the image. Some questions were forming as she looked and listened.

The perinatologist came in and introduced herself. She too ran the transducer over Franny’s belly, then wiped off the goo and sat down next to her.

Yes, she confirmed, Franny’s baby was “equine” she said. Meaning, they couldn’t tell yet if it was a horse, or pony, or donkey or mule.

“Will it live?”

These can be very difficult pregnancies, she said frankly, and while it may be born alive, most do not live long after birth. And, she added, the delivery process can be very hard on the mother. Sometimes there is premature labor, sometimes high blood pressure, “eclampsia” she said. And it the fetus survives to term the delivery will need to be by C-section.

“What if I don’t want to keep the pregnancy?” Franny asked. “What if I want it to be over now?”

Here Dr. Barford looked down. Many women might choose that, given this diagnosis, but here in Idaho, that choice is not available to you.

“What?” Franny asked.

No, Dr. Barford explained. Unless you can show a criminal complaint of rape or incest, your pregnancy cannot be terminated, because at this stage it would mean that your um, baby would most surely die.

“But you said it wouldn’t live after birth.”

Yes, but some live for a while. But none have gone on to be full grown horses. Or donkeys. Or any full-grown equine species.

Franny frowned. “Rape or incest? She blushed.

Dr. Barford nodded silently. You would need to show a proper police report.

Franny shook her head. “You mean, I have a pony growing inside me and I have to just carry this pregnancy, even if it means I could get sick, have to have surgery to deliver it, and then it’s going to die before it grows up?”

Dr. Barford nodded. Those are the laws here in Idaho.

Franny heard the swish of the heartbeat from the monitor and remembered the four folded up little legs and the nubbin of the tail. “Has anyone ever had a unicorn?” she asked.

Dr. Barford smiled. I don’t think so. But there’s always a first time.

 

We needed to make a trip to Boise this last week. It was beautiful driving weather for the trip south. But we needed to wait for the wrecked propane taker truck to be cleared from the two-lane road that connects our expansive state. All north south traffic goes through Riggins, the little town at the confluence of the Main Salmon and the Little Salmon Rivers.

But the bomb of 8000 gallons of propane didn’t explode and somehow everything got cleared up so traffic could resume. As we made our way at 25 mph through the hamlet of Riggins, I saw a new billboard on the east of the road. It looked kind of homemade, but I’ll bet there’s some money behind it. Yellow background for what looked like fluorescent blue all cap letters: “Get porn out of Riggins schools”.

Overturned propane tankers stop traffic unless they explode. Porn bombs wreck schools.

I found myself wondering just who would throw this porn bomb. I thought of public figures. Let’s not name any names, but we have the video of a freshman Idaho State Senator at his local school board meeting throwing rhetoric and disruption bombs. So, I get it. Idaho has adopted the bomb throwing model of statesmanship. And who more would want to bomb our public schools than the Idaho Freedom Foundation? Their Washington-based leader (oops, geographic bomb?) Wayne Hoffman is on record exclaiming government should have no role in education. So why not lob a porn bomb at every passing north south transient in Idaho? I doubt Wayne paid for the billboard. But, given the intricacies of the obscure out of state funding funneling into our political cesspool, we’ll probably never know.

So, I drove on past the billboard and kept wondering.

Just what porn should we be getting out of our public schools? Bible verses refer to incest, sodomy, private parts, but we all know the Bible isn’t a threat to our children’s moral compass, is it? There could be folks taking offense at Chaucer’s saucy language in The Canterbury Tales. Maybe that old classic should be eradicated. I think I would have paid better attention in High School English is I’d known there were naughty bits.

I’m sure Walt Whitman’s poetry will get chopped, since he does “Sing the Body Electric”. And Marquez would have to go. Jeez, we’ll only have advertising copy left maybe.

But this porn bomb thrown at our public schools is more a logic bomb. If the Freedom Foundation and its subservient legislators are so bent on blowing up the public school system, what vision do they have for education? Oh, I know their mantra, I’ve heard it forever. Give the money to the parents, they are the best guardians of their children’s education. The market forces unleashed will remake education into the well-oiled machine of industry.

If the billboard’s author lived in Riggins, and if the author was indeed worried about porn in the schools, why didn’t they go to a school board meeting and ask? Why didn’t they run for a school board seat? Why didn’t they use the governance system to address their fears? Bomb throwing, berating people, disrupting boring meetings might just be more fun, huh?

If you want to “send the money to the parents” and you think our education system will be solved, just read Tara Westover’s Idaho story, Educated. Her memoir will open your eyes to the possibilities of parenting models in Idaho.

And that’s where you think taxpayer money should go?

The twisted, convoluted, even pornographic nature of this attempt to porn bomb our public schools lies in the duplicity, the devious nature of the proponents’ actions. Throwing porn bombs is a lot easier that sitting on a school board and trying to serve a community. Is that what you want your kids to learn?

 

Now that we are relaxed about the Covid pandemic, should we grade ourselves on our response? Or do we just want to go “whew!”, wipe our brows and put our noses back to the grindstones?

Well, you’re going to do what you want to do, and I’m going to do what I want to do. Maybe that’s the lesson we have learned from this.

I read a mind-numbing column proudly published in a reputable North Idaho newspaper where the board certified ophthalmologist still argues for Ivermectin. Some docs are going to do what they are going to do. I didn’t learn that during the pandemic. I’ve known that from my first days in medical school. Heath care is not a monolith, just as We the People are not.

And it might just be that trait that I like about people. I respect cowboys. Indeed, I’m a bit of one. I have always bucked the big pharma-driven trends on prescribing medications. But I’m not asking Cowboy Bob for public health advice. And I don’t recommend you look there either.

So, it’s hard to be too critical about Idaho’s response to Covid. Our Covid death rate was near the national average, as was our infection rate and immunization rate. That means about 5000 people died in Idaho from Covid. Keep in mind, Covid started out, when nobody was immunized, before the Omicron variant, with a death rate that killed 1 out of a thousand infected.

So, let’s pat ourselves on the back. Average is good, isn’t it? One thing we have clearly learned is the public is not very good at assessing and responding to risks.

Some of us are. And the data on that is now in. A British Medical Journal study looked at the many counties in the lower 48. (Why do Brits get to grade us Americans?). They compared the Covid death and infection rate to the immunization rates. Counties with high immunization rates reduced their Covid deaths by 81% when compared to counties with low immunization rates. Maybe the immunizations were a good idea. But I’m sure you have your own opinion about that.

One of the reasons to grade our response to a “bad cold” pandemic that killed about a million Americans is because the next one might be a bit rougher.

Have you priced eggs recently? Have you heard of the H5N1 Bird Flu?

Remember that Covid only killed 1/1000? H5N1 rarely infects humans, so far. But when it does, the mortality rate is 56%. That comes to 560 dead of the 1000 infected. That’s 560 times a fatal as Covid.

But we are safe so far from the bird flu, right? It is rapidly transmitted between birds. It is even infecting migratory wild birds now. Penned flocks die like, well, chickens. But they are just birds.

Some animals that prey on or scavenge bird carcasses have become infected. We lost a skunk to it here in Idaho. So, mind your roadkill harvesting.

In the last few months there have been outbreaks in mammals. A mink farm in Spain reported an outbreak. It has not been confirmed but it is suspected the virus spread amongst the animals.

And that’s where the leap occurs. When a virus mutates to infect the upper and lower respiratory tract cells in humans, as Covid did, then we sneeze, we cough, we spread it. And, if the damage the virus does to our bodies stays as virulent as the current H5N1, we will die at a much faster rate than the “bad cold” Covid pandemic.

When you pack the world with as many humans as we have, something is going to get us. And even getting an “A” on your pandemic response report card won’t stop all the deaths. That doesn’t mean we shouldn’t try to do our best.

 

Governor Little proudly proclaimed he had “cut red tape” right after his first inauguration four years ago when he restructured the state entity overlooking all the professions. Maybe he cut more than red tape.

You need to understand this system a bit before I get into a full-blown rant.

There are MANY professions in this state that get their sanction to perform their services from state statute. In my short time in the legislature, it seemed like every year another profession wanted to be “licensed”. The health care professions sector alone includes nurses, doctors, physical therapists, and indeed, ten more. For some reason, midwives and genetic counsellors aren’t included in the “health professions”, but instead with the “occupational licenses”, along with another dozen professions, including Outfitters and Guides. This reorganization was supposed to streamline the licensing process.

You might find yourself questioning why the state even gets involved in this licensing process. I know the Freedom Foundation does. Libertarians think any restriction on “free trade” just drives up costs. Does a license somehow ensure the professional you engage provides quality services? We have all followed how a licensed physician, trained to do laboratory tests provided telehealth primary care during the pandemic. And we’ve seen how the Idaho Board of Medicine dismissed complaints, seemingly without investigating them. So, don’t let that $200 annual license fee I pay convince you of the quality of my care.

So, Idaho could just go all cowboy and just let the public beware. There’d sure be less red tape.

But cutting red tape might also mean there’s less folks to answer the phones when there’s a problem.

Let me tell you about a problem. The clinic I work in has tried to hire nurses. Let me tell you, nurses are getting hard to come by. Moreover, the interview process can be long, the background checks take time, but here’s the final delay. Idaho licensure requires nurses to submit fingerprints.

I remember having to submit fingerprints when I got an Idaho medical license. I had to wipe off the embedded grease from cranking my Model T. For some reason back then I didn’t question the need for such a hoop to jump through. Maybe I was numbed by all the premed hoops (physics, organic chem) and medical school hoops (short white coats and board exams) and residency hoops (no sleep).

National nursing organizations support the requirement for fingerprints. Only six states don’t require them. A lot of people seem to think, including Idaho, I guess, it makes sense. Along with the requirement is an FBI background check for past crimes. I’m sure you are comforted that the nurse putting in your urinary catheter has no armed robbery convictions. Maybe not.

Here’s my gripe. Thanks for waiting this long. Both the nurses my clinic hired have had to postpone their start dates a month waiting for their fingerprints to be approved. They have had to submit multiple samples, all at added cost, and always a dely.

I tried to call the Idaho Board of Nursing to ask what the problem was. I got two phone numbers. Both went to voicemail. Neither called me back.

There, you’ve listened to my rant. I apologize. Maybe it got you thinking if we really need this whole licensure thing. I have very strongly mixed feelings about it. If Idaho government is going to give a profession the ability to restrict practice in the marketplace, citizens deserve some confidence in the quality of that state sanctioned profession.

And if the state is going to continue expecting professionals to jump through these licensure hoops, they should be timely. I’m not asking for more red tape. Just someone to answer the phone.

 

When it’s hard to give praise, it should be worth more. This is going to be very hard for me to offer. It shouldn’t be. When ideas are the subject, not behavior or intentions, we should look squarely at the ideas and consider praise or rejection. That’s not hard, is it?

So, I want to praise a bill in the Idaho legislature offered up by Representative Heather Scott. I don’t want to praise Heather when she wraps herself in the Stars and Bars or her disruptive tendencies in the Idaho House. I just want to offer my support to a simple bill she has introduced.

House Bill 20 adds a misdemeanor criminal penalty to bad faith reporting of child abuse, neglect, or abandonment.

Why is such a penalty needed? Shouldn’t we protect anybody who is trying to prevent or report child abuse? Here’s where we get into the real world. The laws we write should have a clear awareness of the real world.

We see so many ideas floated in the swirling pot of the Idaho legislature that are just dog whistle attempts to protect us from the boogey man. I could list them, but I’m sure we would not agree on the real-world threats we face. Your fear of Sharia Law might be as great as my concern about ground water.

But I digress. I must move forward with the real-world reason this law makes sense.

For many years I served on my county Multidisciplinary Task Force for the Prevention of Child Abuse. Every county in the state is supposed to have one. I got chosen to participate because the law that established these groups called for a member of the healthcare community to serve. At the time, I was the county coroner. I was also a practicing family physician. So, I went to these monthly meetings on my lunch hour. They agreed to meet at that time so I wouldn’t have to miss clinic time. Every other person on this task force was a state, county, or city employee, not a private businessman. Doctors are businessmen. Time out of clinic is lost income.

We would start each meeting by reviewing the month’s list of Child Protective Services referrals. We, as a task force were charged to make sure proper handling of these cases was being done.

There were usually twenty or thirty, maybe up to forty referrals in our little county. They were graded by risk to the child, high to low. Each month there would be just one or two high risk situations. The vast majority of the referrals were found to be either low risk, unfounded, or even false.

It was not uncommon for there to be disputed custody, an acrimonious divorce and custody battle going on. One parent might make an allegation against the other and, through investigation CPS could determine the allegation was sometimes false, sometimes unfounded, and sometimes offered in bad faith to try to influence the court.

False claims take up time and effort. Bad faith claims are an attempt to use the power of the state for malicious purposes. It is quite fair that there should be consequences for such bad behavior. Thank you to Representative Scott for putting this forward.

I wish all people behaved with integrity. I want to believe most people do. But I live in the real world, so I know this is not always true. I take cash when I sell on Craigslist. I count the bills before the buyer leaves. And I give cash when I buy.

It is only fair that the laws we write express such expectation of integrity. And it is only fair that bad faith actions have consequences.

 

Our founders thought some freedoms should be in our Constitution. They couldn’t agree on all of them, so they became the first ten amendments. amendments. The Bill of Rights was passed after the Constitution was ratified. These first ten amendments had the effect of limiting how government could impose itself on a citizen.

The Idaho legislature has worked hard for many years to define freedoms for “the unborn”, so now we have a real mess of conflicting laws saying abortion is illegal. I doubt they will get to work cleaning up any of these conflicts this session, but I wonder, given the recent events in my town, whether any legislator would consider protecting us against unwarranted searches.

By the way, if you didn’t know, I live in Moscow, Idaho. Yeah, we’ve been in the news a bit lately.

The Fourth Amendment protects us from “unreasonable search” and specifies that warrants for searches shall specify probable cause. The courts describe the details, and they are being redefined as the world changes.

No founder knew about DNA. But we have a case in our town that just might pivot on such evidence.

Some states have decided to weigh in on their interpretation of this freedom. Idaho should too. Clarity for the investigating agencies helps convictions stick when the rules are followed. Otherwise, convictions can become lake house payments for appellant lawyers.

Defining this freedom for modern times would take some careful consideration and study. DNA databases are often proprietary. And these private companies can and do develop their own rules for how their information can be used. But they can also be bought and sold. And with these transactions, their assets, their DNA databases, are transferred.

Think about it. You sign on to get some genealogical information. Maybe you read the long legal document before you give them your credit card info. You don’t plan on committing any major crimes soon, so you figure it’s just for the lawyers to argue about.

But your information can also tell an investigator about your relatives. The DNA they got from a crime scene might suggest some relation of yours. That relative didn’t give permission. You may not know your crazy uncle really was crazy, maybe homicidal. But you just fingered him. Maybe you’re alright with that use of that information. Uncle Charlie might not be. And if he has good lawyers we’re now on shifting sands.

I would challenge the Idaho legislature to consider this work. Indeed, given their embrace of freedom, I would hope the Idaho Freedom Foundation would get on board. Maybe they have, I don’t know.

I have no idea if any legislators are considering this. Given their track records, I bet they are just waiting for some “model legislation” from ALEC. That’s too bad. I believe we here in Idaho have some thinking and some work to do.

We want crimes solved. We want to feel safe in our communities. Given the crowds down at the pool hall last week, I’d say the students have returned here to our college town from their Christmas break and feel pretty safe. But there is a long road ahead for trial and conviction. Maybe just seeing a suspect in orange coveralls makes people feel safe.

Defining the legal limits of DNA database searches will help law enforcement know how to search. Further, it should protect us from unwarranted searches by our government. Balancing this is the work our legislators should be doing. I want our system of justice to serve us all.

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