Posts published in “Schmidt”

So the University of Idaho and the University of Utah have come to an agreement on medical education for Idaho. Maybe the legislative work group was involved, maybe not. This sort of deal is truly back room. It makes you wonder if there was some well-connected financier with a private island and young girls involved. But Idaho is not really in the Epstein Class.

It matters for Idaho taxpayers. It’s our money going down these drains to their powerful cesspools. But the deal is announced and the legislature must now decide.

There are some important questions.

#1. Do you have the vision?

Doing new things requires a clear and directive vision. I saw none of this from our legislative task force. What should the health care for Idaho look like in the future? Just what skills need to be trained and staffed? Who will be the “provider” in the small town or the big city medical center? I saw no plan for this.

#2. Do you have the money?

Doing new things costs money. The Idaho legislature has spent the last five years depleting the revenue stream. Our legislators have given tax breaks to the wealthy and corporations so we now, while our economy booms and population grows, have less tax dollars.

They will cut funding to K12 schools, they will cut funding for health care and prisons. But they will find money for this endeavor? We’ll see.

#3. Do we have the will?

Going a new direction requires fortitude. It will take years of dedicated work to build the relationships, the staff, the commitments from the medical community. Doctors are needed to train doctors. Nurses are needed to train nurses. Doctors and nurses and Physician Assistants have to learn to work together. Training them together is the best way to make this happen.

Nothing in this announced Treasure Valley plan describes this. And the idea that our legislature, who has spent years hating the medical profession, will jump on board, is ludicrous. The legislators who have put their thumb on the scale for medical education are motivated by their own petty grievances. None have a clear vision for the future of Idaho health care. Soon as their pet peeve is dispensed, they will fade. There is no will.

So I have asked my questions. Will the Idaho voters ask theirs?

I doubt medical education is at the front of any Idaho voter’s mind. Most are probably working to pay the rent and get to work in the morning. I have always wondered just why the Idaho legislature even cared.

Old Cece came up with the WAMI program as a band aid. It has worked for a while. Fifty years. Great band aid.

But we now need to move on. We have had a great affiliation with the University of Washington. I am a graduate of their medical school. Indeed, the top graduate going into Family Medicine in 1986. And I have practiced here in Idaho until a couple years ago.

I appreciate that the University of Idaho and the University of Utah have come to some agreement about medical education. But it seems to me they are just shrugging into more of what we’ve always done.

It’s time to do more.

It’s time to look at the big picture of health care in the state of Idaho and start building for our future needs.

We need more information.

We need to know how rural communities serve and struggle.

We need to know just what specialists are necessary to serve our people.

We need to understand the value of medical care; what works and what is waste.

I can’t right now believe our legislature, who represents us, gives a shit. But they represent us, don’t they?

I really wish we all cared.

 

The news and the Idaho Department of Health and Welfare are trumpeting the billion-dollar, five-year grant to our state. This fiasco was shoe-horned into the One Big Beautiful Boondoggle that cut taxes and exploded our debt.

Our federal “Gang of Four” want credit for bringing the dollars home, while they cut Medicaid funding and ballooned our debt. Go ahead, slap them on the back.

Vote for them again. After all, they are Republican and Trump lackeys.

This grant required states to propose projects that would “qualify” in a narrow three-month window. How’s that for thoughtful expenditure of our tax dollars?

The projects had to be sustained beyond the five-year grant period by the state. Do you think the Idaho legislature is going to come up with $200M/year for Idaho healthcare when the grant runs out?

Most of the grant money will be for technology improvements. I have seen this before. Who gets that money? Not local communities. The big tech bros who sat behind Trump at the inaugural catch this effluent downstream. It will just wash through our depleted state.

The ACA (Obamacare for you Republicans) did the same thing. I was working on the IDHW budgets in those years. I asked my analyst (Hey Tater!) what the heck this money was doing. Indeed, it was all Federal money, from our federal income taxes. It was supposed to be moving clinics and hospitals to more electronic medical records. I asked him to look into it. He told me the money was helping. I shrugged and it got appropriated. That was stupid.

I had been through this in real life. I was in the first large clinic in Idaho to adopt electronic medical records. We were on the cutting edge. And we made the investment without any federal or state grants. We spent our own money. Why?

I learned we had different reasons for this investment. I believed that having our medical records in a searchable database we could study our practices and find out the best treatments, the best way to deal with the common problems we saw daily.

My partners had different reasons. We had five people working in our medical records department at the time. They were low wage but had benefits and retirement. After the million-dollar investment we had one medical records employee.

Three years into the “experiment”, long before Obamacare, I proposed leveraging this investment to my partners. Let’s do studies on our data. Let’s find out what our best treatment for a urinary tract infection is. We could find out how we are treating high blood pressure. We could improve our practice.

It was an impassioned speech. The group around the table was quiet. Don’t you want to learn how to treat your patients better, I asked. They were all quiet. I looked at the guy next to me. Don’t you? I asked directly.

He looked up at me, squarely in the eyes, and honestly said, “No.”

The allure of data, analysis, technology in medical care is a sham if there is no commitment from the professionals pulling the levers.

So we need to be asking ourselves some painful questions.

Why does Idaho need more doctors if they are just here to make themselves richer?

Do doctors really improve the health of a community?

What do you people want from healthcare?

We don’t have to answer these tough questions (though we should), but big money is asking and answering them while we pay the taxes, and the taxpayer funded grants go out the door.

The billion-dollar grant to Idaho will go to big tech companies who sell kiosks and apps to connect to a provider. The call you make will go to Islamabad, or more likely AI, and you might get the reassurance you need or not.

Will your community be better off?

I am sorry I shrugged with the ACA money for electronic records. It didn’t cost Idaho taxpayers. But it cost us all. We should be expecting more and getting more for the way too much we pay for this horrible health care system. This needs to change.

 

So the Idaho legislature is in session, and we should all be paying attention. For we elected these clowns. Maybe a clown show is what we want.

I don’t. So allow me some suggestions.

It seems Idaho wants to increase the number of doctors who practice here. The legislature even spent our money so these clowns could get together and consider some recommendations. They say we need 1400 more docs just to be “average”. And they have their $recommendations$.

Allow me, as a retired, worn out, possibly criminal Idaho Family Doc to comment. Do you need my bona fides? The years I worked in our small-town seeing patients in the clinic, delivering babies, covering the ER, taking care of ICU patients and sometimes calling the helicopter? If you do, let me know.

If this interim committee looking into the need for doctors in Idaho might have had lunch with the other interim committee calling themselves “DOGE Idaho” maybe there might have been some synergy. But that’s probably a “woke” concept in our state.

DOGE Idaho has decided it would be best for Idaho to drop Medicaid Expansion coverage. To be honest, I wasn’t surprised. Idaho legislators have had their shorts in a twist ever since Idaho voters told them to quit clowning around.

Idaho voters understood the numbers and the injustice of the “Gap” people in the ACA= Obamacare mess. Some folks can’t qualify for Medicaid, and they can’t go on the exchange to buy insurance. They were in the gap. Idaho voters solved their problem with a righteous and compassionate vote.

So it now costs our Idaho taxpayers about as much as we spend on private school vouchers. 50,000 people get your tax dollars to send their kids to a private school, and 90,000 Idahoans get access to health insurance.

Please allow me to square this circle.

Idaho legislators have driven doctors from this state. These clowns created this mess.

Twice in my weak career I performed what the Idaho legislature now call a criminal act. I did things to cause the delivery of two fetuses I knew would not survive birth. And Idaho legislators call that a crime.

So you want more doctors in this great state? Maybe you should quit calling them criminals for giving care.

You already require all doctors supported in their medical education by Idaho taxpayers to return here and work for four years.

Maybe you should make the schools they send their kids to exemplary.

Maybe you should make this a state doctors want to practice in.

And here’s a hint. It comes from a retired, washed-up old family doc. Doc’s like getting paid for what they do. And you now want to take away that payment?

There are lots of folks with “real” insurance, like all you clowns in the Idaho legislature have at our expense, but insurance is how doctors get paid. Don’t get me started on the stupidity of this ACA/Obamacare system.

But you clowns are considering two stupid things to be spending our taxpayer dollars. You want to cut off payment to doctors and hospitals, and at the same time spend money to bring more doctors to this state. Can’t you see?

Doctors don’t like Medicaid. It pays much less than your gold-plated insurance. But it pays something.

Idaho DOGE should have spent some time on this one. Why do most private insurance companies have >15% overhead and Medicaid and Medicare, the government insurances have overhead costs below 5%? Shouldn’t we be trying to lower overhead costs?

You have been generous. You have allowed me to call my state legislators “clowns” and you have let me get into the weeds of health care policy. I apologize about the clown’s thing. But please, don’t stop thinking about this health care mess we are in. We need to solve it.

 

The Idaho legislature and our Governor have noted the influx of disenfranchised Californians moving into our state. They have heard the boom of the economic growth. And they have asked, as Dorothy did, “Is this Kansas?” And they have said “Yes Dorothy, we are in Kansas.”

The Idaho legislature and our Governor have cut taxes so much we now face a budget deficit while our population grows. I know Governor Little thought this was unwise, but he signed it. Our Republican legislature voted for this whole hog. We will pay. Our population increases and our state funding declines.

Kansas did this. In 2012, the Kansas legislature and Governor Brownback passed huge income tax cuts. The supply side people cheered. Grover Norquist, the pseudo economist who argued he wanted government to be so small he could drown it in a bathtub, was in ecstasy. The Koch Brothers, Texas billionaires who pull Idaho state legislators strings grinned. The Kansas model would prove all their points.

But it didn’t.

Cutting taxes does not make an economy boom. It didn’t for Kansas. They depleted their reserves and struggled to fund schools. Idaho has this on the horizon.

Especially when tax cuts just benefit the wealthy and corporations. Us pogues drive the consumer economy, and we have not gotten these Idaho gifts. We are hurting. But our schools and our roads and our lives will suffer.

So how did the Kansas Experiment work out? Not so great.

Kansas is almost as Republican as Idaho, but Governor Brownback ended up leaving the state to serve as “Ambassador at Large for Religious Freedom”. A Democrat succeeded him in the Governor’s mansion in Topeka.

Idaho would never do that. And we don’t have a Governor’s mansion.

I doubt Brad has international ambassadorial dreams.

He loves Idaho. And he knew these tax cuts were stupid. He said so. But he signed them.

Idaho has seen growth. People love the Treasure Valley. Do they need schools and roads? Maybe they are over 60 and just want a small ranchette. At least they have escaped the liberals in California.

Is this the Idaho Brad Little said he wanted?

No.

He said he wanted this to be a state where the kids born here would find good jobs and want to raise their  families. I can’t think of a higher aspiration. Three of my four daughters are Idaho taxpayers. I love this state too. It’s why this Idaho Democrat voted for him.

I realize such an endorsement might not be welcome. That’s his problem.

But then he signed the ruby slippers tax cuts. And he’s holding back money to balance the budget. That’s his job. But he did sign the bills. We will dip into reserves, so the pain isn’t felt this year, but it’s coming. The budget will be balanced. And we will feel it.

Brad knows state finances better than anyone. And he can see the coming crash. But he signed the bills.

The problem is the Idaho legislature, who we elect from these bizarre districts. Our legislators write these laws.

But then Brad signs them.

We, the voters, need to be seeing this issue. Please study Kansas. They did the experiment. Why do we need to redo it here?

Maybe the problem isn’t with Brad or those clowns in the Capitol. It’s with us. We don’t learn.

Maybe we don’t care about Kansas.

Maybe we’ll just have to learn this lesson here in our beloved state.

We deserve the representation we vote for. And they, no we have brought this upon us. When it comes, look in the mirror and think what you/we could have done different.

For the twister comes.

 

I try to write about healthcare policy in Idaho, but it seems it’s just déjà vu all over again.

It seems Idaho legislators can’t get enough of the boogeyman Medicaid Expansion. Why do we elect these clowns?

We voters studied the complex numbers. We thought it was about giving people a fair shake. We voted to expand Medicaid coverage to the people in the gap. About 100,000 Idahoans could not qualify for Medicaid and could not go to the exchange to purchase health insurance with Federal income tax credits. These folks were in the gap. We saw this as unfair. So we fixed the problem. What are you crazy legislators now thinking? They talk about dropping this coverage.

We could go through all the numbers again.

But numbers don’t persuade some political consultant once told me. Maybe it’s the image.

Conservatives see loser people out there taking their hard-earned money.

Liberals think everybody needs a hand.

Conservatives think the hand up promotes dependence.

Liberals can’t let go of their empathy.

Both you guys are right.

But we need to build a system. And we’re stuck with the laws we have. Nobody seems to want to talk about the messed-up healthcare system we currently have. Or how to make it better.

I do.

The Affordable Health Care Act (Obamacare for you Republicans) tried to use the current (massive) health insurance industry as a tool to get more people insured. Obama mistakenly thought working with the health insurance industry would buy Republican votes. He ran into the “Party of NO”.

The ACA used state-based health insurance exchanges to give folks access to affordable plans. The marketplace was where you were supposed to go to be able to shop for the plan you wanted and could afford.

Let me tell you how brave our former Governor, Butch Otter was to champion this in a Tea Party leaning legislature. But he did it. So Idaho now has Your Health Idaho.

But the first plan had flaws. Folks above 300% of the Federal Poverty level on the exchange got bit in the butt. The subsidy tapered too fast.

And when the subsidy cliff became evident, our current Governor spoke up. I wrote about this a long time ago.

Then old man Biden got elected and congress “fixed” the cliff.

This is what the current government shut down is all about. Should we keep health insurance affordable for all?

Let me simplify the question.

Do you think American citizens should have affordable health care insurance coverage?

I can tell how our Idaho legislators would answer that question.

Please remember, all of you Idaho voters who elect these clowns, you are paying for their gold-plated health insurance on your dime when they are working a ¼ time job. The health insurance benefit our legislators receive is probably worth more than the salary we pay them. But they grouse about extending health insurance to Idaho’s working poor, most of them doing two or three ¼ time jobs. No (current) legislator has opted out of these high dollar benefits we pay for. But they claim the Idaho taxpayer can’t afford to support Medicaid Expansion benefits.

Do you have any sense of fairness? I hope you do. I know they don’t. But you vote for them.

Let’s not skip over the fundamental question.

Should people have basic health insurance?

Idaho just kicked another 12,000 kids off health insurance.

I’m not talking about getting everything you want. I’m talking about a fall off the roof not costing you your home.

Believe me, it would.

It shouldn’t.

We should all have basic health care coverage.

I can’t believe these clowns we elect and pay for their fancy health insurance don’t share this value. Again. It’s here again.