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Is Idaho Donald Trump’s kind of place?

We now have a pretty clear idea of who all the major contenders for president will be in 2016: At this point all or nearly all have announced. (The New York Times declared the field unofficially closed after the announcement last week of Ohio Governor John Kasich.)

So who’s the Republican now most likely to pick up support in the Gem State?

The last couple of nomination contests weren’t good normal case studies, because Mitt Romney had unusually strongly connections to the Idaho area, between his ties to Utah and his Mormon religion, which he has in common with about a third of Idahoans, the bulk of that third being Republican.

Romney aside, the hearts of many Idaho Republicans seem traditionally to go toward insurgent and anti-establishment contenders, and candidates who match up with the Idaho self-image.

The biggest share of those Idaho Republicans who didn’t back Romney in the nomination fight in 2012 went for Ron Paul, whose candidacy was an irritant to much of the establishment. In 2000, there wasn’t really an insurgent candidate. George W. Bush got much of the state’s support and was the big favorite nationally from early on, but there was a significant base for Alan Keyes as well. In 1996, Pat Buchanan was the closest thing around to an insurgent anti-establishing candidate, but he never organized substantially in Idaho, and never picked up a lot of national traction.

When Ronald Reagan, still probably as popular in Idaho as he ever was, got his start, he was an insurgent candidate, running from a long-shot mode in 1968 and as a serious but definitely outsider challenger to a sitting president in 1976. And Reagan won that 1976 Idaho primary hugely, with 74.3% of the vote, his best vote anywhere in the country that year. A lot of the affection for him in Idaho built from that time, from his role not as a front runner or incumbent but as a challenger to powers that be.

Also liked: Challenger to powers that be who are dismissed by them. People like Helen Chenoweth and Sarah Palin picked up a lot of traction in Idaho in no small part for that reason. Their backers might call it being unafraid to speak the truth, their critics might call it speaking foolishness, but in Idaho you’ll find enough voters in the first camp to form a significant base.

Does Donald Trump fit into that mold? Or does someone else do so better?

Reagan had been a governor, but many of the people who like Trump say that much of what they like about him is that he’s an outsider, so presumably someone who hasn’t been a governor or a senator might have some particular appeal. They also like the idea that he “can’t be bought,” that he’s independently wealthy enough that he could do as he chooses. These concepts would have some resonance in the Idaho Republican electorate. Across that very large Republican field of candidates, only three, Trump, Ben Carson and Carly Fiorina, have not been either a governor or a senator. And Carson and Fiorina are not top-rank contenders, at least at present.

And this time there aren’t any Republican candidates who touch the self-identity chords in Idaho the way Reagan, George W. Bush or Mitt Romney did.

Might Idaho be Trump territory? Could be, if The Donald lasts in his campaigning hothouse long enough to get to next year’s Idaho primary.

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Idaho Idaho column Stapilus

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Being neither a medical nor a legal professional, I’m wary of stepping too far into this intersection of the two arenas. But there’s a large public policy question here worth your, as well as my, consideration.

On July 7 the Idaho Supreme Court decided Sohar Chavez v. Kevin Stokes, a worker compensation case. Chavez worked as an irrigator for Stokes on a farm near Payette; one day in September 2012 his pinky finger was caught and mangled in a piece of machinery. Stokes wasn’t insured for workers compensation but paid without dispute Chavez’ various medical expenses – except one.

After the accident happened, Chavez drove himself to the home of a Payette area law officer, where paramedics tried to treat him. Someone – apparently a paramedic – made the decision to call for the Life Flight helicopter, which flew him to the St. Alphonsus hospital in Boise. A few days later Life Flight issued a bill for $21,201. Stokes paid all the other expenses, but argued that the Life Flight, or at least its cost, was not necessary or reasonable.

The dispute over this has lasted a long time. About a year after the accident a referee was called in, and sought an independent doctor’s opinion. The doctor said the injury to the finger (which was serious enough that it was amputated at St. Alphonsus) was serious but it “was not in any way, shape or form, life critical. For that reason I do not understand why Life Flight was called or addressed in the first place, and why the case was not taken to Holy Rosary. Indeed, it is extremely reasonable that the patient would be taken physically to Holy Rosary Hospital. Had there been an incident which may in some way benefited from a vascular reconstruction, then the patient could be transferred to St. Alphonsus or St. Luke’s. Indeed, this was in no way necessary.”

The Holy Rosary Medical Center at Ontario is a substantial general-purpose hospital located about four to five miles from Payette, and could have been reached in a few minutes. St. Alphonsus in Boise was about an hour away by car, less by helicopter but still a longer trip even by air than to Holy Rosary. The referee concluded that the medical work could have been done properly at Ontario.

There are specific rules and guidelines in Idaho (as elsewhere) covering when a medical procedure is “reasonable,” and in this case the court applied some of those rules and partly reversed an earlier ruling. Overall, the unanimous court said, “We recognize that the Life Flight transport may be seen as arguably unnecessary with the benefit of hindsight, but the evidence nonetheless supports the Commission’s finding that the Life Flight transport was reasonable medical treatment at the time of Chavez’s injury.”

So, the conclusion was that the $21,201 less-than-an-hour helicopter flight was deemed a legitimate medical expense, and had to be paid by Stokes.

As the court’s language suggests, hindsight is easier than real-time emergency action.

Could the same result have been obtained for $21,201 less? It would seem so.

The answers aren’t completely settled and obvious in this area. The question of what was the right thing to do in this case was answered in different ways by various professionals. But the case of Chavez v. Stokes shines a light on why getting a handle on our medical expenses has been so hard, and on some of the discussions we’re going to have to have if we ever hope to bring them under some rational control.

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Idaho Idaho column Stapilus

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

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

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

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

Is everyone properly shocked . . . ?

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

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

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

No one really knows.

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

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

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Idaho Idaho column Stapilus

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As the seemingly endless chatter about how “sovereign” Idaho is continues, and another anniversary of statehood approaches, let’s look back on how it looked leading up to the moment of statehood.

You could say that Territorial Delegate Fred T. Dubois’ wire back to Boise, upon approval, to “Turn the Eagle loose!”, was more emblematic of his emotions than of what he had experienced along the way.

Idaho territory had already gone through, and narrowly evaded, a number of proposals to break it up and combine it with other jurisdictions. Idaho activists wanted to establish some legitimacy for their request, so they called for a constitutional convention to write a state constitution – which met, and drafted the constitution (albeit amended) Idaho still has. The convention had no legal authority to meet,not only because – unlike the four previous states to be admitted – Congress had not approved any such convention but also because the territorial legislature hadn’t done so either.

The convention did take care to say, in the third section of the first article, that “The state of Idaho is an inseparable part of the American Union, and the Constitution of the United States is the supreme law of the land.”

The legitimacy of the convention was only a minor problem in Congress, where a resolution approving statehood had to pass both the House and Senate. Democrats, though in the minority, were not eager to admit Idaho, since that would mean yet another Republican state (as everyone knew Idaho would be), especially after recently admitting the Republican Dakotas, Montana and Washington (as it was then).

The Idaho bills – more than one of them – reached consideration point early in 1890, at a critical juncture. Congress’ action was sure to turn on a case before the U.S. Supreme Court, Davis v. Beason. Samuel Davis was a Mormon who had voted after taking the “test oath” – a territorial law requirement that the voter not adhere to certain principles of the Church of Jesus Christ of Latter Day Saints – and was charged and convicted of perjury. Davis’ case before the Supreme Court was based on the idea that the test oath was unconstitutional.

Dubois, the Idaho territorial delegation who spearheaded the statehood effort, wrote to an ally in Idaho that “If their decision is adverse, of course we are done . . . I shall not ask for statehood unless we can keep the Mormons out of our politics.”

When the Supreme Court ruled against Davis, in favor of the Test Oath, the bills began to move through Congress, but amid raucous debate, a lot of it having to do with Mormons. Then a fierce debate erupted over “free silver” (a coinage question that would become much more intense in the coming decade). After anti-climactic floor votes, the admission bill was signed by President Benjamin Harrison on July 3.

Conditions were attached. For example, 3.5 million acres of the new state specifically were set aside to be used as an education endowment, and the use of them was closely regulated. The subject of how to use those Idaho lands has been back in Congress from time to time, notably in 1998 when then-Representative Mike Crapo proposed a loosening of the rules.

If it’s an immaculate sovereign conception anyone is looking for, Idaho’s isn’t it.

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Try drawing a straight line through the results in the school-related election results from this week, and where it seems to land is on a season of education discontent in Idaho.

You might run into trouble trying to get a lot more specific than that – the discontent appears to bounce in several directions. But indicators of discontent were all over in last Tuesday’s elections.

As usual this time of year, a bunch of levy and bond issues were on the ballot, and as usual a good many (a lot of those supplemental levies that just maintain existing operations) passed.

But voter turnout was low (it seemed generally lower than last year) and overall support for incumbent positions seemed down. Even, for that matter, some proposals for money-saving improvements.

This year the biggest proposal, a $56.1 million bond at Idaho Falls failed, though barely. That amount alone was triple the total amount of all the school issues that passed.

A batch of school board elections wound up with striking sometimes unconventional results. In the largest school district in Idaho, West Ada, two of the three seats up for election went to outsiders. Julie Madsen, a physician, took out a board member who had served 13 years. And maybe the most interesting winner of the night was the other newcomer there, Russell Joki, a former Nampa school superintendent (and failed 2013 Meridian City Council candidate) who for years pursued a legal case against school districts charging fees to students. “School districts should not be charging fees for any part of the locally approved, endorsed, or sanctioned educational experience offered to students,” he wrote in a 2013 opinion piece. What will he do about that now as a board member?

In Caldwell, where all three board seats were decided by extremely small margins, a local tempest developed when a challenger, former Democratic legislative candidate Travis Manning, defeated an incumbent. Some area conservatives argued he should be disqualified: He’s a teacher in a neighboring school district, and associated with the teacher’s union. But Manning’s politics may have a lot to do with it too, and the dynamics of the Caldwell board may change a bit with his arrival.

Then there was the case in southeast Idaho of two small districts, North Gem and Grace (in Caribou County), which were proposed for consolidation. It would seem to make perfect sense. The districts have small populations and school attendance and a limited tax base. On top of that building renovations (especially a century-old school at Bancroft) and other costs have been pressuring taxpayers, something a merger might ease. But the voters, after seeing a good deal of local divisiveness on the question, rejected it, which means they’ll soon be faced with several difficult and expensive bond issues.

The Idaho Legislature’s actions on schools this year may have been a side factor in some of this. The legislature funded schools a little more amply than in most recent years, and that could have affected some attitudes locally.

But the common thread, in so many places, of boat-rocking is hard to miss. A fair number of voters seems to have decided they’re not happy; what they haven’t yet concluded, evidently, is what to do about it.

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Idaho Idaho column Stapilus

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Now that the presidential contest has begun to fill out, some of the probabilities for Idaho’s role are filling in, though one big element remains a vast mystery.

Least mysterious is the end result next year: No matter who the Republican or Democratic party nominate for president, Idaho’s four electoral votes are a near slam dunk to go to the Republican. That much is about as certain as anything can be in Idaho politics.

The next highest probability is that Idaho’s Democrats will wind up supporting Hillary Clinton for their party’s nomination. That shouldn’t necessarily seem like a given if you recall what happened in 2008: A weak Clinton organization in Idaho was swamped by a thoroughly-organized Barack Obama crew which drew huge numbers to party caucuses and around 14,000 people to hear their candidate campaign at Boise.

One of Clinton’s big mistakes in 2008 was bypassing the smaller, and mostly Republican, states along the way to the nomination. These states contribute delegates too, and states like Idaho allowed Obama to rack up delegate totals ahead of Clinton’s, allowing him to win the nomination nationally not by knockout but by steady accretion. Several news reports indicate the Clinton campaign has learned from that experience and will not be ignoring the Idahos around the country. Clinton forces already are on the ground, and you can expect her to have most of the Idaho organization – all she needs to secure Idaho’s delegates, at least – locked down and in place by Labor Day. By the time any other contenders (Bernie Sanders or Martin O’Malley, for example) arrive, they may find not many resources left for them.

So much for the readily foreseeable. Now the harder question: Who will Idaho Republicans like for president?

In most past years, the answer was easy. Idaho Republicans absolutely loved Ronald Reagan, and in the last two contests their clear preference was for Mitt Romney. A laundry list of reasons for those preferences was obvious then and now. While the Republican nominee, whoever it is, will almost certainly get the state’s support in November, it’s less clear who they will prefer within this large and still-growing Republican field.

Last week, the Idaho Politics Weekly poll asked this question (it was unclear whether Republicans only were polled), and no one topped 13%. That percentage was held by the two prospects with family ties to previous Republican presidential candidates who did well in Idaho: Jeb Bush, brother of George W. and son of George H.W., and Rand Paul, son of Ron, who picked up a lot of northern Idaho support in 2012 and 2008. Scott Walker, nationally the hot Republican flavor this month, was third with eight percent, and others including Marco Rubio, Ted Cruz, Chris Cristie and Ben Carson were well below that. Note too that the Bush and Paul early advantage doubtless comes in part because of the historical connections; they have yet to solidify such limited Idaho backing as they have on their own.

Where will Idaho’s preferences go? My guess at the moment would center on Rand Paul, partly because of the affection in many quarters for his father, and partly because there’s a certain type of rebellious streak in him that evokes the sense of an anti-establishment candidate like those who often appeal to Idaho Republican voters. But that sort of aura is fragile, and it could fade in the months to come. A second possibility, if he catches on enough nationally, might be Mike Huckabee. Marco Rubio will get to make a pitch when he speaks to a state Republican event this summer.

But really, Idaho’s Republican voters may be very much up for grabs.

Republican candidates did not ignore Idaho voters, in the fight for the nomination, in 2012; most of the major contenders campaigned in the Gem State. Don’t be surprised if that happens again.

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Idaho Idaho column Stapilus

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The View
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Just a few thoughts this evening – more tomorrow – in looking at the Northwest results. (As is our wont, we’ll leave most of the national commentary to other places.)

Talking to a caller early today, I remarked that I didn’t see many surprises and didn’t expect a lot of change in Northwest politics. With most of the results in, I see no need to change that. While control of the U.S. Senate will change some pictures for the Senate delegation, the in-Northwest political scene changed remarkably little.

Every incumbent member of Congress in the Northwest was re-elected, and not only that, re-elected easily, mostly in landslides, Democrats and Republicans alike.

The two governors up for elections, Democrat John Kitzhaber of Oregon and Republican Butch Otter of Idaho, both under heavily assault in this campaign, won re-election, to a fourth and third term respectively.

The most interesting of the congressional races, in Washington’s 4th district, pitted two Republicans against each other, Tea Party activist Clint Didier against the more mainstream former legislator Dan Newhouse. Newhouse, who had the endorsement of the incumbent (Doc Hastings), won, narrowly, tempering the tone of the state’s House delegation a smidge.

Washington’s legislature looks likely to be split again in the term ahead – the key indicators being the Tim Sheldon and Mark Miloscia – but at least one ballot issue showed no turn away from left-activism by the electorate: The decisive win in favor of expanding background checks for gun purchases. And you can match that up against Oregon’s vote in fabor of joining Washington (and Colorado) in the crop of states seeking to legalize marijuana, keeping the issue from remaining a two-state experiment.

A surprising number of Idaho Democrats pulled together scenarios for possible Democratic wins, up to and including the governorship. My take, on radio and elsewhere, was that Democrats had a small edge to win the superintendent of public instruction job, weren’t favored but could come close for secretary of state, and would be unlikely to win elsewhere among major offices. Some horn tooting, then: Democrat Jana Jones may have won for superintendent (just as this is written, the vote is a dead heat – we’ll know more later), Democrat Holli Woodings has a decent percentage but still is losing for secretary, and no other Democrats were coming close.

My call, though, for most significant Idaho election of the night – assuming that later returns uphold the early – is in a House seat in District 15, a west-Boise district held easily for decades by Republicans, but essential to a breakthrough into the suburbs if Democrats are ever going to gain significantly in Idaho. Those early results showed Democrat Steve Berch, who has run for the House twice before (two years ago in this district) defeating well-established incumbent Republican Lynn Luker. The other two incumbent Republicans in 15 also were on the razor’s edge, and could go either way tomorrow. A decade from now, these votes in District 15 may be seen as the most significant event – as regards change – in this election year in Idaho. [UPDATE: Late results did change the totals significantly in the District 15 races, giving the three Republicans there wins; so this year was not the year it turned. But the district still is showing itself as closely competitive, and a Democratic win there in an upcoming cycle clearly is not out of reach.]

But in the main, and for the next couple of years . . . for all the discontent that seems to be out there, people in the Northwest mostly voted for more of the same.

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The View
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While such factors as immigration and Democratic crossover may have slightly padded the stunning Tuesday primary loss by House Majority Leader Eric Cantor, some of the most careful analysis of the loss seems to point to something else: The feeling that Cantor had lost touch with his district.

There was the sense that he wasn’t back home much, that he was always on the tube or in DC, and that when he did show up he was surrounded by a heavily armed security detail. How would an average citizen get a word with him?

Compare that to standard practice in, say, Oregon, where elected officials routinely visit back home and are quite accessible when they do.

But then, the idea of rising a little too high in Washington and losing that local connection is not a strange concept in the Northwest. Decades ago, Oregon Representative Al Ullman had risen to a position of real power in the House only to be taken out back home when people saw he wasn’t getting back to the district very often. In 1994, people in eastern Washington had some of the same view – probably with less justification – about Tom Foley, then the House speaker. And he too lost.

As it happens, the current Republican representatives in each of those same districts, Cathy McMorris Rodgers in Washington and Greg Walden in Oregon, are in House leadership right now, albeit at a lower and less visible level than Foley – or Cantor. Either of them might be a plausible contender for Cantor’s leadership post, from which he is planning to resign this summer.

Indications are that they aren’t going for it. Walden hasn’t had a lot to say about the situation, and McMorris Rodgers seems to have swept aside the idea of what’s now looking like a crowded race for the number two job in the House.

They may be wise to take that attitude. Both have what look like secure seats at conditions stand. But sometimes the risk increases as you fly closer to the sun, and they may be well aware of that.

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The View
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If James Kelly and Brett Wilcox succeed in getting their top-two primary proposal on to the ballot, I sure wouldn’t bet against it passing. (See the Oregonian article out today on this.)

Part of the reason is that anyone who isn’t a registered Republican or Democrat automatically would have a reason to vote for it: It would give them meaningful entre into a bunch of primary races they’re now closed off from. And while 20 years ago the number of non-major party registered voters in Oregon was roughly about half the number of Republican or of Democrats, they’re now more numerous than Republicans and not far off from Democrats.

(I’ll admit to some bias here, being a longtime shut-out NAV registrant. I know I could register opportunistically to vote in either party’s primary and then switch back, but that sort of thing just doesn’t feel very honest to me.)

That’s a huge voting block of about a third of the electorate.

Plenty of major party members likely would be in favor too, though. Both parties would have increased opportunities in legislative districts and in other venues where they currently have no realistic chance of winning; general elections have no real significance in most of the state. Moreover, a larger variety of people from both parties could wind up serving, expanding the tents on both sides.

You don’t even get the sense that many of the top elected officials in place now necessarily would be much opposed to the idea.

And while the idea hasn’t exactly wonderfully reformed politics in Washington and California, it hasn’t hurt, either, and people seem happy enough with it.

This could happen.

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