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Posts published in January 2019

Who does he work for?


If you had a really smart employee, who indeed worked hard, but refused to do the work you had assigned; what would you do?

Idaho State Representative Joe Palmer serves the 20th legislative District, a densely populated area in west Ada County south of Eagle, north of the Interstate, that is mostly Meridian. He has served five terms, ten years, and risen to a committee chairmanship.

He has refused to do his job when asked by the governor and directed by the Speaker of the House, even when commanded by statute. But he doesn’t work for them; the voters of District 20 keep him in office.

Governor Otter asked the legislature to study Idaho’s religious shield laws in 2015. These laws protect parents from being charged with neglect should their child die from a treatable illness if they withhold treatment for religious reasons. An estimated 2-3 die annually in Idaho from this neglect. Representative Palmer was appointed as co-chair of this group. One meeting was held with good testimony about a very difficult subject. Palmer refused to call another meeting or offer any recommendations. Yes, it was a tough assignment, but children in Idaho are still dying from parental neglect of curable illness. His constituents must support this.

Representative Palmer has shirked his duty in Idaho law, despite his oath to uphold Idaho laws. The gas tax and registration bill from 2015 hiked fees and taxes to pay for road maintenance, but did not address the difference that big trucks pay compared to smaller vehicles. The premise of Idaho highway funding is that of a “user fee”: we are all supposed to pay for the wear and tear we cause on the roads we use. Analysis shows big trucks pay less than the wear and tear they cause, and cars pay more. The 2015 Highway bill directed the legislature to study this and make recommendations. Palmer, chairman of the House Transportation Committee, has refused to meet for the past three years, despite the law calling on him. He has been quoted as saying “any tax put on big trucks will just be passed on to consumers”, which is true. But Joe, if you don’t believe highway funding should be based on a user fee principle, please, Joe, what principle would you propose?

No doubt, his district loves him. He got over 80% of the votes in the last election. The vote totals might just reflect his deeply republican district, since the other two republican district representatives were unopposed. So, he knows he ain’t going to be fired by his boss, the voters. I always wondered how my constituents knew what work I was doing in the Capitol. Maybe Representative Palmer’s constituents are happy with his nonaction. I’ll bet they don’t even know he represents them in Boise.

But all Idaho Representatives, regardless of political affiliation answer to the Speaker of the House. Why hasn’t Speaker Bedke let Palmer know he’s shirking his duty? Palmer was a childhood friend of Representative Mike Moyle, Majority Leader of the House. Are we just good old boys in the Idaho House?

Representative Palmer is a bright man, but I suspect he avoids tough issues. We all do this too much. If Idaho wants to lose the taint of cronyism, we are going to have to step up and have some hard conversations. Facing difficult issues is hard work. Elected officials are going to have to expect hard work of themselves and each other. Voters should expect as much too.

Still charging lightweights


Despite claims that Idaho law prevented Ada County Highway District from charging fees on vehicles in excess of 8,000 lbs., the GUARDIAN learned Monday ACHD has dropped all efforts to seek legislation that would correct the omission of heavyweights.
Senate majority leader Chuck Winder told the GUARDIAN, “ACHD told us they have no plans to charge fees on the heavier vehicles and they have made no effort to seek any legislation.”

When voters learned that rigs above 8,000lbs. were exempt from the current law that has remained in effect, they soundly defeated a proposed 70% fee hike.

The existing ACHD fee structure and exemption for heavyweights can only be removed by voters. Since its unlikely the ACHD board will repeal the current fees, it looks like a referendum may be the only recourse for citizens to seek equity with the damaging big rigs.

If enough signatures are gathered, the repeal could be on the ballot. ACHD in November had publicly claimed they would seek legislation to correct the unfair nature of the law, but urged people to vote in favor of the fee hike anyway.

A source close to ACHD also confirmed Winder’s statement. We even talked to a representative at one of the largest heavyweight fleets in the county who told us the company has a policy of “paying their fair share,” and they would support legislation to allow ACHD to charge the vehicles over 8,000lbs.

UPDATE 5:30p.m. 1-28-19

Here is text of a memo from ACHD Attorney Steven Price to Rep. John Gannon which says ACHD board has supported a fee on trucks, contrary to what Sen. Winder was told by someone else.

“As I indicated this morning, ACHD is very supportive this legislation. I will review the your proposed bill with the Director and the Commission at the Commission’s next meeting. The Commission has been very supportive of a Vehicle Registration Fee for trucks over 8000 lbs.”

EDITOR NOTE–This story has been very difficult to report. We have several versions/conclusions from reliable sources. It appears there is a fair amount of maneuvering between county staff, state staff, elected officials, and trucking industry. We MAY see a bill proposing a flat fee of $75 on trucks being proposed. Even though it is a state issue, only ACHD is affected.

Reflections on the shutdown


As our nation breaths a collective sigh of relief that the government shutdown has ended, it’s worth reflecting on the factors that forced the president to stop holding federal workers hostage even though his demand for $5.7 billion for a border wall went unmet.

I think the shutdown ended because of the convergence of four factors: (1) Trump’s poll numbers were in free fall; (2) Senate Majority Leader Mitch McConnell finally allowed a vote on two competing bills to re-open the government. Neither passed, but the Democratic proposal received more votes than the Republican bill; (3) The FAA issued a full ground stop at LaGuardia Airport in New York due to massive delays; and (4) Nancy Pelosi made it unmistakably clear that there would be no State of the Union address from the House chamber until the government re-opened. This fourth factor, I suspect, was far and away the most important.

What did NOT sway the president was the suffering of 800,000 federal workers and many more federal contractors. Countless stories of people facing eviction, rationing insulin, and lining up at food pantries did not move the president one iota. He did not “feel their pain.” Surely, these whiners were Democrats, part of his imagined “deep state,” no doubt the local grocers would give them credit, the landlords, pharmacies, and utility companies would be “happy to work with them.” Couldn’t they all just get bridge loans or call a rich uncle?

We know that Trump is cruel. We’ve seen it time after time – at his rallies, in his rhetoric, in his utter indifference to the pain and suffering of victims of tragedies from hurricanes to mass shootings. But he knows that others have compassion, and he was counting on that compassion to make others capitulate, to give him what he wanted so the pain and suffering would stop.

And this brings me back to Nancy Pelosi. She and her caucus, compassion intact, did not capitulate to the president’s pig-headed cruelty. In her words, “We cannot have the president, every time he has an objection, to say I’ll shut down the government until you come to my way of thinking … If we hold the employees hostage now, they’re hostage forever.” And Pelosi made clear that – while the government remained shut down – she would not engage in negotiations. She would not allow the president to use the federal workforce as leverage for his wall. Her message was plain. “Open the government, and then we can talk.”

Day after day, the president didn’t budge. But then, seemingly overnight, he not only budged but completely yielded, ending the shutdown and getting nothing to meet his $5.7 billion demand. The logjam broke not long after Pelosi wrote the president a gently worded letter in which she "respectfully suggested" the two of them find "another suitable date" for the president to give his State of the Union speech—once the shutdown had ended.

In response, Trump acted as if he had not been disinvited writing to let her know he was planning to show up anyway, end of discussion. But unlike the president, the Speaker has more than a passing familiarity with U.S. Constitution. In Article II, Section 3, the Constitution mandates that the president “shall from time to time give to the Congress Information of the State of the Union, and recommend to their Consideration such Measures as he shall judge necessary and expedient.” It does not state how or when these recommendations should be given.

Mr. Trump could give such information and make such recommendations from the Oval Office, or some other venue, or he could deliver remarks in writing, as other presidents had done. What he could not do; however, was to speak from the House Chamber without a concurrent resolution from Congress extending him an invitation.
Well knowing that nothing but a prime-time, all the bells and whistles speech would satisfy this reality TV president, the Speaker held firm. In unambiguous prose, she replied: “I am writing to inform you that the House of Representatives will not consider a concurrent resolution authorizing the President’s State of the Union address in the House Chamber until government has opened.”

Upon receipt of this letter, one of the president’s fearful minions no doubt explained to the boss that the Speaker could, in fact, disinvite him and had, in fact, done so. His bullying and manipulation hadn’t worked. He was forced to concede. After that, it was just a matter of time before the government would re-open. The pain of the shutdown had become personal to the president.

There are those who say that Pelosi’s stand was “petty,” and “foolish,” that she “stooped to his level.” To those people I ask, “Did you want to end the shutdown or not?” Pelosi’s approach to the bully-in-chief was smart and strategic and effective. Until Mr. Trump felt some personal pain, he wasn’t going to budge. Nancy Pelosi made sure he did.

Faith healing and right to life


In the 1944 decision of Prince v. Massachusetts, which can be found at 321 U.S. 158, the United States Supreme Court upheld the ability of a state to protect a child against a parent’s harmful religious practices. The Court said “the right to practice religion freely does not include the right to expose” a child “to ill health or death.”

The Prince decision recognized that people of faith have the constitutional right to believe as they wish. However, a state government may step in where a parent’s spiritual beliefs cause harm to his or her children. “Parents may be free to become martyrs themselves. But it does not follow that they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.”

Even before statehood, Idaho Territory required all parents to “furnish necessary food, clothing, shelter, or medical attention” to their children. This requirement is currently contained in Idaho Code section 18-401. This statute, together with one prohibiting any person from endangering the health of a child (Idaho Code section 18-1501), protected the health of Idaho kids for many years. But, in 1972, the Legislature inserted faith-healing provisions into both of them. Since then, persons who practice faith healing may refuse to provide food and medical care to their children, without penalty, even if the children die or suffer grievous bodily harm.

The main beneficiary of the faith-healing exemption is the Followers of Christ group in Canyon County. Church graveyards contain the remains of many children who could have been saved by readily available medical care.

The statutory faith-healing exemptions certainly appear to violate the Guaranty of Religious Liberty provision (Article 1, Section 4) of the Idaho Constitution. The framers of the Constitution wanted to protect religious freedom, but were also intent on preventing religious preferences. The framers adopted a stricter separation of church and state for Idaho than that in the U.S. Constitution.

Our Constitution prohibits “any preference being given by law to any religious denomination or mode of worship.” Faith healing looks very much like a prohibited preference for a particular mode of worship, in addition to being a horrible fate for innocent children. While the great majority of Idaho citizens would be held to answer on serious criminal charges for starving a child or refusing to provide the child with necessary medical care, faith healers can do so without legal consequence.

The faith-healing exemption has not been tested in court yet, but that is a possible option for removing the preference. However, the Legislature caused the problem and should take responsibility for correcting it.

Each year, the Legislature passes legislation intended to protect fetuses from being aborted. This is largely based on the religious belief that a soul is created at inception, that it has the right to live, and that government must act to protect its right to life until it is carried to term.

The contention is that the government has a strong role in protecting the right to life of every fetus. Wouldn’t it follow that the government should protect the life and health of every child born in the state? Why should the law give faith healers a preference to deny their children life-saving medical care, as well as necessary food, clothing and shelter?

Let’s ask our legislators to remove the religious preference of faith healers so that they, like all of the rest of us, must provide reasonable care for their kids. There is no good reason why those kids should be denied the right to life. And, it should be stressed to legislators that the intent of removing the preference is not to punish people, but to establish the limits of acceptable conduct toward vulnerable children.

The census counts


The upcoming 2020 census is important. Damned important!

Given that fact, why are a full one-third of Americans saying they may not fill out forms or answer the questions or are only “somewhat likely” to do so? (See above graph.)

The U.S. Census Bureau has been polling and using focus groups to determine how close we’re likely to get to a nearly complete count next year. And if we don’t, why not? It’s an effort to understand citizen attitudes about the census, what potential barriers to participation are out there and what motivations are for those who don’t intend - or are unlikely - to respond.

The survey reached a national sampling of about 50,000 homes. With a 35-percent response rate, results are well-above an average sample return size and considered reliable. The Bureau also conducted 42 focus group sessions in 14 cities. Every attempt was made to include hard-to-count populations such as racial and ethnic minorities, non-English speaking, those with low Internet proficiency, young people who move frequently, rural communities and other populations at low risk of response. Pretty comprehensive effort.

Bottom line, here’s what was learned.

Two-thirds of responders are “extremely likely” or “very likely” to fill out the census form. But, at the same time, many people said they were unfamiliar with the census process with only about a third being “extremely” or “very familiar.”

Five main barriers were found that might prevent people from participating. In order, they were: privacy concerns about data/confidentially; fear of repercussions of some sort (probably regarding residency status); feeling the whole census“doesn’t matter;” distrust in ALL levels of government; belief that completing the census forms might not “benefit me personally.” To me, those last two are sad commentaries on what parts our society have become in some quarters.

Another disturbing finding was this. While funding for public services was a top motivator in respondents, less than half knew the census results were used to determine that community funding. Seems sort of a mental contradiction there.

The Census folks have decided on several steps to deal with issues uncovered in their outreach efforts.

Probably the most expensive (this is government, after all) is the need for an extensive PR campaign (lots of paid advertising, individual mailing and the like) to tell a wide audience of the importance of both the census and its needed participation. Second, there’s a necessity to reach out to the younger population to explain what census taking is, what the process involves and why it’s important for them to be counted. (Secondary teachers and college instructors take note.)

The Bureau also intends to involve local communities to explain how census results benefit them now and in the future. There’ll be an effort to get local leaders to participate in advance publicity.

It’s also apparent just addressing expressed concerns about data collection and privacy alone will not necessarily mitigate those issues. While much of the ad campaign will feature reassurances about privacy and confidentiality, inside the Bureau, it’s not widely believed those worried about such things will be assuaged. Another commentary about the society we live in.

None of the head-counting importance is lost on politicians of all stripes. Legislative and congressional district representation is largely determined by the numbers. Small states like Idaho, Nevada and Utah could see an increase in congressional representation. And, the numbers could greatly influence state legislative districts. Especially if we can draw new lines with some impartial integrity. In other words, put an end to politicians gerrymandering for their own interests and third-party panels using the most reliable statistics available.

Yes, the ten-year count is important. Very important! Which is why that nearly one-third of Americans being “unlikely” or “unwilling” to take part is so discouraging.

One other note: none of the sampling dealt with the unwarranted attempt by the Trump administration to stick a citizenship question into the census-taking. At the moment, a federal judge has blocked use of such a query. But, you can bet the issue is far from dead.

Idaho Weekly briefing – January 28

This is a summary of a few items in the Idaho Weekly Briefing for January 28. Would you like to know more? Send us a note at

The federal government shutdown appeared headed to an end last week week, as Idaho's congressional delegation played distinctive rules on it. The Idaho Legislature saw a significant number of bills, on a wide range of subjects, introduced.

On January 23 the U.S. House voted on a bill proposed by Democrats, but similar to one which passed with bipartisan support a month ago in the Senate, on reopening the federal government. Representative Mike Simpson voted in favor of the bill, and Representative Russ Fulcher voted against.

Superintendent of Public Instruction Sherri Ybarra outlined her vision for the future of Idaho’s public schools Thursday morning in her budget presentation to the Legislature’s Joint Finance-Appropriations Committee.

Idaho Fish and Game is collecting public input on the newly updated draft of the Mountain Goat Management Plan. This planning document provides guidance for the Department to implement management actions, including season recommendations, for mountain goats throughout the state.

Attorney General Lawrence Wasden announced that he and 45 other state attorneys general have reached a $120 million settlement with Johnson & Johnson and subsidiary DePuy.

Lewis-Clark State College students who want to pursue a law degree and are accepted into the University of Idaho College of Law will now have a quicker path to earn that degree thanks to a transfer articulation agreement between the two schools.

Taxpayers will see big differences when they file their Idaho income tax returns for 2018 due to recent changes to tax laws.

More than a quarter-of-a-million passengers traveled through the Idaho Falls Regional Airport during 2018, according the most recent numbers compiled by airport personnel. The total of 320,000 passengers is an increase of more than 30,000 passengers from 2017, reflecting a 10% increase over the previous year and the highest totals for the airport for more than a decade.

IMAGE A photo by an Idahoan traveling last week on the snowy road north to Featherville. (photo/Dave Hand)

In boardrooms, too


One-hundred-and-two years ago this month, an extraordinary 37-year-old crusader from Missoula, Mont., became the first woman to sit in the United States Congress. Jeannette Rankin would likely take some satisfaction in knowing that more than a century later, 131 women now grace the halls of Congress. But she would probably also be saying such progress took too long and genuine equality for women is still a goal, not a reality.

Unquestionably, the environment for women in politics and government has improved, even vastly improved since Rankin’s day.

Idaho, for example, recently elected its first woman lieutenant governor and women were nominated for a number of offices contested in the 2018 election. Still, women occupy only 23 of the 105 seats in the Legislature, Idaho hasn’t elected a woman to Congress in a quarter-century and just one woman sits on the Idaho Supreme Court.

The Supreme Court is a good case study of how barriers still remain for women. Justice Robyn Brody campaigned her way on to the court in 2016, while former Gov. C.L. “Butch” Otter, with numerous opportunities to appoint a woman, inexplicably never did during 12 years in office. Otter recently passed over three eminently qualified women to appoint the only male offered up by the Idaho Judicial Council. A woman hasn’t been appointed to the Supreme Court since 1993.

Female representation in Idaho business is generally about as impressive as Otter’s record of appointing women to the high court.

The eight most prominently traded public companies in Idaho currently have 74 board members and only 10 of them are women. Micron, an international company with a big presence in Boise, in Asia and in Europe, has two women on its board, as does food producer Lamb Weston.

Boise Cascade, Hecla Mining and US Ecology each have a single woman board member, while U.S. Geothermal and Pet IQ have none. A company often properly characterized as conservative to a fault, Idaho Power Co., actually has three women among its 10 board members.

There is abundant research — the global nonprofit Catalyst collects much of it — that clearly shows diversifying a corporate boardroom, and particularly advancing women to key governance positions, leads to improved financial performance, helps promote innovation and even reduces controversies related to how a company is managed.

California recently mandated that every publicly traded company in the state have at least one woman on its board by the end of the year and as many as three by 2021. Some experts have suggested that mandates or quotas will inevitably lead to legal challenges and then-Gov. Jerry Brown signed the legislation even while expressing concern about how it will work in practice.

Still, Iceland, Norway and France have shaken up corporate governance by instituting quotas that require certain levels of female representation in the boardroom. In 2017, women occupied more than 40 percent of the board seats in the largest public companies in all three countries, a major improvement from 10 years earlier.

Idaho being Idaho, don’t hold your breath waiting for the Legislature to mandate female representation on the boards of companies located or operating in the state, and such a mandate may not be the most effective way to create these opportunities for women.

New York Times columnist Andrew Ross Sorkin suggests, “Investors, big and small, can use their influence to press corporate boards to diversify. Firms like BlackRock and pension funds like CalPERS, the California Public Employees’ Retirement System, are already working to effect change.”

The Public Employee Retirement Fund of Idaho, or PERSI, currently has $17 billion under management on behalf of tens of thousands of beneficiaries. That’s $17 billion worth of leverage if the PERSI board wants to exercise that leverage. The board, by the way, currently has a vacancy and Gov. Brad Little should appoint a woman to join the two already on the board, creating a female majority.

As Sorkin notes, the huge California public retirement system told more than 500 companies in 2017 that they needed to improve diversity, and the California fund has “voted against directors at companies that have failed to respond to its requests.” It’s worth noting that more than half of the members of the CalPERS’ board are female.

Ultimately, however, and for the near term at least, it is corporate CEOs and corporate board members — mostly older white males — who must change the dynamic that keeps women out of too many boardrooms and prevents too much talent from contributing. If business leaders make more opportunities for women a genuine priority, it will happen and at a much faster rate.

When Rankin ran for Congress in Montana in 1916, the huge Anaconda Copper Mining Co., one of the industrial giants of its day, dominated the state’s economy. She was no fan of “the Company,” regularly lamenting its influence over Montana politicians and its disdain for its workers and their unions. The big boss of Anaconda was a tough Irish businessman named Cornelius “Con” Kelley, a titan of American industry. When Kelley died in 1957 it took two long paragraphs in his New York Times obituary to list his dozens of corporate directorships. It is a safe bet he never shared the boardroom with a woman.

Rankin, after two terms in Congress separated by more than 20 years, never served on a corporate board. And as a proud Republican progressive of the old school, she would likely have been appalled by the thought of lending such support to a corporate cause.

Rankin lived out her life as a pacifist, an advocate for women, education and peace, even leading a protest against the Vietnam War at age 88. Change comes slowly — too slowly much of the time. Montana hasn’t elected another woman to Congress since Rankin was last on the ballot in 1940.

We should do better.

Johnson served as press secretary and chief of staff to the late former Idaho Gov. Cecil D. Andrus. He lives in Manzanita, Ore.

A shutdown of votes and wishes


On December 19, the U.S. Senate passed on a voice vote - with no opposition in evidence - a bill aimed at averting the impending federal government shutdown. It had support of all or nearly all Republicans and Democrats in the chamber, and was thought likely to pass in the House of Representatives. Senators started singing Christmas carols on the floor.

Then came a declaration from President Donald Trump, who initially seemed to back the bill, but after taking heat, said he would not sign it because it did not include funds for construction of a border wall with Mexico. That killed the bill in the then-Republican-led House. It was nonetheless an actual compromise, something un-thrilled Democrats and Republicans could (and in the Senate, did) vote for.

After party control shifted, the House wound up passing a measure much like the old Senate bill - which, once again, had been supported by nearly all Senate Republicans as well as Democrats - with the statement that funding for the wall could be considered separately. In fact, it has voted for 10 related bills along those lines, with mostly Democrats in favor but picking up some Republican backing. One Republican voting aye on the bill passed on Wednesday was Representative Mike Simpson of Idaho. He will take heat for that.

On Thursday, the Senate voted on and killed two budget bills. One was backed by Trump and touted as a compromise, though it contained no concessions and included what the corporate world would call “poison pills”. Only one Democrat supported it. The other was called the Democratic bill - though, once again, this was largely the same thing Senate Republicans had solidly backed a month earlier - and though it got a half-dozen Republican votes, it too failed. Idaho’s senators, Mike Crapo and Jim Risch, were not among the six.

Idaho’s congressional delegation has had a busy week.

Simpson said, “The House voted on a package of bills that were negotiated last year between the House and the Senate, Republicans and Democrats. Although it does not represent my preferred starting place for negotiations, I support it because it includes provisions that are important for Idaho that I personally worked to secure, including increased funding for sage grouse conservation, PILT, wildfire prevention and suppression, and a prohibition on listing sage grouse as an endangered species, among many others.” But he also blasted Democrats for not looking more favorably on the Trump proposal.

His new fellow Idaho representative, Russ Fulcher, was quoted as saying, “It’s not a debate about what the right thing to do is, it is a power play between the speaker and the president. That's basically all this falls down to."

Actually, it must be more than that, or else the votes behind the speaker and the president, which allow them to take these positions, wouldn’t be there. And it does after all have immense national impact.

Fulcher: “My urging is to forget about the politics, forget about the party moniker right now.” But unlike Simpson, he voted against the proposal which, once again, had been developed and approved by both Republicans and Democrats.

A week ago, Risch participated with a group of Senate Republicans offering a bill to avert federal government shutdowns in the future, by setting up an automatic continuing resolution - sort of putting the federal government on temporary budget autopilot - in case of a budget stalemate. He also said, “Shutting down the government is the complete opposite of what we were elected to do - govern. I have co-sponsored this legislation year after year and hope we can finally move it forward. Real people with real problems get caught in the balance of government shutdowns and we need to act for them and for the sake of government efficiency. I would prefer a smaller and less intrusive government than what we have, but regardless it needs to operate.”

Good sentiments, and at the least a reasonable legislative concept. But with all these good intentions and good will, why are the votes - all of the delegation’s votes - still not there for an actual compromise, like the one Congress had but a month ago, to end a shutdown now with no end yet in sight?

Medical loyalty


I really do value loyalty, despite the things I say about it both last week and this. It’s just that I think we need loyalty to values or ideals, not people or groups.

I hate taxes as much as the next guy, but I see their purpose if they serve a goal I embrace. I got elected to the Idaho legislature right after the Affordable Care Act passed and the Republican animus against this health care policy was palpable in the state house. It might have been my second year serving when a resolution came through castigating the Affordable Care Act’s tax on medical devices. The resolution was telling our representatives in Washington DC to work to repeal the tax; the list of reasons for the repeal was long. The tax has been postponed, not repealed, thanks to another government shut down deal.

Why should medical devices pay an extra tax? They can save lives, heck most of us are walking around with one in us. I am. I had a hip resurfaced about eight years ago. I researched the different choices and made my decision, then found a surgeon that used that kind and had the procedure done.

But then consider the situation I have seen in a nearby hospital. This hospital has three different orthopedic surgeons and they all do hip replacement surgery. (Not the resurfacing like I had, the total replacement kind, whole new ball and socket.) Here’s the catch: each surgeon uses a different model of hip replacement device. Each believes strongly that the model they use is the best. So, the hospital where they work has to stock multiple sizes of each model, keep on hand the different tools required for the procedures, and keep the OR personnel trained in the use and surgery of all three different devices and tools.

Do you think this might contribute to the high cost of healthcare?

This is something else you need to understand: there is no clear evidence that one type of device is better than the next. And device manufacturers are always coming up with “new and improved” versions, requiring new tools, different training and OR procedures.

I can understand the loyalty of the surgeons who have used a certain device. They trust their familiarity with the tools and their skills with the procedures. But when there is no clear evidence, the surgeon’s loyalty to their preference costs all of us. Why shouldn’t a tax on these devices help the market perform better?

There is no doubt “health care is complicated”. I agree with President Trump on this one. I appreciate you readers sticking with me through this maze. But if we Americans are going to solve our health care fiasco, we are going to have to be willing to have loyalties to our greater good. We should be considering the best policy based on evidence, not partisan “wins or losses”. So, the medical device excise tax made some sense to me.

But my perspective might be different than yours.

Why should lots of medical device companies making a profit worry me, or you for that matter? My IRA probably has some in there. But what I’m most concerned about, my deepest loyalty, is having affordable healthcare, accessible to all. If my IRA takes a hit, but my health insurance premium goes down, I’m OK. But it shouldn’t be our own self-interest driving this decision. It should be all of ours; the greater good.