Posts published in “Schmidt”

As a retired Idaho Family Physician, I always knew this was a frontier state. Some folks must travel a hundred miles for basic health care.

But the folks in the big cities can forget this.

When I trained, in medical school and residency, we appreciated the frontiers. I was trained in places that dealt with the difficult cases from the Alaskan outback to the North Idaho wilds. They got sorted out by the locals, and the problems came on to us.

I wanted to be out there, sorting it out. I got excellent training.

This sort of care needs vision, coordination and cooperation. It doesn’t just happen.

I could tell you all the failures and successes I have dealt with.

It’s part of why I ran for office, to serve in the Idaho legislature. I remember telling a prominent lobbyist, the support for the WWAMI program was a budget placeholder. Sure, we are sending money to Washington, but it’s teaching us legislators just what investment we need to make to build the physician base for us here. We will someday go off on our own.

Idaho should build its own medical training system. And the money we have been spending on supporting WWAMI and U of Utah students will be the budgetary base we can build on.

So now we have a five-year grant opportunity from the One Big Whatever.

But our Idaho legislators are hesitant to support any of this money to be a build out for an Idaho Medical future.

Their hesitancy is because such an investment now would require ongoing funding.

Duh.

The federal money is only five years, if you have the balls to take it. The Feds (Trump et al) were wise to see if a state had the balls to commit.

Maybe we don’t. Maybe the policy makers we elect don’t see training docs and nurses and EMTs worth the taxes we take from you. Maybe they think…I don’t honestly know what they think.

But I know that training good practitioners to care for the health of our communities is a good investment.

Just as I was leaving the Idaho legislature, I came to realize many of our elected officials did not share my view.

I was fighting for Medicaid Expansion. They hated my guts.

But some understood. John Rusche MD, from Lewiston and Fred Wood MD from Burley and I had frequent discussions. Notice, it’s just the degree behind their names, not their political affiliation.

But todays Idaho legislature with its culture warriors and California transplants has no physicians, few medical personnel in their mix.

But they will decide where we should stand on this opportunity for investment.

We trust them, don’t we?

They don’t want the taxpayer to be on the hook for any medical education investment. Heck, they probably think taxpayer dollars should only go to moms that stay at home and home school their kids.

You got me going. Let me return to the point.

Do you think an investment in medical education would serve the prosperity of this state?

If you don’t, then why the hell are you sending money to the states of Utah and Washington to train our future doctors? And why would you support the money our taxpayers send to ISU for pharmacists and LCSC for nurses, and there’s a lot more you could cut if you want a list.

Just answer the question!

They aren’t. The legislators you will elect aren’t answering this question. Maybe you aren’t either.

It’s a reasonable question.

In the old days, 150 years ago, doctors took money from the folks who wanted to learn and then they showed them the ropes.

But the medical care then was dismal. The study of that care, and the recommendations have given us our current system.

We should have good providers caring for us. It’s worth the investment.

When I was in the Idaho Senate, Brad Little presided as the President of the Senate. He was the elected Lieutenant Governor. Butch Otter sat in the Governor’s office on the second floor of the Capitol.

All us Senators were cautioned to only refer to “The Governor” when we were debating a bill as “the gentleman on the second floor”. Maybe he had threatened a veto, maybe he supported, but it was crucial to maintain the separation of the different branches. That discipline of speech, enforced by the President, Brad Little over us Senators with the gavel, made me appreciate the importance of the separation of our duties. And of the clear distinction in the Idaho Constitution of the separation of powers.

The legislature elected every two years has a primary duty to our electorate, the people. We controlled expenditures. If the executive branch thought something should be done, but we didn’t, we didn’t give them the money.

This is written clearly in the Idaho Constitution.

The legislature couldn’t control the executive branch. Nor could the Executive branch direct the legislature. These bodies had a separate, but unified goal: to serve the state.

But the bodies, the legislature and the Governor, might have different visions.

So why don’t they just get together and agree?

That would be a different form of government than our Constitution directed.

I was always impressed when Butch wouldn’t cross this line. Honestly, I didn’t find Governor Otter impressive most times. But he knew the principles of governance, and he honored them and stood by them. He tried to persuade the legislature, but he honored the separation of the roles.

Brad has forgotten this. Maybe he is taking a lesson from his mentor in the White House.

Honest disagreements are what our governance structure expected and built into the framework in our Constitutions.

Brad has shit on this. Our Governor has given over the function of the executive branch to the legislative. While that might seem a niggling, whiny complaint, and I’ll agree, it does sound so, it gets to the principle of the work we elect these folks to do.

Stand up for us.

Stand up for your office.

Stand up for something.

Brad is not standing up.

He’s not standing up for the separation of powers our Constitution demands. He’s not standing up for the office of Governor of the State of Idaho. He’s not standing up for us, who elected him.

Here’s just some of the evidence.

Trump and our Idaho congressional delegation cut Medicaid funding in their One Big Beautiful Bill. They knew our rural hospitals would be gutted. So they offered some cheese.

We are mice, eh?

Five years of big money grants to ease the pain. So now we scramble for their cheese.

Brad set up a committee to review this.

Did they meet? There are no minutes for us to review.

Then the Idaho Legislature took charge. This was a clear Constitutional violation.

And Brad did what he does. He shrugged.

Hundreds of millions of health care funding will leave this state. Does a tenth, a hundredth of that bother Syringa General in Grangeville or Lost Rivers in Arco or Benewah Community Hospital in St Maries?

It should bother you.

We all should be working for a sustainable solution.

Brad gave some wimpy legislators the handle on this weak money. They don’t care if your small-town hospital dies.

Brad doesn’t seem to care either.

He can see the writing on the wall. Our government just doesn’t seem to care.

So why should he?

I’ve known Brad for a few years. I’ve drunk beer and laughed with him. He’s better than this.

What’s wrong?

Has he bought in to the bigger MAGA vision to tear it all down?

Brad, what’s wrong?

The Idaho Department of Health and Welfare is spending our taxpayer dollars to go around the state and “listen” to our concerns. Idaho is about to grant a multibillion-dollar contract, the biggest ever in state history. Is this a wise investment, this listening thing? Its peanuts compared to the contract.

Lord knows, the legislature, who decided these billions of our tax dollars should go this way don’t listen. They ignore testimony. My elected State Senator has rarely appeared in public forums in my district for his last six years. The last time he did, it made national news. So he has learned. Don’t listen.

But the IDHW is listening. Maybe.

I am wondering if this representative government can survive. It’s up to you.

In the meantime, our taxpayer funded IDHW has gone around the state asking folks what are their concerns as Idaho Medicaid moves to managed care.

Our legislature has required this change to managed care. It’s all the rage. Maybe you have experienced it. You must go to an “in network” provider or the insurance company repossess your car. It’s that kind of health care we love, don’t we? Now we can stick it to those lazy Medicaid patients.

The DHW is asking, what do you think we should do? Will they listen?

There was a “listening session” this last week in Lewiston. I am not currently a provider who gets Medicaid dollars, or an enrollee. I was conflicted about making the $20 drive.

But the sessions have been very well attended. The department has posted the anonymized comments online.

As I read through them, I see a recurrent issue from providers. Keep in mind, managed care is nothing new. Big insurance companies have used this technique for years to control their costs and thus maximize their profits. Providers know the routine.

The insurance companies restrict their “panels” to low-cost providers. You liked you doctor? Sorry, not in panel.

They deny coverage for a recommended treatment. You can appeal; the doctor can appeal. Do you have a few months? Years?

I was a low-cost provider. I didn’t order a lot of tests or recommend many stupid surgeries. Lots of patients went elsewhere. They chose. So did I. They could find a doctor that would do what they wanted. I kept doing what I thought was a good job for my patients.

In the end, we’re all paying. It’s insurance.

This scenario is playing out big time here in Idaho. Hospitals and doctors across the state are fighting for more money. Insurance companies fight back. Such is the nature of a normal healthy marketplace.

When will you folks realize healthcare is not a marketplace?

Except maybe plastic surgery. Is that what you need?

I guess the Idaho legislature believes private equity funded big insurance companies are better suited to protect the taxpayer dollar than our own government.

Will they listen?

One of the recurrent questions from providers was, what would be the appeal process? Who can we gripe to when the insurer denies what we say is appropriate care?

I assume the IDHW will include that in their contract they put out.

Or will they? So now, our representatives want to contract out listening?

Idaho receives about $3B from the federal deficit government to pay for our Medicaid health care. Don’t get me started on the amount of tax dollars we are spending on debt service. We are talking about health care spending here.

But the two biggest drivers of fixed federal spending, after Social Security, are Medicare and Medicaid.

So you see this as a solution?

I have told you before, it hasn’t worked. President Bush gave us privatized Medicare. It has been proven to be a big waste.

Maybe Idaho is just behind the curve.

We should be listening.

I know how this feels. We were a young family with cheap, weak, barely any health insurance. I was a medical student. My wife worked nights as a janitor.

We bought the cheap health insurance through the medical school. But it cost more than we paid in rent.

Our doctor accepted the weak payment. But then our baby got sick. And the insurance would not cover “preexisting conditions”. She was born with this problem, and it was making her very sick.

So I know the burden of this lousy health care system we have cobbled together. It seems it’s just to make the doctors rich, and the health insurance CEO’s and the hospital CEO’s and enrich the venture capital companies buying and selling our risk pools.

Nobody seems to care about us. Not Joe Biden, not Donald Trump, not any Democrat or Republican I could name. Surely none of Idaho’s congressional delegation gives a shit about the basic comfort, the basic need for decent health care access.

Idaho ranks 12th in the nation for the most uninsured citizens. And we expanded Medicaid. Almost all the states 11 and up, didn’t. We did what we could. More needs to be done.

Over 12% of Idahoans have NO HEALTH INSURANCE. One in eight. Next time you’re at McDonalds, look around. If you are reading this, I’ll bet you have health insurance. Lots don’t. Maybe it’s not fashionable in this culture we are developing to think about those around us who might have less.

But when you have a sick baby, who keeps getting infections, fevers, damaging her organs, what are you supposed to do?

The Christian Nationalists would say charity.

And that’s what we got. Charity. They scanned, diagnosed, and hospitalized and operated. And the social worked sat down with us and said, “Don’t worry, this will be paid for.”

Charity is wonderful. We felt blessed. The burden dropped off. We received more care for our infant than I could have gotten from selling our car, my motorcycle, my medical books. They would have been a drop in the bucket.

So, is your vision that we should have a system that grants charity? If a deemed recipient is granted, they get the largess of the wealthy, the endowed?

I wonder what would have happened if me and Martha had been East County trailer trash. Charity?

Poor communities have Go Fund Me’s and jars by the check out.

The burden we have created to access health care harms.

The young family with the sick child might wait. Charity is a burden, and unreliable, though honorable.

It seems like we are afraid to throw open the doors.

None of you conservative Republican Idahoans want to have this conversation. Heck, most my wealthy liberal Democratic friends don’t either. What’s the problem? It’s just ten percent you idiot, why are you worried about them?

Because I was in that ten percent. I’m not now, but I was. And I remember.

You probably know a similar story. Doesn’t this make you want to solve this?

Our Governor appointed a Director of the Department of Health and Welfare who cut kids off Medicaid health insurance at a record rate. Idaho jumped to SECOND in the nation (behind Texas) for uninsured children. Are you proud Brad?

Maybe you are happy about this. Maybe you think people shouldn’t have children unless they can provide for them.

This is a very important conversation we need to be having. I don’t mean to offend you. I mean to inspire you. We have a very serious problem right here. And it doesn’t seem any of our politicians we elect based on our Fox News or CNN feed give a shit.

It’s time we decided what’s important. And we let them know.

I don’t make such claims lightly.

Our previous Director of The Department of Health and Welfare, Alex Adams closed down a program for families to care for their disabled children funded with federal money with such claims. Back when I was on the Board of H&W, when there was a board, before the legislature in its wisdom cancelled the board, I asked him if any accusations of fraud were referred to our Attorney General. He mumbled something. No prosecutions have followed.

So a director, appointed by our Governor can shut down a funded program on unfounded allegations.

I get it. You conservative Republicans don’t want any taxpayer dollars going to the “unfit, the needy, the disabled”. You just want our taxpayer dollars going to families who want their kids to go to private, Christian schools.

Please, if you are concerned about fraud, you Conservative Idaho Republicans, wake up and watch $186M dollars shoot out to folks a few legislators think should get it.

For that’s what our Senator Crapo championed, and our congressional delegation (all Trump lackeys) voted for. According to the federal website, Idaho has received $186M dollars and it is in some account somewhere at the Idaho DHW.

But the Idaho legislature must approve any of this spending. They have set the delegating committee as 8 members, all Republican, but what does that mean here in Idaho?

The Department has great plans. I apologize for my cynicism. When I read the plans, they sound like gobbledygook. Please read them, you folks out there in rural Idaho and tell me if that’s what you think you need.

There’s a lot of cyber, technology, AI references in there. Just who do you think is going to get that money? Not Syringa General Hospital, or Clearwater Valley, or Lost Rivers. No, these grants will go to the big companies selling these services, whose employees live in Seattle and San Francisco.

We are getting fleeced. Our national debt is exploding, our health care system is a mess, and this grant program throws more dog bits to a very fat dog.

And our legislators have designed a system to funnel that money to whomever buys them the best lunch.

I hate to tell you, but we here in Idaho are small potatoes. A million-dollar grant can be awarded for a persuading $50 lunch.

And the Co-Chair of this committee, Jordan Redman has already faced charges of self-serving as a public servant.

So legislators could be acting badly. This is just old news. I’ve seen it before, maybe you have too.

Here’s the crippling coda.

The federal legislation to send this $1B to Idaho included a stipulation that the state would continue to support the programs developed.

Can you imagine the Idaho legislature coughing up another $200M a year to the Idaho DHW to fund AI kiosks in our small towns? And what would these AI kiosks do to help small communities thrive?

We are ripe for corruption. I have seen it in our Capitol. A person in charge of dispersing grants for school internet fudged the granting process. And that was just $25M. Somebody sued, the court found the process bad, and Idaho lost.

Now we are upping the ante.

Forking out grants while you are slicing the Medicaid program may hope to soften the blow. That’s just feeding into the deep corruption we already have.

Instead we need to be asking some very fundamental questions.

Should we all have access to healthcare?

What should our basic healthcare look like?

How should this system be paid for?

The United States pays per person almost twice what the next country in the world pays. We are rich. And we are wasting a wonderful opportunity to be great.