Work for It

It seems our Governor is considering work requirements for Medicaid enrollees. He hasn’t done his research.

Or maybe he has, and this is a Trojan Horse, just waiting for the Idaho Freedom Foundation to roll it within its walls.

Do I need to remind you just what Medicaid is?

Okay, it’s a Federal/ State partnership to get people health insurance. States can enroll, but don’t have to. Idaho could disenroll at any time. Maybe Idaho would if those fire breathing IFF legislators got some cojones. Instead, they just want to grouse, kick dirt, and blame poor people for taking their money to get health insurance. Meanwhile, they get their health insurance paid for by us Idaho taxpayers to the tune of $15,000 a year. Makes sense, doesn’t it?

Anyway, it seems the Medicaid Expansion Initiative is still twisting the IFF legislators’ shorts. I hear it at town halls, I hear it when the budget is puzzled over. Heck, I hated seeing the climb in Medicaid costs when I served on the Joint Finance Committee. But maybe only Brad is seeing the big picture.

We have just kicked 120,000 Idahoans off Medicaid. That will make the Medicaid budget more palatable this year for the legislature. They don’t care that the vast majority of those kicked off don’t even know they have been. They’ll find out when their meds run out. And then we’ll pay for their time in the hospital, the ER, or the jail or prison.

When we cut Medicaid back in 2011 due to the economic downturn foisted on us by the big banks, I told my fellow Senators, “You can save money by not changing the oil in your rig. But it will cost you in the long run.” All those cuts did indeed cost more through increased indigent and ER bills.

So why is Brad talking about work requirements now? I have no clear idea. He doesn’t call me.

Work requirements have been tried in a few states. Idaho even has a work requirement application pending. It was not approved by Trump, nor Biden. But maybe now, Brad thinks. Or does he?

The Arkansas experiment is the only one with any good data. And it was brief, only lasting less than a year. But they successfully kicked 18,000 people off coverage. Those kicked off could have reapplied, but only 11% did. Sounds like a win for us taxpayers, huh?

Did you know that over 60% of people on Medicaid already work at least half time?

Did you know that having health insurance has a significant positive influence on getting employment?

Did you know that 25% of people on Medicaid have poor internet access?

Brad knows all this.

Put this all together and Medicaid work requirements starts to sound like another IFF library porn dog whistle. But our Governor blowing it?

Brad also knows, for Medicaid in Idaho to be a better program we need to invest in directing money to smart choices, not just writing checks for whatever bills we get. That will require some investment.

Blue Cross has rooms of people authorizing, or not, tests, procedures, medications. Idaho Medicaid doesn’t.

Let me digress. Idaho Medicaid had a computer algorithm that required any change in narcotic prescription had to go through the “prior authorization” process. I was trying to get a chronic pain patient to taper his narcotics. He finally agreed. I wrote a stepped down prescription for him. The pharmacy wouldn’t fill it because it needed to be “Prior Authorized”, even though it was a lower dose. So now he gets no meds, is in withdrawal, and he thinks I’m an idiot.

Maybe I was.

But sure enough, we can do better. Medicaid needs to be better. It can be.

Posted in Uncategorized | Tagged , , | Comments Off on Work for It

Coroner Story: Road

She was found by the road. And so, I was called.

It can be foggy after a rain in the spring. The wheat loves the rain that rolls in from the ocean two hundred miles west. We get good rain here in June. Dry land wheat flourishes.

I got the call before lunch on a Saturday. I wasn’t covering the ER or working in our Saturday clinic. I thought I had it to myself. But I am the county coroner.

“Dr. Hawthorne, Idaho State Police request that you come to a scene.” The polite professional dispatch lady gave me directions. She was not a patient, though some of them were. It can make the professionalism a bit hard.

It was south of town, off the main highway.

I’d been to plenty of death scenes on that highway. Three people killed when a semi had braked on the downhill and its’ unloaded trailer had swung into the oncoming lane. Two young women dead, and one child in the back seat as the big semi-trailer wheel had rolled over their compact. An infant had survived.

I had known both the young moms from their ER visits. Sometimes crazed by drugs, other times desperate from emotions. Those can look the same. But they are dead now, a different, other time coroner call. It seems this county, my home is peopled with these memories, these events. My limited contact of an ER visit, an office visit, or a death scene investigation doesn’t really bring out the best. These interactions don’t all run together, except when they do.

As I see up ahead the grade where the two moms were killed, I remember another, further along, past the crest of this hill.

A head on, both drivers dead, one trying to pass. Both cars were in their lanes, but the southbound car was now facing north, and the northbound car now facing opposite, their mangled front bumpers about ten feet apart. When such energy is applied squarely, inversion can happen. Like making a ball stop on the pool table, the impact has to be square. Both died almost instantly.

Back a half mile, had been another scene. A mother who had gone off one of these dangerous curves in her minivan. All the kids survived.  She had not. This stretch of road has killed a lot of folks. And our state has still not fixed it.

But this call was off a slow side road.

The morning fog had burned off and it was a bright, early summer day. The fields were deep green with two-foot-tall winter wheat. They plant it in the fall, and it slowly grows, then erupts in the spring rains and warmth.

I rounded the treacherous curves and climbed the hill where the semi-trailer had taken out the young moms and one of their babes. On the other side I got down to the country road that headed due west, off the main two-lane fatal highway.

After a half mile, the ISP rigs were there. And I saw a tan blanket over something on the left, south shoulder.  I pulled over to the right in my little rusty Hilux..

As I got out, I just looked around. There was a tall field of winter wheat to the south. The ISP rigs bracketed the blanket covered victim. And the two ISP officers were striding down from the hill north of the quiet road.

I waited.

Introductions. I didn’t know them, and they didn’t know me. Now we did.

They told me the story as they had sorted it out, but suggested I come up the hill to see what they had seen. I appreciated they were open to my observations.

A local had been going to town early this morning. It was quite foggy, but he had seen the deceased right there by the side of the road and had called it in. The sheriff’s office had assumed from the description it was a highway fatality and had called the State Patrol, so that’s why they were here. Jurisdiction wasn’t something I studied. But I learned it mattered to many I dealt with.

They had investigated. The deceased was identified. The scene was confusing.

By now we have crested the little northern hill. I turn and look south as they are laying out their understanding.

Green fields tell the tale of recent intrusion. The signs are clear from here. There is a mashed up stand close to the road, then a two track through the field in a long loop ending at an older sedan stuck out in the soft, moist soil. The field where the car is stuck is below the road. It is softer, more fertile soil.

“So, it looks to me like she went off the road and landed in the field.” The ISP officer is painting the picture. “Then she tried to keep driving but got stuck.”

I can see what he’s saying.

“Have you looked at the vehicle?”

He laughs. “Yeah, it’s all beat to shit.”

I look for a while.

“Let me look at her.” We go back down the hill to the tan blanket.

She’s a young, vital woman. But dead. She lies face up, her head to the east. It’s as if is she is at peace next to the road. It’s like she just couldn’t keep going.

Her blouse is torn and there are linear bloody scratches on her upper chest.

I notice an asymmetry. Her left chest is much prouder than her right. I notice her trachea, her windpipe, is deviated to the right. These are signs we were taught to look for in accident victims when they came into the emergency room.

I press on her sternum. I feel a grating.

I place my hand on her curly brown hair and twist her head. There is no crepitus.

I have decided from this brief examination she had a significant chest trauma that probably gave her a tension pneumothorax. This is a serious condition that pushes air into one side of the chest and deflates the other side. There is a simple treatment. But untreated, the tension slows the blood flow through the heart, suspended there in our chest. And we die of acute heart failure. The air pressure blocks the blood flow to the heart, and we can’t get enough blood to pump to us. I had been schooled in how to treat this when such patients come into the ER. But she never made it that far.

“Let’s look at the car.”

We head out into the soggy wheat field. Winter wheat can be tall in these bottoms. It’s above waist height.

The old sedan had lost its windshield. The roof isn’t caved in, but the side windows are blown. I can’t get the driver side door to open.

“This car landed on its roof and rolled back onto its wheels.” I’m telling the ISP guys my impression. “She thought she was OK, so she kept driving. Then she got stuck in this wet ground.”

They are looking at the rear wheels sunken in the soft soil.

“She couldn’t open the door, it’s jammed.” I jerked on the handle. “So, she climbed out. See the blood on these shards?” I pointed to the jagged glass on the driver’s door window. “She must have been high as hell.”

“So, what killed her?”

“From my examination, she had a tension pneumothorax. One side of her chest got deflated and the other got too full. She must have pounded her chest against that steering wheel when her car flipped. It’s even possible she was partially ejected. When a car spins the force is powerful, and I doubt she was belted. She could had been half out the window as the car rolled on top of her. I’ve seen that before. It had to hurt like hell, but she was probably high and didn’t feel it. After a while, when she was walking along the road, she couldn’t breathe. Each breath fills one lung, and it pushes into the other collapsing one. It messes up the blood flow. She must have headed off walking back to the highway and just laid down and died when her oxygen ran short. Meth is powerful.”

Her tox screen came back with morphine and methamphetamine.

Cause of Death: Chest Trauma from Motor Vehicle Accident

Manner Of Death: Accidental

I didn’t usually take these calls as coroner. I was always afraid it was some voyeur, too interested in something that was none of their business. But coroner reports are public record, even if it’s none of their business. That was why I rarely completed a coroner’s report, just filled out the death certificate.

I try to make it about the paperwork, the investigation, keep things official. There’s always more to the story.

But I got told this woman wanted to talk to me about this roadside death. It was weeks after I had filed the death certificate.

I’m not sure why, but I called her back.

We swapped identities. She stated she was the sister of the deceased. I believed her.

“Sandra always struggled.” She offered. The toxicology findings are not on the death certificate.

“I’m sorry for your loss.” I paused.

I could hear her sorrow, her struggle for peace on the distant phone.

She asked: “Was there any other evidence about her death?”

I paused again, not knowing if such information would bring peace, or more misery. But through the long wires and distance I thought it might help her some to share.

So, I did. Kind of against my professional nature, but really, even the dead, and the survivors, need care. That’s what we should do. Care for each other. And telling a story can be caring.

Posted in Uncategorized | Tagged | Comments Off on Coroner Story: Road

Influence

We are products of our environments, no doubt, but we bring our traits, our tendencies to such. The environment shapes each of us differently.

My late father was born more than a hundred years ago. His broken home and rural poverty affected him. But growing up in the depression, then serving in WWII may have made him part of Tom Brokaw’s “Greatest Generation”, though he lived with and never really recovered from those scarring times. I don’t think he could see his scars, or even feel them. Maybe I did some, through living with him.

I’m not sure I can see how I was influenced by my environment, though I take this time to reflect on the mirror darkly before me.

I’m a late Boomer, born in the mid 1950’s. I watched the small town my father took us to explode into suburbs. The vineyards and groves were bulldozed for tract houses. I still abhor rampant growth.

It seems to be what Idaho leaders are embracing, since our policies have made us the fastest growing state for five years running now. While US population growth has slowed to its lowest since the Pilgrims, Idaho booms. Idaho’s population is countercyclical, I guess. Too crowded elsewhere, come to Idaho.

But when I was entering and finishing undergraduate college, the economic milieu was dominated by inflation. And I believe that economic climate influenced me. Sure, there was the Viet Nam war, race riots, assassinations, and Watergate, but the elevator music in the background was the burdensome tune of despair. The value of your wealth, if you had any, was not going to be worth as much very soon. Why invest in a solid future when it is going to slowly melt to less?

I finished my degree and had no plans for a future in 1976. After a year of wandering, I landed in Idaho. Back then, the state had well short of a million residents. Boise was booming with 4% annual growth, but I didn’t find the Treasure Valley attractive. I went to my step grandmothers ranch above Hells Canyon.

It was there I came to have faith in investment. The fences needed posts, the hay needed mowing, the wood needed sawing, every rig needed fixing. After a couple years of this I realized I needed a career beyond the ranch. So, I went out and got one.

Inflation had dropped, but boy, interest rates were high. We see the same playing out right now. Still, interest rates now are nowhere near what it was when we bought our first and only house.

I look at our current economic environment and the burden inflation will have on my children, and theirs.  Inflation has dropped a bit. Maybe things will be okay. My kids all struggle to afford buying a house. Prices are high.

Idaho’s population booms. And not just people, our incomes have grown. We lead the nation in median income growth. Admittedly, we started pretty low. There was plenty of room for growth.

As the Idaho legislature comes into session this coming week, I hope they have these ideas in mind. The first meeting of the Economic Outlook and Revenue Assessment Committee is today. Tune in. They are tasked with guessing what taxes will be coming in. They have undershot the number since the bust of 2008. Such predictions inhibit the willingness to invest.

I would hope our leaders could see the value in stable growth, and wise investment. Such wisdom will inspire the generations to come.

Booms are unsustainable. They hurt. Wise investment promotes stable and sustainable growth. That should be the goal.

Posted in Uncategorized | Tagged , | Comments Off on Influence

Coroner Story: Black Heelocopters

Sometimes how you get the call is an important part of the story. Sometimes, it’s who calls you, sometimes it why they thought you needed to be called, sometimes it why you weren’t called. All these little nuances to being a small town, rural county coroner fascinate me. So, when I picked up my phone on a warm fall afternoon and I got gruff old Ivan’s voice yelling into my ear, “Doc!?”, I didn’t expect this to be a coroner call.

“Yeah Ivan, what can I do for you?” He’s 85 years old, a crusty skin and bones old rancher in the east county. I see him maybe once a year as his doctor, less if he had his way. But the time I stuck him in the hospital with congestive failure and told him he wouldn’t make his 82nd birthday inspired him to come in annually after that, mainly to rub my nose in my errant prognosis.

I saw him more when his wife was dying. They cared for her at home right up to the end. She got demented and went fast, thank God. I’d met her three or four years earlier and while I was asking her about her family history, she looked me in the eye and told me a fractured but intelligible story of her brother, five years older, who’d gotten demented and died within a year.

“That old Alzheimer’s can really take you down,” she’d tsk’ed and shook her head. I nodded but silently disagreed. Alzheimer’s usually takes some one five years or more after the initial diagnosis. My mom had taken more than ten years. Usually, it’s plenty of time for families to flounder with personality changes, bed sores, diaper changes, nursing home costs and guilt. But Ivan’s Irene had just gotten pleasantly forgetful and died a year later. Her pattern, and her brothers made me fear I’d missed a diagnosis. None of this was on Ivan’s still sharp mind this fall Saturday afternoon.

“You still the coroner?” he yelled. His deafness made him yell. He was the deaf one, but he yelled to others out of politeness, I guess. “I know I voted for you once but maybe I missed something.”

“Yeah Ivan, I’m still the coroner. You fixing to die or something?”

“What?”

“How can I help you? Yes, I’m still the coroner.” That last part as loud as I could yell into the phone.

“Oh no, I’m not dead. At least I don’t think so.” He laughs. “Say, I got a dead guy for you.”

“Really?”

“Yup. Out on American Ridge. I was out looking to bring in some cows and found him.”

“You call the sheriff?”

“No. Should I? I don’t think he needs arresting, he’s dead.”

“Where are you now?”

“I’m back at the house. But he’s up on the ridge like I said.”

“OK Ivan. I’m going to call the sheriff’s office then we’ll come out to your house, and you can show us this guy.”

“When’ll it be?”

“Maybe an hour. Why?”

“I was gonna get something to eat.”

“You go right ahead. See you soon.”

I hadn’t wanted to suss out details, yelling into the phone and his hard of hearing. I knew Ivan was a solid guy and wouldn’t be calling me about some pile of deer bones or an old flannel jacket on a log. So, I called the sheriff’s office. I think this was the first and only time I ever called them about a dead body. They usually called me. But it can go all sorts of ways. One time the funeral home called the local police about a coroner case. An old guy had driven his ’63 Chevy truck into the funeral home parking lot, taped a note to the driver side window and shot himself behind the wheel. He was trying to save us all the hassle. But we all got rousted out anyway and then had to call to get his bloody truck towed away.

I got to Ivan’s house after the deputy. They have radios. The deputy and Ivan were up on the front porch. Though sunny, there was a fall chill and a westerly breeze that suggested rain. Hunting season was full bore, so my hunch was this body was a lost hunter. But usually Search and Rescue hears about such a thing before the guy’s feet get cold. He doesn’t come back to camp and the word goes out. Still, some guys go out by themselves, break a leg, who knows.

I climb the porch steps. “Hello Ivan. Hello Brandon.”

Ivan smiles. Brandon grins. “Did you take a wrong turn doc?” He knows I’m famous for getting lost on the county roads.

“No, I just had to put the tools away. I’m mudding some sheet rock.”

“Oh yeah. Don’t want that shit to dry on the tools.” He’s being familiar but I doubt he’s ever remodeled or fixed up even his single wide.

“So, what have we got?”

“Ivan here says it’s a plane wreck.”

“Really?” I’m surprised. I felt bad for not asking more over the phone. But in person is best with this old guy. I made him come in once a year at least for his medicine refills, though he only took one or two pills, way below average. He took great glee showing me he had beat my prognosis. I had to go over him pretty good, since he minimized everything. The 2-centimeter skin cancer on his right shoulder I’d found under the Carhart jacket, wool shirt and long underwear.

“Oh, that.” He’d said when I asked him about it. Plane wreck? Small potatoes, I guess.

Ivan was retelling Brandon about how he’d noticed all the broken trees across the canyon. I could figure this was a retelling since Brandon rolled his eyes at me. Somebody had to cut him off; we’re losing daylight.

“So, Ivan, can you get us to this wreck? I wore my boots. How far is it?”

He puckered to an expression of thought. “Well, what rig we gonna take?”

“Which one did you take?” I yell at Ivan.

Brandon interrupted. “You get the twenty doc. I’m gonna tell dispatch about the plane wreck thing.” He went to his rig and the radio.

Ivan’s grinning at me about his answer. “Well, doc, I was on Sadie.” He looked at me intently and waited.

“Who’s Sadie?” You gotta let them tell the joke.

“She’s my old mare!” He slaps his thigh.

Old brittle 85-year-old on horseback with congestive failure rubbing my doctor nose in it.

“So how can I get there?”

“You driving that thing?” He nods at my rusty old Toyota two-wheel drive pickup.

“I drove it here. We need four-wheel?”

“It’s a bit muddy past the gate.”

“We’ll take the deputy’s rig. It’s got four-wheel.”

Brandon said no one knew of any plane wrecks but dispatch was going to check with the FAA. We all got into the deputy’s Ford Explorer. I got to sit in the back where the doors don’t open from the inside, so Ivan managed the gates. They were his anyway.

It was about three in the afternoon now and it would be getting dark by 5:30 or 6. At least it wasn’t raining yet or snowing. We passed three wire gates then we get into broken timber. Ivan was telling Brandon how he’d come at it a different way on horseback so he’s not sure we can see it here from the dirt track. “Hell, Sadie saw it first!” he yells. “I’m looking for cows and she keeps staring off at the far ridge, so’s I think she’s seeing some there, but that’s when I saw the broken trees and the plane.”

“Did you go up to it?” Brandon asks.

“Naw, but I could see something in the pilot’s seat with the glasses. He’s dead.”

After twenty minutes and maybe five miles Ivan suggests we stop. By the rig he offers, “Just climb up this ridge and head south a bit.” He’s gesturing with gnarled hands and stiff shoulders. “We was up on this ridge I think when we seen it.” He twists back. “I could show you but I’m not too good in this downfall.” Another gimped up gesture and I’m looking for a path.

“If you’re staying here, I’ll leave the keys with you if you need to warm up.” Brandon handed the old man the keys.

We clambered over logs and through brush. I didn’t sense any ridge nor even magnetic direction. After thirty minutes we agreed to go back and get Ivan. “I seen you were dropping down too soon” he grinned.

There were the usual jokes about if anybody got hurt at least we had a doctor. And if it really went to shit, we had the coroner. I’ve heard them too many times. Ivan was remarkably agile, though slow and I’m thinking of daylight. He followed game trails and stayed with the grade until we came to a clearing.

“You might be able to see some broken trees from here off that a way.” He gestured again. Both Brandon and I looked off. It was a quarter mile or so below us still. The thing that got my attention was the fine white dusting across a couple hundred yards before the broken trees and white fuselage shined at us.

“Think it was a crop duster?” Brandon asks.

“Nope,” I say. “They don’t spray white powder.”

“OK Ivan, we can see it. Do you think you can get back up to the rig?”

“I think I better stay with you guys. You got pretty fouled up last time I sent you off. It ain’t far.”

We dipped back down into the timber following the old man. There was a temptation, like when you shoot a deer, to head off full bore to where you think it’s down. But long ago I learned that temptation is to be avoided. Slow and steady got Ivan to 85. By the looks of it he’ll make 90 at this rate.

The white powder I saw contrasting the dark needles wasn’t visible on the ground, but I warned Brandon. “Don’t touch the ground and put your fingers in your mouth. You won’t be passing any drug screens the sheriff puts you through.”

“Is it OK to breathe?” He chuckles.

“Only through your nose.”

The wreckage was mostly intact though both wings had sheared, and the fuselage buckled. We could see it was a twin-engine prop, no numbers on it. Ivan had stopped and was looking back. “I think I spotted her from up over there.” He gestures back toward a clearing across the canyon a couple hundred yards up and over; always orienting. “I could see the guy in the pilot’s seat. He’s dead. That’s why I called you.” He reminds us.

Brandon was ahead of us downhill looking into the tilted cabin, past the bent and split open fuselage. There were lots of wrapped bricks and white powder back here. He hustled up the slope a little breathless. “I gotta call this in. They’re gonna want to know about this. I’ll head back to my radio in the rig. Hope I can raise them here. If I can’t I’ll drive out a ways. You guys gonna be OK? I’ll be right back.” He was panting.

“Sure.”

“Take your time.” Ivan advised. “We’ll be fine.”

Brandon scoots up the sidehill back toward the Explorer. I walk down toward the cockpit. Ivan follows. It’s pretty quiet here in this canyon, no wind, but I can see it’s getting gray. We have another couple hours of light I figure.

The windows are all broken out and I can step into the tilted plane pretty easily with the left side torn open. Ivan was right, the pilot was very dead, not days, just pale and stiff. But it’s been cool, and this is a north slope, so maybe a couple days. No animals had gotten to him. There’s blood out both ears and the head is tilted at a funny angle.

I spook when “What do you think killed him doc?” is yelled in my ear. Ivan is all serious and frowning.

“Jesus, Ivan.” I want to tell him to soften his voice here in the presence of the dead, but I know it’s no use. “I think he died in a plane wreck.”

Ivan’s laughter is loud, and he laughs too long; my skin crawls a bit, I don’t know why. He gets serious and asks me intently, wanting to know. “No, I mean doc, did he bleed to death? I see some blood but not that much.”

“Oh, Ivan, it’s hard to tell. Here let me check.” I reach in and twist his head a bit and feel some grating bones. “Yeah, I think his neck is broken.” The yelling I have to do makes this almost obscene.

“But is that what killed him? People survive…” he trailed off as I turned my back to him. I wanted to get some identification. There were satchels that looked like luggage on the cabin floor and more stacked up where the copilot’s seat would have been. I zipped open a small one behind the pilot’s seat. There on top of rumpled clothes were three passports, one Columbian, one Mexican, one Peruvian. Miguel Sandoval was on the Mexican, Manuel Salinas was on the Peruvian and Miguel Santoro was on the Columbian. There were three other satchels jumbled next to him. I unzipped one. Bundles of US currency were neatly stacked and wrapped, some fifties, some twenties, some hundreds.

I jumped again when Ivan said, quieter this time, “Don’t know as I’d called you guys if I’d a known all that was there.”

Brandon got back in about a half hour. He looked troubled. “We’ll stay put ‘til they get here. Won’t be long.” For some reason I didn’t ask who. “Why don’t you take Ivan back up to the rig so he don’t have to scramble around if it gets dark.”

Ivan and I made the slow walk back to the Explorer, then I headed back down and across the slope, a little faster on my own.

When the big black helicopter came over just before dark and all the paramilitary dark suited guys came down the slope, I knew it wasn’t our sheriff’s department. A short man approached us with his combat weapon by his side as the others fanned out and disappeared in the gloom. He had night vision goggles up on his helmet, black clothes, black gloves and a smile. He didn’t offer his hand. He spoke to Brandon. “OK, we got it. You can take off.”

Brandon nodded and softly gestured to me as he turned up the slope. “Hey,” was my simple objection and the short man turned toward me.

“Who are you?” he shot at me.

“I’m the county coroner.”

His smirk didn’t feel so good. “You can go, sir. We got it.”

“And just who are you?”

Brandon was three or four steps up the slope. He stuck out a beckoning hand. “C’mon doc.” Like I’m a balky puppy. The short guy was getting ready to turn away again and I asserted all the authority a county coroner has. “What happens to the body?”

This time he wasn’t deferential. He snapped back toward me and up in the trees I could see a dark shape, maybe two, step into view. The short man looked me directly in the eyes. “You can go. We got this.”

Brandon was now stepping down the slope, impatient with me. “Come on doc. We’re going. These guys are taking over. They’ll take care of it. We gotta get back.” He put his hand on my shoulder, softly, not like he would have grabbed a puppy’s scruff, but like we were having beers. “C’mon.”

The trail back up was dark.  I only slipped a couple times.

“You guys see that big black heelocopter?” Ivan asked. Brandon wouldn’t tell us nothing. Maybe he didn’t know.

It was about three weeks later I got a call from the medical examiner’s office in Spokane. “Dr. Hawthorne?”

“Yes, how can I help you?” I hadn’t requested their services for years.

“We have a body here and we need your permission to release it to the family.”

I’m clueless. “Who is it?”

“Manuel Sandoval”

“Why are you calling me? I don’t know this guy. It’s not my case.”

“Our paperwork says you are the coroner on this case, and we just need your permission to release the body.”

“So, are you sending me a death certificate; an autopsy report?”

“Uh, no. Those were sent to Washington. We just need your authorization to release the body.”

“Call Washington. I don’t know anything about this.”

“Uh, we did. They said to call you.”

Deep sigh. I thought of Ivan’s smile and his slow steady gait. How he looked the graceful scarecrow under the dark pine canopy weaving through the brush and sticks. I thought how he would laugh at this silly joke. I wanted to be sitting on his porch in the afternoon sun, telling him this story, yelling him this story, repeating myself when he said “eh?” and finally getting tired of the whole tale, realizing it’s not a short joke but a long one with nothing really to laugh at. But then we’d just sit there and look at the sun on the hills from his old farmhouse.

“You have my permission to release the body.”

No death certificate filed.

Posted in Uncategorized | Tagged | Comments Off on Coroner Story: Black Heelocopters

Bull Schmidt

I know Congressman Russ Fulcher well. And I appreciate he can say what he thinks should be said. But I feel free to call him out when he speaks, what my high school taunters called, “Bull Schmidt.”

There has been a 20-yearlong lawsuit about Idaho salmon and the lower four Snake River dams. For those of you who don’t live here, our salmon spawn in our streams, then must go to the ocean through state boundaries established by 1870’s Congresses. To get to the ocean Idaho Salmon must traverse falls and waters now slack behind dams in a state called Washington, then down a dammed Columbia between Oregon and Washington. These boundaries do not respect anadromous fish. But we have a federal government that authorized the damming of this channel. It is now a channel of death.

It seems there is finally an agreement, of sorts. It seems, the claimants will agree to not pursue further expensive lawsuits if renewable energy is promoted to replace the measly megawatts of the lower four Snake River dams, situated in Washington.

These lower four dams have long been in dispute. They were almost an afterthought of the Army Corps of Engineers.

But the salmon have always been prized.

It wasn’t long after white men came to this country before nets were strung across the Columbia. Canned salmon rivaled red fir as our greatest export after the beaver and gold were gone. Downstream Oregon established a Fish and Game commission to regulate the harvest of salmon in the 1870’s when they saw the carnage. Upstream Idaho just shrugged. We spent our game preservation energy on elk.

But the Federal Government did sign a treaty with the Nez Perce. Then they manufactured another, more suiting their needs. But the Nez Perce did not sign. A surrogate did. Then the US Army drove the nontreaty folks into death. If only Custer hadn’t been such a damn fool.

That 1855 treaty promised that the land my house stands on would forever belong to the people that saved the lives of the Corps of Discovery. But the nimiipuu  do not make that claim.

They want the salmon promised.

Congressman Fulcher claims the deal made about the lower four dams will destroy our economy. I say “our” because I live here. I drive through Lewiston and Clarkston to go steelhead and salmon fishing. I know these small towns.

The proposal to make the lower Snake River slack water suggested having an Idaho seaport would boom their economy. But please just look at the numbers. Lewiston and Clarkston boomed while they were building the dams. But since they have grown like the rest of us. Dams have not made them boom. But the salmon have dwindled.

So, Congressman Fulcher is guilty of “bull Schmidt”. Increasing alternative energy sources to replace what the dams produce will not decimate the economy of this region. It will weaken the arguments of the dam huggers.

The dams were initially approved by Congress in the 1940’s. But the Bureau of Reclamation and the Army Corps of Engineers thought they were not worth the expense. The combined use of passage for barges and hydroelectric diminished their effectiveness. But when the funding was slipped into a secret plan despite Eisenhower’s disapproval, they got built.

So, the outrage Congressman Russ Fulcher exclaims at the deal agreed to replace these dams’ energy production should be considered in the history of how these concrete fiascoes got built.

Nobody was listened to when Ice Harbor got funded.

Then Lower Monumental and Little Goose followed.

And the salmon runs died off.

Then Little Granite and now we have multimillion dollar salmon recovery efforts, hatchery fish, and our economies are about what they were.

So, you want to kill the salmon for what?

Bull Schmidt, Congressman. I’d be glad to say it to your face.

Posted in Uncategorized | Tagged | Comments Off on Bull Schmidt

Intentions

Do you want everybody to have health insurance? I am yelling this question into a sharp, dark westerly wind, in the middle of a long winters’ night. Questions like that know their own answers. I know it. But I want you to know it too and feel good about your answer. I feel fine about mine.

This comes up because we bought our daughter a truck she found on a lot in Spokane. She has an old 4Runner on its last legs. But a new car is out of the question on her salary.

I drove it down to our Idaho town and took it to our DMV to register it and get the title transferred. I brought in all the paperwork from the used car lot to the nice lady. She sorted the papers for me and handed back the half dozen she didn’t need.

“Do you want my proof of insurance?” I’d held that sheet back. We’d just gotten the form in the mail.

“No, we confirm insurance electronically.” She smiled at me. She was getting out all her paper forms she needed me to sign.

“Do they tell you what we paid too?” I should not be amazed at this level of data sharing, but it always feels like an infringement. She laughed and said no.

Then I went through our plan. We had paid for the truck, but we wanted to give it to our daughter who lives down in Canyon County. She works for the government so she couldn’t afford the brakes and axle seals and steering rack that needed replacement on the old 4Runner.

The kind, efficient lady listened and suggested we just add her to the title. Then, after a time, she could just remove us from the title, and it would save her the hassle.

And, she offered, since I didn’t have plates to transfer, they could have the new plates sent to her.

How helpful! “That would be great!” I said. “Do you need her address? And her name?”

“No, she’s here in our system.”

I was shocked. “Do you have her street address?” She printed up a form that had my daughter’s name and address.

So, the Idaho DMV can find my daughter without me even giving them her name, or her street address.

And this year, the Idaho Department of Health and Welfare kicked 100,000 people off Medicaid because they couldn’t get a reply to a mailing or an email. Go figure.

I actually tried to. At a recent IDHW Board meeting I asked what data bases they used to try to find these folks they were kicking off coverage for lack of response. I asked if they used the Secretary of States voter registration data base. It’s public record. They did not. They suggested they had paid some national company some money to help, but, shrug, this was as good as they could do.

I knew the back story. But right here you need to answer that question I screamed into the storm. Do you want everybody to have health insurance? If your answer is no, then the backstory will satisfy you.

This year, the Idaho legislature budgeted for 120,000 less people to be enrolled in Medicaid. And so, the IDHW did that job. The Department will meet its budget.

But those folks will get care.

They will call for an appointment in a doctor’s office and tell the nice phone lady they have Medicaid. But when they come in for the appointment for their diabetes, the receptionist will tell them they are not covered. And they will go back home.

But then a week or a month later they will get hauled into the emergency room. Then, the hospital will have their paid staff go about re-enrolling them.

You probably know it would have been cheapest for them to die quietly at home. Is that your intention?

Posted in Uncategorized | Tagged , | Comments Off on Intentions

Coroner Story…..New Years

It was a weekend of being on call for the group.

I started early Saturday morning in the hospital. I rounded on patients in the hospital then I needed to cover the Saturday clinic from 830 to 1:00 in the afternoon.  It was a fairly light obligation on rounds, so I started in the hospital at about 7 AM, still dark on this deep winter, New Year’s Saturday. 

I first saw the two other patients I was covering for my partners.  Read the chart, check the history, review the notes left by my partners, then talk with and examine the patient.

My third hospital patient was Mrs. Smith.  I knew her since I had just become her doctor.

She was an elderly woman who had come to the hospital three days before.  She was brought to the emergency room by worried children who were responding to her complaints of chest pain.  On examination and questioning it seemed Mrs. Smith had experienced a heart attack in the day or two priors.  She said she felt fine now and didn’t see the need to be in the hospital.  Her daughters were worried.  I had been called as the doctor on call for “unattended patients”. The hospital kept a schedule for the community primary care doctors to admit folks from the ER who didn’t have a local doctor. This woman did not go to doctors. She was my kind of patient.

I reviewed the tests and listened to her story that Thursday afternoon. I explained to her that we usually hospitalized people after a heart attack to observe them and treat any irregular heart rhythms or medical problems.  I understood her wanting to return to the comfort of her home, but I felt it would be prudent to be in the hospital for a day or two.

“By the way Mrs. Smith, who is your regular doctor?”  I always want people to have their preferred provider.

“Well, I guess you are now, honey.”  She grinned at me.

“I’ll be glad to do that.  Do you have any questions about me?”

“Oh no, you look like a fine young man.”  She patted my hand and looked at her worried daughter with almost a giggle.

She had no serious problems from her heart attack so far.  In fact, I’m sure her heart injury had occurred at least a day before and we just needed to care for her should any complications arise.  It turned out she had diabetes but wasn’t taking any medicine nor hadn’t for quite a while.  It just wasn’t something that worried her much.  Her daughters rolled their eyes and shook their heads (tsk tsk) when I asked them.

“Oh, Mom doesn’t like doctors.  She took medicine for a while I think, but then just stopped.  She didn’t want to come to the hospital with this chest pain even.  She sure did take to you though,” they both smiled.

“Well, we’ll see how she feels in a day or two when I bug her to take her medicine.”

“Oh, I’m sure she’ll listen to you.”

I smiled.  No sense arguing.  We’ll just wait-and-see.

On her second hospital day I had come by to see Mrs. Smith in the evening.  She was her usual chipper self but a little bit more tired than the first day.  Her pulse was a little weaker, but steady, and her blood pressure down a bit, but not short of breath or with any swollen ankles.  So, it seemed like her heart attack had weakened her heart but not seriously at this point.  Still, I needed to know some things from her.

“Good evening Mrs. Smith.  How do you feel tonight?”

“Oh, just fine.  A little tired.”

“Have you had any chest pain?”

“No, I’ve felt just fine.”

“Did you walk at all today?”

“Just to the bathroom.”

“Did that tire you out?”

“No.”

“Did you feel short of breath?”

“No.”

“Good.”

I was feeling her pulse as we talked.  Steady.  Regular, but a bit weak.  Still, it was the end of the day.

“Mrs. Smith, all the tests confirm you have had a heart attack, but you seem to be doing OK.  I expect you to go home in a day or two.  Probably by Monday if all goes well.”

“Oh, I hope so.”

“You live alone, don’t you?”

“Yes.  My daughter’s visit a lot.  My husband died six years ago.”

“You like living at home, don’t you?”

“Oh yes.  I love my little house and my yard.”

“Mrs. Smith, I don’t want to alarm you, but I need to ask you some questions.  When you are here in the hospital we can do things to you in many ways, some things that you may or may not want done.  We do our best to respect your wishes.  Sometimes things happen and people can’t talk to us. But we could do things to treat them that may revive them or not.  For instance, if your heart were to stop beating, we have ways to treat that that many restart it.  It has to do with shocking the heart with electricity.  Further, if you were to stop breathing, we can put a tube down into your throat and breathe for you with a machine.  Now, are these things you would want us to do?  Have you ever thought about this before?”

“Honey, you just do what you think is best.”

“I’d really like to do what you want.  It’s very hard for me to know what you would like.  We’ve only just met.  I’d like you to think about this.  If you like I could talk with you and your daughters about it.”

She looked fairly peaceful about the whole discussion.  “That would be all right.”

“Why don’t we visit tomorrow morning.  Do you think your daughter could be here Saturday morning?”

“I’ll ask her.  I’ll call her tonight on the phone.”

“Well, tell her I’ll be here around 8:00 if she can make it.  Otherwise, I’ll just talk with you.  Sleep well.  Tell the nurses if you have any pain or feel short of breath.  Goodnight.”

So, I had cleared the decks and now this sunny January morning I hoped to discuss Mrs. Smith’s wishes with her and at least one of her daughters. 

Federal law requires that all patients entering the hospital be asked if they want resuscitation.  (Advance Directives is the government- speak term).  But most of the time the admitting clerk just checks the box “patient unable to discuss” and fulfills the obligation.  Mrs. Smith had now been in the hospital for three days with a heart attack and we didn’t know her wishes.  Truthfully, she probably didn’t know what she wanted.  She didn’t even know the possibilities.  Doctors who perform CPR almost always check the Do Not Resuscitate box. But patients and family think such violent treatment is care.

It was a very pleasant and comfortable talk.  One of Mrs. Smith’s daughters was there.  Mrs. Smith had decided that if her heart stopped or she stopped breathing she wanted nothing done.  “Mr. Smith has been gone for six years now and I’ve thought for a while now it was time to join him.”  Her daughter was blinking back tears.

“Mrs. Smith, I appreciate what you want, and we will respect your wishes, but honestly, I’m not sure this is your time to die.  You have had a heart attack, but I think you’ll make a full recovery.  Still, it is best to know what you want should anything unexpected happen.”

She just smiled at me warmly and patted her daughter’s hand in comfort.

I had not checked her pulse or examined her in an attempt to use all my time with the discussion about her “Advanced Directives.”  As I left the room I glanced at her bedside chart: blood pressure even lower and some weight gain; pulse still regular but a little higher.  A little troubling.  I checked with the nurse on my way out.  She too frowned at the vital signs, concerned.  I told her of the discussion, ordered a new medication and went to the morning clinic.  I made sure I had written an order for “No Code” in her chart and told this to the nurse. Then I went across the street to see the morning patients.

Busy clinic as usual.  At 11:00 there was a knock on the examining room door of the 10th little kid with a cold that day.  My nurse said through crack of the door “Sheriff’s office, line one”. That was her code for a coroner’s call. 

“I’ll be right out.”

The Sherriff’s dispatcher asked that I go to a rural Cemetery in the south of the county for a suicide.  I had to leave and disappoint the last 15 people with colds.  I wouldn’t be able to cure them today.

The directions were very good, but I was still nervous.

About getting lost.  I always seem to get lost when looking for these out of the way deaths.  And everybody acts like you know the same country they do.  “Oh, you know, right past Mrs. Kannikiberg’s old house, where that divorcee is now living and she has all those boyfriends”.  Trying to pin down the dispatcher to right and left, miles, yards, color of houses, etc. is painful.  They act like I’m an idiot.

Suicide in the Cemetery.  Reminded me of the 80-year-old guy who parked in front of the funeral home and shot himself, trying to be considerate, save the undertakers the trip. But they had to have the soiled pickup towed.

I’ll bet this guy wasn’t being considerate.  I looked across the winter landscape.  Not much snow, sunny, with a chill blustery wind out of the west.  I’ll bet he went up on Cemetery Hill last night to look into the wind out of the west and eternity. 

There was very little traffic and no ice on the road.  I had a pleasant drive.  As I wandered through the small town heading east, I saw the hill with the sheriff’s patrol cars on it.  A couple well-established trees signified it wasn’t just another hilltop.  I couldn’t see the headstones from this distance, but it had to be my objective, since there are only so many hills with sheriff’s patrol cars on them. The hill had a view over the little town and valley, I’m sure a comfort to the people attending funerals. Probably give a sense of perspective and peace. 

Although I could see the top of the hill, finding the drive to get me up there took a while.  After my first circle around it on dirt farm roads I took the first driveway that I had initially passed up.  It was right by a trailer house, and I didn’t see the sharp left and the gate right afterwards.

As I crested the top of the hill, entering the cemetery, I noticed how the one deputy’s rig was running, a trail of steam out of the tailpipe torn to the east by the wind.  They were seeking a warm refuge in the bitter breeze of the hilltop. I doubted they were contemplating the peaceful perspective, with their motor running, the radio conversations with dispatch and parked next to a cold car with a dead teenager in it.

As I parked, I saw the victim’s car.  It was painted half black, half primer, a 1970s Pontiac with a peeling vinyl top.  From here I could see the windows misted over and the back window frosted pink.

“So, Doc, you get some clues in your first sweep around the hill?”  Both deputies grin.  People always love it when other’s look dumb.

I didn’t answer.

“Yeah, we watched you from up here.  If you went around again, we were going to come down for you.”

I still didn’t want to rise to their taunts.  “So, what have you got?”  I asked.

“19-year-old male, at least we think he is.  Caretaker found him this morning.  Opened up at 10 AM and drove up here.  The car was running.  He looked in the window and saw him dead and went down and called dispatch.  He said he locked up the gate the night before at 8 like usual but didn’t come up here so he figured the kid must have drove up before that and then the caretaker locked him in.  Says he didn’t hear anything.  He lives down in that trailer at the bottom that you went by.  They let him stay there for cheap for minding the cemetery.”

“Who is he?” I nod at the dark car.

“Well, we haven’t ID him, because we’re waiting for you, but the car is registered to David Rich.  His mom called the sheriff’s office this morning saying he didn’t come in last night and an officer went to her home.  We haven’t told her yet because we’re not sure he’s dead.  (He grinned at me).  We thought we’d wait for you to declare him dead.  Then we can check his pockets.”

“Mom say he was depressed?  She worried about him?”

“Well, she says he just broke up with a girl.  But the girl didn’t see him last night, the mom says anyway.  But she must be kinda suspicious since she’s called all over this morning looking for him.  He’s just moved back in with his mom.  He had some troubles recently, I guess.  Lost his job.  Didn’t graduate from high school last year and his girlfriend is just 16 so that actually is illegal if they are having sex, you know.” (Another grin)

“He shoot himself?”

“Boy did he.”

 We’ve walked up to the driver side window now.  The car is parked facing west, into the biting wind.  It is a big 1970s two door muscle car.

The wind draws tears to my eyes and drops from my nose.

I can see him through the window.  Not much of his face left.  Top of the head gone and the face split.  He’s got a jacket on.  It is remarkably clean, unlike the rest of the car.  Splatter goes along the line of force.

A rifle with a banana clip is between his legs now with the muzzle on his chest.  One hand is on the rifle and the other lying by his left side.

“Look here Doc, we think he may have got off a second round.  There are two dents in the roof back here from bullets.  That’s a semi-automatic and sometimes they jerk enough with the first shot to discharge a second round.”

Two small pimples protrude the roofs peeling vinyl.  I’ll bet this occupied their conversation before I became a more available distraction.

“Could be,” I said.  “Is the door locked?”

“Don’t know.  Caretaker said he heard the radio, and the car was running when he came up but it don’t sound like it’s on now.  Probably ran out of gas and now the battery’s gone dead.  Here Doc.  I’ll clear that gun for you.”

I stand back and the deputy opens the big door.  It creaks loudly.  “Bet he had a hard time sneaking in at night with that door” I offer.

“I’m not sure he had to Doc.  His mom was a real terror.  We know her pretty well.  She’s out all the time.  We think she’s into meth but haven’t pinned anything on her.  I bet she wasn’t even home last night to know if he was home or not.”

The deputy is removing the rifle, a cheap imitation AK-47 with a wooden stock.  The boy’s arm is stiff on the stock.  I can see the majority of the mess is in the back seat and on the headliner.  Blood pooled on the floor of the back and brain bits; skull bits sprayed all over.  Front seat pretty clean except for his premorbid mess; the empty cigarette packs and candy wrappers and old cassette tapes.

As we are manipulating his stiff, near-frozen body to get to the wallet we see the note in the front seat next to him.  A little blood is on it.  Block print.  Miss-spelled words.  He says sorry to his girlfriend.  Not a word to Mom.  His wallet is bloody and the deputy with the latex gloves gets the driver’s license out.

“Yup, that’s him.  See Doc, the key’s still on.  Musta run out of gas and the battery finally went dead like we said.  When you think he did this?”

“Oh, last night I guess, before midnight.  Car cooled down fast in this wind.  Probably got down below 20 last night.  He’s pretty cold and stiff already.”  Lots of this job is just being observant.

My beeper goes off.  It is the phone number for the hospital.  “Well, I got to go.  Call the funeral home to come get him”.

“Autopsy?”  The deputy asks me.  They always want an autopsy.

“Nope.  You guys going to talk to the mom?  Somebody gonna talk to the girlfriend?”

“We’ll take care of it, Doc.”

I drive down the hill.  The caretaker is on his trailer porch watching me as I go through the gate.  He’s frowning at me. Could be just the sun and cold wind.  Then again, he could think I’m a real loser too and worthy of his contempt.  Death seems to bring out judgments in people.

As I’m heading down the hill and into the little town, I bet to myself the beep I got at the cemetery is about a lab test result on Mrs. Smith.  Or maybe she’s having problems.  I worry a bit.  The drive back I’m not as relaxed.  I get a bit more worried when I get the second beep, just 10 minutes later.  I speed up a bit but there’s only so much you can do in an old Toyota pickup.  As I crest the hill and coast down toward town doing the legal 55 miles an hour, I notice an old green Datsun 210 coming up the hill toward me.  As I watch it starts to drift into my lane just 100 yards ahead.  I drift to the right, onto the shoulder and slow down, gripping the wheel tighter, ready for a swerve.  At 50 yards I see the driver is bent over doing something, not watching the road. He drifts all the way to my shoulder then finally corrects back into his lane just 10 yards from me, never slowing.

I am stopped as he passes.  This casual little green bullet of death speeds on oblivious. I felt the nausea of visceral fear. My perspective on death expanded and contracted suddenly on the clear sunny lonely highway of the New Year.

When I get to the hospital, they tell me Mrs. Smith died about noon.  They coded her, doing CPR for 10 minutes until the nurse I spoke to this morning called from the nurses break room where she was having her lunch that Mrs. Smith was a “no code”.  They found my note in the chart and stopped pressing on her chest after the futile ten minutes of trauma, the indignity I had tried to save her from.  The family was in the room with her now.

“Were they here with her when she coded?”

“No, they had gone out to lunch.”

Cause of death: gunshot wound to the head.

manner of death: suicide

Cause of death: myocardial infarction

manner of death: natural

Posted in Uncategorized | Comments Off on Coroner Story…..New Years

The Call

I was cutting dadoes down in my shop when I felt the vibration in my breast pocket. Unidentified number so I went back to the table saw. When I got another shot of the cooling morning coffee I looked again and there was a voice mail. Before deleting, I looked at the Apple transcription.

“…consultant to the President…wish to speak…could you call us back…time sensitive.”

Geez.

So, I listened to it before deleting it. This could be a real scam. I figured they wanted my Social Security number for sure. But no, despite the mumbling, I detected they knew me, and just wanted to talk. So, I called them back.

“Senator Schmidt?” they answered quickly.

“Just who are you?”

“I work for the President’s campaign team, and we wanted to visit with you about his healthcare plan.”

“You’ve got to be kidding.”

“No, we really need some ideas, and we’ve used AI to find the folks with the best ideas and the algorithm came up with you. And there were some others. But I need your thoughts.”

I finished the dregs of the cool coffee. “What’s the big rush?”

“Well, you see, he made this big announcement that he was planning to replace the Affordable Care Act with something new and different, so we are reaching out. AI says you have not been fully supportive of the ACA in your writings. It strongly recommended your input.”

“Geez, Biden wants to replace the ACA? I hadn’t heard that.”

There was a long pause. “Oh no, not Biden. I am referring to The President. We all here refer to him as the Real President on the team.”

I laughed out loud. “So, Trump made this big promise with no ideas?”

“It wasn’t in the script. The President does that. He senses things and goes off script. We were all very unprepared. But we have very strong algorithms.”

“So, you call me. Heck, I’m cutting dadoes.”

“Senator…”

I cut in “State Senator.”

“Be that as it may, we are looking for your best ideas.”

I brushed the dust off the table saw top. “You don’t need me for this. Just read the data, the polls. The United States spends more on health care than any other country in the world and we have the worst outcomes of any developed country. The younger voters strongly favor universal coverage. It’s just the old geezers like me with Medicare that oppose it, since we’ve already got it. If he wants the youth vote tell old carrot face to go full Bernie.”

There was a long pause, and I heard some noise.

“I could go on. Every state that expanded Medicaid, a small step toward universal coverage saw an economic bump. Here in Idaho, it was real and dramatic. Think what that would do to the Dow Jones if a President with some spine was able to push that through those old Republican fully insured Senators.”

I heard a voice I recognized say in the background, “Can’t we get somebody else? I like his spunk, but I can’t go full Bernie.”

“Hey,” I yelled. “Am I on speaker phone!”

“Um, yes, Senator, you are. The President has been listening in with his advisors.”

“Maybe you ought to say that up front, you know?”

“I apologize.”

I paused and they did too. But I jumped at the space.

“Mister President. I know Bernie isn’t your idea of a strong man. But health care coverage for everybody in this country is what’s holding us back in the world economy. We’re smarter and more hard working than the Germans but we spend twice as much as them on healthcare. Have some cojones. Admit we need to make this leap. Biden took the baby step on infrastructure and global warming. Show you have the manhood to address true healthcare reform.”

The line went dead. I went back to cutting dadoes.

Posted in Uncategorized | Comments Off on The Call

Communism, Not Libraries

It seems the Freedom Foundation warriors have library porn in their cross hairs. Who would oppose protecting children? The sweet little things.

I just had a long afternoon with some difficult, not very sweet granddaughters. They were not at their best. But I would still sacrifice to protect them from harm. So why not use this as a dog whistle? Those Freedom Foundation strategists have me beat by a mile.

What I’m confused about is all the communism they are avoiding.

Yes, communism right here in this deep red state. State-sanctioned, written into our sacred Idaho code, communism is in our laws. And our Freedom Foundation warriors are just looking the other way.

What, you say you are unaware?

I wasn’t really. But I was inspired about this from a newspaper article. Remember those? They are so quaint.

This article was announcing multiple grants to North Idaho hospitals and clinics with practitioners who needed help with loan repayment. It turns out the Idaho legislature authorized taxing Idaho supported medical students up to 4% a year of what the state chips in for their medical education. (Math: 140 students X 4% of $30K= $168K. The state is supposed to chip in another $84K). This money, collected from all the students is then distributed to those working in Idaho in underserved areas. That sure sounds like communism to me, doesn’t it? Taxing everybody to then send money off to the poor folks?

Not that family docs in small town Idaho are poor. They make at least twice what a teacher makes. But it is a marketplace, that cartel of MDs, also a state-sanctioned restricted market. Getting the not-so-smart ones like me to serve in needed areas with taxes on their classmates sounds at least socialist, if not outright communist.

But it’s everywhere. I’ve written about the Idaho Potato Commission before. If you want to sell your potatoes as “Idaho Potatoes” you have to pay a tax to The Commission. And Idaho law has empowered The Commission to inspect your books, and bring you to court over your small, or very big potatoes. It’s an arrangement the potato farmers seem to appreciate. But jeez, state-sanctioned taxation of potato farmers? Next, we’ll be requiring them to swear allegiance to The Party. We all know what party that would be.

Health Care is not immune from the communist infection. All (except five…that is a very deep story) agreed to pay an “assessment” (soft for “tax”) back to the Idaho Department of Health and Welfare for every Medicaid dollar they received. The tax was set at 10%. This agreement was offered by the hospitals during the 2008 downturn, and they could see big Medicaid cuts on the horizon. They knew the magic of the Federal Medicaid program. Every dollar Idaho spends on Medicaid is matched with three Federal dollars. If Idaho hospitals send ten percent of their money back to the IDHW, they can expect a three to one match in return. Can you say Ponzi? Some states had a much higher “assessment”. This spiral was cut short by the feds about 12 years back, and Idaho was not the worst schemer in this plot.

Idaho nursing homes also pay a Medicaid “assessment”.

When the “assessment” was enacted into Idaho law it was strongly endorsed by the Hospital Association. And it still is.

So, sometimes, interested parties choose to tax themselves for their benefit. All of themselves. And they seem to believe the tax serves them all, even though some of them get more money than others.

I guess this kind of makes sense. But it’s still not free market capitalism. Why hasn’t the Freedom Foundation taken on the Potato Commission? Or the Wheat Commission? There’s communism everywhere, not just in our libraries.

Posted in Uncategorized | Comments Off on Communism, Not Libraries

Give Thanks

It was over six years ago I asked for a spot on this medium. The editor looked through my blog and said I could slip into the Thursday slot. He was aware of my political past. Maybe he thought I had something to offer. I am thankful for his generosity. But I had no concept back then that the Thursday slot meant Thanksgiving, year after year.

I needed to have an annual Thanksgiving post.

I have not always observed the holiday in my posts. I have mixed feelings about both the holiday and large family gatherings. So, some of my fourth Thursday of November posts have not mentioned Pilgrims.

Not that anybody reads this when they are thawing turkeys or greeting relatives. But I have taken this task to heart. So, I post today for your and my Idaho Thanksgiving.

I don’t really know if those east coast Pilgrims were thankful. Lincoln made it a national Holiday 200 years after the Mayflower landed. He had a wise political mind. National Holidays in the midst of a brutal civil war might have just been him playing a public sentiment chip when his hand was weak after the Second Bull Run. And it really boosted the turkey farmers.

It is said the Pilgrims ate turkey and corn and shared a table with their fellow settlers and the natives they were soon to displace. It sure sounds like a wonderful scene, and we all grew up with that image, didn’t we?

But our Idaho natives did not share turkey and corn with the whites with the guns. The Nez Perce shared camas and salmon with the starving Corps of Discovery as they stumbled out of the North Idaho wilderness. These welcoming natives saved the Corps’ lives. And then we displaced them from their lands, despite a treaty. And they have not pursued their war against us. I am thankful for their generous nature and troubled to be living on their land.

So out of reverence for the concept, the worthiness of such a wholesome and spiritual practice as these indigenous people demonstrated, I give thanks. May we all be so welcoming, and forgiving.

I offer thanks to my family, that they tolerate my odd moods and thoughtless behaviors. I can be hard to live with. But they have not kicked me out yet. I am thankful.

This beautiful land, this place I live, I appreciate deeply. I give thanks. I don’t mind the dark, the cold, the rain or snow. I know it triggers life in the seeds as they lie awaiting warmth and the sun of a new season. The blazing red-purple sunset, the golden low light of autumn carries me through the gray days and chill nights. I can abide and do so with gratitude.

But the newcomers and the traffic have me perplexed. I greatly appreciate solitude. That is part of what drew me to Idaho. Though I have come to understand I needed more than myself to be healthy. So, I live in community.

It is hard to accept this change, though all of you might not feel it. Some of Idaho is exploding, some stays about the same. A few communities shrink. I should be as welcoming as the Nez Perce were. But then…

I hope these newcomers too have gratitude for this place. Despite the fact that one of the things that made Idaho wonderful for me was that they hadn’t moved here yet. But then, I did. I moved here from another too-crowded place.

This is a wonderful place, this state. We are made up of the leftovers of the states around us as they were carving out their borders. I love leftovers, don’t you? Happy national holiday to you and yours. May you be blessed with gratitude.

Posted in Uncategorized | Comments Off on Give Thanks