West of the Rotunda

This got a reaction

Here’s the rub. In the old days, local news got very interested when the legislature, and our local representatives were messing with us down in the marble halls of the State Capitol.

Here in Moscow, Idaho, home of the flagship University for the state, THE University of Idaho (Go Vandals!) those days are gone. Our local paper no longer questions our representatives. And our representatives no longer talk to us. So, if the shiv is coming to our backside, we have little warning in the chow line.

The U of I has long been the home for the first-year medical students of the WAMI->WWAMI program. In 1972 Idaho joined with Washington, Alaska, Montana, and later Wyoming to form a consortium to train MD’s.

Back when it meant a couple professors and ten first year students, it didn’t mean a lot of cash for the local economy. But the program has grown. There are now 40 first year students, and that many second-year students are in town for another six months.  And the well-paid faculty numbers have grown. And many graduates have returned to Idaho. I’m one.

So why would one of our local elected representatives be working to move this cash cow elsewhere?

Brandon Mitchell has served this district for five years. He lives here. He claims to be a good friend of the Director of the Idaho WWAMI program. But he has consistently voted to dump WWAMI.

His first effort was back in 2021 when he supported the “No Public Funds For Abortion Act”. This modest bill prohibited any entity getting Idaho taxpayer dollars from, among other things, “Provide training to provide for abortions.”

So, the University of Washington, whom we have this WWAMI deal with must comply with Idaho law if they want to keep getting Idaho dollars and students.

Here’s the rub. And it’s a rub you should all know. It comes down to definitions. How do you define “abortion”?

This “Act” says: “the act of using or prescribing any instrument, medicine, drug, or any other substance, device, or means with the intent to terminate the clinically diagnosable pregnancy of a woman with knowledge that the termination by those means will, with reasonable likelihood, cause the death of the unborn child.”

That might make sense to you but consider this. Under that definition, I should be in an Idaho prison.

There are some babies who are alive in the shelter of their mother’s wombs but will die upon birth. The doctor who delivers that baby, under current Idaho law is a felon, will lose their license. And Idaho required the University of Washington to not train our students how to care for these women.

Brandon Mitchell cosponsored this law. And he supports the current bills in the Idaho legislature to cut our affiliation with the University of Washington.

Honestly, I wouldn’t doubt the UW cares much. They state they regret the divorce. But why? Who wants a radical legislature telling them how to train physicians. According to many evaluators, WWAMI is the preeminent primary care program in the country. Why not build on the best?

And why send these dollars away from your local community to Utah, or BYU, or the private, for-profit medical school in Meridian?

These are decent questions our local paper should be asking of our elected representatives.

The U of I is also deflecting on these questions. They sound like a teenager explaining away their parents’ acrimonious divorce.

The U of I spends our taxpayer dollars to have a lobbyist, Brandon Mitchell’s predecessor, Caroline Nilsson Troy,  in the Capitol. And we elect these clowns who want to shiv us in the chow line.

Why doesn’t the local paper cover this?

Do we even care?

I do. Don’t stab me in the back.

Here’s my letter to the editor responding to the “reaction”:

I appreciate Dan Schoenberg’s interest in the future of medical education in Idaho. And I must apologize, he is right, I did exaggerate. For I was anticipating WWAMI would get the axe. Instead, we got the cudgel.

When my column written on March 26^th, Mitchell had voted for the original HB 368 that cut WWAMI. The Senate amended it. But there had been plenty of WWAMI attacks in the session. We’ll see how it turns out.

But Dan did not address the real question I posed in my column. Representative Mitchell supported and sponsored in 2021 the “No Public Funds for Abortion” bill that defined abortion in a way that makes caring for women with problem pregnancies illegal.

This is the real issue.

Do we wonder why doctors are leaving Idaho?

Should we wonder why quality medical schools don’t find our association worth the effort?

Caring for pregnant women is complex, fraught, and delicate. The Idaho legislature does not have the wisdom or compassion to legislate how this should be done. No legislature does. Stay out of the discussion. It is between a family and their medical providers.

But Representative Mitchell, who Dan Schoenberg seems to speak for seems to think this is beside the point.

I don’t. It’s very important to me. I wish they felt the same.

I would love to have further conversations with Dan or Rep. Mitchell if they chose. This needs attention.

We’re Going to be Managed

It looks like Medicaid in Idaho will now come under the “managed care” umbrella.

I hope you don’t just shrug. But you probably will, since you don’t think this affects you. It does. It affects all of us.

The medical profession has long touted the sanctity of the doctor patient relationship. Except when it came to who pays. We should now be realizing, we all pay. And we are all paying way too much.

Most of us don’t know what this “managed care” thing means. I would argue most of our legislators don’t know either. But they pass the laws, and we send our taxes. We should be expecting more from them. And us.

Many states have done this before.

Here’s the simple description. Idaho puts our $3B Medicaid payment system/ patient care system out to contract. The details of such a contract are very important. Idaho will need to hire some $mart people to design this.

Big companie$ bid.

We grant a contract.

And the money continues to $huffle, but the bid winner gets their take. Their stockholders benefit from their profit. Maybe you have United Health in your portfolio.

Somebody needs to be paying attention.

Has the legislature been paying attention to how the multibillion-dollar MediCaid budget has been spent? Remember, they are ¼ time employees.

Oh, that’s right, they had a “work group” that looked at Medicaid managed care. Mostly Republicans, and they couldn’t come up with a recommendation. But here we are, late in a legislative session, and this big money deal is done.

It seems a bit like Elon got their ear. Slash and burn.

People need care. Don’t let me go all liberal on you, it’s just some numbers.

About 300,000 Idahoans are on Medicaid. So, if you are in a room of seven here in Idaho, the odds are one of you is on this program.

Some are pregnant, some are children, some are disabled. And some, maybe 90,000 are in the “expansion” population. These are folks who make too little to go on the Idaho Exchange and buy health insurance there.

So, our legislators believe some big health care company can manage the health insurance costs for all these different folks and save us taxpayers money.

Like I said, they are not alone. Over 30 states have done this. Have they saved money? Have they provided better care? The answer is not clear.

But the other Medi, MediCARE has done this.

You might have some experience with this, since George Bush II got managed care plans into MEDICARE (old folks need CARE).

MedicAID is for poor and disabled/ MediCARE is for us old folks.

The managed care plans for MediCARE have a long track record, since it’s been around for over 20 years. The results aren’t great. These big insurance companies don’t save us money, and they kick off the expensive folks back to regular MediCARE.

Maybe their shareholders are happy.

This is the health insurance game. If you want to make a profit (who doesn’t?) get rid of your high-cost patients. And provide the least care you can.

MediCAID will be no different. If we want a good delivery system, good care at lower cost, somebody will need to be paying attention.

When states contract with insurance companies for managed care, most require they can only keep 15% for “expenses”, that is CEO pay, etc.

In Idaho, our current overhead is less than 3% of the budget.

Somebody’s going to get very rich on this.

Maybe that’s not news.

Maybe that’s what everybody expects.

Health care is big business in this country, and we here in Idaho just bought in.

I hope your portfolio flourishes.

There are all kinds. There are the ones with minutes or the ones on the sidewalk. There are ones with published agenda and the ones over a couple beers. I admit I don’t always like meetings, especially when I don’t think they serve a purpose.

But you can change that.

When I first got appointed to the Idaho Board of Health and Welfare, I did my research. Before accepting the appointment, I reviewed the minutes of the previous meetings. That had little to inspire me.

But then I remembered the previous H&W Board member from my district, the late Tom Stroschein. I served for six years on the Senate Health and Welfare Committee. Tom would show up every year when he came down to Boise for a Board meeting.

He was an old southeast Idaho sheep rancher, so he had an “aw shucks” manner. And he was a Democrat, now from this tiny liberal part of the state. He would stand before us, recognized by the Chairwoman, Senator Patti Anne Lodge and he would give this self-deprecating “aw shucks” two- or three-minute speech that he was just here to connect.

He just wanted the Senate committee members to know who he was, and he could talk to them about the things the Department of Health and Welfare was doing, and he was keeping an eye on things, as they should be too.

He was saying, “We’re in this together.”

My fellow committee members were answering emails as he spoke, and I’ll admit, after the second year of the “aw shucks” I got a little tired of it.

But he had a valuable point. Standing up and saying, “Let’s all work together for the people we serve” might not be popular these days. But it is worth saying.

And doing.

I only write this because the next scheduled meeting (March 20^th) of the Idaho H&W Board has been canceled until after the legislative session. I understand this, but it saddens me.

Idaho DHW staff and director are busting their butts to address legislation that might affect them, and the citizens we serve.

I will admit I have not been the open and honest advocate Tom was. Last year, my only time on the board when a meeting was held during session, I got out of town quick. I did not really want to walk the marble halls and schmooze.

But that’s really what we need to be doing.

Yes, I’ve got the big yellow “D” sewn to my coat, so talking to legislators can be difficult.

But it’s what we should do.

Or is it?

Governor Little (who appointed me to the DHW Board) got 37,457 calls about the private school tax credit bill. They ran 7/1 opposed. He signed it, though the bill did not meet the criteria he outlined.

So, what is the point of this meeting?

The point is, we get to know each other.

I think our Governor heard from the 32K opponents and decided it wasn’t a deal breaker.

Have you ever had a conversation with someone and faced a deal breaker? They said something, and you had to walk away? Before you walk away, you consider the ramifications. Will I need to work with this person again? For if you do, you don’t just walk away.

Tom Stroschein was trying to open up a dialogue. That was brave and honorable.

I knew him well and talked with him regularly. But my fatigue with his appeals was because I didn’t realize he wasn’t really talking to me.

I don’t know that Tom got many folks to listen.

I have not had his courage.

But that effort, to stop someone on the street, talk to them at a town hall, listen to their perspective, share your own with humility and kindness, will make this a better union.

And that is our fundamental goal.

It appears Representative Jordan Redman has given up on his Idaho Medicaid Expansion repeal bill, HB 138. It barely passed the House and was headed to stormy waters in the Senate. You have to ask, why does this effort to get people off health insurance keep coming up?

So there’s another shot out of the cannon, HB 328. It’s complicated.

Sorry about all the details here, but it is worth your consideration.

Maybe not, if the US Congress decides to make big cuts to Medicaid to fund the Trump Rich People’s Tax Cuts. Whatever is attempted on the state level will be shriveled by the federales.

I truly appreciate all this effort. As I have said so many times, the health care swamp in this country could just be our downfall.

But cuts to Medicaid?

What does one Idahoan on Medicaid Expansion cost the taxpayer?

Keep in mind, under the current split, Idaho pays 10% of the total cost. And don’t let the big numbers thrown around confuse you.

There are many folks covered in Medicaid. There’s the most expensive with severe disabilities. They cost over $20K/ year per person.

Then there’s the kids. Children are cheap. They cost less than $3K per year.

Medicaid Expansion folks cost about $7K/ year.

So, Idaho pays $700 a year of Idaho taxpayer dollars to get them health insurance.

What does Idaho pay to get its legislators health care insurance?

I’m sure Representative Redman knows these numbers. He sells health insurance. Him and his wife and six kids get covered on our tab at over $10K per year. That’s a nice juicy benefit.

But these Medicaid Expansion losers could be scamming us. Sitting on the couch and playing video games all day and we have to pay for their doctor bills. I can see why there is the concern.

So instead of dropping Medicaid Expansion as would have happened in the first bill proposed, this new bill wants to privatize the health care coverage of this small sector of Idaho.

What’s wrong with that?

By the way, privatize has become “Managed Care” in the newspeak of this age.

We have seen how “Managed Care” has affected Medicare (Old people’s guvmint health insurance). Everybody confuses these: Medicare/ Medicaid = Mediconfusion.

Private companies can take over tax funded Medicare (old folks) health insurance and run it for a profit for their stockholders. There’s 20 years of experience. It’s clear. Profit is a powerful motivator, even in this “helping” industry of healthcare. The care is worse, the cost is more , but the profits are real.

It appears Rep. Redman and his cosponsors have decided Idaho would be better served to hand over Idaho Medicaid Expansion to the private equity folks.

At the same time, they want to abandon the effort started ten years ago to hold doctors accountable for wasteful practices.

The most powerful force in this twisted, arcane, convoluted system of health care in this very health care expensive country is, unfortunately, the doctor.

We have given this demigod the power to order unnecessary tests, perform unnecessary surgeries, prescribe harmful and unnecessary medications, and thereby spend our money. If it’s private insurance, the stockholders are pissed. If it’s public insurance, we taxpayers weep. If it’s a normal, honest citizen under this hammer, they just get smashed.

This needs to change.

Idaho started down the road to change this about ten years ago. The progress has been slow.

But throw that baby out now to the venture capitalist wolves?

I am very thankful that our state legislators are trying to reform health insurance. It could be so much better.

But why is their focus on Medicaid? That’s a small apple. Medicaid controls how much it pays. Why aren’t they looking at the big apple, their own big red benefit we all pay for?