Tragedy and Public Policy


We can't measure rain that doesn't fall, but we sure ought to recognize a drought.

We can’t measure rain that doesn’t fall, but we sure ought to recognize a drought.

We had a hearing this last week to consider whether Idaho should change Medicaid eligibility so all folks in Idaho can have insurance coverage. This sometimes gets shortened to “Medicaid Expansion”. The hearing was short and mostly civil. One doctor from Eastern Idaho who had cared for a patient who died from severe asthma, an eminently treatable condition, suggested the Idaho legislature was “killing” Idaho citizens. I thought I would look into that.

Truly, we in Idaho government have made a choice not to consider this issue for the last three years. There have been two governor-appointed”work groups” who have recommended the governor “expand Medicaid” eligibility. He has chosen not to, and neither has the legislature discussed it. Have lots of people died from this inaction?

Well, we do know that by not acting in 2013 when we first could have, Idaho has lost hundreds of millions. But savings not received are like rain that didn’t fall; it’s hard to measure. But it shouldn’t take a farmer to know when you’re in a drought.

We do know that a positive decision by our legislature and governor did result in savings for the taxpayer. The Catastrophic Health Care Fund Board, (CAT Fund) of which I am a member, returned to the state general fund this session almost $30M almost all due to folks getting insurance through the state health insurance exchange. This positive choice has give us a measurable outcome.

So were lives lost that can be pinned on us legislators? Jenny’s story is compelling. Indeed, in my practice years ago I had a young man with severe asthma who would not come in because he had no insurance or money. This was way before the Affordable Care Act.  He struggled, always on the edge of a severe attack. I hospitalized him a couple times and saw him in the office whenever he came in, giving him as much free medicine as I could gather. But then, I signed his death certificate when he was found dead at home at the age of 30. If he’d had insurance would he be alive now? But the death averted by appropriate care is much like that rain that doesn’t fall; hard to know, hard to count. Still, we shouldn’t have our heads in the sand.


Every couple months we review applications from counties to the CAT Fund. This may come to 1200 a year. We got a smaller batch in December, only about 120, since the case numbers are trending down. I went through those cases this morning to look for deaths or diseases that might have been prevented. It’s very hard to tell from the sketchy details provided. Here’s my list from just a tenth of the annual cases:

64 year old male income $800/mo; Skin infection: tissue infection: DEATH

42 year old male income $1200/mo; multi organ failure…SURVIVED taxpayer cost: $36K

51 year old male income $200/mo; UTI: sepsis: DEATH  Taxpayer cost: $46K

32 year old male income $00/mo;   Tooth infection:neck infection: SURVIVED  cost: $22K

56 year old male income $730/mo; Heart disease:infection:DEATH    cost:$165K

38 year old male income $2300/mo; Stroke:DEATH         cost: $138K

56 year old female  income $00/mo; GI bleed; DEATH   cost $30K

62 year old male income $500/mo; pneumonia:cancer:DEATH    cost $15K


Honestly, I really don’t know if all these deaths could have been averted, I doubt anybody does. I did my best to communicate to the young man so long ago I would happily see him for no charge. I wanted him healthy and productive. But his disease, again one we usually can manage with medications and attention, proved fatal.

There are so many reasons why our current indigent and catastrophic system is wrong.  I will let you decide if it is killing people. But I can see a way out of this drought. And we are in one, can’t you see?


About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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