West of the Rotunda

I am struggling with a plumbing problem. No, it’s not my prostate, though you’d be forgiven for assuming such, given my age and decrepitude. It’s a 350# cast iron bathtub. I asked the plumbers if they could install it. They winced and asked if this summer would work. So, I cut the holes and bought the fittings, but the darn thing just won’t hook up. Tomorrow I’m calling the plumbers. I’ll bring them cookies.

Getting professional help should not be shameful. That’s what the Office of Performance Evaluation does for the Idaho legislature and us citizens. We should all read their reports before turning to Netflix. Or maybe late at night when sleep won’t come.

The reports don’t read like romance novels, but they sure captivated me when I first got elected to the legislature. They had a trove of evaluations and recommendations for fixing our state. So, it bothers me that the Idaho Republican legislature is planning to politicize this independent, nonpartisan, award-winning office. They are working just fine. What are they trying to fix? And for what purpose? This move is unwise.

It shouldn’t surprise me. OPE has provided no studies on pornography in libraries or gender reassignment surgery or the deadly MRNA vaccines. These are the issues our Republican legislature wants to pass laws about. Fixing EMS funding, evaluating Medicaid payments and reducing prison recidivism just aren’t red meat.

The proposal is to dismantle the balanced bipartisan Oversight Committee that directs the proposals and instead leave the direction to the Majority run Legislative council. Representative Blanksma successfully got this change through the House. There were only two Republican votes against it. Her arguments were that the Majority legislative leadership can be as unbiased as a balanced bipartisan committee. Sorry, I just don’t believe it. Democrats, if they were in the majority can be just as biased as Republicans. Be careful how you build things.

However, I am pleased to compliment Representative Blanksma for addressing maternal and child health. Her proposal would expand Medicaid health insurance coverage for children up to 205% of the federal poverty level. We are currently one of two states (Idaho and North Dakota) that doesn’t cover kids at this level.

Her proposal also recommends maternal Medicaid coverage be expanded to 12 months after delivery. It currently shuts off at 60 days. We are with 13 other states with such weak support for our moms. Of course, there is a price tag for this. So I can imagine some strong Freedom Foundation opposition.

Blanksma’s bill is sitting in House Health and Welfare Committee, awaiting a public hearing.

Getting advice or recommendations from independent people who study issues in our state is not always welcome nor heeded by our esteemed legislators.

Maybe that’s why the independent Maternal Mortality Review Committee is looking at the axe. This body was established in 2019, with a sunset date of July 2023. The bill to remove the sunset date is also sitting in the House H&W committee.

It’s no wonder they might sunset. They may have delivered some unwelcome news. Maternal deaths have doubled in Idaho since the MMRC was established. Their recommendations were to expand Medicaid coverage for moms to 12 months after delivery. So, Blanksma’s Maternal Child Medicaid Expansion coverage is addressing this recommendation. Good for her. I hope she has as much success getting this health bill through the House as she did with the OPE restructuring.

I know there’s a certain unpopularity about listening to experts. It has been openly expressed in our Idaho legislature. But don’t wait for a cast iron bathtub to convince you. Experience and knowledge are valuable. Wise people don’t shun such advice.

Franny was nervous as the ultrasound tech chatted and booted up her machine. The warmed jelly spread over her lower abdomen and the transducer pressed. The screen was facing away, and the technician stopped her friendly chatter.

“What is it?” Franny asked.

“Nothing. I’ll be right back.” And she left the room.

A tall man entered with the technician at his elbow. “What’s wrong?” Franny, now desperate, asked.

“We’re just trying to get better pictures. We don’t want you to worry.” He murmured in a quiet soothing voice.

“Oh, good. I was getting worried. What do you see?”

There was a long bit of silence as the tall man moved the transducer with more force, pressing uncomfortably on her full bladder. He looked up at Franny, then back at the screen and said,” It looks like you have a case of beucephaly.”

“What’s that?”

He paused again. “We can see the heart beating, and the head well formed, but your baby has four legs and a tail.”

“What?”

“It seems you have a horse, maybe a pony growing inside you.”

“Oh,” said Franny. “Will it live?”

He frowned. “We don’t often see cases like this. I recommend you talk with a high-risk pregnancy specialist.”

“Can I see it?”

He spun the monitor screen toward her. The black and white fuzzy screen showed the image of a little, folded up pony. Franny smiled. She had always liked horses.

“Let me see if I can get Dr. Barford to come in. She’s just down the hall.”

Franny listened to the swishing of the heartbeat and studied the image. Some questions were forming as she looked and listened.

The perinatologist came in and introduced herself. She too ran the transducer over Franny’s belly, then wiped off the goo and sat down next to her.

Yes, she confirmed, Franny’s baby was “equine” she said. Meaning, they couldn’t tell yet if it was a horse, or pony, or donkey or mule.

“Will it live?”

These can be very difficult pregnancies, she said frankly, and while it may be born alive, most do not live long after birth. And, she added, the delivery process can be very hard on the mother. Sometimes there is premature labor, sometimes high blood pressure, “eclampsia” she said. And it the fetus survives to term the delivery will need to be by C-section.

“What if I don’t want to keep the pregnancy?” Franny asked. “What if I want it to be over now?”

Here Dr. Barford looked down. Many women might choose that, given this diagnosis, but here in Idaho, that choice is not available to you.

“What?” Franny asked.

No, Dr. Barford explained. Unless you can show a criminal complaint of rape or incest, your pregnancy cannot be terminated, because at this stage it would mean that your um, baby would most surely die.

“But you said it wouldn’t live after birth.”

Yes, but some live for a while. But none have gone on to be full grown horses. Or donkeys. Or any full-grown equine species.

Franny frowned. “Rape or incest? She blushed.

Dr. Barford nodded silently. You would need to show a proper police report.

Franny shook her head. “You mean, I have a pony growing inside me and I have to just carry this pregnancy, even if it means I could get sick, have to have surgery to deliver it, and then it’s going to die before it grows up?”

Dr. Barford nodded. Those are the laws here in Idaho.

Franny heard the swish of the heartbeat from the monitor and remembered the four folded up little legs and the nubbin of the tail. “Has anyone ever had a unicorn?” she asked.

Dr. Barford smiled. I don’t think so. But there’s always a first time.

We needed to make a trip to Boise this last week. It was beautiful driving weather for the trip south. But we needed to wait for the wrecked propane tanker truck to be cleared from the two-lane road that connects our expansive state. All north south traffic goes through Riggins, the little town at the confluence of the Main Salmon and the Little Salmon Rivers.

But the bomb of 8000 gallons of propane didn’t explode and somehow everything got cleared up so traffic could resume. As we made our way at 25 mph through the hamlet of Riggins, I saw a new billboard on the east of the road. It looked kind of homemade, but I’ll bet there’s some money behind it. Yellow background for what looked like fluorescent blue all cap letters: “Get porn out of Riggins schools”.

Overturned propane tankers stop traffic unless they explode. Porn bombs wreck schools.

I found myself wondering just who would throw this porn bomb. I thought of public figures. Let’s not name any names, but we have the video of a freshman Idaho State Senator at his local school board meeting throwing rhetoric and disruption bombs. So, I get it. Idaho has adopted the bomb throwing model of statesmanship. And who more would want to bomb our public schools than the Idaho Freedom Foundation? Their Washington-based leader (oops, geographic bomb?) Wayne Hoffman is on record exclaiming government should have no role in education. So why not lob a porn bomb at every passing north south transient in Idaho? But I doubt Wayne paid for the billboard. But, given the intricacies of the obscure out of state funding funneling into our political cesspool, we’ll probably never know.

So, I drove on past the billboard and kept wondering.

Just what porn should we be getting out of our public schools? Bible verses refer to incest, sodomy, private parts, but we all know the Bible isn’t a threat to our children’s moral compass, is it? There could be folks taking offense at Chaucer’s saucy language in The Canterbury Tales. Maybe that old classic should be eradicated. I think I would have paid better attention in High School English is I’d known there were naughty bits.

I’m sure Walt Whitman’s poetry will get chopped, since he does “Sing the Body Electric”. And Marquez would have to go. Jeez, we’ll only have advertising copy left maybe.

But this porn bomb thrown at our public schools is more a logic bomb. If the Freedom Foundation and its subservient legislators are so bent on blowing up the public school system, what vision do they have for education? Oh, I know their mantra, I’ve heard it forever. Give the money to the parents, they are the best guardians of their children’s education. The market forces unleashed will remake education into the well-oiled machine of industry.

If the billboard’s author lived in Riggins, and if the author was indeed worried about porn in the schools, why didn’t they go to a school board meeting and ask? Why didn’t they run for a school board seat? Why didn’t they use the governance system to address their fears? Bomb throwing, berating people, disrupting boring meetings might just be more fun, huh?

If you want to “send the money to the parents” and you think our education system will be solved, just read Tara Westover’s Idaho story, Educated. Her memoir will open your eyes to the possibilities of parenting models in Idaho.

And that’s where you think taxpayer money should go?

The twisted, convoluted, even pornographic nature of this attempt to porn bomb our public schools lies in the duplicity, the devious nature of the proponents’ actions. Throwing porn bombs is a lot easier that sitting on a school board and trying to serve a community. Is that what you want your kids to learn?

Now that we are relaxed about the Covid pandemic, should we grade ourselves on our response? Or do we just want to go “whew!”, wipe our brows and put our noses back to the grindstones?

Well, you’re going to do what you want to do, and I’m going to do what I want to do. Maybe that’s the lesson we have learned from this.

I read a mind-numbing column proudly published in a reputable North Idaho newspaper where the board certified ophthalmologist still argues for Ivermectin. Some docs are going to do what they are going to do. I didn’t learn that during the pandemic. I’ve known that from my first days in medical school. Heath care is not a monolith, just as We the People are not.

And it might just be that trait that I like about people. I respect cowboys. Indeed, I’m a bit of one. I have always bucked the big pharma-driven trends on prescribing medications. But I’m not asking Cowboy Bob for public health advice. And I don’t recommend you look there either.

So, it’s hard to be too critical about Idaho’s response to Covid. Our Covid death rate was near the national average, as was our infection rate and immunization rate. That means about 5000 people died in Idaho from Covid. Keep in mind, Covid started out, when nobody was immunized, before the Omicron variant, with a death rate that killed 1 out of a thousand infected.

So, let’s pat ourselves on the back. Average is good, isn’t it? One thing we have clearly learned is the public is not very good at assessing and responding to risks.

Some of us are. And the data on that is now in. A British Medical Journal study looked at the many counties in the lower 48. (Why do Brits get to grade us Americans?). They compared the Covid death and infection rate to the immunization rates. Counties with high immunization rates reduced their Covid deaths by 81% when compared to counties with low immunization rates. Maybe the immunizations were a good idea. But I’m sure you have your own opinion about that.

One of the reasons to grade our response to a “bad cold” pandemic that killed about a million Americans is because the next one might be a bit rougher.

Have you priced eggs recently? Have you heard of the H5N1 Bird Flu?

Remember that Covid only killed 1/1000? H5N1 rarely infects humans, so far. But when it does, the mortality rate is 56%. That comes to 560 dead of the 1000 infected. That’s 560 times a fatal as Covid.

But we are safe so far from the bird flu, right? It is rapidly transmitted between birds. It is even infecting migratory wild birds now. Penned flocks die like, well, chickens. But they are just birds.

Some animals that prey on or scavenge bird carcasses have become infected. We lost a skunk to it here in Idaho. So, mind your roadkill harvesting.

In the last few months there have been outbreaks in mammals. A mink farm in Spain reported an outbreak. It has not been confirmed but it is suspected the virus spread amongst the animals.

And that’s where the leap occurs. When a virus mutates to infect the upper and lower respiratory tract cells in humans, as Covid did, then we sneeze, we cough, we spread it. And, if the damage the virus does to our bodies stays as virulent as the current H5N1, we will die at a much faster rate than the “bad cold” Covid pandemic.

When you pack the world with as many humans as we have, something is going to get us. And even getting an “A” on your pandemic response report card won’t stop all the deaths. That doesn’t mean we shouldn’t try to do our best.

Governor Little proudly proclaimed he had “cut red tape” right after his first inauguration four years ago when he restructured the state entity overlooking all the professions. Maybe he cut more than red tape.

You need to understand this system a bit before I get into a full-blown rant.

There are MANY professions in this state that get their sanction to perform their services from state statute. In my short time in the legislature, it seemed like every year another profession wanted to be “licensed”. The health care professions sector alone includes nurses, doctors, physical therapists, and indeed, ten more. For some reason, midwives and genetic counsellors aren’t included in the “health professions”, but instead with the “occupational licenses”, along with another dozen professions, including Outfitters and Guides. This reorganization was supposed to streamline the licensing process.

You might find yourself questioning why the state even gets involved in this licensing process. I know the Freedom Foundation does. Libertarians think any restriction on “free trade” just drives up costs. Does a license somehow ensure the professional you engage provides quality services? We have all followed how a licensed physician, trained to do laboratory tests provided telehealth primary care during the pandemic. And we’ve seen how the Idaho Board of Medicine dismissed complaints against this physician, seemingly without investigating them. So, don’t let my $200 annual Medical license fee convince you of the quality of my care.

Maybe Idaho could just go all cowboy and let the public beware. There’d sure be less red tape.

But cutting red tape might also mean there’s less folks to answer the phones when there’s a problem.

Let’s look at a problem. The clinic I work in has tried to hire nurses. Let me tell you, nurses are getting hard to come by. Moreover, the interview process can be long, the background checks take time, but here’s the final delay. Idaho licensure requires nurses to submit fingerprints.

I remember having to submit fingerprints when I got an Idaho medical license. I had to wipe off the embedded grease from cranking my Model T. For some reason back then I didn’t question the need for such a hoop to jump through. Maybe I was numbed by all the premed hoops (physics, organic chem) and medical school hoops (short white coats and board exams) and residency hoops (no sleep).

National nursing organizations support the requirement for fingerprints. Only six states don’t require them. A lot of people seem to think, including Idaho, I guess, it makes sense. Along with the requirement is an FBI background check for past crimes. I’m sure you are comforted that the nurse putting in your urinary catheter has no armed robbery convictions. Maybe not.

Here’s my gripe. Thanks for waiting this long. Both the nurses my clinic hired have had to postpone their start dates a month waiting for their fingerprints to be approved. They have had to submit multiple samples, all at added cost, and always a delay.

I tried to call the Idaho Board of Nursing to ask what the problem was. I got two phone numbers. Both went to voicemail. Neither called me back.

There, you’ve listened to my rant. I apologize. Maybe it got you thinking if we really need this whole licensure thing. I have very strongly mixed feelings about it. If Idaho government is going to give a profession the ability to restrict practice in the marketplace, citizens deserve some confidence in the quality of that state sanctioned profession.

And if the state is going to continue expecting professionals to jump through these licensure hoops, they should be timely. I’m not asking for more red tape. Just someone to answer the phone.

When it’s hard to give praise, it should be worth more. This is going to be very hard for me to offer. It shouldn’t be. When ideas are the subject, not behavior or intentions, we should look squarely at the ideas and consider praise or rejection. That’s not hard, is it?

So, I want to praise a bill in the Idaho legislature offered up by Representative Heather Scott. I don’t want to praise Heather when she wraps herself in the Stars and Bars or her disruptive tendencies in the Idaho House. I just want to offer my support to a simple bill she has introduced.

House Bill 20 adds a misdemeanor criminal penalty to bad faith reporting of child abuse, neglect, or abandonment.

Why is such a penalty needed? Shouldn’t we protect anybody who is trying to prevent or report child abuse? Here’s where we get into the real world. The laws we write should have a clear awareness of the real world.

We see so many ideas floated in the swirling pot of the Idaho legislature that are just dog whistle attempts to protect us from the boogey man. I could list them, but I’m sure we would not agree on the real-world threats we face. Your fear of Sharia Law might be as great as my concern about ground water.

But I digress. I must move forward with the real-world reason this law makes sense.

For many years I served on my county Multidisciplinary Task Force for the Prevention of Child Abuse. Every county in the state is supposed to have one. I got chosen to participate because the law that established these groups called for a member of the healthcare community to serve. At the time, I was the county coroner. I was also a practicing family physician. So, I went to these monthly meetings on my lunch hour. They agreed to meet at that time so I wouldn’t have to miss clinic time. Every other person on this task force was a state, county, or city employee, not a private businessman. Doctors are businessmen. Time out of clinic is lost income.

We would start each meeting by reviewing the month’s list of Child Protective Services referrals. We, as a task force were charged to make sure proper handling of these cases was being done.

There were usually twenty or thirty, maybe up to forty referrals in our little county. They were graded by risk to the child, high to low. Each month there would be just one or two high risk situations. The vast majority of the referrals were found to be either low risk, unfounded, or even false.

It was not uncommon for there to be disputed custody, an acrimonious divorce and custody battle going on. One parent might make an allegation against the other and, through investigation CPS could determine the allegation was sometimes false, sometimes unfounded, and sometimes offered in bad faith to try to influence the court.

False claims take up time and effort. Bad faith claims are an attempt to use the power of the state for malicious purposes. It is quite fair that there should be consequences for such bad behavior. Thank you to Representative Scott for putting this forward.

I wish all people behaved with integrity. I want to believe most people do. But I live in the real world, so I know this is not always true. I take cash when I sell on Craigslist. I count the bills before the buyer leaves. And I give cash when I buy.

It is only fair that the laws we write express such expectation of integrity. And it is only fair that bad faith actions have consequences.

Our founders thought some freedoms should be in our Constitution. They couldn’t agree on all of them, so they became the first ten amendments. amendments. The Bill of Rights was passed after the Constitution was ratified. These first ten amendments had the effect of limiting how government could impose itself on a citizen.

The Idaho legislature has worked hard for many years to define freedoms for “the unborn”, so now we have a real mess of conflicting laws saying abortion is illegal. I doubt they will get to work cleaning up any of these conflicts this session, but I wonder, given the recent events in my town, whether any legislator would consider protecting us against unwarranted searches.

By the way, if you didn’t know, I live in Moscow, Idaho. Yeah, we’ve been in the news a bit lately.

The Fourth Amendment protects us from “unreasonable search” and specifies that warrants for searches shall specify probable cause. The courts describe the details, and they are being redefined as the world changes.

No founder knew about DNA. But we have a case in our town that just might pivot on such evidence.

Some states have decided to weigh in on their interpretation of this freedom. Idaho should too. Clarity for the investigating agencies helps convictions stick when the rules are followed. Otherwise, convictions can become lake house payments for appellant lawyers.

Defining this freedom for modern times would take some careful consideration and study. DNA databases are often proprietary. And these private companies can and do develop their own rules for how their information can be used. But they can also be bought and sold. And with these transactions, their assets, their DNA databases, are transferred.

Think about it. You sign on to get some genealogical information. Maybe you read the long legal document before you give them your credit card info. You don’t plan on committing any major crimes soon, so you figure it’s just for the lawyers to argue about.

But your information can also tell an investigator about your relatives. The DNA they got from a crime scene might suggest some relation of yours. That relative didn’t give permission. You may not know your crazy uncle really was crazy, maybe homicidal. But you just fingered him. Maybe you’re alright with that use of that information. Uncle Charlie might not be. And if he has good lawyers we’re now on shifting sands.

I would challenge the Idaho legislature to consider this work. Indeed, given their embrace of freedom, I would hope the Idaho Freedom Foundation would get on board. Maybe they have, I don’t know.

I have no idea if any legislators are considering this. Given their track records, I bet they are just waiting for some “model legislation” from ALEC. That’s too bad. I believe we here in Idaho have some thinking and some work to do.

We want crimes solved. We want to feel safe in our communities. Given the crowds down at the pool hall last week, I’d say the students have returned here to our college town from their Christmas break and feel pretty safe. But there is a long road ahead for trial and conviction. Maybe just seeing a suspect in orange coveralls makes people feel safe.

Defining the legal limits of DNA database searches will help law enforcement know how to search. Further, it should protect us from unwarranted searches by our government. Balancing this is the work our legislators should be doing.  I want our system of justice to serve us all.

Since Joe Biden finally visited the southern border, I want to know when Brad Little is going to close Idaho’s borders. Who are all these people?

For the sixth year in a row, we are in the top tier of fastest growing states. We had a minor slip this year to the second spot, after coming in first for the previous five. Estimates have us a little north of 1.9 million. The state has more than doubled since I moved here to hunt mastodons in my youth.

No wonder the legislature sits on a budget surplus. I guess all these newcomers buy things and pay taxes. Those elderly legislators have reserved parking there in the Capitol garage, so they don’t see the crowds swarming in. And they go home when the legislature adjourns to their 500-acre gated ranches where the ag designation protects them from property taxes. I doubt many have a mortgage. Maybe some.

But they for sure have health insurance. Even if they are on Medicare, they can still get taxpayer paid health insurance as a state employee, even though they are part-time. Maybe they consider themselves full time now that we said they can call a session whenever they get a few colleagues to sign on. That health insurance benefit is quite a perk. Right up there with the reserved parking.

And now they are talking about how much it costs them to fund Medicaid expansion. They are still butt-hurt about that initiative that passed back in 2018.

I understand the worry about Medicaid funding. I watched the costs go up for years. Though I am proud to say, the 4 years I did the DHW budgets on JFAC, the cost increase was comparable to inflation. What we had no control over back then was the Catastrophic Health Care Fund for the uninsured. That cost doubled in ten years.

So here I am whining about all these folks moving in, but I don’t think we should be going back to “the good old days”. I saw a case of “the good old days” in the clinic a few weeks back. Fifty-year-old working guy made $200 bucks a month more than made him eligible for Medicaid. He didn’t go on the exchange, took his chances. His shortness of breath finally took him to the ER. They gave him an antibiotic and sent him home. When he couldn’t breathe the next day, he went back. This time they found the pulmonary emboli and the 10-centimeter mass in his chest. Who should pay for this?

He’s not going to be back at work for a while. The bill for the two ER visits would probably take his home and tools. Or they could go unpaid, and the hospital could cut a couple nurses from their staff. I wonder just what the Idaho legislature sees as a solution for this. I expect we’ll hear some proposals.

I am greatly disappointed that we haven’t made much investment to look at how we pay what we pay in the Medicaid program. A recent legislative study suggested Medicaid payment rates hadn’t been evaluated for many years. If you want to pay less, and I do, it seems worth evaluating just exactly what you are paying for and whether it is worth what you are getting. So, the Idaho legislature will gavel into session this week, the Governor has been inaugurated and the interns have been hired, trained, and warned. The bars in Boise have stocked their shelves, the reserved parking spaces are swept free of the pigeon droppings and our elected leaders will gather to serve our common good. All is well.

Just as Speaker Mike Moyle has established, partisan power has its benefits. As his doubtful idol, Barack Obama said, “Elections have consequences.” Speaker Mike decided to reduce the number of House seats for the minority party on the Budget Committee, JFAC. Why should he stop there?

Idaho law gives the Governor power to appoint members of boards and commissions that are empowered to direct state agencies. This is a process that is supposed to enfranchise the public in the government they elect.

The Idaho Constitution limits the number of departments to twenty. And Idaho law defines just who can serve on these boards. Back in the 1960-70’s, when Idaho had a Democratic governor, but the legislature was mainly Republican (a bit less so than now), the legislature enacted laws requiring the partisan membership of these boards and commissions be somewhat balanced. For instance, the Public Utilities Commission, the folks who regulate the power company this state was named after, Idaho Power, has three members. It may not have more than two members of the same political party. Why? I guess back when we had a more balance state, the need for balance on these governing bodies was thought to be valuable.

Maybe Speaker Mike has other ideas. He needs to start drafting a lot of bills.

This was floated by Representative Brent Crane a few years or so back about the Redistricting Commission. His point was, we are a republican state, why do we need balance on that Commission? He quieted down when he realized redistricting appointments were mandated to be balanced in the Idaho Constitution. But boards for Education, Transportation, Commerce, Corrections, etc. are in statute. Statute is the legislatures sandbox. They can make the game however they choose. Start drafting.

To be honest, I’m not sure why this matters. Maybe at some time it did. Maybe being a commissioner was a steppingstone to higher office. I know that has been the case for some legislators. No Idaho Democrats that I can think of, but quite a few Republicans. It should be a place to learn about governance and serving the public good. And then to move from there to legislating for the public good makes good sense.

So maybe the balance our current laws require on these Idaho Boards and Commissions will change. Maybe Speaker Mike and the Idaho legislature Republican supermajority will see the folly of such partisan affiliation and decide to strike such requirements from our laws. After all, most statewide votes are 60/40 republican/democrat. Why should we even be considering a commissioner’s partisan affiliation? Shouldn’t we just be considering their fitness to serve? To the victor the spoils, right?

I guess it gets back to just how you see this government serving us. Many see government as a vending machine. You put in your money, and you should get back what you want without having to kick it or shake it too much. Republicans think you should get Coke, Democrats, Pepsi. So, if Democrats win the election, all you can get is Pepsi, no Coke in the machine. And the versa if Republicans win.

What a dismal picture of the common good.

I don’t see government as a vending machine. Government serves us all. But if you want beer in the vending machine, that will need some review by a commission or a board and maybe some reference to the laws and maybe the Constitution.

Serving us all is a tough job. Serving all our constituents is indeed very tough, I can say as an unelected legislative representative. I must not have been doing a good enough job. The voters told me so.

But did they know my work? Or were they just responding to the partisan label? Maybe that partisan label has little value. It sure has power.

Have you wrapped all the presents? Have you looked under the tree? Are the stockings hung with the hope of St. Nick? I hope so. Idaho rural hospitals will be offered a stocking stuffer this year from our federal government that might leave them asking, “Where’s the pony?”

This policy shift comes in last years budget bill. That’s where most things happen in Washington DC nowadays. No committee hearings on boring budget items or policy decisions. It seems the only public hearings and debates are about things that have plenty of partisan opportunities for sound bites and teeth gnashing. Small town hospitals? Yawn. Unless you live or work there.

This gift is pony droppings.

There has been no doubt some small town hospitals are stressed. A study found over 600 are at risk of closing in the next ten years. Over 180 have closed in the last 17. So, the budget proposal offers a “fix”.

If a rural hospital promises to not keep patients longer than a day, they will get $3.2M in federal dollars annually. You shift your small hospital from providing inpatient care to being an urgent care facility with a helipad, you get a boost. What are they thinking?

Is inpatient care cheaper at big city hospitals? Is it better? We don’t know the answer to these questions, but we really do know what happens to small towns where the hospitals close. One in 12 jobs in small towns are supported by their small hospitals. After hospitals close small-town populations shrink.

What does the landscape look like here in Idaho? Honestly, not as bad as in many states. If you look at the maps for closures and at-risk rural hospitals, you might as well overlay the map for states that have not expanded Medicaid coverage. We did that. But it took the Idaho voters, not the governor or the legislature to get that done.

Idaho currently has 30 rural hospitals. None had closed in the last 20 years and only two are considered at risk. That is the lowest rate of any state with a substantial rural population. What makes Idaho special? I would argue, good local governance.

If our federal delegation wanted to do something that would substantively help our rural communities instead of gelding their hospital services, there are many choices, many solutions. Private insurance companies pay less to rural providers than urban ones for the same services. And rural hospitals have a higher percentage of private insurance patients than urban hospitals do. You can blame Medicare and Medicaid all you want, but there’s good evidence that changing the way rural hospitals are compensated mainly by private insurers, would avoid this problem.

This choking out of rural healthcare has been a long time coming. When the pandemic hit and DC sloshed cash outwards, the rural hospitals got some boost. That dries up on New Years Eve. This “solution” is supposed to forestall some closures by making the local hospitals walk-in urgent care clinics.

I don’t envy the small hospital board members considering this. Should they accept the “gift” their congressmen have offered and close their facility to inpatients? That would mean grandpa’s pneumonia gets him a helicopter ride to the big city. And Billie Jean won’t be having her baby where she was born. No, you can’t make sure babies come out in less than 24 hours.

I see this “solution” as just another example of how we Americans don’t want to face our problems. I’m glad we have these volunteer hospital board members in our communities who understand and want to serve their neighbors. Congress is offering them money to stab their neighbors in the back.

Thank your local hospital board member and wish them a Merry Christmas. They deserve it.