Skip and Scooter talk about Brad

Posted on April 19, 2019 by ddxdx

It was a rushed lunch since all the fraternities had gotten together, but Skip wanted to grab a sandwich before O-chem at 1:30. “You got any turkey?” he asked Blanche, the cook.

“They’re all labeled out there, just look.” She didn’t roll her eyes.

Skip got one with the white meat and dropped his satchel to eat. Scooter high-fived him with a “Haaayy” and grabbed a pink meat sandwich. “I love Blanche’s ham sandwiches.” And he plopped down next to Skip.

“So, isn’t that cool that the governor was a Phi Delt?” Scooter started.

“Yeah, but he’s a Republican.”

“What difference does that make? He’s a bro!” Another high five.

“At least he wants to make Idaho a place we want to come back to.” Skip offered.

“Yeah, and I heard he defended us from the initiative attack.”

“Huh?” Skip asked through a mouthful of white bread.

“Yeah, didn’t you know? All those Californians wanted to make Idaho pass initiatives and he fought that off.”

Skip swallowed. “I heard he vetoed the bill about initiatives.”

“Yeah!” Scooter did another high five. “Our man! Phi Delt!”

Blanche came out. “You guys take another sandwich. They going to waste.”

Scooter grabbed another and said, “And he said he really wants Idaho to be a place for us to work and raise our families. Ain’t that cool?”

“Sure,” Skip agreed. He looked at the pile of sandwiches. “I just wonder if I can make a living here in Idaho.”

“Hey,” Scooter frowned. “Just get a job from the old man. That’s what I’m going to do.”

Skip paused. Scooter had never really learned much about his bro’s; Skip decided to tell him.

“Scooter, my dad is dead. My mom is a school teacher and I want to get into med school. Idaho has the lowest pay for doctors in the country and the hardest acceptance rate to med school.”

Scooter looked down. “Sorry man. That’s tough. My old man has a ranch, so that’s what I’ll be doing.”

Blanche brought over two paper plates of sandwiches. “You boys take these.”

“Thanks Blanche.” Skip offered. “Did you get to hear the Governor?”

She looked puzzled.

“He came to talk to all of us this morning. He told us how he wants to make this state a place where we can raise our kids. Yeah, Brad Little was a Phi Delt!” Fist bump.

Blanche looked down. “I was cooking for you all.”

Skip asked, “Where are your kids Blanche?  Are they still in Idaho?”

She looked at him hard, then she looked at Scooter. “Yeah, you Phi Delts are the ticket.” And she turned away.

As she ambled back to the kitchen, Scooter murmured to Skip, “Hey man, don’t ask her about her kids.”

“Why not?” Skip was blushing.

“Well, I’ve heard she’s raising her grandkids. Something about her daughter in prison or something.”

Skip looked down. Scooter grabbed his bag. “Gotta go, Poly Sci at 1:30.” He took his sandwiches and left.

Skip picked up his satchel and went into the kitchen. Blanche was leaning over the sink. He put his hand on her shoulder. “Blanche, I’m sorry.”

She let the water run over her hands and the pot she was washing for a while then she turned to the young man. “You don’t got nothing to be sorry for.”

“I’m sorry if my question caused you any pain.”

Blanche looked at the young man a long time. “It’s OK.” She smiled. “Sure was nice you all got to hear from our governor.”

Skip thought about what he’d heard. The governor so full of confidence and advice for the young fraternity and sorority members, about coming back to Idaho and making the state better. It had felt inspirational.

“I believe he wants to make this state better.” Blanche looked down. “I just want my family to be better.” And she turned back to the pots in the sink.

Posted in Idaho Politics, Uncategorized | Tagged | Comments Off on Skip and Scooter talk about Brad

Entitled

Posted on April 11, 2019 by ddxdx

I can understand legislative Republicans need to put sideboards on Medicaid Expansion. Since many government programs have become labeled “entitlements” we see them differently than if they were earned. I can understand legislative Republicans trying to fight people receiving a public benefit feeling entitled when others pay for it.

Many years back, I remember hearing two locals in a bar talking in the fall in central Idaho. One turned to the other, “You got your elk?”. He nodded, “You get yours?” My stomach was turning. Those animals they harvested were not theirs. Neither of these men were entitled to an elk. They should have been thankful to the Almighty for the harvest, but their words, their attitude conveyed that they felt entitled to “their elk”.

I was accepted to two colleges, one private and one state in my senior high school year. It turned out with the scholarships the private school ended up costing my family less, so I chose it. That was a big mistake. Because, for the next four years I spent time with a lot of classmates who felt very entitled to their enrollment, their opportunities, and the future they anticipated. I came to hate rich people, a prejudice I still struggle with.

Entitlement in the healthcare field can be brutal. Doctors can feel entitled to respect and income from their lofty positions; some patients feel entitled to a life free from pain and some consider they are entitled to a life beyond the natural course. We are only entitled to the grace of this life we have been given; every day we should give humble thanks.

Getting elected to represent our constituents can also give one a sense of entitlement. Indeed, the law and the process empower the elected official with the legal power to vote for laws that will constrain all of us. We are a nation of laws. Such is the nature of this republic. But I look for humility in the public servants I vote for. Maybe you don’t; humility doesn’t win a lot of votes.

I have considered all this as I watch the Idaho legislature struggle with Medicaid expansion, Proposition 2, the initiative Idaho voters approved by a substantial margin in November. It was an issue the legislature avoided for six years. But Idaho voters endorsed the plan to enroll people who could not access health insurance in the most cost-effective way. But the legislature has decided they know best and have proposed a new and different plan. It now awaits the governor’s signature.

I appreciate the Idaho Republican legislator’s intent. But they have crafted the wrong solution.

Governor Little should veto this legislation. The reasons are clear.

First, it will keep more people in poverty. Evidence from other states clearly shows this. People with health insurance are more likely to look for work and stay at work than those without.

Second, it will grow government and add cost to Idaho taxpayers. Chasing down deadbeats from Boise is more expensive than looking them in the eye in our own communities and letting them know we expect more. Don’t think a government program like “Work Requirements” can absolve us from our own civic duty.

Third, there are no supports, “springboards” as Governor Little has described them, in the legislation. People might need help to get back to work, to climb out of the hole they are in. The help is out here; this legislation has no connection to these supports. It’s just a stick; no carrot.

Finally, I could point to the convoluted process this legislation has taken; more time, more effort could produce a better result. The bill was introduced in a Senate committee, substantially changed through amendments on the floor of the Senate, then changed again on the floor of the House. It comes back to the Senate committee who did not support the amendments but the full Senate did, only because the House was holding a hostage bill: Medicaid funding.

I appreciate the intent. Nobody deserves to be entitled. Not even the Idaho legislature.

Governor Little signed this legislation into law on Tuesday, two days after this was written.

Posted in Uncategorized | Comments Off on Entitled

Hostages, Leadership and “the Bedke Rule”

Posted on March 27, 2019 by ddxdx

The primary function of the Idaho legislature is to set the annual budget. Our dear representatives love to wax eloquent on policy issues, and that is well within their function. But this year the Idaho voters spoke up on a policy issue the legislature has avoided for six years, Medicaid Expansion, and the Idaho House of Representatives is holding the Idaho voters hostage, refusing to address the budget for what is now Idaho law.

Six budget bills were passed by the Idaho Senate weeks ago that funded Medicaid Expansion. For weeks now, House leadership has refused to bring them up for a vote. Instead they have passed a “sideboards” bill, sending it to the Senate despite overwhelming testimony in opposition. And realize, this “sideboards bill” will cost Idaho taxpayers millions more than the simple Medicaid Expansion bills sitting on the House calendar.

Further, House Republicans signaled to the Senate they wanted the “Gag the Voters” initiative-killing bill (SB1159) sent over so they can approve it. House Republicans are puckered up on the lemonade they are making from what they see as a real lemon; the voter passed Medicaid Expansion Initiative.

House Speaker Scott Bedke got hurt real bad in 2013, his first year as the leader, when he let the House vote on a state health insurance exchange. He thought he had the majority of his caucus in support, but two Republican House members switched their votes at the last minute and the only way the exchange bill passed the House was thanks to strong Democratic support. He has vowed to never let such a thing happen again. The only way a tough bill comes to the floor of the Idaho House is with Speaker Bedke’s approval and he will only allow such a vote if he knows he has the majority of his caucus on board. That’s the “Bedke Rule” and it sucks.

By holding the Medicaid Funding bills hostage Speaker Bedke is giving the already supermajority House Republicans (56) total power over the body. He is negating the votes of the super minority House Democrats (14). Bedke is letting partisan politics trump the will of the people and holding them hostage.

I understand the Idaho Republican Party feels stung by the people’s initiative. They took a strong official stance against Proposition Two, even though many of their fellow Republicans, including former Governor Otter endorsed and voted for it. It makes partisan sense for them to now remove the people’s power of the initiative as they are doing with the “Voter Gag” initiative killing bill SB1159. But if they were being honest they would just work to repeal the Constitutional power of the initiative, not make it impossible through a law.

The Idaho legislature has been on a power grab for years now. The recent Constitutional Amendment to enshrine administrative rules review took two tries and some substantial Farm Bureau funding to pass the second time. This was the legislature puffing its chest against the executive branch.

But now they want to exert their power over the people. It’s not the first time. Every time voters have passed an initiative the Republican-led legislature has voted to make the initiative process further from the reach of the voters. In 1997, after the term limits initiative the legislature raised the bar. That was declared unconstitutional, so they quietly repealed the statute. But when the LUNA Laws were repealed by referendum, the Republican legislature reinstated the higher bar requirements, essentially ignoring the judicial branch. Now they want the initiative process beyond reach, securing their power in what is constitutionally designed to be a balanced system.

Speaker Bedke’s refusal to vote on the appropriations bills sitting on his calendar for the last two weeks is further bullying of the public he and his fellow Republican legislators are sworn to serve. This is not leadership, it is tyranny. Good people must resist when they see tyranny, especially in those they elect.

Posted in Uncategorized | Comments Off on Hostages, Leadership and “the Bedke Rule”

The Sham of Testimony

Posted on March 20, 2019 by ddxdx

We elect our representatives. They are our voice in making the laws that govern us. Why do they need our input except at the ballot box every two years? What purpose does this public testimony on proposed legislation serve? If we do not have the backbone to hold them to account come election, then why should they listen in their deliberations?

It was almost relieving to see ten-term, 20-year State Senator Lodge acknowledge this last week. As Chairman of the Senate State Affairs committee she had a roomful of people who had come from far and wide to speak on SB 1159, changes to the Idaho initiative process. She let the three who wanted to speak in favor and then four of the 100+ who were opposed speak, then wanted to call for a vote. In her defense she said, “All the rest are opposed.” So, it’s like she knew what the committee was going to hear and didn’t see the purpose. After all, they are our elected representatives. Let them get on with it.

There was another time I have seen such an overt sham of public testimony. In my first term in the State Senate, 2011 Tom Luna, newly reelected Republican Superintendent of Public Instruction proposed his LUNA Laws. He had not mentioned them on the stump, campaigning just months before. But here he had a new legislature and what he considered to be a mandate, so he proposed his new laws; funding technology over teachers in the classroom. Public testimony ran for days, 95/5 opposed. But the laws passed. Then came the referenda and the laws were repealed at the next state-wide election 2 years later by an overwhelming 70/30 vote.

But here’s the thing: every legislator who voted for those laws was reelected.

Figure it out voters. I applaud that you might use the referendum process to rebuke your legislators for passing stupid laws. I acknowledge your wisdom when you want to initiate action like Medicaid Expansion because your elected legislators have ignored a problem with an easy fix. But I am amazed at the insanity of reelecting the same people to represent us, when we disagree with their decisions. Shame on us.

Idaho’s citizen Legislators, one Senator and two Representatives each serve districts of approximately 40,000 people. It is estimated that people can only closely know approximately 150 people. That means, for each of us to know our representatives in the legislature well, we have to make a big effort; have a cup of coffee, go to a town hall, make time for a meeting, or read their newsletters.

When I was in the Senate I sent out a weekly newsletter that approximately 1500 people read. If they were all talking to 150 different people, I would have been reelected easily. But I came to believe all these people knew and talked to each other. We are talking to the people who agree with us. Can we change this?

Who are these elected officials who represent us talking to? Where are they getting input? First, I would hope it’s from the elected officials in their district: the county commissioners, the city councilors, the highway district commissioners, the school board members.

Can this be dismissed to partisan affiliation? If so, we all should be questioning that insanity. But it may be true. I have heard a legislator say he met with his party central committee before each legislative session to consider legislation. Welcome to the echo chamber.

Don’t expect your passionate testimony to persuade the citizen legislators you have elected. It may be heartfelt and in fact, it may represent the sentiments of many of your fellow voters. But it is much more powerful to elect people who actually do represent your values. Share your values.

Posted in Uncategorized | Comments Off on The Sham of Testimony

Brad’s Right

Posted on March 12, 2019 by ddxdx

While the legislature struggles with modifying Medicaid Expansion, costing more, getting less insured, Governor Brad Little on the campaign trail was beating a different drum. He was looking beyond the twisted shorts condition of legislative Republicans who fought Proposition 2; he can see the bigger picture. Health insurance for those beyond Idaho’s exchange, Your Health Idaho, are getting squeezed out of health care insurance.

To be eligible for participation in the exchange you have to make between 100%-400% of the federal poverty level. Medicaid expansion addresses those below 138% FPL.

If you are a 60-year-old and you can participate on the YHI exchange and you make $45K per year, you might only have to pay 3% of your income for health insurance since you get subsidies. But if you make more than the 400% upper limit to participate in YHI, say up to $50K, you wouldn’t be eligible for exchange subsidies and the cost might jump to 32% of your income. This is called the health insurance “subsidy cliff”. Many Idahoans are standing on it. That’s me folks. And it’s steep. Why would I pay a fifth to a third of my income for something I might not use? I’d be a fool. Most Idahoans aren’t.

This is from the Kaiser Family Foundation . Idaho’s numbers are a bit different, but the cliff’s as steep.

This is where the growing numbers for Idaho’s Catastrophic Health Plan are coming from. There is “the gap” population, the 70,000 below the 100% limit for enrollment on YHI, who will now be covered by expanded Medicaid; they won’t be the uninsured anymore. But those above 400% are going to or have dropped health insurance because they aren’t fools. Brad pointed this out whenever he could. I didn’t hear his solution.

The trouble with Idaho’s indigent program is, we take your assets if you can’t pay your medical bills. The really low-income folks, those below 100% often had few assets. But I imagine those making $50K have some tools, a work truck, maybe a back hoe the county can file a lien on. There goes their health and their means of income if they get unlucky and sick. Welcome to Idaho and medical bankruptcy.

So, beyond Bernie’s “Medicare for All”, what can Idaho do about this? It’s a head scratcher. Brad keeps talking about the Idaho High Risk Pool model and it’s worth consideration. The HRP was developed 20 years ago by State Senator Dean Cameron (now Director of the Department of Insurance) for people with preexisting conditions who couldn’t get health insurance. It was funded by a tax on all other health insurances sold in the state. It worked well for the ten years before the ACA eliminated preexisting conditions as an exclusion, then the enrollment dwindled to double digits and the fund ballooned to $20M. Could such a plan work again?

Some states have tried it, the reinsurance model, but each has varying success based on how much cost they are willing to shift. That’s the key, the willingness to properly fund the investment.

It’s worth fixing this.  Most businesses in Idaho have less than 50 employees. There are many small shops or self-employed folks who drive this economy and need this support to make health insurance affordable.

A recent suggestion from the Trump administration was for states to apply for waivers to Medicaid to allow subsidies for those above 400%. Of course, for this to fit the budget neutral requirement, the subsidies for lower income folks would have to go down to pay for the higher income folks cost reductions. Isn’t that how it always goes?

Polls show most people are not happy with how health insurance works in this country. Why can’t Idaho take some time and effort and make this work for our citizens? It’s worth the effort.

Posted in Uncategorized | Comments Off on Brad’s Right

OK, Now What’s it Cost?

Posted on March 6, 2019 by ddxdx

In a noble effort, Idaho Representative John Vander Woude is bravely standing up to the bully majority voting public and protecting his fellow aggrieved minority legislators. He has vowed to fight the will of the “uninformed” voters. “We don’t always let the majority make all the decisions because our Constitution is to protect the rights of everybody, not just the majority,” he said.

Thank God for brave legislators standing up to protect us from ourselves. We need it don’t we? After all, Idaho voters have made so many mistakes in our initiative votes.

The Fish and Game Commission (passed by initiative in 1938) ought to be thrown out; why do we need such folly? At the very least we should require some means testing for all who wish to take public game from the taxpayer’s trough.

And the publicly passed Sunshine Laws (1974) to insure open government might need a test too. Vander Woude should champion IQ testing of all those who want to run for office and gain income and health insurance at taxpayer expense.

The first trouble with losing is how it makes you feel. Wayne Hoffman and the Idaho Republican Party felt so bad about losing their fight over Medicaid Expansion that they took their pouting all the way to the Idaho Supreme Court. Well, the only thing they won there was being excused from paying the winning sides (the voters) legal fees.

The second trouble with losing is what you learn from it. In this case, “wrongness” is not being considered by Republicans. It was wrong for the Idaho legislature to avoid this topic for six years while many of our working poor citizens were without access to health insurance. It was and is wrong to wastefully spend taxpayer money for medical bills for catastrophic and indigent care.

Losing can teach humility. It shouldn’t teach shame. There is nothing wrong with losing if you have done your best and you fought for what was right. Believe me, I know this; I’m an Idaho Democrat.

If Representative Vander Woude has the honest intent of making Medicaid expansion work best for Idaho, let’s ask questions through clear, not red Republican or blue Democrat, but clear glasses at Medicaid Expansion. After all, many Republicans voted for it. And it is now law for all Idaho.

Here are some questions to help you frame your decisions.

Do you believe all Idahoans should have health insurance? If the answer is NO, you should be fighting for full repeal. 40% of Idahoans agree with you. If the answer is yes, then the next question:

Do you think the program to get all Idahoans covered by health insurance should be done at the lowest expense to the taxpayer? If the answer is YES, then you should support Proposition 2 unaltered. If the answer is NO, then the choices become wide and range from cheap to costly.

Honestly, these are the sorts of questions that are critically important to public policy. If you want people to participate in a program (immunizations, sex education, car insurance) then you design the program to maximize participation. You would automatically enroll them and give them the choice to “opt out”. If you don’t want them to participate, you require them to “opt in”. There are all kinds of incentives to use. It just comes down to where do you want to go.

Posted in Health Care, Idaho Politics, Policy | Comments Off on OK, Now What’s it Cost?

A Small but Engaged Electorate

Posted on March 6, 2019 by ddxdx

I watched a large North Idaho county Republican Central Committee town hall meeting last week. Now I understand Idaho politics.

The hall was full, maybe a hundred citizens. It was a pleasant venue with a sound system and refreshments. The purpose of the meeting was to hear from “their” elected legislators. Since the county only had Republican legislators, the possessive might be used narrowly here. All nine showed up; the stage was as crowded as the hall.

I was struck how the speakers were cheered or applauded for the more extreme statement they could make. It was like the crowd wanted some raw meat, some blood. The elected leaders felt and responded to the pressure. Some statements were just plain not true; but they got no challenge. There were references to “the enemy” out there; I assumed they meant me, a Democrat. I wished I’d been in the room.

One State Senator I know well, a very conservative guy, made the most moderate and least volatile comments. I know his views, and we rarely agree, but I respected his demeanor. Maybe his measured speech reflected his seniority; he had served the longest of the group.

I was invited once to a County Republican Central Committee meeting in my legislative district. It was right after I got elected as a Democrat for the district. My goal was to represent the whole district, not just those who voted for me so I welcomed the invitation.

This was a business meeting, so I sat quietly as the chairman ran through business. Toward the end of the meeting the chairman offered her take on the recently completed legislative session, specifically praising a resolution to have all Federal Lands returned to Idaho ownership. She pointed out I had opposed this and asked if I wanted to explain my vote. I stood and thanked her for the opportunity. I told them how much I love access to public lands. I hunted and fished and got wood in the National Forest. The resolution I voted against had three references to “sale” of these lands. I pointed out how Idaho had 3 million acres of state land at statehood and now we’re down to 2 million, and more is sold off every year. I’m all in favor of managing our public lands with more state voice, but I don’t trust Idaho to keep public lands out of rich people’s hands who can lock them up.

The room was silent for quite a while. A voice in the back asked why I hadn’t tried to amend the resolution. Resolutions cannot be amended, I answered, you vote yes or no. The chairman thanked me politely for my response and I sat down.

I never got invited back. But I sure appreciated that invitation. Further, I think they heard me. At least I received no jeers or catcalls, no derision. It was a respectful conversation where folks disagreed. The second Sagebrush Rebellion has died down and Idaho is now exerting Good Neighbor authority in federal land management.

Whenever I had town halls, I always looked for republican faces in the crowd. I wanted all to feel welcome. And I didn’t want to just hear from people I agreed with. But that sort of representation is based on a balanced electorate, not a room full of the like-minded. Such can become a mob, and such is not responsible governance.

Idaho politics is not balanced. If politics interests you, get off your butt and get to a central committee meeting; I don’t care which party. We need to work together, and this dismal party system is what we’ve got for now. Make it work. You may find not all the folks who embrace your partisan banner make good sense either.

Posted in Idaho Politics | Comments Off on A Small but Engaged Electorate

Sideboards, Springboards, or Spanking Boards?

Posted on February 27, 2019 by ddxdx

I understand the Idaho legislature has twisted shorts with the Medicaid Expansion initiative approved by 61% of Idahoans. They sat on their hands for six years and did nothing. They might have nodded quietly three years ago that those in “The Gap” were stuck in an unfair, unjust situation, unable to access healthcare insurance. They might have even agreed five years ago that paying for Catastrophic health care was the wrong way to deal with this problem, though it’s been the “Idaho Way” for decades. But they never got to work on the problem. Well, voter support for Medicaid Expansion in Idaho slowly grew and come November 2018, most Idahoans supported the simplest, most cost-effective way to get our Idaho working poor health insurance. But now many of our proudly elected legislators think they know better than the voters.

One of the beauties of this behemoth called Medicaid is that it’s a partnership between the federal government and the states. So, states can experiment; many have. Idaho has and does. The experiments are telling. Let’s learn from them.

We’re hearing a lot about “sideboards”. When I hear that term, I think of the panels we used to get cows or calves into a squeeze chute for branding, vaccinations, dehorning or castration.

The main “sideboard” bandied about in the marble halls of our beautiful Capitol has to do with work requirements. I wonder if our legislators know anybody in “the Gap”. I see these folks every day.  But here’s the Idaho statistics. Over 60% of people in “The Gap” are working the equivalent of full time, many in multiple jobs. Another 30% are caring for either children or elderly in their homes or are full time students. So, 10% might need a boost.

Let’s look at what other states have done and learn from them. Arkansas instituted a “work requirement”. It cost the state $10+M to build the system, and effectively kicked 18,000 out of Medicaid. So, this program used a broad brush, painting all who gained access to Medicaid health insurance under their expansion as needing to prove their work. What did they find? In Arkansas, as we have said about “the Gap” folks in Idaho, 90% of those eligible for Medicaid were already working, caring for others or students. Of the folks kicked off Medicaid, 80% lost coverage for failing to report through the online portal. Dollars to donuts, Arkansas’ online service doesn’t come close to Amazons.

This “sideboard” seems more like the paddle board hanging in the principal’s office. If you’re poor and have limited online access, then bend over.

But Montana painted their program with a fine tipped brush. They knew what we and our legislators should know. Most poor people need a springboard, not a paddling. Montana used the Medicaid expansion program to offer job training assistance. On enrollment the offer was made and a follow up letter was sent. There was no significant taxpayer cost. About 10% of the enrollees sought the help. They had a meeting with a Department of Labor staffer, got directed toward training, education, skills opportunities and Montana has seen movement toward higher paying jobs.

Montana offered a springboard. Many who needed it took the offer and we are all better off for it.

Idaho has a robust and widely available Department of Labor with a new energetic Director, Jani Revier. I’m sure the department could handle the 5000 referrals from the new Medicaid enrollment and they would welcome the motivated clients.

I wonder if this is the springboard Brad Little has been referring to. I know many in the Idaho legislature prefer the paddle. Since we’re so late to the game, why don’t we learn from others experiments. Let’s do it right.

 

Posted in Health Care, Idaho Politics, Policy | Tagged , | Comments Off on Sideboards, Springboards, or Spanking Boards?

Booze, Big Bucks and Buy Outs

Posted on February 20, 2019 by ddxdx

Idaho territory was a rugged place. While LDS settlers were diverting streams and cultivating fields in the southeast, the mining camps in central and North Idaho were raucous, unruly and not ashamed of it. But the drafters of the Idaho Constitution in 1889 were feeling the wave of temperance rising: Article 3, Section 24 reads:

PROMOTION OF TEMPERANCE AND MORALITY. The first concern of all good government is the virtue and sobriety of the people, and the purity of the home. The legislature should further all wise and well directed efforts for the promotion of temperance and morality.

Idaho went on to establish a Prohibition amendment to our state Constitution in 1917, two years before ratifying the 18th Amendment to the US Constitution which established nation-wide prohibition.

But then came repeal in 1933 and Idaho, somewhat reluctantly followed suit. The Idaho Liquor Act passed the legislature in 1939 and its framework exists today with some modifications. It’s an old, complicated system of regulating liquor licenses controlling the manufacture, sale, distribution and serving of alcoholic beverages. It has created an artificial market for liquor licenses that means for some regions they are dear, expensive or unattainable. Other markets they go unclaimed. Make no mistake, this law has created winners and losers. And the winners aren’t about to embrace the losers.

You see, the State Alcohol Control Board (ABC) limits licenses in cities based on their population. But if there are no licenses available from the state, you can buy someone else’s license or lease it. Here’s a broker where you can shop. A license that cost you $200 from the state, if you put your name on the waiting list and bided time, is now worth $200,000 on the “liquor license market”. You can’t just sit on a license, you have to operate a real functioning bar for at least 6 months or you lose your $200 fee and the license. But if you “season” your license, it becomes very valuable. Last year a license in Coeur D Alene was worth $300,000. Add to this, the state collects a 10% fee on any liquor license transaction. Throw in the changing populations of towns and this amplifies the obscurity of this system. The people who paid a lot don’t want to see their investment devalued should some crazy legislator want to shake up the 80-year-old system. I don’t see how this promotes temperance and morality.

I respect any legislator willing to address this mess. Many have. Governor Otter tried in 2009.  But he gave up after his bill died in the Senate that year. Issues as tough as this require perseverance. A couple years ago Representative Luke Malek (R, Couer D Alene) brought a bill but again it died; then he decided to run for Congress. This year Senator Jim Rice (R Nampa) has brought a bill very similar to Malek’s. It got killed in a Senate committee last week.

I applaud Senator Rice. I hope he’s willing to stick around and see it through. He might have to hand this one off to someone younger; I suspect it will take a few years. And he’ll have to have tough skin because lots of liquor license owners think their ox is going to get gored. Probably the only solution will be for the taxpayers to buy out all those over-priced liquor licenses so we can start over. I doubt Senator Rice will promise Mexico will pay for the buy outs. That one is over-ripe.

 

Posted in Idaho Politics | Comments Off on Booze, Big Bucks and Buy Outs

Pain and Suffering

Posted on February 14, 2019 by ddxdx

Idaho can’t say we’re winning the war against accidental opioid deaths, but we’re fighting a good fight. As you can see, the numbers are climbing. If you want a very in depth and excellent analysis of the situation, read this from the Idaho Department of Health and Welfare. I will focus on two points.

Idaho has a higher rate of prescribing opioids than the national average. We as a state have a long way to go in educating prescribers on best practices to avoid overdose deaths. We have made education available for prescribers through the Board of Medicine, the Board of Pharmacy, the DHW; many resources are available. Indeed, there’s education but also sanctions. The legislature has made it possible for the two independent Boards (Pharmacy, who keep the data on prescribing and Medicine, who has the power to sanction) to communicate about prescribing practices. The BoP maintains an accurate data base of controlled substance prescriptions that can be accessed 24/7 by prescribers and pharmacists. The legislature has made this access easier, but not mandatory. Use of the data base has steadily increased. Still, the number of narcotic prescriptions continues to rise.

Of interest, the highest rates of prescribing narcotics are in our rural and frontier counties. I don’t think it hurts more to live on the frontier, but the association between chronic pain and poverty and rural or frontier life is real. Caring for chronic pain is a demanding task and resources can be limited for a rural practitioner. Still, with this information, with proper education, incentives and support, I believe this can improve. We shall see.

But we can only see how we are doing if we have good information; that gets to the second point. Idaho is quite likely underreporting accidental overdose deaths from prescription narcotics. Of all reported overdose deaths in Idaho only 2/3rds had a drug listed as a cause on the death certificate. Overdose deaths without a drug listed as the cause don’t get counted as narcotic overdoses. Some weren’t; some were. We won’t know unless we investigate and report.

Overdose deaths are investigated and reported by the county coroner. Idaho has 44 county coroners and I can tell you, they all don’t have a CSI lab. Heck, many don’t even have an official vehicle; I didn’t. You’d think the counties most likely to have lax reporting would be the rural ones, and indeed some are. In Ada County about 90% of the overdose deaths designate a drug; but Bonneville County reported just 40%. Canyon County only hit 35%. Maybe we have a faulty system. Studies of death investigations nationwide have shown that states that have a county coroner system (as opposed to a Medical Examiner system) are much lower at determining which drug caused the overdose death.

Ever since I was the Latah County Coroner for 15 years I have wondered about the wisdom of the county coroner system for the state of Idaho.

I write this as a practicing physician who prescribes controlled substances and as a former County Coroner. I appeal to my physician colleagues: we can do a better job prescribing narcotics, treating pain, preserving the health of our communities.

To all the County Coroners, ask yourselves, are you happy with the system you have for investigating deaths? Are you doing a good job? Are there ways this could be done better? Just because it’s the law we have now doesn’t mean we can’t improve the system. Think about it.

Posted in Health Care, Idaho Politics, Policy | Comments Off on Pain and Suffering