West of the Rotunda

Justice

Posted on December 13, 2013 by ddxdx

Welcome to Cache Valley, Idaho

An Oregon congresswoman spoke at my sister’s memorial service 20 years ago. It was a painful time for me, but her words stayed. She said, “If you value freedom you must work for justice.” In doing this legislative work I find that justice is not always easy to see, and the work to do for it may come down to how you chose to spend the money you have. Working for justice requires deeper thought, longer looks, and getting off a comfortable bus to see what could be missed.

Serving on Joint Finance and Appropriations Committee (JFAC) has been a joy and a burden. There is so much to learn that it can seem overwhelming. But the people on the committee are a joy; the staff and the co-chairmen encourage the work, forgive the ignorance and reward the effort. And the ultimate reward is having a voice in how the state spends. I hope to give good service to my constituents and my state.

This September 2013 the JFAC “bus” toured state facilities in southeast Idaho. It is important for members to know how we are spending taxpayer money. We saw what Idaho State University was doing in health care education and the struggles they had with some buildings. We visited a state crime lab in an old building down by the train tracks and the women’s prison in Pocatello. We got down to Bear Lake State Park and Lava Hot Springs. We heard from passionate educators in Grace, Idaho where they give the kids a week off early in the school year to help with the potato harvest. Each stop made me wonder how taxpayer dollars can help, or if they should “help” at all. Our state doesn’t have much to spend and most communities help themselves best. But I believe we legislators are obliged, indeed entrusted, to serve the common good.

Each stop also provoked questions:

Why does the state own and operate a hot springs resort? Is there more value in public access to a beautiful high desert lake or in private ownership? Do schools need state direction to solve their education issues or can they manage best locally? Can convicted criminals contribute to society?

I have many more questions but I want to tell you a story from the last day of the tour.

Franklin, Idaho, has the distinction of being the first white settlement in Idaho. No honor is lost that the founders thought they were in Utah until the territorial surveyors corrected this false impression. They had been sent here by their leader, Brigham Young and they persevered. They irrigated the desert, grew crops, built a railroad and a thriving community. We visited a State Historical Society site that included the stone house of the pioneer Bishop Lorenzo Hill Hatch.

The pamphlet described his as the town’s first mayor and a “legislator”. From reading The Tie That Binds about the state convention to write the Idaho Constitution I knew that the biggest issue facing the body was whether Mormons should be allowed to vote(they weren’t), so how could a Mormon Bishop be a legislator? I asked our guide, a retired legislator himself,”It says here he was a legislator, but I thought Mormons couldn’t vote.”

He shook his head, unsure. “No, you’re right. I’m not sure how that happened. At early statehood we were right down there with the Indians.”

I researched further and found that Bishop Hatch served in the Territorial Legislature, before statehood and Mormon disenfranchisement. In one of his letters from his service he described Boise as “a city of great wickedness and debauchery of all kinds.” His work in the Territorial Legislature may have given gentiles a view of an upstanding Mormon, but the Idaho Constitution went on to prohibit the Mormon vote. Indeed, as Idaho approached statehood Bishop Hatch was arrested and charged with polygamy, testament to the many struggles this state has had and continues to have with the concept of “common good”.

As we prepared to leave Franklin the State Historical Society Director encouraged us to stop at the Bear River Massacre site on our way out of town. She warned that it is not always easy to see and it is not easy to pull a big bus over by the side of the road but she said it was worth the stop. The retired legislator said he would meet us there. I had read about the site and the only Civil War “battle” in Idaho, where an estimated 250-500 Shoshone-Bannock natives were killed by a contingent of US Army sent north from Salt Lake City in January 1863. The village was encamped at the confluence of Beaver Creek and the Bear River when the US (Union) army came upon them. The young US soldiers were California Volunteers, sent to Utah to maintain our Union as the carnage in the East mounted. It was very cold and it is said the whiskey ration doled out the night before the attack froze in their canteens. Still, I couldn’t imagine what they thought on that freezing January day. At the dusty wayside I stepped off the bus and looked. Two other legislators joined me.

There is a stone plinth, probably erected in the 1930’s with brass plaques on the four sides. The first one I read commemorated the local Mormon families taking in the orphans of the massacre. As I focused on the monument, a fellow legislator pointed to a scrubby tree and said, “Hey, what’s this?” We walked over and came under its shade. When I described the vision to a young friend and how I imagined tourists driving by at 65 MPH, and if they didn’t stop, pull over and get out but caught a glimpse of the tree and it’s adornments by the monument, they may not notice much, he said as summary of my stumbling description, what I couldn’t: ”Hey, what’s all that garbage in that tree?”

But it wasn’t garbage.

How easily we can misinterpret. Hanging from the branches of this scrubby high desert tree behind the state sign and the stone monument with brass plaques were offerings no doubt to the suffering of ancestors, and maybe a testament to their own. The intention, the honor, the reverence was palpable. It might not be an official state sign, but it was a moving place to stand, under that tree, with all that care and devotion.

I was so happy that I got off the bus.

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Ride for the Brand

Posted on March 31, 2013 by ddxdx

I spent one summer moving cows around Cuddy Mountain near Hells Canyon with my grandfather Henry.

Some of the top of Cuddy Mountain is flat, but there’s a lot of steep too.

I learned a lot about him, horses, cows and the work we need to do. This reflection comes because of a phrase I have been hearing around the statehouse, “Ride for the Brand”.

At the beginning of our legislative session this year, I was sent down with two fellow State Senators to the Governor’s office to tell him the Senate was ready to hear his State of the State address. The lead Senator greeted the governor with a hearty hello and declared, “Governor, I want you to know, we are here to ride for the brand!” They shook hands and clapped each other on the shoulder. I stood in the back ground. And then later I heard a Republican House freshman describe his campaign motto had been “Ride for the Brand”. I remember receiving an invitation in 2010 to our reelected Governor Otters inaugural party with the “Ride for the Brand” motto on the inside of the card. So this motto has caught my eye. Just what does it mean, to me and to my fellow public servants? Am I branded, a “D” behind my name on the ballot? Do we work for the brand or for the greater good? I am wondering.

I met Henry on the Snake River at the base of Brownlee Dam the summer of my thirteenth year. He put me on a horse to ride in to the “retirement” ranch they had settled into, Starveout Ranch, high up above the Wildhorse River on the flank of Cuddy Mountain.

That summer Henry and Helena, just newly retired, had agreed to ride the Cuddy Mountain range for Helena’s cousin Holworth Nixon. His cows were up on the Forest Service range that had been theirs before retirement. We left Starveout, with its green pastures, milk cows and chickens, running water and propane lights, no electricity, no phone to climb to the top of Cuddy Mountain, stay in a cow camp shack with a wood stove, haul water and herd cows. I loved it.

We rode for the brand of Holworth Nixon, which was a Circle “C”. Henry and Helena’s brand was an “O Cross Bar”. Henry rode for years for Albert Campbell and the OX ranch. I found out the “O Cross Bar” brand is still available from the Idaho Brand Board, one of the first registered in 1949 and last renewed in 2000, the year Helena died. I don’t think I will pay the $126 to get it registered.

Up on Cuddy Mountain at the cow camp at Summer’s Grave we would have a predawn breakfast of sourdough pancakes, collect the horses that had been hobbled and saddle and ride off to move cows. The top of Cuddy Mountain is a timbered rolling expanse all above 6000 elevation. I was at the mercy of Henry and Helena’s local knowledge. But by the end of the third week, places did start to look familiar. In the morning we would head out to “Paddy Flat” or “Windy Knob” or “Jims Point” and find some cows grazing. We would ride around until we had a bunch, then start moving them across to “Green Saddle” or “Bacon Meadows”. Along the way I often got the story about why it was called “Bacon Meadows”.

Henry had a colorful vocabulary. I counted once and it came to a fifth of the words he uttered were profane. He only used four cuss words, but he used them a lot. “She’s a damn good mare.” “That sumbitch fooled me.” “Helluva fine day.” As we were trailing the ambling white face cows Henry nodded ahead and informed me, “There’s a goddamed OX cow”. I hadn’t noticed. But I looked closer and she had a big OX brand on her side. We were riding Circle C cows.

“What do we do?”

“Oh hell, they’ll come git the sonovabitch come fall. Damn stupid to run her off up here, but that ol’ sonovabitch Albert Campbell used to make us do that.” Henry grinned and shook his head. “He was a helluva businessman.”

We didn’t drive off the cows that weren’t our brand that summer. But we noted it, or at least Henry did. He kept track, but kept them together. It seemed to work on the mountain. It seemed the fair thing to do. I would hope we can keep the work of our state in such perspective.

I’ll always remember that summer. Henry died that fall, a stroke. I barely got to know him. I hope my grandkids know me better. And I hope I have as much to teach them.

Schmidt Grave

Posted in Idaho Politics, Reflection | 1 Comment

What I Did Last Summer

Posted on March 18, 2013 by ddxdx

Last summer I thought I could change things. I tried to be a force for justice. In the process I learned a lot about the politics of power and people. I’m not sure I made a dent. You let me know what you think.

Why I’m A Family Doctor

I never watched Dr. Welby

I chose to be a Family Physician because it suited my personality. I don’t like facing limits imposed from the outside; I want to set my own. A Family Doctor is trained to deal with problems from the cradle to the grave and must know one’s own limitations. But I also believed what the professors in my medical school said, that well- trained, hardworking, primary care physicians could solve the nation’s health care problems. Good primary care would lower costs and improve outcomes. So I did Family Medicine for 20 years. I loved the work and thought I was paid well. But I saw that I was paid a third of what specialists were paid, outcomes were ignored, and less and less medical students were choosing primary care. Then, two years ago, here in the Idaho legislature, I saw a chance to try to solve a very small part of this huge problem.

Getting Started

Idaho has an insurance program that pays doctors for treating injured workers. The Idaho Industrial Commission is required to annually bring to the legislature its schedule for payment to physicians who treat injured workers. In 2012 they suggested a 10% increase in payments since there had been no increase for the three previous years. By itself, this seemed reasonable, but here it gets complicated, so pay attention. We are going to get into the nitty-gritty of how doctors are paid for what they do.

Into The Weeds of Physician Compensation

Even big problems can be lost in the weeds

In 2006 the state of Idaho changed Industrial Commission payment to doctors from the Usual Customary and Reasonable (UCR) method to the Resourced Based Relative Value Scale (RVRBS) method. The UCR method says the doctor can charge and be paid what is usual, customary and reasonable for the area in which they practice. In other words, you can charge what is “usual” and insurance companies pay. But the RVRBS method says the charge for a certain service is based on what resources are brought to such an encounter. It was an attempt to develop a fair payment system, not based on charging history, but instead on what “work” or resources are required to do different “doctor things”.

When the Idaho Industrial Commission made this switch some doctors were mad. Indeed, it ended up in court, with the state of Idaho suing some surgeons for fixing prices. But the RVRBS method of payment is considered fair and most insurance companies use it, as does Medicare and Medicaid. But, because of historic differences in payments most insurance payment scales use conversion factors. Here’s how these work.

Dr. Jones sees a kid in the office for a rash. The RVRBS method would say her effort is worth, let’s say, 0.7 Relative Value Units (RVUs). A surgeon takes out little Johnny’s appendix and that work comes to 5.9 RVUs. (All these are hypothetical values.) As a Family Doctor working in a clinic we would negotiate with insurance companies for payment and we might get paid $50/RVU. Surgeons negotiate with insurance companies and get $95/RVU. So even though the RVRB System is supposed to account for the different skills, time, effort and risk brought to the doctor’s work, payments still valued specialty and procedural care more than primary care.

When the Idaho Industrial Commission made the conversion to RVU payments, there was such an outcry from some Idaho surgical specialists that the Commission was afraid some would refuse to see Industrial commission patients, so they put in conversion factors. These conversion factors were applied to the different codes that doctors used to submit payments. Surgical codes would have an RVU multiplied by a conversion factor (in this case approximately $135). Office codes would be multiplied by a different conversion factor (approximately $55). So again, we are valuing different care differently, even though the RVRBS payment method is supposed to account for this.

When the Industrial Commission came to our Senate committee in 2012 to increase payments to physicians, they just applied a small change to just a few the conversion factors. I thought we should be narrowing the difference between the conversion factors faster. They listened politely but said they had a subcommittee that made recommendations to them, and they were just passing on their recommendation. I asked to visit with the subcommittee. And I called the representative for the Idaho Medical Association.

Politics is about relationships and working with people. Passion can become an obstacle for compromise and process. I tried to maintain respect for the process, but I will always have a passion for the value of primary care.

Changing Oil and the Idaho Medical Association

I’m not this neat

The IMA said they could not support me to decrease the conversion factor difference unless they were directed by their board. It was suggested I come to the July House of Delegates meeting in Sun Valley and plead my case. I have only sparingly been a member of the Idaho Medical Association, since I didn’t think primary care was well represented in this group. But the new President was a Family Doctor, half the Board was in Primary Care, so I have been a member now for 3 years. I signed up for the July meeting and drafted a resolution to present to the body.

The Industrial Commission subcommittee met in June and I phoned in my concerns from my Moscow garage where I was changing the oil in my pickup. They were receptive but wanted input from the IMA.

I also met with the Idaho Academy of Family Physicians in June and tried to get them to support my effort. They said they had just had a board meeting and wouldn’t meet again until September, after the IMA House of Delegates. They encouraged my efforts, but could not officially take a stance.

So you are getting to see what I did for part of last summer.

Failure

I was disappointed in my political abilities with the Idaho Medical Association House of Delegates. I drafted a resolution that would move the multiple Industrial Commission conversion factors to a single one in a revenue neutral fashion over time. This would mean the highly paid surgical procedures would get less and the office visits would get more, but they would still be based on the RVU formula. I suggested a ten year transition period. Honestly, who knows what will be happening in health care in ten years, but I am a moderate guy, I like my burgers medium and I drive old cars, so there it is. But there were folks who wanted to make it happen right away. I feared this was asking too much and indeed, the motion got referred back to the Executive Board to decide. I felt I had not spoken up strongly enough for my vision. But I did learn the people, the trends and ways of acting.

I was also somewhat confident that the Executive Board would support the transformation, since most were primary care providers. I was heart-broken in the fall when I learned they had voted to take no action.

Success, sort of

So last summer, besides trying to adjust Idaho Industrial Commission physician payment, meeting in McCall and Sun Valley with a lot of doctors, I was also working in the ER and campaigning for the Idaho Senate in my new district. It was a close election, but I got voted in to come back to the Senate. And then I got reappointed to the same committee that reviewed IIC physician payments. I was very surprised to see their proposed rule that reduced the conversion factors from 7 to 6 and reduced the differences between the conversions. I asked them, why did they propose this? They said it was what their subcommittee suggested. I asked if the IMA was opposed. She shook her head and smiled.

I don’t think I won this battle, but we gained some ground. Health care costs are killing our country. And if this small skirmish in this small state in this small theater of the medical conflict is any sign of the effort it will take to turn this around, be prepared for the battle ahead.

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Posted in Policy, Reflection | 1 Comment

Ms. Information

Posted on February 9, 2013 by ddxdx

As legislators we study bills, and then we vote to pass or kill them in our legislature. It is a process set in our Idaho Constitution, written in 1889. But there is a way to subvert this process and technology has made this easier.

We Idaho citizen legislators are supposed to be receptive to our constituents, and I try to be. I assume my colleagues are making the same effort. A couple weeks ago in a Senate committee two bills were proposed that made simple sense to me. I believe the truth around these laws was subverted.

If you want to, read SB1011 and SB1012. I encourage you to read them, since that is what we will vote on, or not in this case. I will try to tell you the story. It goes from zebras to the Koch brothers, but there are connections.

Idaho has had a long history of having a low rate of childhood immunizations. When I was a doctor practicing in Moscow, I spent time explaining immunizations, their risks and benefits to young moms and families and encouraged them to make a decision and proceed. I believe immunizations have saved a lot of lives. Indeed antibiotics are a distant second to immunizations when we talk of reducing childhood mortality.

Still, many parents don’t trust immunizations and chose not to have their children immunized. And many believe immunizations cause more harm than good. I did my best to respect the wishes of the families I served. And as a legislator, I try to maintain such respect for these choices.

Doctors kept immunization records in their offices on messy paper hand written charts, and sometimes parents would keep “shot records” on little folded yellow cards. I had one in my wallet for years. But Idaho got epidemics of whooping cough, and I saw cases of measles early on in Moscow. So either the

immunizations weren’t working or we weren’t immunizing enough kids to prevent these potentially fatal diseases. At this point I could digress to discuss “herd immunity”, which means, if most of the members of a herd are immunized, those that aren’t still receive a benefit, since they are exposed to less disease. But I will avoid the digression.

If 95% are immunized, the remaining 5% are protected.

I believed Idaho was immunizing at a rate similar to the rest of the nation, we just weren’t recording it very well. Others thought our immunization rate was low. To try to answer this question Idaho developed an immunization registry, IRIS. When first put in place parents had to “Opt In”, meaning parents had to say, when they chose to have their children immunized, that it was OK to transmit this information to the state registry. Our reported immunization rates stayed low. But a few years later the choice was made to switch to an “Opt Out” procedure, meaning, unless the parents asked to be excluded, the information would be entered into the state maintained data base. Suddenly, our immunization rates were now comparable to the national rates. It matters how you ask the question. My suspicions of poor recording were confirmed.

When the switch was made to the “Opt Out” protocol we made the law as specific as we could to protect the privacy of individuals “opting out” so that, if they didn’t want their information in the data base it would not be entered. But along comes electronic records and data gets entered often automatically. So let’s say a kid comes to my office for a well-child exam and the Mom is OK with the kid getting shots but doesn’t want her child in the state data base. We don’t send the information in, respecting her wishes. But four years later little Johnnie gets a cut, goes to the ER and gets stitches, and they ask, “Does he need a tetanus?” Mom can’t remember and so they give him a tetanus shot and this information is entered automatically since the electronic system is programmed to do this, and the ER doesn’t ask. I agree this is just as bothersome as a website keeping my log in data. But we are in the information age.

So the SB1011 is an attempt to solve this issue. If a mother says, “I don’t want Johnnie in the data base,” then we keep Johnnie’s name and date of birth on a list so when another provider tries to enter Johnnies tetanus at the ER, the data base can immediately stop that entry. SB 1011 is trying to respect the wishes of people who want to “Opt Out”.

In the last 5 years there have been over 3 million immunizations entered into the Idaho immunization data base and 185 cases of people wishing to “Opt Out”. But the proposed legislation is trying to bring us into the electronic age. Adults get flu shots, pneumonia shots, shingles immunizations. Do they want their information in the registry? Can we further protect the people who want to be excluded by retaining an identifier that protects them from their data being entered without their permission? This is what we want to accomplish with these bills.

Now we come to politics. Our state is engaged in a great debate. Many fear the intrusion of government in health care. And some are flexing their muscle in this debate. When this bill first came up I received 10-20 emails opposed. At the committee hearing many testified, including Wayne Hoffman, leader of the Idaho Freedom Foundation, with ties to ALEC and the Koch Brothers. Now I have received nearly 100 emails opposed to these bills. But the testimonies and the emails oppose this legislation because:

SB1011, and SB1012, are both an intrusion into your personal privacy.

It has become clear that some of our children are being sacrificed.

Those who wish to research vaccines won’t have a hard time finding the unthinkable ingredients used and the mass amounts of both physical and mental problems they create.

(Quoted text from emails)

I wondered how this had gotten so confused, so obfuscated, so misdirected with misinformation. Then a constituent sent me the text of an email he had received:

URGENT: New legislation has been introduced in the state of Idaho that would register every man, woman, and child in the state-run Immunization Registry (IRIS) to monitor their vaccine status. This sort of information has been used around the nation by Child Protective Services (CPS) to remove children from their parents because CPS deemed vaccination avoidance to be a form of medical neglect.

SB 1011 would require that every child in Idaho be registered in IRIS, even if you have chosen to opt them out of some or all vaccines. This would enable your child to be red-flagged by the Idaho Department of Health and Welfare.

SB 1012 would require all Idahoans from cradle to grave to be registered in IRIS. Can you imagine the wasted tax dollars monitoring everyone’s flu vaccine status, sending out reminders, and bothering folks who have decided a different path than that suggested?

If you know anyone in the state of Idaho, please make sure to forward this to them! Please email the members of the Idaho Senate Health and Welfare Committee and ask them to oppose this legislation. A two-minute email stating why you are opposed and copied to all the committee will suffice.

Suggested talking points pick one or a few:

-This is an intrusion into your privacy.

-Your medical records belong to you and the physician of your choice.

-You do not want the state to have the power to access your medical records either through IRIS or a state health insurance exchange.

-It is an unnecessary gathering of your personal information that could be abused in future

-As more parents educate themselves about the risks of the current vaccine requirements for daycare and school in Idaho, it would be a good idea for law makers to ask their constituents why the increase in recommended vaccines are not in their children’s best interest.

-While public health officials reassure that public that vaccines cause no harm, there is a Federal tax-payer funded program that compensates those who have been injured by vaccines

-There is abundant science showing cause for concern

-You have educated yourself about the best path for your family and do not need or want intrusion into these private matters from the state.

Frightening. These are great misrepresentations, in fact, these are lies. To what purpose?

There are many who do not want their children immunized. There are many who do not trust their governments. But I believe this campaign is using the fear these folks have to a different end. Who benefits from such tactics? I believe this is just a run up to the Otter-Hoffman lead ticket we will see in the coming weeks about the Health Insurance exchange. Fear-driven politics is being twisted to serve someone else’s purpose.

This week, the Department of Health and Welfare proposed a new bill that gave up on keeping data to protect the ones who want to opt out. So now, because of all the misinformation, those wishing to not be in the IRIS data base are going to be more likely to be accidentally included. Yes, it is complicated, and it takes some study to do these things right. Connecting to someone’s fear is much faster, much easier, and the internet helps.

So, you have just learned more than you wish to about immunizations and politics. I don’t know if this new bill will pass. And I don’t know if the state exchange bill will pass. But I believe the two are tied together. And misinformation about both is most of what we talk about. Please be patient. I believe the truth and freedom, and responsibility can win in this fracas, and our state will be served.

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You Can’t tell a Law by it’s Title

Posted on February 4, 2013 by ddxdx

My expertise lies not in the law. The constitution of our nation and our state are the laws of the land, and as an elected representative I am sworn to uphold these laws. So when I read the constitution and think it means one thing, and the experts tell me another, I very carefully listen and make a judgment.

In my last post I suggested that our state founders thought corporate personal property should, indeed must be taxed. I cited Article 7 Section 8:

ARTICLE VII FINANCE AND REVENUE

Section 8. CORPORATE PROPERTY MUST BE TAXED. The power to tax corporations or corporate property, both real and personal, shall never be relinquished or suspended, and all corporations in this state or doing business therein, shall be subject to taxation for state, county, school, municipal, and other purposes, on real and personal property owned or used by them, and not by this constitution exempted from taxation within the territorial limits of the authority levying the tax.

Learned scholars have interpreted this to mean that the State of Idaho cannot relinquish the power of taxation on corporate personal property, otherwise how could the exemptions that have occurred over the years be allowed? I was mailed this citation from a 1930 Idaho Supreme Court decision, and it was mentioned by the lawyer for the Attorney General:

Court Case 1

Sent to me by an old constitutional lawyerWho knows more than me

Sent to me by an old constitutional lawyer
Who knows more than meSo it is clear, the interpretation of Section 8 means the Legislature has the power to exempt and even remove taxation of Corporate Personal Property. We cannot relinquish the power to tax, though we may chose not to impose such tax. It is also clear from another legal interpretation that if the legislature, by removing this tax, forces counties or municipalities to default on obligations (bonds) or not fulfill their statutory (indigent health care, law enforcement, jails, mental health) or constitutional (schools) obligations, the legislature would be in violation of its constitutional authority. I hope we can proceed with wisdom and justice.

I draw your attention to the title of the section:

CORPORATE PROPERTY MUST BE TAXED

Whenever we hear a bill read on the floor of the Senate and it comes before us to debate and vote, the President of the Senate asks, “Are there corrections to the title?” He pauses and has always gone on with, “Hearing none, the title is approved. The secretary may read the bill.”

If I had been in the Idaho Constitutional Senate in 1889 and heard this title read and back then in my frock coat with a spittoon by my desk, and I also with the benefit of time machine wisdom I had my present day experience, I would have objected and asked that the title be amended to read:

CORPORATE PROPERTY MAY BE TAXED

I vow to pay better attention when the president of the Senate asks for corrections to the title. And I’ll try to have a clearer vision of the future. Presently, my glass through to the future remains dim.

*****

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Posted in Idaho Politics, Policy | Comments Off

The Drama of Business Personal Property Taxation

Posted on January 18, 2013 by ddxdx

The legislature here in Idaho faces pressure to eliminate the business personal property tax. We have been talking about it for years. The pressure feels like a huge freight train coming at us, while we are tied to the tracks. We need to think clearly and not panic in the face of such pressure, as no hero will come to untie the binds to save us. We must save ourselves.

Many say the business personal property tax is a bad tax, and it may be more so than others, but that argument could be made for all taxes. Let’s look at it with the principles of fairness in mind. Businesses that own real estate pay tax on the land, just like a home owner. Businesses that buy things pay sales tax, like a mom in a grocery store. Businesses that make income pay income tax, like a construction worker. To add, businesses that own tangible property, other than land, that they use for their business, like a contractor’s tools or an accountant’s computers or a doctor’s stethoscopes, pay tax on the estimated value of these items. This is called business personal property tax.

I remember when I first came to Moscow to practice medicine I received two letters from the county. The first was a summons for jury duty. The second was a letter from the county assessor, asking me to list all of my personal property I would use in my business and estimate its value. My medical school books had been very expensive, and I thought I would use them in the treatment of patients. In addition, I had two stethoscopes, both given to me, but I figured they were worth a hundred bucks each. So I sent the list in and waited for the call to serve on a jury. I was never called for jury duty, but I did get a bill from the county assessor for $1.25. Over the years I kept getting those bills but my valuation of the books diminished, and when the payment became less than the postage, they stopped.

Back then I was annoyed by this silly tax and thought I could provide better value seeing patients than doing jury duty. But as I now reflect, I think these are fair costs a citizen and businessman should pay to be in our state, our civic duty. But the unfairness and the burden of this tax for businesses as well as the difficulty collecting it and inaccuracy of self reporting have been argued to the legislature for years. Finally in 2008, at the peak of an economic boom, the Idaho legislature passed a law exempting all businesses from the taxation of the first $100K of business personal property. The counties who collected this revenue would now lose it, and it would have to be reimbursed from the state general fund through sales and income tax revenue. But as economic circumstances turned for the worse in 2008, the legislature decided to put a trigger that would postpone the tax relief. In other words, it would only take effect if the state economy grew more than 4.8% or if state tax revenues rose above those in 2008. We have not reached these triggers yet but it looks like we might in 2014 or 2015. As a result of this, the folks who want this tax to go away are in a hurry.

Remember the 80:20 rule. In medicine, 20% of the patients are responsible for 80% of the costs, and 20% of the doctors are responsible for 80% of malpractice claims. Along the same lines, if we exempt the first $100K of business personal property from this tax, 85% of businesses will pay nothing, but only 20% of the tax will be eliminated. The result is the big businesses pay most of this tax, and that is why they are pushing hard to make this go away.

Why do we even tax corporations on tangible property? Many states have decided it is necessary, as forty one have the tax, and only nine do not. In the 1880’s, when the Idaho Constitution was being written, several eastern states decided to overturn the business personal property tax. But our founders saw such a choice as a ploy to attract large business to the state and such a policy would starve the state of revenue and lead Idaho to a “race to the bottom” with other states. I believe Idaho retained the tax for important reasons. I believe the legislature must follow the first Idahoans and resist succumbing to the same pressure faced today.

Read this section of the Idaho Constitution carefully:

ARTICLE VII FINANCE AND REVENUE

I believe our founders had important reasons for writing this into the Idaho Constitution. Historically, railroad companies and mining businesses were the large corporations that had the potential to make a lot of money and hold sway in our early state. There was no income tax in those days. Yet, our founders knew if you wanted to be a citizen of this state, do business here and make a profit, corporations should contribute to the public good. This tax was a way to maintain such a relationship between the public good and the corporate privilege to profit.

Many lawyers I have spoken with do not consider the above section of the Idaho Constitution an impediment to repealing the business personal property tax, despite what I consider to be clear language that prohibits such action. Legal arguments aside, we should respect the intent of such language. Idaho’s founders knew we must maintain a solvency for civic well-being. This tool they thought critical. Now reflect on this:

On the basis of taxes paid per person, Idaho’s overall tax burden ranks 51st nationally (out of 51) and 11th regionally (out of the 11 western states).

*Type of Tax*	*National Ranking*	*% Compared to National Average*	*Regional Ranking*	*% Compared to Regional Median*
Property Tax	41	41.2% below	9	35.3% below
Sales Tax	37	22.2% below	9	30.5% below
Individual Income	32	19.2% below	6	Equal
Corporate Income	40	54.8% below	7	2.9% below
Overall Ranking	51	32.7% below	11	19.2% below

Because of relatively low income in Idaho, the state’s overall tax burden relative to income is 46th nationally and 11th among the 11 western states.

*Type of Tax*	*National Ranking*	*% Compared to National Average*	*Regional Ranking*	*% Compared to Regional Median*
Property Tax	38	26.4% below	9	22.1% below
Sales Tax	27	1.8% below	9	9.3% below
Individual Income	25	2.0% above	4	12.0% above
Corporate Income	37	43.0% below	5	6.4% above
Overall Ranking	46	15.1% below	11	6.5% below

Idaho has a public revenue drought. We are last in the country in our K12 investment per student. We have the lowest wages and personal income in the nation. We cannot maintain our roads or buildings. This has forced our local taxing districts to pick up the slack to fund their schools. Business personal property tax is one revenue source that helps ease the burden on local communities and the families within them.

This tax may be tedious, but it is one of the building blocks that provide a foundation to maintain the public good. To address these concerns, we must weigh the options. Keep the tax at cost to big business, or eliminate at cost to communities? Times have changed since the founders developed our Constitution, but our basic principles have not. Before “racing to the bottom,” we have to look at how we can adjust a bad tax while still keeping communities whole.

Last fall at a campaign event in a small town I met a tall, quiet man who owned a trucking company. He introduced himself to me and bent down to say, “You need to raise my taxes. These lousy roads are destroying my business.” I smiled and thanked him. I wonder if he voted for me. He looked like a Republican.

Posted in Idaho Politics, Policy | 1 Comment

Do No Harm

Posted on April 4, 2012 by ddxdx

This year (2012) our state has been through a difficult legislative session with a controversial mandatory ultrasound bill that got strong reaction from voters. The majority party finally decided to listen when they heard from constituent women. I write this post about something we did last session(2011) that didn’t get as strong a reaction.

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This principle from the Hippocratic Oath was a little hard for me to accept as a young man in my early medical training. I was drawn to the idea of risk, of trying something to see what would happen. But as I aged I came to appreciate this fundamentally conservative value. Be careful. Take limited risks, especially with the lives and welfare of those you serve.

The principle behind this 2500 year old edict may stem from an acceptance of the vector of our life. We are all born and we all die. So, doctor, do your best for life, but be careful knowing death comes to all. I have seen a lot of modern medicine deny this fact of mortality. Some treatments lose sight that life is limited and we must cherish what we are allotted.

Here in public policy I also try to minimize harm. Unfortunately, the choices we are faced with often come down to deciding who wins and who loses. I would hope our wisdom can strike a balance. I don’t think we did in the case I will discuss.

Last session we passed a law called The Fetal Pain Act. It put into Idaho law many things that will help the folks nationally who want to overturn Roe vs. Wade. I predicted it would harm a few innocent folks here in Idaho. I have now found out that it did.

In short, this law banned ending any pregnancy after 20 weeks gestation for any reason other than to improve the likelihood of a healthy baby. In 2009, before there was any law there were 6 abortions done after 20 weeks in the state of Idaho. We don’t know exactly why each of these was done, but we do know there are approximately 4-6 anencephalic babies born each year in our state. These babies have no brain development and cannot survive long after birth. Few even take a first breath, though some do.

Here is a link to a photo of an anencephalic baby but I warn you, the appearance can be disturbing.

I would like you to put yourself in the position of a young woman, anxious about her pregnancy, who now is told her baby has this deformity. Sometimes the condition isn’t discovered until the mid trimester, around 18-20 weeks gestation. Because of this law now she is also told, if it is after 20 weeks gestation, she must carry this baby to term or travel to another state, away from her home to end this nonviable pregnancy. Three such cases have occurred in the last 7 months since this law took effect. The law we passed last year made these women go away from their home and out of state to obtain care. Over 90% of women who are carrying a fetus with this deformity chose to end the pregnancy early. They no longer can in the state of Idaho after 20 weeks gestation. Our law says if you choose such action we consider it a criminal act.

I understand objections to abortion. I believe the state should only very carefully interject itself in this most delicate, most painful circumstance for a woman, a family. I believe we did harm to these women, these families. I am sorry.

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VINE Pickle

Posted on March 29, 2012 by ddxdx

There once was an old man living in a little house by himself. His neighbors noticed he was getting thinner and weaker. A little girl came to visit one day and noticed the man had no food in the larder but had three jars on the shelf. One was empty and the other two had money in them. “I could go buy you some food if you want.” She offered.

The starving little man looked at the three jars and grimaced. “I have no money for food.” He picked up the empty jar and held it out to her.

“But there’s money.” She pointed at the others with coins and bills in them.

“Ah,” the weak old man shook his head. “You don’t understand. This jar is for rent and for wood for the stove, and this jar is for seeds for the garden and clothes. I set this system up a while ago when things were tight and it has served me well. I will just go without food for a while until I get some work. That’s the money that goes into the food jar.”

The little girl shook her head and wondered.

Last summer I met with representatives of the Idaho Sheriffs Association. I had to get cleaned up out of my painting clothes to be presentable for the meeting. People forget we are legislators year round, not just when we are in session in Boise. These representatives were up in Moscow for a meeting and they had called me a week before to set up this meeting. They had a bill and they wanted my support.

For two years the state has been enrolled in a Victim Identification Network (VINE service). This is an online data base that allows anybody, victims, law enforcement, corrections or prosecutors to log on and find out the status of an offender. The tool was sold to states as a support for victims since we require that victims are notified if their assailant is to be released. But prosecutors and corrections use it all the time too. So does law enforcement, to see the location and status of offenders. So it’s a valuable tool.

The service has been funded for the last two years by a federal grant which is going away this year. This is what is driving the Sheriffs Association legislation. They want to keep the tool and think they have a way to pay for it. They are suggesting a fee be charged to each convicted felon, that fee will go into a dedicated fund which the Director of the Idaho State Police can disperse to pay for the VINE service.

I told the Sheriffs I could support the legislation, but I didn’t like the dedicated fund strategy. I think it can sometimes get us in a pickle.

But we do this a lot in this state to avoid raising taxes. We try to direct “user fees” to a dedicated fund that pays for a specific part of government. Last year even this strategy didn’t work; the House killed a bill to increase funding for Police Officer Standards Training that tacked another $5 onto each ISP traffic ticket. My reaction to this process got me into a 33-1 pickle on a different bill.

The Alcohol Beverage Control is an enforcement branch of the Idaho State Police charged with making sure alcohol is served and sold and consumed in a legal fashion. ABC has been funded by shrinking general fund money over the years so that now we only have one officer for the whole state with a 2012 general fund budget of$100,000. The bill that was the solution to this dwindling support takes the money from Alcohol licenses and fines ($1.5 million) that previously went into the General fund instead puts it into a dedicated fund that would pay for enforcement.

As the roll call came across the floor, everybody voting “aye” for this logical solution, I reflected on the changes to government we were doing. First, we would be jumping a department from a funding level of $100,000 one year to 15X that the next year. This seemed like bad management to me. Also, we were doing this because we didn’t have the guts to make this decision ourselves; instead we were setting up jars that held the dedicated monies. I passed the first time around on the roll call, but on second call I was the last one and gave the only “nay” vote. I support the Alcohol Beverage Control, but we should have the character to make these decisions as a body, rather than voting to take the decision out of our hands.

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Licensing Massage

Posted on March 23, 2012 by ddxdx

Recently we approved Senate Bill 1295a, which requires massage therapists to become licensed within the State of Idaho and “creates entry-level standards for the massage therapy profession.” It now has passed the House Commerce and Human Resources Committee and has moved on to the full House for approval. I voted in favor of the bill on the Senate floor, along with 27 of my colleagues. As a member of the Senate Health and Welfare Committee, I was able to hear testimony on this issue. Nearly all of those who spoke to the committee were in favor of the bill, including representatives from two organizations of massage therapists: the American Massage Therapy Association and the Associated Bodywork and Massage Professionals. There was one opponent who testified that licensing was unnecessary. Sometimes it comes down to who is in front of you.

Forty three other states currently have state boards that regulate massage therapist licensing. Proponents argued that SB 1295a incorporates the best principles learned in the other states which streamline the licensing process. A state board might also ensure appropriate health and safety safeguards for consumers by allowing for a complaint and disciplinary process. The board will be funded by the annual dues the therapists agree to charge themselves.

There was some debate against the bill. Critics argued that this was an example of government intrusion into the free market. The argument goes that if a massage therapist isn’t qualified or professional they won’t be in business very long. Regulations, such as the licensing fees in SB 1295a, could drive up operational costs that would then be passed onto the consumer.

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Idaho was the first state to give me a medical license.

What I carry in my wallet

I was a resident in training in Spokane Washington in 1988. I got an Idaho medical license before my Washington one because Idaho only required one year of training after medical school and Washington required two. I was eager to get my license and start moonlighting, making extra money to pay off my medical school debts. I sent in the paperwork and the fee ($50 back then, now it’s 10X that, and 5X that for annual renewal) then had to be fingerprinted and have a personal interview. I drove down from Spokane to Lewiston. I sat in a doctor’s office for 30 minutes then was called into an office. I waited another 15 minutes and the doctor breezed in, “Where’s your paperwork?”

I handed it to him. He flipped through and signed a couple places. He said a couple things and I left to drive back up the 2 hours to Spokane.

Make no mistake; licensing is no guarantee of quality. The Idaho Board of Medicine takes away about one or two licenses a year of its 5000 current licensees. It sanctions another 10-20. So the Board, who grants licenses, is really in the business of finding outliers, not improving quality or guaranteeing it.

Back a few years ago the podiatrists in Idaho wanted to be licensed separate from doctors. They never got a lot of members to pay annual licensing fees, then they had some litigation issues, and now they are in significant arrears.

So will massage therapists be better off licensed? Will the public be better served? I got some nasty emails because in committee there were a couple comments about folks who are doing “something else” (Senator Broadsword said, “In Wallace they were called seamstresses.”) and it really isn’t “massage”. I think “seamstresses” will still be out there.

Maybe this licensing can make the distinction more clear. I hope we can move the massage therapists along the line of professionalism. That’s the goal. They are truly a professional group and their services valuable. But we’ll have to keep an eye on them.

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The Cost of Choice

Posted on March 17, 2012 by ddxdx

Public education in this country is struggling as is health care. But from a historical perspective, they are headed in opposite directions. Our state mandated public schools in our constitution.

ARTICLE IX SECTION 1.LEGISLATURE TO ESTABLISH SYSTEM OF FREE SCHOOLS. The stability of a republican form of government depending mainly upon the intelligence of the people, it shall be the duty of the legislature of Idaho, to establish and maintain a general, uniform and thorough system of public, free common schools.

Most elementary education in our country has been funded with tax dollars. Until the 1950’s most health care was private pay, then the work-based health insurance benefit took hold, then Medicare and Medicaid happened in the 1960’s and now health care is >50% government funded. But I wonder if the principles are the same.

In health care economics I was taught that you could look at three competing aspects to the system: Access, Cost, and Quality. Better quality will cost more. If we increase access (or choice, an aspect of access) then cost goes up. If we lower cost, both access and quality will suffer. You can’t have it all, low cost, high quality and unlimited access.

Charter schools increase choice for parents and students. In principle, I support this. Our town has excellent charter schools that are thriving and popular. You need to understand that charter schools are publicly funded. They get tax dollars from the district where they are based. But funding this choice is a problem. Let me explain. We recently passed a bill to remove the cap on charter schools in the state. By removing the cap our state will be eligible for more federal education grants. We can only have 6 new charter schools per year in the state and only 1 per district. The sponsor passed out a handout to show that the costs of charter schools were comparable to regular schools. I immediately went to my town:

Moscow School District $4300 Elementary State Revenues per Average Daily Attendance(what the state pays to the district for an elementary kid to be taught each year.)

Charter A $5600

Charter B $6300

So the larger Moscow District School gets paid less per student then the smaller charter schools. I can understand this. There are economies of scale. The most expensive school in the state( a rural public school) gets $19k/ student, but they only have six kids.

Remember, the money for the two charter schools in Moscow comes from the Moscow School District budget. Each kid that moves from the main school to the charter takes with her more than she was getting to cover her costs in the district. So the money shifts from the district to the charters. We have more choice and it costs more overall.

And we haven’t even covered the cost of facilities. Charter schools can’t run a bond election to build a school but the district schools do. And the district will have to keep the heat on and fix the roof even if the classrooms are only half full. I believe this school choice route is going to cost us all more. And here we are embracing choice in a time when we are restricting budgets. I think we need to be honest with ourselves about this. We sure haven’t had an honest discussion about what we want in healthcare. Honest discussions are tough.

Posted in Education, Idaho Politics, Policy | Comments Off

Justice

Ride for the Brand

What I Did Last Summer

Ms. Information

You Can’t tell a Law by it’s Title

The Drama of Business Personal Property Taxation

Do No Harm

VINE Pickle

Licensing Massage

The Cost of Choice

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