West of the Rotunda

Idaho wants citizen (read “part time”) legislators. We are paid part time and expected to live our lives in our districts when not in session.  I respect that. We have legislative session from the first Monday of the first full week in January until sine die, a Latin term for final day, when the legislature decides its work has concluded. That came in April this year, a very long session. I have not posted on this blog since then, but I don’t want to give the impression that I am not still doing legislative work.

There are interim committees. I am on four plus one. That’s a lot. Here’s the list:

Millennium Fund Committee
Idaho receives money from the Tobacco Settlement Fund to the tune of 10 million dollars a year. Lots of states use this money in different ways. Some dump it into their General Fund and build roads or fund schools. Idaho has decided that this money should be used for Substance Abuse and tobacco use prevention. Twenty percent of this money is placed in an endowment fund and the earnings are spent. The fund is growing. This committee decides how the earnings are appropriated. Last year I sat in on three meetings where we heard proposals for these expenditures, then voted on the appropriation. In the end the Joint Finance and Appropriations Committee (JFAC) disregarded the committee’s recommendations and made its own decision about where the money should go.
I learned a bit with this work. As I listened to testimony from different folks about how they would use the money we could send their way, I reflected on my time as a doctor talking to people about quitting smoking or getting off drugs. Listening, studying, and understanding the problem is the key. There is no substitute. I voted for programs where people talk with people. You will see billboards by the highways about meth. They are the products of the Meth Project. They got $500,000 form the Millennium fund, over my negative vote. They claim great returns on investment.  I have data that speaks otherwise.  A member of our committee sits on the Board for the Meth Project as does the governor’s wife. I think it’s about people talking with people. So I voted my conscience.

Energy Environment and Technology Interim Committee

We are currently tasked with updating and rewriting the Energy Plan for the state of Idaho. It was last written in 2006 and was honestly very progressive. Can you think of as more pivotal point than energy? I have been doing my homework. We have had two meetings this summer and there will be at least two more.

Health Care Task Force
I argued for this position and got it. I believe we need to change how our state delivers health care.

The Task Force was started 10 or so years ago to study health insurance and keep it affordable for Idahoans. But right now we are in a fight over whether the state of Idaho accepts federal money to establish insurance exchanges. Most of our two meetings have been focused on this issue. Insurance exchanges are designed to expedite market forces on the cost of insurance. I think it’s an easy yes, but our governor has incited the conservatives of the majority party against anything federal. So they are working out their conflicts.
We have had two meetings, but I learn more from the research. The legislative fight this coming session may be over exchanges, but the victory will come when we can draw the discussion into the larger picture.

Catastrophic Fund Board (Also known as the CAT Board, but we don’t deal with this:)

This is just a small part of the larger picture. Idaho is required by statue to pay for medical costs for people who are considered medically indigent, that is, cannot pay their medical bills. The counties are the ones required to pay. About 12 years ago a law was passed that said if the bill to the county was greater than $10,000 the state would develop a reinsurance pool (Catastrophic Fund, or “CAT Fund”) for the balance over that amount. The bar has since been raised to $11,000. This means that if a person in Latah County breaks their leg and doesn’t have insurance, can’t qualify for Medicaid, and their medical bills are more than their assets (minus their home and one vehicle), then the hospital and doctor bills go to the county. The county pays no more than $11,000; any amount beyond that is passed on to the state. In 2010 the state paid approximately $35 million into this program from the General Fund. My best estimate is that the counties paid about $40 million. That means the taxpayers of the state of Idaho are insuring the uninsured from both property taxes and general fund revenues about $75 million dollars per year.
This Board comprises county commissioners, the director of the Department of Health and Welfare, two Representatives (one from each party), and two Senators (one from each party). Last session the Republican Senator spoke to promote a bill the CAT Fund had proposed. I rose to support it. He came up to me afterward to suggest I consider a nomination to the Board. I accepted and was appointed. I believe this is a leverage point.

Change in Employment Compensation Committee
This committee is tasked with recommending to the legislature whether to accept, modify or reject the governor’s recommendation for changing the state employee compensation. We have not met, but I expect we will right before the session.

I will continue to write about each of these issues and more in the coming weeks. I will also continue to be a part time legislator, working as a Family Physician, fixing my vehicles and homes, and gardening. I always meet with constituents and try to do my best at this, a part time job.

Comments are welcome but will not be posted.

The clouds parted and the rain has stopped. Trees try to bud and crocuses spring forth. We are working long and hard to get bills through the session. We took a Friday noon break to get a picture of us all together.

Senate Democratic Caucus 2011

On the left is Les Bock District 16, Boise. He is a lawyer with a deep sense of justice. Next is me, then Edgar Malapeai from Pocatello, current minority leader and former teacher and referee.  Then Michelle Stennett from Ketchum with Elliot Werk from Boise behind. On the right is Diane Bilyeu from Pocatello and next to her Nicole Lefavour from here in Boise.

Just seven minority senators out of 35 total. We have to have a strong shared vision and work well together to have any influence at all.

It has been hard for me to find the heat in all the smoke surrounding this one. I expected to have an advantage understanding this, but maybe I am seeing too many subtleties.

Peer review is a medical staff process that I am quite familiar with. When doctors criticize each other it is supposed to be a healthy collegial process that leads to reflection and improved care. We all should reflect on our decisions and actions with the intent to do better (or the same) next time.  Doctors are supposed to do this in the “peer review” process in hospital committees and meetings. Since the 1970’s the state of Idaho has considered professional peer review important enough for the public welfare that the state has declared the process immune from discovery by a third party in a lawsuit. So a patient who considers himself wronged by a physician’s care cannot troll through the peer review minutes for support. It is protected from such discovery.

Two years ago the Idaho Supreme Court decided that a patient who was injured by a physician’s care could sue the hospital for negligent credentialing. That is, the peer review was still immune, but the actions that the hospital took based on peer review are not. So we have before us a bill [HB162] that extends the immunity for peer review decisions outward to include the actions of the hospital that are based on peer review.

In my experience the peer review process has been very frustrating. I always wanted more collegial and critical discussions about patient care decisions. I spent a lot of time encouraging doctors to change their behavior. I wanted input on my own. Collegial criticism has always been difficult to bring about for many reasons. Most people, not just doctors, do not chose to reflect. Few are comfortable with criticism. I considered these to be essential elements in medical training and thus in the practice of medicine. Yet in the hospital and the clinic I found resistance and denial were the norm when I tried to promote these practices. And the excuse most often offered for why to not be involved in critical peer review had to do with the fear of litigation. Like admitting one’s mistakes or examining another’s begged a lawsuit.

Disgruntled patients are not the only source of this fear, because patient care peer review is protected. Sometimes,  physicians fear their colleagues. This is the uncomfortable secret of peer review: sometimes doctors do not get along or do not agree on what is the best course of treatment, and sometimes they can even be downright vindictive. Who would want to try to promote reflection in such a colleague? Worse, if these character flaws spill over into clinical judgment, can one keep to the issue of patient care when there are personality conflicts? And finally, add to this that medicine is a business, and we physicians have our financial futures tied to reputation and affiliation. Consider this swamp of conflicts in which a profession is granted immunity from discovery to better itself and the care it provides. It is amazing there is no brown ooze coming out from under the door closed on the peer review panel.

We heard HB162 last week in Senate Health and Welfare committee. Representatives of the Idaho Hospital Association and the Idaho Medical Association both spoke in favor of the bill. There were lawyers who spoke in opposition and doctors who spoke on both sides. What most impressed me was that there were five doctors from a Boise specialty hospital that thought this bill was going to allow competing hospitals or physicians to limit their practice;“economic credentialing”. The decision to allow a physician to practice in a hospital or to limit their scope of practice can be quite subjective. If these decisions are made for the purpose of promoting the business interests of one party over another then the spirit of peer review is not met. There are many stories of this happening. I have seen it myself. One doctor with a certain kind of training may not think other doctors with a different kind of training should do a certain procedure. The more lucrative the procedure, the stronger is the defense of “the right way” to do things. And there is no clear evidence on “the right way”, despite the advertisements one sees in the papers or television.

I honestly had not decided how I would vote before the testimony. I had received emails and heard conversations on both sides.  I wondered if there was a problem in Boise that did not apply to rural Idaho hospitals. In the end, I was most influenced by the repeated and heated overstatements by the opponents who feared economic credentialing. In my careful reading of the bill I did not think such a fear was warranted. I want there to be good peer review. I hope this promotes it. So I voted yes, to pass the bill to the floor.

But I will pay attention if it passes into law. I am not sure if this will keep smoldering, burst into a decent fire that might shed some light, or just go out.

The bill was just defeated on the Senate floor 14-21, not even close. I’ll still pay attention.

Comments are read but not posted.

I learn something new every day. Maybe those who have done this for years can see the bigger patterns, like sensing the storm when sniffing a wind shift. I am still immersed in reading each word of each bill and wondering why it is raining.

But I am getting a sense of some patterns I see in the bills. For instance there is one I have recognized and call, “A Solution Looking for a Problem”. As an example I will tell you of a phone call a couple weeks ago.  A lady called me for an interview for her newspaper article. She was doing a feature story on breastfeeding. “Senator Schmidt, did you know Idaho has no laws protecting breastfeeding?”

I was not aware of that. She added, “Eighteen states have laws protecting breastfeeding.”

I asked her, “From what?”

She did not understand so I restated, “You say Idaho doesn’t have a law to protect breastfeeding. I didn’t know it was being attacked.”

She somewhat agreed maybe it was not under siege considering that breastfeeding rates in Idaho are near the top in the nation. And she admitted to just having a baby and to thinking all women should breastfeed.

I agreed with the merits of breastfeeding and told how I always encouraged the women whose babies I delivered to breastfeed. But I had to accept that it was not for all women. Support and encouragement can help, but it does not always fit. We parted the phone call with no legislation in mind.

There have been bills that have rolled through this session and will become law that were of this purpose, that is to project ones values onto the populace.  Sometimes we legislators just want to stand up and say what we are for. Other times there is a bigger, national agenda that is being served. I am sorry, but with the current majority here in Idaho’s statehouse, posturing of this “Solution Looking for a Problem” sort has become common. I hope Idaho gets tired of it.

There is another kind of bill I have recognized as a “Simple Fix”. Sadly, these are rare and sometimes simple turn out to be only illusions. It is still interesting.

In these times of tight margins and fluid labor needs there have developed businesses called Professional Employer Organizations .  PEO’s outsource human resource management as well as employ workers but make them available for businesses. So businesses do not actually have to hire workers, they can “co-employ” them with the PEO. It seems to me PEO’s bundle labor like Goldman Sachs bundled mortgages.

I can see the purpose PEOs serve both for businesses and employees. But for every benefit there is a cost. Just as home ownership can be a burden of loyalty and investment when one just needs shelter, getting hired into a big company sometimes can be too much commitment for a young worker. (Of course, a big business might have a long-term strategy that would benefit from loyalty in which case this would not fit. Doesn’t it seem sort of mercenary when one considers loyalty as part of a business strategy?)

Our simple fix had to do with these PEO’s. H0154 was not regulating them; just making them follow the rules all other employers have to follow. It seems some PEO’s have not been filing their quarterly wage reports with the state unemployment insurance fund. Thus employees of the PEO’s were not recorded as employed and could not receive unemployment benefits. And it seems some weren’t paying their unemployment insurance premiums but couldn’t be fined because the law didn’t clearly apply. We just needed to add a PEO category to the current employment law.  This will be simple enough to fix. And we will.

Then there is the “Just One More Step” bill. These expand a current law into newer or broader territory. We hear one of these this morning. Here in Idaho we have a “Right to Farm” Act. It is being expanded this year with new language and broader implications. When I read the bill I thought these expansions seemed excessive and too broad. But during committee testimony I got a sense why farmers felt the need to expand their “Right to Farm”. One opponent to the bill pointed her finger at the committee while calling the bill cowardly and evil. After we voted the bill forward she came up to me in the hallway and said, “And you call yourself a Democrat!”  I think the “Right to Farm” will be taking a step forward.

The winds of politics shift. Just like looking out the window sometimes gives one a better sense of the weather than the newspaper forecast, I am learning to look up from the printed bills to see the approaching storm.  I can always use the paper bills to shield the rain.

 All comments are read but not posted.

We passed the “Bad Dog Bill” [SB1143] out of the Senate yesterday. I first saw it on the Agricultural Affairs Committee. The author, a veterinarian from here in Boise deserves a medal for perseverance and heroism. He donated two years of meetings emails, rewrites and phone calls to move this forward. I appreciated it, but mostly he just got a lot of questions from the committee.

For years Idaho statutes have addressed bad dogs in a confusing and conflicting way. For instance, if a dog bit your cow or horse it could be destroyed as vicious. But if it bit you or your kid it was considered dangerous and could be confined and restricted. If it bit you or your kid a second time it could be destroyed.

It has always been the law in Idaho that a dog threatening you or your stock (not chickens) can be shot. This bill does not change that. We are still a frontier state, even though 95% of dogs live indoors now.  50 years ago the ratio was opposite with 95% of dogs living outdoors. So our dog culture has changed somewhat. We still respect the stockman.

The definition of “dog” in this bill is an interesting issue that got no notice. See Section 25-2806 line 11-12 (“Any canine species”). So, Idaho law makes it legal to shoot a wolf attacking your stock.

The good veterinarian’s new law made better sense. It did not classify any breeds as bad, because that fashion comes and goes. It did set up categories of “dangerous” and “at risk”. A bad dog could be redeemed from the “at risk” category after a few years of good behavior.

Of course, when you do something that will apply to the whole state you need to have some flexibility. These laws would be the baseline from which counties or cities could write more restrictive ordinances.

It is a testimony to our state that we tolerate such variation. For instance, the city of Rathdrum has decided to no longer require licensing for dogs.

 “The city wonders if less government will mean more compliance with dog licensing.” 

I can understand deciding not to do the licensing anymore, but I don’t understand how that would increase compliance. Just like the veterinarian did, if you want something to change, I think you have to devote some time and effort to it.

The “Bad Dog Bill” was sent to the amending order to change one small part. Sometimes this can open up a big can of worms and the bill can die. But the amendment got passed and the bill will move on to the House. I hope the author will see this step as some reward.  I have heard the House is much tougher on this sort of regulation.

All comments are read but not posted.

Leverage

The Senate follows rules from a different century. I am not sure if they serve the current one. The argument that “this is how we have always done things” has never sat well with me. Still, these rules serve an elegant purpose. We must make decisions as a body. And remain civil.

I studied these rules and have read them at least three times. I still have to look things up. I have been told you have to live them to know their meaning. I am sure it will be years for me.

My first week in the chamber I recognized the phrase “I ask unanimous consent . . . ” This is used in different circumstances to speed things along. It allows us to jump from one order of business to a distant one with such a simple request. The chair replies, “Are there objections? Hearing none we will advance to . . .”

In that first week I wondered what would happen if I objected. I imagined a lot of angry stares. And things grinding to a halt.

The Senate rules specify that all legislation must be read three times before a debate and vote. Thus there is the First Reading Calendar, then the Second Reading Calendar and finally the Third Reading Calendar before a debate and a vote can occur.

It is common for a Senator to stand and ask at the beginning of the First Reading Calendar, “For unanimous consent that all bills be read by number and title only and let the record show they have been read in full.”

The President will respond with “Hearing no objections, so ordered.” The secretary will then read the numbers and titles and the bills will be moved forward to the next calendar. So things move. (You can watch this any time from 10:00-12:00 a.m., Mountain Time, here. I will warn you, it is pretty boring. Not to me, but to most folks.)

But the final reading (in the 13th order of business) is a bit different. The bills are listed in order and the secretary starts reading the bill. She has a sweet voice but keeps it very monotone, I think a respectful practice. After a sentence or two the sponsoring senator will stand and be recognized by the chair. The sponsor asks “unanimous consent that further reading of bill #____ be dispensed with and let the record show it has been read section by section and placed before the Senate for final consideration.”

It was here we objected when unanimous consent was asked to dispose of reading SB 1108 and SB1110, the bills changing Idaho education. We had planned this for a couple days, and had told our plan to our Republican allies, and the Republican leadership. When SB 1108 and SB1110 came to the floor on third reading the bills would be read in their entirety. They needed a full hearing.

I do not know how the opposition felt about requiring the bills be read. I felt good about it. After the reading (it took two hours for SB 1108) we debated for another 2 hours. It was respectful and pointed. When the roll call vote was called we lost 15-20. Keep in mind that 8 republicans voted with us 7 democrats. And if we had walked out there still would have been a quorum. They would not have missed us. We stalled but we couldn’t stop it. It will take more public outcry to redirect this ship. And even then, I’m afraid at least 1108 (the one crippling the union) will pass. (They both passed the House this week)

Three more votes and it would have gone the other way. I am going to work to find those three votes.

All comments are read but not posted.

Church and Message

I stayed in Boise last weekend to attend some state Democratic Party functions, particularly the Frank and Bethine Church Dinner. It was sunny and pleasant here and snowy on the Palouse, but I still missed my home. We had organizational meetings and informational talks and fundraising events. It was great to get together.

I was in a group Saturday afternoon that discussed messaging. This is the process of transmitting information in just a few words or symbols. The connection between the words and emotions is often critical. Think of the phrases “Pro Life” and “Pro Choice”.  We are surrounded by messaging. Just do it. But the Democratic Party is famous for the 12-point plan, not a clear message, until along came “hope and change.”  Now that we have change we are hoping for a message that resonates.

President Reagan seemed to transmit the message of hope. America would rise above our problems and triumph, like in the old 1950’s movies. He was the “Great Communicator”.

Here in Idaho we Democrats are much marginalized. We need to have words and phrases we can identify with. I found the exercise interesting but the main thing I took away was the word “stewardship” and a lot of one-word phrases the Republicans would use to characterize us.

The highlight of the weekend was my Sunday morning in church. This was my first time to go to church here in Boise. Despite the one-hour time difference I felt a unity with my wife, Martha, because I knew she would be going to church in Moscow.

I always want to know the sermon title. Martha just goes. The title for the sermon here in Boise was “Make a Joyful Noise”.  It was supposed to kick off their fund drive, which they call their Stewardship Campaign. There were trumpet cantatas and hymns to sing. The minister asked each of us to consider what would be our “theme song” or hymn that would reflect our nature. I chose mine quickly. What would yours be?

The minister explained that religion combines intimacy with awe, and then solidifies the experience in the community.

I thought of my time in the Capitol and if there was any awe involved. I believe there has been. I have been touched by stories and effort. Irony always brings a laugh. I have heard honest emotion. And I share this experience with at least 34 others. If I become jaded and cynical, I hope I quit or change before the voters express disgust.

This weekend I was able to attend church in Moscow. The sermon spoke to how we need to have multigenerational activities if we want to thrive as a congregation. Our minister spoke of the generations. I am a late Boomer. She described the GenXers and the Millenials as both more liberal but also less involved in organized church activities. Maybe they will take to politics. Idaho’s future rises.

Thank you for comments. I read them all but do not post them.

Sometimes irony is everywhere.

We had a full agenda in Agricultural Affairs this morning. I did not expect such a hubbub over raising fees for brand inspections. But such is senate life.

Brand inspections are done by state brand inspectors. These inspections record transfer of title to, or possession of, livestock.  Inspectors authenticate ownership, and are also called to investigate theft. The Idaho Brand Board registers brands and keeps track of them. Fees are charged for these services. The Brand Board is funded only with fees; it receives no General Fund money.  The Brand Board was bringing a bill before us requesting an increase in their fees.

I made a mistake questioning the brand board director. I was trying to figure out what animals get brands. I should have read the bill more carefully, for it was right there. The director responded soberly, “By statute, livestock in the state of Idaho are defined as all cattle, horses, mules or asses.” There was tittering in the early morning audience.

A committee member commented that “Some out there might be thinking some here on this committee need inspecting.”

The Brand Board director offered to check for rib marks if such was called for. He was blushing.

“No, it wasn’t that kind of asses they were saying.” The joke took a while to die down.

But soon the question at hand became quite evident. In these times, while we are cutting funding for schools and Medicaid, should we be raising fees on brands? Aren’t we supposed to be shrinking government?

The Brand Board explained they had met with the Cattlemen’s Association and the Dairymen’s Association, both of which agreed a fee increase was reasonable. They would be paying it. And there hadn’t been a fee increase for over 20 years.

I watched this one closely and did not speak. One Senator was quite bothered that we would increase these fees when “times are tough”.

We voted 9-1 to raise the fees. We will see how it does on the floor of the Senate. Then there is the House. Times are tough for growth of cooperative effort.

Thank you for comments. All are read but I do not post comments.

I have heard this term used with respect to our federal government and the degree of debt we face as a nation. It sounds alarming. I wonder if alarm is the intent.

I remember the frugal ways of my parents. While we may have qualified for bankruptcy at one point (that is unable to pay debts) my parents never went through the process of “declaring”, although I remember hushed discussions around the kitchen table. For my parents, such a choice of legal declaration would have been an emotional burden greater than the 18th century debtors’ prisons that populated our early colonies. I admit to embracing my parents’ ways.  The specter of debt still frightens me. And the shame of being unable to pay looms large. But I have outgrown the unreasonable fear of debt.

It was hard to spend the money I had as a child. This miserliness was just the child’s illogical extension of the fear of debt. I guess I could have become a hoarder, but I am not sure if this is the path for such a condition.  I had a difficult time accepting the debt of medical school because I could not see it as an investment that would reap the reward of a career I now treasure. It was finally as a businessman and partner that I came to understand debt as a measure of commitment.

Our country has a large debt.  It is hard to know what to compare the debt to, that is, how to measure our assets. Often debt is compared to the Gross Domestic Product (GDP). As you can see from the graph, back in 1947 we had a higher ratio of debt to GDP.  

Historical Public Debt and Debt/GDP Ratio

I doubt there was a lot of worry back then. We had just won a world war. A common enemy can unify and focus.

I write this because I think our situation is manageable, not dire. I believe we will need to change a lot of our thoughts and our ways. Continuing to do the same in the face of such a curve would be foolish. 

I was motivated to this reflection after a breakfast with a young 4H student. He was in Boise to learn about the legislative process. At the breakfast gathering we were addressed by our Lieutenant Governor who spoke again of looming federal deficits. I wondered what this young man thought.

  He shared with me his thoughts that our country was bankrupt. He sounded a bit down, like we had our future sealed in a dismal way. Here he was at a 4H gathering but he sounded hopeless.  I wanted to talk with him more to understand his thoughts and hopes but the program and the schedule would not allow. Here is what I would have said:

Well, yes our country does have great debt. But we can pay this debt. I am committed to do so. I believe you are already paying on that commitment with me. You are building your skills. You are growing your character and your spirit. Don’t lose hope. When you are in touch with your best self, when we all are, our accomplishments will astound.

 My generation must not get in the way of your success. Our old answers will not fit for you. We must not cling to old ways out of fear.  We must not stifle your education nor steal your hopes. We must not let our fears cost you your future. Nor should you be alarmed by our fear. We boomers have had a wonderful run. I believe you have a bright future. But, yes, things will change, no doubt. And shouldn’t they?

I wonder what he would have said.

All comments are read but not posted.