Licensing Massage

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

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.

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IGEM for the Flagship

Our governor has rolled out a very small stimulus proposal for our lagging state economy and the state’s oldest University. IGEM stands for Idaho Global Entrepreneurial Mission. It is an attempt to transfer technology developments from the state research centers (Universities, INL and CAES) to businesses who want to develop such innovations. There will be taxpayer money in a fund in the Department of Commerce that is directed by a board dominated by industry representatives to support development of selected technologies, matching them with capital and management in private industry. There will be intellectual property agreements between the state institutions and private industry that define the ownership and thus returns from such transfers. A bill we recently passed defines most of this.

Some of the money that comes from such developments will come back to the state and the fostering institutions, based on agreements between the board and private developers. So the University of Idaho supports this. I do too. I just want the relationships to be clear.

There was another recent public-private deal with the University of Idaho. The Idaho Wheat Commission set up an endowment in conjunction with LimaGrain, a French seed cooperative for wheat research at the University of Idaho Department of Agricultural sciences. The wheat farmers agreed to increase their own assessment (what they pay per bushel) to fund this. We had to pass a bill to allow this. It got quite a bit of push back from some Senators thinking we should not be raising taxes, even though it was the wheat farmers themselves that proposed this. I imagine there may be some wheat growers that think they shouldn’t pay more to the Wheat Commission.  But we were told there was broad support. In the bill that raised the assessment there were new provisions for removing commissioners, I suppose just in case there was a revolt of wheat farmers against the increased assessment.

I cite these two examples of how our University is creatively dealing with the lack of funding support it is getting from the Legislature. I’m not even going to mention the Board of Education and the flagship issue.

Here’s the trend for funding in Idaho over the last seventeen years.

Notice both K-12 and higher Ed are being outstripped by Health and Welfare and Corrections spending and their clear downward trend in the last 4 years. I worry that our state is not investing properly in our future, and we are looking elsewhere for this support. Nothing is free. We will pay in some way. I want to keep this issue in front of our legislature. If we value it, shouldn’t we be supporting it?

 

Founder, University of Idaho, 188J. W. Brigham and wife. He is the only living founder of the University of Idaho. She was among the first students to enroll. 1939--now deceased--Mr. Brigham. Mr. and Mrs. J. W. Brigham, Genesee. Mr. Brigham introduced and pushed through to passage the bill creating the University in last territorial legislature in January, 1889. He then was youngest man in the ""council or senate"" in the last territorial legislature, a kid of 32 years. Now 81, still active. He homesteaded the 320-acre farm on which he now lives in 1879. Then were only eight settlers living between Lewiston and Moscow. Has had five children attend university, youngest sophomore in engineering, now enrolled. Date 1939?

Earlier in the session I got reminded by a constituent that I sit in the seat of J.W. Brigham, the first state Senator from Latah County. He was the youngest man in the Territorial Council or Senate and pushed through the University of Idaho into the Constitution. Without the University there is no doubt our town, our county would be very different. I will work to keep the value of the University before this legislature.

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Repetition and Influence

There are phrases that get repeated by rote here in the Senate, things we say over and over, sometimes without thinking. One gets used to things that are repeated, pervasive, or that are considered commonplace in a culture, that elsewhere might be odd or questionable. First, let’s consider some of the things we say.

One common phrase I have now memorized is used to interrupt the secretary as she reads the bill for the third time. All bills are required to be read three times before a vote. The first reading is dispensed with, as is the second and on the third reading the floor sponsor stands and interrupts the secretary to say:

I ask unanimous consent that further reading of _____ be dispensed with and the journal show that it has been read a third time at length, section by section and placed before the senate for final consideration.

With no objection, the sponsor may proceed to give his or her presentation of the bill. This makes things go faster.  Last year, we Democrats objected and required that the Luna Bills be read at length the third time. This was proper, just not usual. The House did the same late in the session to protest that their voice wasn’t being heard. We could only slow things down with such a procedural objection. After the reading, the vote is still the same.

Another phrase that gets repeated by rote is when a Senator stands to declare a conflict:

Mr. President under senate rule 39H I hereby declare my conflict of interest in this issue but my intention to vote.

Senate rules require that you declare publicly or in writing your conflict. There is no requirement that the written declaration be recorded. This rule is supposed to maintain the honor of the body of the Senate so our deliberations can be perceived as open in the eyes of the public whom we represent.

So now lets consider rules about what we do. We also have sunshine laws that limit political contributions and require they be reported. We have decided in statute that political contributions are public, so citizens can examine the records and consider if elected officials are representing them, not the highest bidder.

This session we have considered two laws that have directed money to two privately held corporations. Neither were direct transfers of taxpayer dollars. One required money from convicted offenders goes to a company that maintained a public data base on these offenders. The other sent money from the manufacturers of pseudoephedrine to this same data base to collate information on who was buying this substance that can be used to manufacture methamphetamine. Law enforcement, the courts, victims and corrections can use this first data base to track the status of the convict. The second can be used by pharmacies and law enforcement to limit or investigate excessive or illicit drug purchases. Both of these efforts seem laudable and serve the public good.

But here’s the twist. Since these companies are privately held we cannot know who is getting the benefit of this contract. Nor can we know if they are contributing to legislators making these decisions. Private corporations have no obligation to share the identity of their shareholders. 

Another program the state was involved in 4-5 years ago did send taxpayer dollars to a private corporation. The state promoted a Health Information Data Exchange that was supposed to allow hospitals and clinics to pass information between each other. This program got both federal and state money, though it is now privately funded. The company that got the contract is again privately held, and thus obscure.

I am suspicious by nature and I always wonder about motivation. When there is transparency I am reassured. In this case, I cannot know the relationships. And the more I see of these marble hallways and entwined relationships, the more I think we should know where our taxpayer money goes. We shouldn’t just do these things by rote.

 

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Guests and Breakfast Visitors

This last Martin Luther King Day the legislature didn’t take the holiday; we had committee meetings and a brief floor session. I got to introduce some guests from Moscow who came to the Capitol.  Martin Dibble was down here to shear some sheep. He was visiting his son Armen who lives here. If you are ever here in Boise please contact me and I can show you around the Capitol and introduce you to the Senate. You’ll get a round of applause from the Senators.

This state can be remote with the mountains, the panhandle and the wide open spaces. There is a tendency to see Boise as way far away. But there are many folks who come to the legislature to visit during the session, some to pitch their interests, some just to get to know the process and shrink the distance. I really like this contact. It is hard in our busy lives to stay connected.

4H Know Your Government Breakfast

These visitors from Latah County are active in 4H, a great organization for youth. The governor spoke at the breakfast.  Plus, I think I found someone to buy some wiener pigs from this summer.

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Difficult Choice

Early Dialysis Machine

Yesterday afternoon we heard a proposal to phase out this state program. It’s pretty rare to eliminate a government program. It seems easy to get them started, but they never seem to go away. I think it’s time this one did.

The Idaho State End Stage Renal Disease program was started in 1970 by a legislator with a family member who needed dialysis. This was a tragic fatal condition ( “uremic poisoning”) that was just being solved. A man had invented a machine for dialysis but they were not in wide use, nor widely available. Nobody could afford them and there was no mechanism for payment. An engineer in Seattle built a few of the machines of the unpatented design for a friend who was dying of kidney failure. But how do you decide who gets treatment? Indeed, there was even a “God Committee” that decided who got access.

I’m sure the legislator here in Idaho knew if we just directed more money the way of dialysis, there would be more machines. We influence markets all the time with taxpayer dollars. I don’t know if he declared his conflict of interest, but Idaho established this program in the Department of Vocational Rehabilitation. It is still funded to this day to the tune of about $500,000.

The trick is that in 1972 the Federal Government decided that people with End Stage Renal Disease (ESRD) would be eligible for Medicare coverage. We now have many for-profit dialysis companies around the country. And the Idaho program mostly pays for travel expenses to and from dialysis as well as some medications. The money is flowing.

Let us not ignore the tragedy of kidney failure. It is a chronic debilitating disease. I believe it is just and proper for there to be support for these people. We should support their care, their needs. But this program no longer fits the intended role of support nor is it fair or efficient. We need to do better.

There are about 100 people in Idaho receiving these benefits. The very first link in this piece gives more details. We heard testimony from the Department of Voc Rehab and the sponsor supporting the phase out of this program. But there were others in opposition. One man on dialysis spoke passionately that we would be removing support for these patients. On questioning it came out that he was not receiving these benefits, but was considering applying. Two social workers for the for-profit dialysis companies also asked us to not remove these necessary benefits. We pointed out that this program mostly paid folks for travel expenses ($290/ month average), not for dialysis. “But if they can’t get to the center they can’t get treatment.”

It was compelling testimony. There is always a reluctance to take away benefits from unfortunate victims but it was made even more painful knowing we had a committee member whose family had just been through a kidney transplant.

Still, we voted to phase out the program. I believe we can still support these folks. It will need our attention. These are the infinite details we must address in health care reform.

All comments read but not posted

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Personnel Infrastructure

 

We are drawn to the big events, the headline news or the hot item for debate. But I believe our lives are defined not by the drama, but the mundane small details that make up our lives. Like the air we breathe or the water we drink or flush, we can take these small things for granted. Sometimes we overlook the value of those we charge with this important work. I want to address the issue of water operators in the state of Idaho.

The state licenses water facilities at different levels, from very small then levels 1-4. These levels apply to drinking water and waste water plants. If a city has a water plant of a certain level they need operators with a corresponding level of license.

The board that controls the licensing of water operators recommended a rules change that would require some education beyond high school for operators that rose above the first level. This requirement was strongly opposed by small cities. Currently, most cities hire someone out of high school as a level 1 operator, and then the worker can rise through the levels with on-the-job experience. There are some classes available on line. This is what my town Moscow, Idaho has done. I was told the entry Level 1 payment was about $18/ hour( range $13.76-$20.65). Level 2 goes up to $18.50/hr but Level 3 could go all the way up to $26/hr ($50,000/ yr; hourly range $17.34-26.01, $10,000 above the Idaho average). Our Human Resources person said it was almost impossible to hire the level 2 or higher from outside.

Is this fair pay? If there really was such a short supply you’d think the pay rate would go up. Maybe the entry level folks guarantee a supply as they slowly climb the ladder of experience. I wonder if we are affecting the market for this occupation. I voted with the cities to keep on-the-job training as a way to advancement. But I wonder how this is affecting the career.

A public works manager from Emmett told how hard it was to take time off to get classes to go up from a level 1 to a level 3. His city had passed a multimillion dollar bond levy (by > 90%!) to upgrade their water treatment facility. But they couldn’t afford to hire a trained level 3 operator because the person from out of state wanted $60,000 a year.

So the irony for me here is how a city will chose to tax itself for a quality water plant, but can’t see the value in paying a good salary for the person that keeps it running.  This has contributed to our wage gap dilemma.

I spoke with some folks who offer training and suggested to them we get classes in some community colleges available. I don’t know if classroom education would be better than on-the-job. Maybe with the popularity of Dirty Jobs we can inspire some careers in Water Operation. But if the supply of operators goes up, the pay will go down. Fair pay for good work isn’t too much to ask. It looks like a good career to me, truly public service.

 

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Hard Work

 

This can feel like hard work. The days are long and sitting and listening does take effort. I must constantly exercise judgment.  I have known hard work in my life; these are long hours and the work is hard but not strenuous.  Still, at times I feel quite tired. I get up at 5AM and get to the Capitol usually by 6:45. I have committee meetings and Senate floor throughout the day, then will get home after an evening meeting by 8PM. I often read bills in the evening. There is a lot of sitting.

Henry Schmidt 1899-1969

Henry Schmidt, my grandfather worked hard.  He was a cowboy for the Circle C ranch out of New Meadows that ran cows on the Seven Devils range and through the Bear Creek and Wildhorse country. In the 1940’s folks who had come to this area for subsistence were leaving for the war effort factories and Henry started buying up the ranches pretty cheap. He bought 6 or 7 ranches along the Wildhorse River all between 100-200 deeded acres. They might have a shack of a cabin, maybe a barn, a spring or stream and a bench or meadow for hay. Flat ground was at a premium. Only a couple of the places had a road to them, none had electricity or phone. Henry married Helena my step grandmother and they bought cows, put up the hay on the spread-out fields with horses, fed the cows in the winter, drove the small herd across BLM grazing and paid off the bank on the hard work in that hard country.

My father finished his college after WW2 and told me of a summer visit up to the Starveout Ranch, the highest elevation one with the last hay to put up. There was a nice cabin up there that Helena’s father had built when he homesteaded. Dad helped them haying on his summer break. He and Henry drove horse drawn mowers all day and used a dump rake to build the windrows. The hayfield was about 50 acres and pretty steep. They would quit cutting at dark, which was about 9 pm at that latitude in the summer. They would unharness then feed and water the horses, milk the cow, move the ditches to water the pasture while Helena was making dinner. Dad would go up to the screened-in attic to bed after dinner maybe 10PM. He told me that from his bed in the deepening dark he would see Henry riding off down the Starveout Creek trail to the ranches down along Wildhorse River. Henry was going to move the ditches to water different parts of the hayfield for the second crop of hay. Dad would wake up about 2 AM when he heard his dad coming back up the trail horseback. The sky in the east starts to lighten about 4 AM so he’d get up and get ready to start haying by 6. Dad thought he was working hard, but he couldn’t fathom how hard Henry was working. Neither can I. This isn’t work like that.

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Playing the Game

 

Let them play

I got to watch the Moscow Girls basketball team compete down here in the state tournament this last Friday night. There were lots of parents down here for the event and a couple even came by my basement office. I remembered the energy we parents felt at our kid’s extra-curricular activities. I only got to one of Emma’s four state soccer tournaments. It was fun. I never got to see Soona compete at the state swim meet but I caught Mattie’s last one where she won the fly.  Sometimes we parents can forget what it’s all about.

A Senator came up to me on the floor to tell me about a bill he had that affected a school “up in your area”.

“What’s it about?”

“It has to do with letting kids participate in district or state competition if they come from different schools.”

I wasn’t sure about this description. The bill seemed simple enough. But I decided to check with the IHSAA and see what they said about it. In the meantime I checked with the House sponsor, a representative from my district. He said this was a compromise that nobody opposed. “We’ve been working with the agency all summer and they wouldn’t budge. So we offered this solution and they aren’t fighting it.”

The IHSAA told a different story. It seems the senator sponsoring this bill has a son who plays sports at a certain school that isn’t accreditied. IHSAA bylaws allow unaccredited schools to participate as associates. Only schools that have a nationally recognized accreditation are allowed to be members and fully participate (meaning districts and state competition). We have another school in our district with similar accreditation.

The Director of IHSAA said,”These schools will never get accredited because they proudly hire uncredentialed teachers. ” I could remember the letters to the editor in our town newspaper about this.

The “compromise” for IHSAA came when a staff member at the Department of Education called IHSAA and said he would be responsible for the accreditation of these two schools. Still, IHSAA will need to change their bylaws so these two non- nationally accredited Christian schools can compete in sports at the state and district level. And somebody in the State Department of Education is giving his blessing.

It seems to me they want it both ways. They are not held to the same standards as the “guvmint” schools but want to play ball on the same court. Amazing what parents will do for their kid’s sports.

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Electrical Code

 

I am continually amazed at what state government gets involved in. Last year it was the Plumbing Code that became a big fight. This year we had electricians.

In Commerce and Human Resources Committee this year we had the update of the Electrical Code. We got cross wise on Arc Fault Interrupters. These new protectors interrupt a circuit if they sense an arc. This is different from GFI (Ground Fault Interrupters) that are in the bathroom or kitchen. Arc fault interrupter wired circuits are supposed to detect arcing and thus reduce a fire hazard. D

But we had testimony against requiring these in the code. There were electricians at the committee who argued they added too much to the cost of the house. And we needed to help out home builders any chance we got.

I called the electrician I use in Moscow. He’d just put in a new service for me so I had his number in my phone.

“Mark, what can you tell me about arc fault interrupters?”

“Doc, you don’t want them in that old house do you?”

“No, it has to do with the new code we’re looking at for Idaho.”

He went on to tell me the problems he’d had getting them to not trip incorrectly. It seems some of the breakers are very sensitive and trip when you run the vacuum cleaner. He’d even talked with the State inspector who told him that maybe he should tell the home owner to run an extension cord from another room when he was vacuuming.

We voted down adding these to Idaho code. But I think we’ll be requiring them someday. It’s like all the new tests that come out in medicine. We can do a lot but sometimes we find things that we can’t really tell the patient what they mean. I didn’t rush into the newest technology, either with new tests or the new drugs that came out. Maybe that means I’m conservative.

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