West of the Rotunda

I was cutting dadoes down in my shop when I felt the vibration in my breast pocket. Unidentified number so I went back to the table saw. When I got another shot of the cooling morning coffee I looked again and there was a voice mail. Before deleting, I looked at the Apple transcription.

“…consultant to the President…wish to speak…could you call us back…time sensitive.”

Geez.

So, I listened to it before deleting it. This could be a real scam. I figured they wanted my Social Security number for sure. But no, despite the mumbling, I detected they knew me, and just wanted to talk. So, I called them back.

“Senator Schmidt?” they answered quickly.

“Just who are you?”

“I work for the President’s campaign team, and we wanted to visit with you about his healthcare plan.”

“You’ve got to be kidding.”

“No, we really need some ideas, and we’ve used AI to find the folks with the best ideas and the algorithm came up with you. And there were some others. But I need your thoughts.”

I finished the dregs of the cool coffee. “What’s the big rush?”

“Well, you see, he made this big announcement that he was planning to replace the Affordable Care Act with something new and different, so we are reaching out. AI says you have not been fully supportive of the ACA in your writings. It strongly recommended your input.”

“Geez, Biden wants to replace the ACA? I hadn’t heard that.”

There was a long pause. “Oh no, not Biden. I am referring to The President. We all here refer to him as the Real President on the team.”

I laughed out loud. “So, Trump made this big promise with no ideas?”

“It wasn’t in the script. The President does that. He senses things and goes off script. We were all very unprepared. But we have very strong algorithms.”

“So, you call me. Heck, I’m cutting dadoes.”

“Senator…”

I cut in “State Senator.”

“Be that as it may, we are looking for your best ideas.”

I brushed the dust off the table saw top. “You don’t need me for this. Just read the data, the polls. The United States spends more on health care than any other country in the world and we have the worst outcomes of any developed country. The younger voters strongly favor universal coverage. It’s just the old geezers like me with Medicare that oppose it, since we’ve already got it. If he wants the youth vote tell old carrot face to go full Bernie.”

There was a long pause, and I heard some noise.

“I could go on. Every state that expanded Medicaid, a small step toward universal coverage saw an economic bump. Here in Idaho, it was real and dramatic. Think what that would do to the Dow Jones if a President with some spine was able to push that through those old Republican fully insured Senators.”

I heard a voice I recognized say in the background, “Can’t we get somebody else? I like his spunk, but I can’t go full Bernie.”

“Hey,” I yelled. “Am I on speaker phone!”

“Um, yes, Senator, you are. The President has been listening in with his advisors.”

“Maybe you ought to say that up front, you know?”

“I apologize.”

I paused and they did too. But I jumped at the space.

“Mister President. I know Bernie isn’t your idea of a strong man. But health care coverage for everybody in this country is what’s holding us back in the world economy. We’re smarter and more hard working than the Germans but we spend twice as much as them on healthcare. Have some cojones. Admit we need to make this leap. Biden took the baby step on infrastructure and global warming. Show you have the manhood to address true healthcare reform.”

The line went dead. I went back to cutting dadoes.

It seems the Freedom Foundation warriors have library porn in their cross hairs. Who would oppose protecting children? The sweet little things.

I just had a long afternoon with some difficult, not very sweet granddaughters. They were not at their best. But I would still sacrifice to protect them from harm. So why not use this as a dog whistle? Those Freedom Foundation strategists have me beat by a mile.

What I’m confused about is all the communism they are avoiding.

Yes, communism right here in this deep red state. State-sanctioned, written into our sacred Idaho code, communism is in our laws. And our Freedom Foundation warriors are just looking the other way.

What, you say you are unaware?

I wasn’t really. But I was inspired about this from a newspaper article. Remember those? They are so quaint.

This article was announcing multiple grants to North Idaho hospitals and clinics with practitioners who needed help with loan repayment. It turns out the Idaho legislature authorized taxing Idaho supported medical students up to 4% a year of what the state chips in for their medical education. (Math: 140 students X 4% of $30K= $168K. The state is supposed to chip in another $84K). This money, collected from all the students is then distributed to those working in Idaho in underserved areas. That sure sounds like communism to me, doesn’t it? Taxing everybody to then send money off to the poor folks?

Not that family docs in small town Idaho are poor. They make at least twice what a teacher makes. But it is a marketplace, that cartel of MDs, also a state-sanctioned restricted market. Getting the not-so-smart ones like me to serve in needed areas with taxes on their classmates sounds at least socialist, if not outright communist.

But it’s everywhere. I’ve written about the Idaho Potato Commission before. If you want to sell your potatoes as “Idaho Potatoes” you have to pay a tax to The Commission. And Idaho law has empowered The Commission to inspect your books, and bring you to court over your small, or very big potatoes. It’s an arrangement the potato farmers seem to appreciate. But jeez, state-sanctioned taxation of potato farmers? Next, we’ll be requiring them to swear allegiance to The Party. We all know what party that would be.

Health Care is not immune from the communist infection. All (except five…that is a very deep story) agreed to pay an “assessment” (soft for “tax”) back to the Idaho Department of Health and Welfare for every Medicaid dollar they received. The tax was set at 10%. This agreement was offered by the hospitals during the 2008 downturn, and they could see big Medicaid cuts on the horizon. They knew the magic of the Federal Medicaid program. Every dollar Idaho spends on Medicaid is matched with three Federal dollars. If Idaho hospitals send ten percent of their money back to the IDHW, they can expect a three to one match in return. Can you say Ponzi? Some states had a much higher “assessment”. This spiral was cut short by the feds about 12 years back, and Idaho was not the worst schemer in this plot.

Idaho nursing homes also pay a Medicaid “assessment”.

When the “assessment” was enacted into Idaho law it was strongly endorsed by the Hospital Association. And it still is.

So, sometimes, interested parties choose to tax themselves for their benefit. All of themselves. And they seem to believe the tax serves them all, even though some of them get more money than others.

I guess this kind of makes sense. But it’s still not free market capitalism. Why hasn’t the Freedom Foundation taken on the Potato Commission? Or the Wheat Commission? There’s communism everywhere, not just in our libraries.

It was over six years ago I asked for a spot on this medium. The editor looked through my blog and said I could slip into the Thursday slot. He was aware of my political past. Maybe he thought I had something to offer. I am thankful for his generosity. But I had no concept back then that the Thursday slot meant Thanksgiving, year after year.

I needed to have an annual Thanksgiving post.

I have not always observed the holiday in my posts. I have mixed feelings about both the holiday and large family gatherings. So, some of my fourth Thursday of November posts have not mentioned Pilgrims.

Not that anybody reads this when they are thawing turkeys or greeting relatives. But I have taken this task to heart. So, I post today for your and my Idaho Thanksgiving.

I don’t really know if those east coast Pilgrims were thankful. Lincoln made it a national Holiday 200 years after the Mayflower landed. He had a wise political mind. National Holidays in the midst of a brutal civil war might have just been him playing a public sentiment chip when his hand was weak after the Second Bull Run. And it really boosted the turkey farmers.

It is said the Pilgrims ate turkey and corn and shared a table with their fellow settlers and the natives they were soon to displace. It sure sounds like a wonderful scene, and we all grew up with that image, didn’t we?

But our Idaho natives did not share turkey and corn with the whites with the guns. The Nez Perce shared camas and salmon with the starving Corps of Discovery as they stumbled out of the North Idaho wilderness. These welcoming natives saved the Corps’ lives. And then we displaced them from their lands, despite a treaty. And they have not pursued their war against us. I am thankful for their generous nature and troubled to be living on their land.

So out of reverence for the concept, the worthiness of such a wholesome and spiritual practice as these indigenous people demonstrated, I give thanks. May we all be so welcoming, and forgiving.

I offer thanks to my family, that they tolerate my odd moods and thoughtless behaviors. I can be hard to live with. But they have not kicked me out yet. I am thankful.

This beautiful land, this place I live, I appreciate deeply. I give thanks. I don’t mind the dark, the cold, the rain or snow. I know it triggers life in the seeds as they lie awaiting warmth and the sun of a new season. The blazing red-purple sunset, the golden low light of autumn carries me through the gray days and chill nights. I can abide and do so with gratitude.

But the newcomers and the traffic have me perplexed. I greatly appreciate solitude. That is part of what drew me to Idaho. Though I have come to understand I needed more than myself to be healthy. So, I live in community.

It is hard to accept this change, though all of you might not feel it. Some of Idaho is exploding, some stays about the same. A few communities shrink. I should be as welcoming as the Nez Perce were. But then…

I hope these newcomers too have gratitude for this place. Despite the fact that one of the things that made Idaho wonderful for me was that they hadn’t moved here yet. But then, I did. I moved here from another too-crowded place.

This is a wonderful place, this state. We are made up of the leftovers of the states around us as they were carving out their borders. I love leftovers, don’t you? Happy national holiday to you and yours. May you be blessed with gratitude.

I have not been able to make this work here in WordPress, so I have moved my archive and new post to Substack.

Here is the link.

You may get an email from Substack about this too. Sorry for the redundancy.

https://youtu.be/dpLKMOC3vX4?t=5

I don’t know if we all agree that folks with disabilities or low income should have access to health care services. I’d love to have that discussion.

It seems that our nation thought this, and so the Medicaid program was passed into law in 1965. But those were different times. Don’t ask me what I was under the influence of back then.

Medicaid was built as a federal-state partnership. If a state chose to enroll and abide by the federal requirements, the federal government would agree to pay no less than half of the cost, but no more than 80% of the cost. The target population back then was folks with severe disabilities and those under the federal poverty level (FPL).

Idaho might have had a different soul back then, because our legislature signed us up to enroll in Medicaid in 1966. We were an early state to enroll. Maybe the Freedom Foundation wasn’t born then. I was just twelve. It was a long time ago.

So that matching/ shared payment program applied to the traditional Medicaid folks. That matching formula (called the FMAP) is calculated every year based on the average income of the state’s residents compared to the national average.

Idaho has had a generous FMAP match for many years, often 70% federal, 30% State, based on our lower incomes. Most states are 50/50. This year we get a bump. Our state income went up. This year we will now have to pay 2% more.

For those of you here in Idaho still burning about Medicaid Expansion, this is NOT a flag to wave. I know, this is complicated and confusing, and you probably don’t even care. But how, just how are we going to get this done? Please, pay attention and understand the details.

The Medicaid Expansion population will always be supported federally at 90%. The state will only have to pay 10% of that cost. This FMAP bump only applies to those below 100% FPL and the disabled. Believe me, those folks are expensive, but deserving of our care.

I write this to teach, but also to learn. I went to a forum tonight where my local legislators were talking to the crowd about their plans for the coming legislative session. I asked if they had any reaction to this FMAP change. NEITHER representative even knew what I was talking about. NEITHER knew how Medicaid is funded.

So, I wish to ask the crowd, should we be providing healthcare to the disabled and poor? If not, just say so, and a simple vote by you legislators who represent me could disenroll us from the Medicaid program. I can write the bill for you.

But if not, if you think people with disabilities and those who don’t get health insurance from their work should have access to health care, then how, just how are we going to do this?

I have read many other plans. The Idaho Freedom Foundation foisted one a few years back when they were opposing Medicaid Expansion. It proposed everybody have a health savings account. I guess they hadn’t read that 60% of us couldn’t finance a blown transmission let alone cancer.

Paul Ryan, remember him? He quit being Speaker of the House right after he got the Trump Tax Cuts through. Maybe he saw the folly. Maybe he saw a more stable job. But his argument was to replace the Medicaid formula with block grants.

I was just entering state politics at the time. I saw the value in his proposal. Look carefully at the formula. If Idaho figures out how to save a ton of money on Medicaid, we only get 30% of the savings. Block grants would build in more incentive.

But then I spent some time in the Idaho legislature. Sorry. I was not impressed.

Just as people start things in all sorts of ways, so do they quit them.

Some people describe “falling into” a job or a profession. Others tell the story of seeking it, “knowing” from a young age that it was their calling.

I’ve seen some folks bounce around, swapping professional hats from one career to the next. I admire that fluidity.

Me, I’ve been a doctor, or in training to be one for over half my life. Not much of a bouncer am I.

I have dabbled widely, from fixing old cars to remodeling houses, but all the while, I have had a singular profession. I was a family doctor.

But I have decided to retire.

I have let go of many things in this career.

I used to practice intubations. That is when you stick a tube down someone’s airway, past the vocal cords, inflate the cuff, then pump air into their lungs when they aren’t breathing. Such a violent act can save a life. I thought I should keep that skill sharp when I was covering emergency rooms. That skill faded long ago.

Same with all the interventions to gain access to a dying patient’s blood stream. I thought I was pretty good at it, but like welding, you need to keep in practice.

I used to love providing obstetric care, delivering babies. I got training to do C-sections, since such an intervention was sometimes called for when you deliver babies.

But after many years of delivering babies, I began to notice a change in myself. During training, as a resident on the delivery ward, two or three women could be in labor at a time. I would check on then regularly, and catch a nap whenever I could, since back then, we did 24–36-hour shifts.

Out in practice, a woman might go into labor midday. I’d check on her, have dinner with the family, check on her again, then sleep a few hours, knowing I had a full clinic schedule the next day. Then I would go in at 2 or 4AM and do the delivery, sew up what needed to be sewed, write the orders, check on the baby, then go back home for a couple more hours of sleep.

As I aged, and I slowed down the number of deliveries I was doing, I found I could not sleep as she labored. I could not put my mind to ease that I had done and checked all that was needed. So, I would sit at the nurses’ station or go check on her more frequently. My inability to nod off was telling me something. My mind was not at peace with the process. Too many worries. I realized it was time to let go of this aspect of the profession I loved.

It has been a bittersweet process, this deciding to retire thing. I thought I had kept sharp, but I found I was looking up more of the medicines my patients had been prescribed. I was looking into the newly recommended medications and studying their chemistry. My natural skeptical nature made me wonder about the wisdom of this pharmaceutical investment. But I needed to know the wisdom of the treatment and make a wise recommendation. I worried I wasn’t as wise as I should be.

So, at the age of 69 I have decided to quit being a family doctor.

It truly was a passion for me. The fact that I earned a bit less than the local superintendent of schools seemed fitting. I saw too many of my colleagues make way too much money. And that should never be what inspires.

I valued the patients, their stories, their suffering, and their willingness to share their plight with me. They were very generous.

I tried to be too. Letting go can be a gift.