West of the Rotunda

I find myself stifling a smirk when I hear a new term for a group. The homeless have become the “Unhoused”. I stifle the smirk because such a response is disrespectful. And the intent of the renaming is to offer respect and dignity to the renamed group. And the smirk may also be because I see such renaming as paltry effort, though, indeed well intentioned.

We cannot address the despair and dysfunction of the people living under tarps, near underpasses and in our metropolitan alleys with a softer new name. It may reflect our kind intent, but I’m sorry, there’s work to do. Creating a kinder, gentler name isn’t enough.

Other countries have addressed this complex problem. The solutions are complex and require significant investment. The price of housing, the availability of healthcare, the livability of cities are complex, swirling issues that some countries have addressed. And indeed, their solutions may not suit our problem. But we have the resources.  I suspect we don’t have the will.

And now I smirk at my own last comment regarding “the will,” because such a criticism would probably be leveled at the unhoused/homeless by those not willing to address a solution. Dismissing our shared responsibilities on this planet by pointing to others’ bootstraps is quite the style. Always has been.

I have come to realize my smirking reaction is not healthy. Not for me, or those I care for. I must do better. But it’s an old habit. It doesn’t dignify.

I found myself brought up short in mid smirk by a daughter a while back. I was bemoaning the low unemployment/ work force shortage we are experiencing. “People just don’t want to work anymore.” Was my smirking phrase.

She lit into me. She detailed the position our generation has saddled theirs with.

If they are a two-parent household, both making a bit above average income, and they pay for childcare, health insurance, taxes, and try to buy a home, they are just above water. Make that a single parent household and the drowning starts. Add a special needs child, or big student loan debt, or some other burden and it becomes evident the rising tide did not float all boats.

And we maintain the illusion of our 1960’s financial model for Social Security and Medicare. The demographics have inverted, yet we still cling to the Ponzi miracle of sustained economic and population growth that was true in 1960 but is no longer. These two great dignifying social programs that progressives point to as accomplishments need some major work if they are to live up to their founding ideals.

My generation has kicked this down the road. No wonder we witness disengagement. We have not been true to the founding principle that these dignifying programs deserved to be sustained. We have shirked; and maybe smirked, gesturing to their bootstraps. Like ours were what got us where we are.

And this is just the economic indignity which we have dropped on the sidewalk and pretended we did not leave. No baggie, we just walked away.

The environmental injustice of melting glaciers was not mentioned. But she could have.

I came away from my daughter’s admonishment knowing her response had more dignity than my whine. And I could see there was work still for our generation to do. It is not as simple as giving them bright shiny new bootstraps.

So, if you catch me stifling a smirk, raise a warning finger at me and smile. I will take the hint, I hope, with dignity.

Idaho’s grandstanding Attorney General, Raul Labrador, has decided he doesn’t like the process whereby the University of Idaho entered into a business deal with the University of Phoenix. He’s threatening the Idaho Board of Education with a lawsuit unless they “do over” an executive meeting where this forth coming deal was discussed. He’s insisting the deal be discussed in public.

I’m all for shining the light on public processes. But private companies might find this a chilling consideration, should any future businesses consider trading assets our way. Maybe that’s Labrador’s plan: throw cold water on state business deals. I am scratching my head about what he’s thinking unless it’s just my original assertion: he’s grabbing for the spotlight.

I can’t say I like the U of Idaho/ Phoenix deal, but the confidential business process is a long-standing Idaho tradition. Public institutions acquire, partner with, or somehow deal with private entities all the time. The Boards that ostensibly govern those state entities (appointed by the governor, approved by the State Senate) might hear some generalities about the process, or not. The discussions might be in public meetings, or they may not.

Take the 2016 affiliation of the private, for-profit medical school in Meridian with Idaho State University. Those deals were done in similar confidential ways. I don’t know if the Board of Education had discussions back then in executive session. But Labrador wasn’t AG then, he can rightly declare.

The announcement of the conclusion of that deal was heralded by most (but not all) as a wondrous accomplishment. Idaho College of Osteopathic Medicine is still a private, for-profit entity, paying Idaho State University an annual sum on their thirty-year lease for the buildings on ISU’s Meridian campus. The payments go right into ISU’s operating budget, with no legislative appropriation. I wonder how many thirty-year leases there are in state contracts. I’ll bet there are a lot. I just know about this one because I asked some questions.

Maybe Labrador is “just asking some questions”. If so, he’s being pretty public about his process.

What business would want to subject a major investment with the whimsical Idaho legislature?

Labrador’s point that there are public meeting laws is fair. And agreeing to support a long-term binding deal by the Board of Education in executive session is clearly not public.

But how is our state going to do business? And a lot of what our state does involves business deals.

I’m no lawyer. But I did spend some time on the easily read “Idaho Open Meeting Law” website that has AG Labrador’s picture quite prominently above the introduction. There, on page 17, in discussing when governmental entities can go into executive session, taken straight out of Idaho Code it says:

(e) To consider preliminary negotiations involving matters of trade or commerce in which the governing body is in competition with governing bodies in other states or nations;

It seems our state, indeed our governing bodies can have nonpublic sessions to consider preliminary business deals.

Since this seems OK under the law, and it’s something Idaho government has been doing for a long time, just what point is AG Labrador making?

Does he have the same sour taste I do about the University of Idaho, the “Flagship University of Idaho” getting in bed with a disreputable, private, for -profit University? If so, that’s a poor excuse to twist the plain words of the law into a bullying action by our states elected head lawyer.

This action, and quite a few others are making Idaho the state doctors are fleeing, and soon lawyers will flock to. Esto Perpetua.

We citizens have decided it is best to let our legislature call itself into session whenever they can get enough to sign on. So be such folly. But while our august lawmaking body does their potato field, or insurance sales work and makes no laws, not in session, some small legislative groups labor on. For there is work to do. This is a wiser strategy.

The House and Senate Health and Welfare Committee chairs, during this last legislative session agreed to sponsor a resolution to call an interim committee together to consider whether it would be wise to move Idaho Medicaid toward managed care. They are thus meeting. I’ll bet you missed it. There were no headlines. But the meeting is available for your review if you have the hour to spare for the download.

I took that time.

They aren’t dummies, this group. That is deeply reassuring to this skeptic.

Just what the heck is “managed care”? Since in modern parlance, we can put a fancy name on anything we want to sell, the buyer should always beware. Make no mistake, we taxpayers are the buyer. Just what are they selling?

And I found the legislative group to share my skepticism. When someone goes into this sort of inquiry with a passionate bias, I expect somebody somewhere to make a lot of taxpayer profit. I did not see such bias as I watched the 4-hour download.

Managed care does not rile up folks like critical race theory does. Or indeed like “death panels” did. Health care policy puts people to sleep. It’s not like you are protecting your children from groomers or predators. The sad truth is, if you want to make some progress on public policy, saving the taxpayer a dime, you need to focus on some details. And that is boring, slogging, sit in the chair and pay-attention work. And that’s what this group seems ready to do. I was a bit thrilled. Are you?

Maybe instead you want to bring your semiauto to a pizza parlor to save the children. It seems that’s the prevalent mood out there. So, I want to speak up about the courage to pay attention to the details. Nobody brandished a weapon. But we are talking big money.

For contracting with a firm to “manage care” for Idaho Medicaid mean we, the Idaho taxpayers, are entering into a $3B dollar contract. Puleeze, notice the “B”. We might spend a million on a bridge, or a new school, but BILLIONS? Who is going to ride herd on such a contract?

It was telling that the spokesperson to the Department of Administration early on in the hearing admitted, meekly, that indeed it would require another full-time hire.

So, we’re going to hire one more person to make sure they don’t rob us blind?

Idaho has, since the Republicans have taken over, continually hummed the off-tune hymn “Business is Better than Government”.

Can I remind you of these mistakes? I know, all you guys with the Trump flags on your ¾ ton pickups will consider this a waste of time, but here I go.

Idaho tried privatizing our prisons. After lots of evidence for failures, a Republican governor who had advocated for this, abandoned his run.

Then there was the IEN fiasco, for broadband in schools.

Then the Luna Laws.

Wherever there is a lot of money in Idaho government, there are contractors out there willing to do our work for us. For a slim(?) share of the (?)profit.

Forty states have Medicaid managed care contracts. We have a lot to learn from them.

Heck, Idaho even has tried managed care with our Medicaid mental health contract. We contracted managed outpatient care back in 2014.

What did other states learn from these efforts? What have we learned?

Our poorly paid interim legislators have some hard work to do.

Our Attorney General is trying for a mulligan from his office in our House of The People down there in Boise. That’s what we get when we elect bullies. They shoot off their mouths, and then expect us to pay for it.

Let me catch you up. An AG’s opinion letter sent to Idaho Representative Brent Crane last month was made public. In it, our new AG, Raul Labrador, stated that a doctor who “referred” a patient across state lines to access abortion care would be guilty of a felony. Further, a doctor who prescribed medication for an abortion for an Idahoan to pick up across state lines would also be felonious.

This “AG analysis” as his signed letter heading indicates, hit the national news and in a few days our AG decides he didn’t really write it. It turns out he, or his staff figured out the analysis was requested by Crane for fundraising, rallying the troops, purposes, so he announced the analysis had never happened. It was “rescinded”.

Still, the alarm bells went off for some folks, mainly the ACLU, and now our AG is spending time defending this letter that he claims was never written in Federal Court. Isn’t that where we want our state’s lawyer spending time? Defending an analysis, he says now he didn’t even write in federal court? I’ll bet some of us do. I doubt AG Labrador serves in the Militia for the Unborn. But I know he wants their votes.

This militia is well organized. I remember getting called out of a room when I first started to practice long ago in Idaho by my nurse. “There’s somebody on line 4 that wants to talk to you.” It was the old days, and I could recognize a long-distance call by the static on the old land lines.

“Doctor Schmidt, will you be providing abortions?”

She waited for my answer.

This last week in the clinic where I work now there were two people scheduled to see me whom I did not know. The reason for the visit was in the computer as “discuss family planning”. I wondered, were they sent to entrap me? Did they want to get me to mention a clinic across state lines where they could access the care unavailable to them in this state? And then would they share this information with our state Attorney General? And would the state troopers roll up as I’m having a beer with dinner?

When asked to clarify his “analysis” by reporters, our Attorney General refused. He did not say this analysis was wrong, he just said it hadn’t happened.

I guess that’s how my fellow Idahoans want this to play out. Only legislatively approved care can be provided by doctors. Really?

It’s going that way with all the hot button issues. Abortion, transgender care, what is next? What kind of personal care will come under the scrutiny of our legislature and the analysis of our AG?

Could a twenty-year-old man request a vasectomy?

Can a 42-year-old woman request fertility treatment?

Can a 95-year-old man get Viagra?

I understand the passion of the Militia for the Unborn. They see the lives to be saved. And what’s a little arson, or a sniper round to save these fetuses?

And now, we have the full power of the government, the state, the marble-halled Capitol, the Peoples House, coming into this conversation.

I talked with the young women about their choices for family planning. I tried to understand their needs, their situation. I decided not to fear that I might be prosecuted. But I considered this going into the room.