As a retired Idaho Family Physician, I always knew this was a frontier state. Some folks must travel a hundred miles for basic health care.

But the folks in the big cities can forget this.

When I trained, in medical school and residency, we appreciated the frontiers. I was trained in places that dealt with the difficult cases from the Alaskan outback to the North Idaho wilds. They got sorted out by the locals, and the problems came on to us.

I wanted to be out there, sorting it out. I got excellent training.

This sort of care needs vision, coordination and cooperation. It doesn’t just happen.

I could tell you all the failures and successes I have dealt with.

It’s part of why I ran for office, to serve in the Idaho legislature. I remember telling a prominent lobbyist, the support for the WWAMI program was a budget placeholder. Sure, we are sending money to Washington, but it’s teaching us legislators just what investment we need to make to build the physician base for us here. We will someday go off on our own.

Idaho should build its own medical training system. And the money we have been spending on supporting WWAMI and U of Utah students will be the budgetary base we can build on.

So now we have a five-year grant opportunity from the One Big Whatever.

But our Idaho legislators are hesitant to support any of this money to be a build out for an Idaho Medical future.

Their hesitancy is because such an investment now would require ongoing funding.

Duh.

The federal money is only five years, if you have the balls to take it. The Feds (Trump et al) were wise to see if a state had the balls to commit.

Maybe we don’t. Maybe the policy makers we elect don’t see training docs and nurses and EMTs worth the taxes we take from you. Maybe they think…I don’t honestly know what they think.

But I know that training good practitioners to care for the health of our communities is a good investment.

Just as I was leaving the Idaho legislature, I came to realize many of our elected officials did not share my view.

I was fighting for Medicaid Expansion. They hated my guts.

But some understood. John Rusche MD, from Lewiston and Fred Wood MD from Burley and I had frequent discussions. Notice, it’s just the degree behind their names, not their political affiliation.

But todays Idaho legislature with its culture warriors and California transplants has no physicians, few medical personnel in their mix.

But they will decide where we should stand on this opportunity for investment.

We trust them, don’t we?

They don’t want the taxpayer to be on the hook for any medical education investment. Heck, they probably think taxpayer dollars should only go to moms that stay at home and home school their kids.

You got me going. Let me return to the point.

Do you think an investment in medical education would serve the prosperity of this state?

If you don’t, then why the hell are you sending money to the states of Utah and Washington to train our future doctors? And why would you support the money our taxpayers send to ISU for pharmacists and LCSC for nurses, and there’s a lot more you could cut if you want a list.

Just answer the question!

They aren’t. The legislators you will elect aren’t answering this question. Maybe you aren’t either.

It’s a reasonable question.

In the old days, 150 years ago, doctors took money from the folks who wanted to learn and then they showed them the ropes.

But the medical care then was dismal. The study of that care, and the recommendations have given us our current system.

We should have good providers caring for us. It’s worth the investment.

Martha, my wife loves to plant and fertilize. When I can’t walk on the walks, I prune.

Plants can deal with pruning. Elk nibble off the tender ends. Plants can deal with us butchers.

It’s time to consider pruning here in Idaho.

Some legislators have called for an Article 5 Constitutional Convention to alter our Federal Constitution. If 2/3 of the states (3…

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When I was in the Idaho Senate, Brad Little presided as the President of the Senate. He was the elected Lieutenant Governor. Butch Otter sat in the Governor’s office on the second floor of the Capitol.

All us Senators were cautioned to only refer to “The Governor” when we were debating a bill as “the gentleman on the second floor”. Maybe Butch had threatened a veto, maybe he supported, but it was crucial to maintain the separation of the different branches. That discipline of speech, enforced by the President, Brad Little over us Senators with the gavel, made me appreciate the importance of the separation of our duties. And of the clear distinction in the Idaho Constitution of the separation of powers.

The legislature elected every two years has a primary duty to our electorate, the people. We controlled expenditures. If the executive branch thought something should be done, but we didn’t, we didn’t give them the money.

This is written clearly in the Idaho Constitution.

The legislature couldn’t control the executive branch. Nor could the Executive branch direct the legislature. These bodies had a separate, but unified goal: to serve the state.

But the bodies, the legislature and the Governor, might have different visions.

So why don’t they just get together and agree?

That would be a different form of government than our Constitution directed.

I was always impressed when Butch wouldn’t cross this line. Honestly, I didn’t find Governor Otter impressive most times. But he knew the principles of governance, and he honored them and stood by them. He tried to persuade the legislature, but he honored the separation of the roles.

Brad has forgotten this. Maybe he is taking a lesson from his mentor in the White House.

Honest disagreements are what our governance structure expected and built into the framework in our Constitutions.

Brad has shit on this. Our Governor has given over the function of the executive branch to the legislative. While that might seem a niggling, whiny complaint, and I’ll agree, it does sound so, it gets to the principle of the work we elect these folks to do.

Stand up for us.

Stand up for your office.

Stand up for something.

Brad is not standing up.

He’s not standing up for the separation of powers our Constitution demands. He’s not standing up for the office of Governor of the State of Idaho. He’s not standing up for us, who elected him.

Here’s just some of the evidence.

Trump and our Idaho congressional delegation cut Medicaid funding in their One Big Beautiful Bill. They knew our rural hospitals would be gutted. So they offered some cheese.

We are mice, eh?

Five years of big money grants to ease the pain. So now we scramble for their cheese.

Brad set up a committee to review this.

Did they meet? There are no minutes for us to review.

Then the Idaho Legislature took charge. This was a clear Constitutional violation.

And Brad did what he does. He shrugged.

Hundreds of millions of health care funding will leave this state. Does a tenth, a hundredth of that bother Syringa General in Grangeville or Lost Rivers in Arco or Benewah Community Hospital in St Maries?

It should bother you.

We all should be working for a sustainable solution.

Brad gave some wimpy legislators the handle on this weak money. They don’t care if your small-town hospital dies.

Brad doesn’t seem to care either.

He can see the writing on the wall. Our government just doesn’t seem to care.

So why should he?

I’ve known Brad for a few years. I’ve drunk beer and laughed with him. He’s better than this.

What’s wrong?

Has he bought in to the bigger MAGA vision to tear it all down?

Brad, what’s wrong?

We’re making America “great” again, and I hope you are embracing these changes. I’ll skip over the deportations and go straight to health care, since that is, I believe the weakness that will bring this nation to its knees.

Most other countries have looked at this problem, had some hard discussions, and solved it. Most who have are just as “free”, “democratic”, “first world” as us. America is the richest country in the world, right now. And we are pushing millions onto the health care cliff.

One false step, one bad disease, and you are bankrupt. How does this make us Great Again?

Let’s just look at Idaho, forget the national picture.

About 30,000 Idahoans have decided to go bare. That’s the number of folks who have dropped out of the state health insurance exchange this year. They are willing to stand on the cliff without a rope.

Let’s back up.

The state exchange was created as part of the “Affordable Care Act” =ACA=Obamacare, to get people affordable health insurance when they made more money than would allow them to qualify for Medicaid, which is health insurance for the REALLY poor. On the Exchange Idahoans could get federal income tax credits to help pay for their health insurance.

But MAGA cut that.

We’re not talking about Medicaid here. We’re talking about low-middle income folks working, maybe self-employed, small business folks who have decided they can’t afford health insurance.

Is this making us GREAT? Again?

The insurance companies understand the market. They know there will be billions of unpaid care given when the folks who chose to go bare fall off the cliff and are wheeled in. And the hospitals will shift the costs to those who do pay, the insured. So they have raised their rates.

Can you see the connection? Most other countries see it. Why don’t we?

If we have everybody in the pool, we all have to pay less. And we all receive the safety rope. And we aren’t out on the edge of the cliff.

Medicaid is down there at the bottom, the very poor. Idaho is working as hard as it can to get as many of those losers kicked off coverage. Maybe you don’t think they are worthy. Then just go ahead and say it. The insurance companies, the small-town hospitals see this coming.

Just one premature baby, one fall off a ladder and you lose your house, everything.

Small aside here: Under the Medicaid “work requirements” bill passed by the Idaho legislature; most legislators would not qualify for Medicaid, let alone the gold-plated health insurance us taxpayers pay for their benefit. GREAT?

The “Good” old days, back when America was GREAT, people got sick, maybe they got care, maybe they didn’t. According to our State Attorney General, nobody died because they couldn’t access health care. Maybe you share his view.

I could tell you stories. How I cared for the uninsured. How I worked to make sure they got care. But then, did the hospital come after them, did the medical claims attorneys file their claims? Did they lose their tools, their homes? Saving a life and destroying a livelihood. GREAT AGAIN?

Does this make any sense to you?

How can we be the richest country in the world and we aren’t willing to sit down and discuss this immense problem.

Idahoans will suffer. Just a couple or a dozen or a hundred of those 30,000 without health insurance might slip off the precipice. They may die. That would be cheap.

Shouldn’t we be all in this for them to live and recover, to the best state of health they can?

Maybe you don’t think so. Maybe you think we should all be in this for ourselves. Our Attorney General thinks so. Do you?

I can tell you, our North Idaho Congressman, Russ Fulcher would not be alive if he didn’t have good taxpayer funded health insurance. But he works diligently to make sure less of us have such access. The hypocrisy.

Maybe that’s what we’ve come to. Just take what you can and the rest of us be damned. Great Again.

The Idaho Department of Health and Welfare is spending our taxpayer dollars to go around the state and “listen” to our concerns. Idaho is about to grant a multibillion-dollar contract, the biggest ever in state history. Is this a wise investment, this listening thing? Its peanuts compared to the contract.

Lord knows, the legislature, who decided these billions of our tax dollars should go this way don’t listen. They ignore testimony. My elected State Senator has rarely appeared in public forums in my district for his last six years. The last time he did, it made national news. So he has learned. Don’t listen.

But the IDHW is listening. Maybe.

I am wondering if this representative government can survive. It’s up to you.

In the meantime, our taxpayer funded IDHW has gone around the state asking folks what are their concerns as Idaho Medicaid moves to managed care.

Our legislature has required this change to managed care. It’s all the rage. Maybe you have experienced it. You must go to an “in network” provider or the insurance company repossess your car. It’s that kind of health care we love, don’t we? Now we can stick it to those lazy Medicaid patients.

The DHW is asking, what do you think we should do? Will they listen?

There was a “listening session” this last week in Lewiston. I am not currently a provider who gets Medicaid dollars, or an enrollee. I was conflicted about making the $20 drive.

But the sessions have been very well attended. The department has posted the anonymized comments online.

As I read through them, I see a recurrent issue from providers. Keep in mind, managed care is nothing new. Big insurance companies have used this technique for years to control their costs and thus maximize their profits. Providers know the routine.

The insurance companies restrict their “panels” to low-cost providers. You liked you doctor? Sorry, not in panel.

They deny coverage for a recommended treatment. You can appeal; the doctor can appeal. Do you have a few months? Years?

I was a low-cost provider. I didn’t order a lot of tests or recommend many stupid surgeries. Lots of patients went elsewhere. They chose. So did I. They could find a doctor that would do what they wanted. I kept doing what I thought was a good job for my patients.

In the end, we’re all paying. It’s insurance.

This scenario is playing out big time here in Idaho. Hospitals and doctors across the state are fighting for more money. Insurance companies fight back. Such is the nature of a normal healthy marketplace.

When will you folks realize healthcare is not a marketplace?

Except maybe plastic surgery. Is that what you need?

I guess the Idaho legislature believes private equity funded big insurance companies are better suited to protect the taxpayer dollar than our own government.

Will they listen?

One of the recurrent questions from providers was, what would be the appeal process? Who can we gripe to when the insurer denies what we say is appropriate care?

I assume the IDHW will include that in their contract they put out.

Or will they? So now, our representatives want to contract out listening?

Idaho receives about $3B from the federal deficit government to pay for our Medicaid health care. Don’t get me started on the amount of tax dollars we are spending on debt service. We are talking about health care spending here.

But the two biggest drivers of fixed federal spending, after Social Security, are Medicare and Medicaid.

So you see this as a solution?

I have told you before, it hasn’t worked. President Bush gave us privatized Medicare. It has been proven to be a big waste.

Maybe Idaho is just behind the curve.

We should be listening.

I know how this feels. We were a young family with cheap, weak, barely any health insurance. I was a medical student. My wife worked nights as a janitor.

We bought the cheap health insurance through the medical school. But it cost more than we paid in rent.

Our doctor accepted the weak payment. But then our baby got sick. And the insurance would not cover “preexisting conditions”. She was born with this problem, and it was making her very sick.

So I know the burden of this lousy health care system we have cobbled together. It seems it’s just to make the doctors rich, and the health insurance CEO’s and the hospital CEO’s and enrich the venture capital companies buying and selling our risk pools.

Nobody seems to care about us. Not Joe Biden, not Donald Trump, not any Democrat or Republican I could name. Surely none of Idaho’s congressional delegation gives a shit about the basic comfort, the basic need for decent health care access.

Idaho ranks 12^th in the nation for the most uninsured citizens. And we expanded Medicaid. Almost all the states 11 and up, didn’t. We did what we could. More needs to be done.

Over 12% of Idahoans have NO HEALTH INSURANCE. One in eight. Next time you’re at McDonalds, look around. If you are reading this, I’ll bet you have health insurance. Lots don’t. Maybe it’s not fashionable in this culture we are developing to think about those around us who might have less.

But when you have a sick baby, who keeps getting infections, fevers, damaging her organs, what are you supposed to do?

The Christian Nationalists would say charity.

And that’s what we got. Charity. They scanned, diagnosed, and hospitalized and operated. And the social worked sat down with us and said, “Don’t worry, this will be paid for.”

Charity is wonderful. We felt blessed. The burden dropped off. We received more care for our infant than I could have gotten from selling our car, my motorcycle, my medical books. They would have been a drop in the bucket.

So, is your vision that we should have a system that grants charity? If a deemed recipient is granted, they get the largess of the wealthy, the endowed?

I wonder what would have happened if me and Martha had been East County trailer trash. Charity?

Poor communities have Go Fund Me’s and jars by the check out.

The burden we have created to access health care harms.

The young family with the sick child might wait. Charity is a burden, and unreliable, though honorable.

It seems like we are afraid to throw open the doors.

None of you conservative Republican Idahoans want to have this conversation. Heck, most my wealthy liberal Democratic friends don’t either. What’s the problem? It’s just ten percent you idiot, why are you worried about them?

Because I was in that ten percent. I’m not now, but I was. And I remember.

You probably know a similar story. Doesn’t this make you want to solve this?

Our Governor appointed a Director of the Department of Health and Welfare who cut kids off Medicaid health insurance at a record rate. Idaho jumped to SECOND in the nation (behind Texas) for uninsured children. Are you proud Brad?

Maybe you are happy about this. Maybe you think people shouldn’t have children unless they can provide for them.

This is a very important conversation we need to be having. I don’t mean to offend you. I mean to inspire you. We have a very serious problem right here. And it doesn’t seem any of our politicians we elect based on our Fox News or CNN feed give a shit.

It’s time we decided what’s important. And we let them know.

I don’t make such claims lightly.

Our previous Director of The Department of Health and Welfare, Alex Adams closed down a program for families to care for their disabled children funded with federal money with such claims. Back when I was on the Board of H&W, when there was a board, before the legislature in its wisdom cancelled the board, I asked him if any accusations of fraud were referred to our Attorney General. He mumbled something. No prosecutions have followed.

So a director, appointed by our Governor can shut down a funded program on unfounded allegations.

I get it. You conservative Republicans don’t want any taxpayer dollars going to the “unfit, the needy, the disabled”. You just want our taxpayer dollars going to families who want their kids to go to private, Christian schools.

Please, if you are concerned about fraud, you Conservative Idaho Republicans, wake up and watch $186M dollars shoot out to folks a few legislators think should get it.

For that’s what our Senator Crapo championed, and our congressional delegation (all Trump lackeys) voted for. According to the federal website, Idaho has received $186M dollars and it is in some account somewhere at the Idaho DHW.

But the Idaho legislature must approve any of this spending. They have set the delegating committee as 8 members, all Republican, but what does that mean here in Idaho?

The Department has great plans. I apologize for my cynicism. When I read the plans, they sound like gobbledygook. Please read them, you folks out there in rural Idaho and tell me if that’s what you think you need.

There’s a lot of cyber, technology, AI references in there. Just who do you think is going to get that money? Not Syringa General Hospital, or Clearwater Valley, or Lost Rivers. No, these grants will go to the big companies selling these services, whose employees live in Seattle and San Francisco.

We are getting fleeced. Our national debt is exploding, our health care system is a mess, and this grant program throws more dog bits to a very fat dog.

And our legislators have designed a system to funnel that money to whomever buys them the best lunch.

I hate to tell you, but we here in Idaho are small potatoes. A million-dollar grant can be awarded for a persuading $50 lunch.

And the Co-Chair of this committee, Jordan Redman has already faced charges of self-serving as a public servant.

So legislators could be acting badly. This is just old news. I’ve seen it before, maybe you have too.

Here’s the crippling coda.

The federal legislation to send this $1B to Idaho included a stipulation that the state would continue to support the programs developed.

Can you imagine the Idaho legislature coughing up another $200M a year to the Idaho DHW to fund AI kiosks in our small towns? And what would these AI kiosks do to help small communities thrive?

We are ripe for corruption. I have seen it in our Capitol. A person in charge of dispersing grants for school internet fudged the granting process. And that was just $25M. Somebody sued, the court found the process bad, and Idaho lost.

Now we are upping the ante.

Forking out grants while you are slicing the Medicaid program may hope to soften the blow. That’s just feeding into the deep corruption we already have.

Instead we need to be asking some very fundamental questions.

Should we all have access to healthcare?

What should our basic healthcare look like?

How should this system be paid for?

The United States pays per person almost twice what the next country in the world pays. We are rich. And we are wasting a wonderful opportunity to be great.

I can imagine how the majority of the legislators we have elected reacted to the news article again putting Idaho at the bottom for K12 spending per student. I’ll bet most of them cheered and a lot of you Idahoans did too.

Maybe even Brad did too. We’ll never know, since he won’t speak up about this issue in an election year. He’ll comfortably win the primary and then easily win the general. He’ll be like Butch Otter, a three term Idaho Governor on his Wikipedia page with no real accomplishments of note.

Like Butch, he hasn’t chosen to make any tough stands. I guess he knows the political landscape of us wimpy Idaho voters. He sees us as sandy sagebrush and cheat grass.

Not me. I live up here on the Palouse.

Idaho is mountains and rivers. And desert and canyons. Why don’t we vote tougher? Maybe we just don’t care about the value of courage. Maybe we don’t care about the value of education and getting our kids to learn to think wisely for themselves.

Butch’s toughest stand was to yell across the parking lot to the Speaker of the House to kill the mandatory ultrasound bill. Women wanting an abortion would be required by law to have an ultrasound, probably a vaginal probe, before it could proceed. Idaho lawmakers were mandating a health care procedure. He stood up as he yelled over the tops of the parked cars, and the Speaker listened. Scott Bedke, now our lieutenant governor killed the bill.

Us Idahoans want courageous leaders, don’t we? Is that courage?

Butch did get braver. But it didn’t cost him anything. He endorsed Medicaid expansion in the last weeks of his last term. When citizens had gotten it onto the ballot, and it was looking like it might pass, he jumped on board. Thanks Butch.

So maybe bravery will come in the final weeks of Brad’s third term.

Our Christian Nationalist legislators are crowing about Idaho to their followers on social media. They are bragging that we have insured Medical Freedom and tax dollars for their Christian Nationalist schools. And they are proud that the liberal, woke public schools are cut to the bone. They are hoping their fellow oppressed rich white folks will move here to Idaho to vote for them. They already have.

So us reasonable Idaho folks, Democrat, Republican have a choice.

I am an Idaho Democrat.

But I have voted for Idaho Republicans.

Some of you Idaho Republicans even voted for me. That’s the only way I could get elected in this district.

We should be talking. We should not be afraid of the cultural warriors. For that is what they want, us to be afraid of their brandished sword of abortion, illegals, woke, liberal, you chose the hot button label.

The only way we are going to have a reasonable conversation is to start sharing our goals.

I thought Brad had a good one. Let’s make this state a place where our children can grow and thrive.

And he followed it up with increased funding for public schools. But it was wimpy.

We are in a hole. Idaho needs some vision.

Maybe your vision is that we need protection from transgender folks. Or we need to get rid of the illegals. Maybe we just need to deport the woke, liberal, socialist Antifas.

I raised my daughters in this state. I wanted them to thrive. I wanted them to be able to afford to buy a house. I wanted them to have good schools for their kids to go to. I wanted them to feel proud about Idaho.

Heck, these mountains, these rivers, the forests, these deserts make me proud. I love them.

We need to agree on what we value. We need to build a community.

It’s hard to know how to frame this, since most of you and I’m sure none of our elected officials give a rat’s behind.

We have a problem here in Idaho. It’s not the trans folks recruiting your grandchildren. It’s not the flags flown by cities. It’s not the liberals you despise and would prefer to deport instead of the “illegals”.

It’s about providing good health care to rural and frontier communities. Our legislature has no clue. They could be helping. But they are not. Clueless.

Do you want our rural communities to thrive?

Do you want a young working family to have the security to have a baby in their small town? Do you want small towns to sustain and grow? Maybe you think we should all just move to the big city. Boise, Meridian, Caldwell, Nampa, all so wonderful.

Family doctors have tried very hard to serve this state. Understand, family doctors treat from the cradle to the grave. OB/Gyn’s treat “female” problems including pregnancy, though some have excused themselves from that burden.

Heck, most family doctors excuse themselves from treating pregnancy and birth. It’s a pain. You can’t have a beer or go to elk camp if you are the doctor for an expectant mother in a small town.

But some vital, courageous family doctors do in our small towns. They suffer for us. And what do our legislators do? They further burden them.

Why aren’t we helping these heroes?

Think about it.

Small hospital, barely getting by, can’t afford to recruit or pay professionals, nurses, anesthetists, to do the work. You need a team. Our legislature cuts their funding.

Women are pregnant, they need care. The local family doc does their best. Labor begins. Something happens. Baby needs to come out. Surgery can solve it. Shouldn’t we want these remote practitioners to have our support? So that young, energetic young families can see these small towns as a possibility? Can’t we build a future for rural Idaho? Instead, we protect them from trans people. So brave we are.

Family doctors deliver more babies in rural Idaho than OB/Gyns. Family doctors look at OB care and blanche. Who will help me?

We need to be helping each other here. You folks down in Boise worrying about your avocado toast need to understand a pregnant woman in Stanley, Kamiah, Winchester, Athol, Mackay is in a quandary.

Maybe you think they just shouldn’t be there. Maybe they will think that too. So you just don’t care about rural Idaho. Do you, Brad?

What does our Idaho legislature and our governor think about this?

I’ve told you before I voted for our Governor because he said he wanted to make this a place where our children could thrive.

I have a daughter who teaches in this state, and he just signed a bill that is making her consider moving elsewhere. Shame.

Our elected officials, from the Governor down to our legislators, none are paying attention to the problems we all face.

From housing we can afford, to schools for our children, to day care so we can work, to health care so we won’t go bankrupt, to having a baby in a safe place.

They don’t care.

It would take just a small investment to help family docs be good at delivering and maybe c-sectioning babies in rural towns.

But investment means taxes, and Idaho just wants to cut them.

Our current Idaho leaders don’t want to invest.

Investment means you believe in the future. Investment is the process of deciding what our future should look like. Investment is a commitment. That’s what it means to have a baby.

Why aren’t we investing in having babies in Idaho?

This is not designed for my liberal friends. I want to speak to my conservative ones. I have a few.

Okay, so we dismantle, dissolve, decapitate Medicaid. What to you propose to replace it?

This is the conversation all us Americans should be having. What should health care look like? Are you happy with what you’ve got? Is it our government’s role to even address this?

Besides the preamble “promote the general welfare” the Constitution does not address health care. They were just building a structure for governance back in 1787.

But we could. And we have.

Medicaid was enacted by Congress in 1965. States had to agree to enroll. Idaho enrolled in 1966. Back then I was 12 years old and living in Southern California. But Idaho had a Republican Governor (Smylie) and a Republican majority in both the Idaho House and Senate. And they voted to enroll in this program. Why? Ask yourself, you Republicans.

Nowadays, Idaho Republicans want to dismantle Medicaid. Maybe I do too. Our health care in this country could be so much better.

But they don’t talk about making the system better. They go back door. They cut taxes so now, they can pretend they can’t fund it. Imagine Speaker Mike Moyle with his hands up. “What can we do?” after he has coordinated five years of tax cuts.

I agree with him. What can we do?

Does the Medicaid program best suit our needs? It may not.

But they just want to break it. Can’t we talk about fixing it?

Here’s the Medicaid primer: States pay a share and the federal government pays a share for health insurance for low income and disabled people. The share is determined by a Federal Statutory formula. The maximum a state pays is 50%. Idaho pays 33%.

So if you don’t like the formula, can we talk about it?

But honestly, for all you Republicans out there, my conservative colleagues, it really is a fundamentally deeper question. Do you think we should all have health insurance?

I know this is a miniscule question when we are at “war”. But it’s actually what we should be talking about right now.

You Republicans have been portraying Medicaid as a liberal handout to lazy people who don’t work, don’t pull their weight.

My liberal buddies think health care should be free for all.

I disagree with you both.

I believe health care needs to be a system. We should design a good system. But we will need to agree on some principles for this system.

Since we haven’t had the courage to face this fundamental task, us liberals have given you Republicans room to talk about “work requirements” and “fraud”.

This is just political ping pong, and the American people are losing as we tap the ball back and forth.

So here, I want to speak to the general public, not Republican or Democrat.

Can we talk about how health care should be in our country?

Don’t tell me we can’t afford it. The United States spends almost twice what the next country in the world spends on health care. We can develop a very robust system.

Some people may lose. Some people may win. But we should all be better off. What we have stinks.

Republicans and the medical profession have long argued that getting government involved in health care is antithetical to our founding principles.

Except maybe when it has to do with abortion.

Or transgender care.

But here we are. Basic health care.

Yes, those painful issues will be involved. Take them off the table and start talking? I’m up for it.

Instead our Idaho Republicans just chip away at the 1960’s program we currently have that serves a lot of poor and disabled folks. That is just cruel.

If you want to dismantle Medicaid, break it, then let’s make a better program to fix the problem.

You break it, you fix it. I’m all in. Show me.

I am not Johnathan Swift. Though you should read him. Gulliver’s Travels was a hoot. Swift’s ‘Modest Proposal’ is good, so I bring it forward.

Health care is expensive and elusive in this great nation. We could all be better with universal access and better service. But the medical profession fights government regulation. And it has been successful.

When the proposal that all Americans should have health insurance was weakly put forth in the “Affordable Care Act” (Obamacare), the plan was negotiated with the health insurance industry.

So we got the mess we have. It’s just as complicated as it was before the ACA, and now Republicans are chipping away at it.

The ACA got more people insured. And this lowered overall health care costs for a while. Don’t think I’m here supporting it. It’s complicated. Getting more people insured lowers costs for us all. This is a fact.

But the Idaho legislature now wants us to go in the other direction.

Our elected legislators want to get less people health insurance.

And their proposal is that we should be checking if they are working so they would then be eligible for the health insurance benefit.

Let me offer my modest proposal.

All Idaho legislators, who work ¼ time, receive taxpayer funded health insurance. Their benefit costs us Idahoans more than $2M a year. Why don’t we put some work requirements on them?

I live in a district where my State Senator will not attend public forums. And my Representative does not respond to my emails. Are they working? But I’m paying for their health insurance?

I’m getting riled up here.

I can see why the folks in the Marble Dome are riled up. I don’t like sending my money off to folks who aren’t working.

Let me give you an example.

I have served on the Idaho Health and Welfare Board for three years. I have attended every meeting in person. Representative John Vander Woude was also, in statute, a member. He was never in attendance.

But my taxes are paying for his health insurance. And our taxes are not paying for mine.

So just who is working here?

Maybe somebody could tell me.

Here is my modest proposal. If Medicaid expansion health care recipients need to prove they are working, so should our elected representatives.

I could go further. The state of Idaho is the largest employer in this state. And you and I pay top dollar for all of these state employees’ health insurance. Are they working? Did they show up?

In fact, us taxpayers pay a lot more for state employee health insurance than we do for Medicaid Expansion folks.

So let the burden of proving you’re working come down on all who suck at the taxpayer teat.

Well, maybe the burden on all state employees is too much. For now, let’s just limit it to the elected folks.

Brad, did you do 80 hours this last month? Please submit the form.

Raul, can you please have your secretary fill out the form for you?

And all you State Senators and Representatives, yeah, Speaker Moyle too, submit the forms so us taxpayers can be assured. Are you really working?

It’s just a modest proposal. If you are working for our common good, we would be glad to pay for your health insurance. If not, or you somehow don’t find the time to acknowledge our inquiry, sorry.

It really is simple. Do you deserve our money?

That’s what you are saying.

And that is what I am saying.

It is a modest proposal.

Let’s see.

What should you do when your neighbor’s garbage stinks?

She hasn’t taken it out for a month now and I can smell it.

She’s a nice lady. Should I yell at her? Or just take it to the curb myself? Tomorrow is garbage day.

This is the crux of the modern dilemma. We build systems to foster prosperity and some folks just don’t get it.

We have free public schools. Some don’t graduate. Some become homeless and criminals. Didn’t we provide them an opportunity?

We have roads to drive on and good water to drink. The taxes we pay on our gas and the municipal fees support this. But still, some folks don’t buy into the opportunity.

Is this the Elegy for Hillbillies? Read J.D. Vance. But please, don’t pay for it. It’s at the library. A free resource you should relish.

So some don’t. Some don’t dump their garbage. The truck comes by in the morning and all you have to do is roll the stink to the curb. But they don’t.

We could all be hillbillies here.

Hillbillies lived in the hills. They dug their outhouse holes and moved them when the urge called. The folks on the stream below dealt with it. Or died of cholera or typhoid.

But we nowadays are civilized.

Maybe civilized means woke. I don’t know. I’m not on Facebook or Twitter or Reddit. But I don’t support folks downstream dying when I pollute their water.

I do have to empty my bowels.

And my neighbor should dispose of her garbage. It stinks.

She should take care of it. And she hasn’t.

So what’s a good citizen to do?

Handgun?

Molotov?

Just what is the right response to a negligent citizen these days?

Maybe we vote. Maybe we vote for the guy who will bring down the hammer. Then we don’t need to. He’s the authority. He has the power. Let our elected official be the bad guy.

I’m sorry. I just see that as the coward’s way out.

We need to be holding our fellow citizens to account. Dump your damn garbage.

We need to be our own National Guard. We don’t need troops from neighboring states to police our streets.

Just go talk to the lady.

But I didn’t.

She wasn’t home and I was down there, and it was stinking, so I trundled her garbage to the curb.

As I did this small thing I wondered if I was promoting her irresponsible behavior. Was I fostering her negligence? Us liberals should worry about this more.

And we should feel fine expecting more from those around us.

That doesn’t mean we should be expecting people to think like us. Or act in the way we think people should.

But there is something to say for taking out your garbage. That is a reasonable expectation.

Once, back when I was a doctor and talking to a patient about their pain, they reacted strongly. “It sounds like you are saying this is all my fault!”

I tried to assure them that was not my intent. Pain and stink are here to teach us something. We should learn from them.

Prescribing the narcotic for pain and taking the neighbors garbage out for them is a stretch, I’ll admit.

But it’s really about accepting our own responsibility for our personal situations.

Liberals need to understand this. We have some agency for our conditions.

So I rolled the garbage to the curb. They picked it up like they were supposed to. She came home. The next day I rolled her bin back to its spot.

But she rolled it out this week.

Back when I was a sailor, heading meant where you wanted to go. The compass might swing, the winds might shift, the swell change, but you had your heading. Deal with it.

Idaho is taking a different heading under our current legislature and Governor. You need to be aware the course has shifted. We aren’t just crew. We get to vote for the captain and officers on this ship.

Senate Bill 1314 gets rid of a bunch of stuff. Mainly it gets rid of citizen oversight. It has passed the Senate. It will pass the House. You, the citizens this government is supposed to serve need to know this course shift.

SB1314 eliminates the regional mental health boards. Citizens involved with mental health get together and discuss what should be done, what should change. I guess these voices are no longer welcome on this ship.

SB1314 gets rid of the State Board of Health and Welfare, on which I serve. I guess the Idaho legislature, our Governor and the Department don’t want citizen input.

The Senate sponsor of this bill pointed to our lack of having regular meetings. She didn’t mention the cause. I was going to tell the Senate committee the story of this but was prevented from testifying. Maybe they don’t want to hear the truth.

You should.

The House sponsor of this bill in committee referred to how the H&W Department thought this might be a cost savings. The cost is $10,000 a year for the Board of H&W. That’s a hundredth of our Governor’s security budget.

The house sponsor, in his hurried testimony did let the cat out of the bag. “We have managed care in mental health, so we don’t need these citizen boards. And we are going to have managed care in Medicaid, so they aren’t needed.”

That’s the punchline. Our elected representatives have decided we would be better represented in our dealings with how our state spends our tax dollars by the corporations they choose to contract with, than a citizen board.

Fellow sailors, does that sound good to you?

I wrote last week about Governance, kind of leading up to this. I was asking, just how do we want to be governed?

Corporations have governance. They are beholden to their stockholders, their boards. Their CEO can get hard questions at those board meetings, or they should.

Maybe that’s the heading Idaho wants, to turn our governance over to corporations. What do you say, sailors?

Here’s why the DHW Board didn’t meet for 10 months. I confronted the Director with a policy choice he had made. He cancelled all further meetings until he got ensconced in a Trump HHS spot.

Departments, Directors don’t like hearing from us sailors. It turns out we listen to folks they might not.

And legislators are the same. They really don’t want to hear from us. I emailed all the Senators I knew about this. None replied.

Maybe it’s a DOGE thing, eliminate all waste, I understand that. I looked for waste long and hard when I reviewed budgets on JFAC. But governance isn’t efficient. It requires listening, understanding, consideration.

Idaho’s heading has changed.

So our elected Republican representatives here in Idaho are embracing governance by corporation. Maybe they just read the Trump tea leaves. I have read the science fiction books. Corporations can run everything. But their decisions consider their own balance, not ours.

You cannot do a thing to change this. You have voted these guys into office, and they now call the shots. They set the new heading.

You could vote somebody else into office.

But that would mean you want a different heading. And that you might care.

God, I hope you do.

It really comes down to us. Not our elected representatives, not our governor or our congressmen. Just how do we want our government to work?

I have to admit, even when I was campaigning to be elected, and after elected and serving in the official governance position of State Senator, I wondered just what people expected of me.

So here we are. A guy in the White House has decided his elected position is our permission for him to enrich himself. Don’t tell me you don’t know.

So maybe that’s all that governance is about. Get into a position of power and enrich yourself or your family.

So much for representative democracy. I could go down the history rabbit hole. Franklin forecast this. Franklin predicted we would end in despotism.

But, I thought, coming to Idaho, this remote place, maybe we would be shielded. Who cares about this wilderness?

I did. I do.

But we are headlining right here to despotism.

It’s about how and where we want our tax dollars spent. We agree to be taxed under the laws of this republic and this state. Then we want the dollars spent wisely.

Our legislature voted last year to send over half of our annual budget off to some contracted for-profit corporation so maybe they could better spend our Medicaid dollars.

Many states have done this before. It is the popular assumption that business can do things better than government.

There is no evidence to support this. Maybe just your faith. Some folks are going to make bank on your faith. Maybe you like that.

Are you happy with how your private, for-profit health insurance company authorizes your out of network needs? Do you think their denials of care make sense?

But this is where our elected officials have decided we should send 1/3 of the pregnant women in Idaho. And ¼ of the children. Idaho Medicaid will go to corporate managed care.

Governance means we care about how things the people we elect control the things that affect us.

Maybe we don’t.

Maybe we don’t care that they get millions, maybe billions for the backroom deals.

And then we get shitty care and long waits on hold and denials, and their stockholders smile as their share values bump. And maybe we don’t care because this will just affect poor people, not us. We are aspiring to be in the Epstein class.

Is governance about us and them?

Are we going to stand up for what we want/need, or are we going to go back to Netflix? Instagram? Facebook?

And if we have health insurance from our employer and we aren’t too bothered, are we going to care about the whole picture.

Maybe we just think those guys, those losers, deserve the poor care maybe we have avoided.

But maybe we haven’t. We live with the annoyance.

Isn’t this what the first aspirational words, written so long ago in our Constitutional Preamble “…a more perfect Union” called us to?

Maybe our current vision of this more perfect union is just what I can get for me and mine. Jeffery Epstein sure knew how to use that motivation.

So maybe we here in Idaho do aspire to be in that Epstein Class.

The contract awarding process for our billions (chump change for this class; we are still a small state) will shuffle big money off to corporations and the accountability will be remote from our elected officials.

Just as the deaths from Governor Little’s hold back don’t lie in his or the Director of the Department of Health and Welfare’s lap. These services are contracted through a managed mental health company. They are to blame.

When we give up our governance to big corporations, we are giving up our freedom. If you can’t see that, then you aren’t paying attention. Still on Netflix?

This picture is from a book I got when I was trying to figure out how to do my job. Now I’m trying to tell Idaho how to do it’s job. Go figure.

A Fortunate Man, the story of a country doctor, by John Berger and Jean Mohr.

*************

Solution?

So the University of Idaho and the University of Utah have come to an agreement on medical education for Idaho. Maybe the legislative work group was involved, maybe not. This sort of deal is truly back room. It makes you wonder if there was some well-connected financier with a private island and young girls involved. But Idaho is not really in the Epstein Class.

It matters for Idaho taxpayers. It’s our money going down these drains to their powerful cesspools. But the deal is announced and the legislature must now decide.

There are some important questions.

#1. Do you have the vision?

Doing new things requires a clear and directive vision. I saw none of this from our legislative task force. What should the health care for Idaho look like in the future? Just what skills need to be trained and staffed? Who will be the “provider” in the small town or the big city medical center? I saw no plan for this.

#2. Do you have the money?

Doing new things costs money. The Idaho legislature has spent the last five years depleting the revenue stream. Our legislators have given tax breaks to the wealthy and corporation so we now, while our economy booms and population grows, have less tax dollars.

They will cut funding to K12 schools, they will cut funding for health care and prisons. But they will find money for this endeavor? We’ll see.

#3. Do we have the will?

Going a new direction requires fortitude. It will take years of dedicated work to build the relationships, the staff, the commitments from the medical community. Doctors are needed to train doctors. Nurses are needed to train nurses. Doctors and nurses and Physician Assistants have to learn to work together. Training them together is the best way to make this happen. Nothing in this announced Treasure Valley plan describes this. And the idea that our legislature, who has spent years hating the medical profession, will jump on board, is ludicrous. The legislators who have put their thumb on the scale for medical education are motivated by their own petty grievances. None have a clear vision for the future of Idaho health care. Soon as their pet peeve is dispensed, they will fade. There is no will.

So I have asked my questions. Will the Idaho voters ask theirs?

I doubt medical education is at the front of any Idaho voter’s mind. Most are probably working to pay the rent and get to work in the morning. I have always wondered just why the Idaho legislature even cared.

Old Cece came up with the WAMI program as a band aid. It has worked for a while. Fifty years. Great band aid.

But we now need to move on. We have had a great affiliation with the University of Washington. I am a graduate of their medical school. Indeed, the top graduate going into Family Medicine in 1986. And I have practiced here in Idaho until a couple years ago.

I appreciate that the University of Idaho and the University of Utah have come to some agreement about medical education. But it seems to me they are just shrugging into more of what we’ve always done.

It’s time to do more.

It’s time to look at the big picture of health care in the state of Idaho and start building for our future needs.

We need more information.

We need to know how rural communities serve and struggle.

We need to know just what specialists are necessary to serve our people.

We need to understand the value of medical care; what works and what is waste.

I can’t right now believe our legislature, who represents us, gives a shit. But they represent us, don’t they?

I really wish we all cared.

Old men like to tell stories. Some are good at it. Some aren’t. We tell them anyway.

I was in the Idaho legislature the last time and only time public K12 funding was cut. I was in the minority and voted against it. Medicaid got cut. It was a dismal time. I entered the Idaho legislature in 2010. The economic crash of 2008 was just washing over the state’s revenue stream. We were growing in population, but the general economic downturn was severe and money was tight. Reserve funds were depleted, zeroed out. That was the situation I joined.

Idaho trails the national economy. By 2010, when I entered the legislative swamp, I could see the national tide beginning to rise. But Idaho must balance revenue against expenditures, according to our Constitution. We cannot bet on a projection.

So we cut budgets.

I watched my colleagues. Mainly the Republicans, since they held the seats and were in charge. I appreciated that they knew the numbers, the fiscal situation, and our mandate. They voted to cut the budgets because there really wasn’t a lot else our state could do right then.

I was betting on more tax revenue coming in than we thought, as the national economy stabilized. I believed some Republicans low balled the projected revenue to justify the cuts. But I respected most of the Republicans who thought we needed to be conservative with our budgeting. We have to balance the book.

And I was right about the revenue. After cutting Medicaid and schools, we ended with a surplus.

I also watched who just wanted to cut the budget out of spite. There are those ideologues. Some conservatives think we should get the government shrunk down to the size we can drown it in a bathtub. But many of my Republican colleagues felt the pain of these cuts. They regretted our circumstance. They saw the need for the services the state provided and regretted we could not continue all those.

That was back in the day.

But Idaho is in this day. And this day, our Republican Idaho legislature has manufactured this “budget crisis”.

The national economy is not on the skids.

Idaho has a Billion dollars in reserves funds. That’s 20% of our annual budget.

But we have our elected representatives planning to cut funding for schools and health care as our population and economy grows. And after they have voted for a billion in tax cuts for corporations and rich people.

I have no idea who I’m talking to here. I’m an old man telling a story. It’s not going well. The room is silent.

This old man remembers those guys in suits in the Capitol with their name tags. I remember the things that were important to them.

I believed most of them listened to and represented their constituents. But also, I knew, some did not.

Once in the lunchroom, when I sat across from a Representative from North Idaho, I asked him who he talked to.

“Oh,” he said chewing his sandwich. “I meet with my central committee regularly.”

I knew this guy. He would vote for any budget cut. And he didn’t care who it might affect.

We do government to help this be a better place, mainly for our kids. So they can have a place to prosper and thrive.

That’s how this old man sees it. But while I’ve been going on, I’ve come to realize, some in the room don’t like the story I have been telling. So I go silent.

As I sit in my chair and ponder the silence, I come to realize, not everybody thinks like I do.

And as I age and decline, I wonder just what is the purpose of this fight?

Then my granddaughter runs in with her new outfit.

We need to be building this place for them.

The news and the Idaho Department of Health and Welfare are trumpeting the billion-dollar, five-year grant to our state. This fiasco was shoe-horned into the One Big Beautiful Boondoggle that cut taxes and exploded our debt.

Idaho’s federal “Gang of Four” want credit for bringing the dollars home, while they cut Medicaid funding and ballooned our debt. Go ahead, slap them on the back. Vote for them again. After all, they are Republican and Trump lackeys.

This grant required states to propose projects that would “qualify” in a narrow three-month window. How’s that for thoughtful expenditure of our tax dollars?

The projects had to be sustained beyond the five-year grant period by the state. Do you think the Idaho legislature is going to come up with $200M/year for Idaho healthcare when the grant runs out?

Most of the grant money will be for technology improvements. I have seen this before. Who gets that money? Not local communities. The big tech bros who sat behind Trump at the inaugural catch this effluent downstream. It will just wash through our depleted state.

The ACA (Obamacare for you Republicans) did the same thing. I was working on the IDHW budgets in those years. I asked my analyst (Hey Tater!) what the heck this money was doing. Indeed, it was all Federal money, from our federal income taxes. It was supposed to be moving clinics and hospitals to more electronic medical records. I asked him to look into it. He told me the money was helping. I shrugged and it got appropriated. That was stupid.

I had been through this in real life. I was in the first large clinic in Idaho to adopt electronic medical records. We were on the cutting edge. And we made the investment without any federal or state grants. We spent our own money. Why?

I learned we had different reasons for this investment. I believed that having our medical records in a searchable database we could study our practices and find out the best treatments, the best way to deal with the common problems we saw daily.

My partners had different reasons. We had five people working in our medical records department at the time. They were low wage but had benefits and retirement. After the million-dollar investment we had one medical records employee.

Three years into the “experiment”, long before Obamacare, I proposed leveraging this investment to my partners. Let’s do studies on our data. Let’s find out what our best treatment for a urinary tract infection is. We could find out how we are treating high blood pressure. We could improve our practice.

It was an impassioned speech. The group around the table was quiet. Don’t you want to learn how to treat your patients better, I asked. They were all quiet. I looked at the guy next to me. Don’t you? I asked directly.

He looked up at me, squarely in the eyes, and honestly said, “No.”

The allure of data, analysis, technology in medical care is a sham if there is no commitment from the professionals pulling the levers.

So we need to be asking ourselves some painful questions.

Why does Idaho need more doctors if they are just here to make themselves richer?

Do doctors really improve the health of a community?

What do you people want from healthcare?

We don’t have to answer these tough questions (though we should), but big money is asking and answering them while we pay the taxes, and the taxpayer funded grants go out the door.

The billion-dollar grant to Idaho will go to big tech companies who sell kiosks and apps to connect to a provider. The call you make will go to Islamabad, or more likely AI, and you might get the reassurance you need or not.

Will your community be better off?

I am sorry I shrugged with the ACA money for electronic records. It didn’t cost Idaho taxpayers. But it cost us all. We should be expecting more and getting more for the way too much we pay for this horrible health care system. This needs to change.

So the Idaho legislature is in session, and we should all be paying attention. For we elected these clowns. Maybe a clown show is what we want.

I don’t. So allow me some suggestions.

It seems Idaho wants to increase the number of doctors who practice here. The legislature even spent our money so these clowns could get together and consider some recommendations. They say we need 1400 more docs just to be “average”. And they have their $recommendations$.

Allow me, as a retired, worn out, possibly criminal Idaho Family Doc to comment. Do you need my bona fides? The years I worked in our small-town seeing patients in the clinic, delivering babies, covering the ER, taking care of ICU patients and sometimes calling the helicopter? If you do, let me know.

If this interim committee looking into the need for doctors in Idaho might have had lunch with the other interim committee calling themselves “DOGE Idaho” maybe there might have been some synergy. But that’s probably a “woke” concept in our state.

DOGE Idaho has decided it would be best for Idaho to drop Medicaid Expansion coverage. To be honest, I wasn’t surprised. Idaho legislators have had their shorts in a twist ever since Idaho voters told them to quit clowning around.

Idaho voters understood the numbers and the injustice of the “Gap” people in the ACA= Obamacare mess. Some folks can’t qualify for Medicaid, and they can’t go on the exchange to buy insurance. They were in the gap. Idaho voters solved their problem with a righteous and compassionate vote.

So it now costs our Idaho taxpayers about as much as we spend on private school vouchers. 50,000 people get your tax dollars to send their kids to a private school, and 90,000 Idahoans get access to health insurance.

Please allow me to square this circle.

Idaho legislators have driven doctors from this state. These clowns created this mess.

Twice in my weak career I performed what the Idaho legislature now call a criminal act. I did things to cause the delivery of two fetuses I knew would not survive birth. And Idaho legislators call that a crime.

So you want more doctors in this great state? Maybe you should quit calling them criminals for giving care.

You already require all doctors supported in their medical education by Idaho taxpayers to return here and work for four years.

Maybe you should make the schools they send their kids to exemplary.

Maybe you should make this a state doctors want to practice in.

And here’s a hint. It comes from a retired, washed-up old family doc. Doc’s like getting paid for what they do. And you now want to take away that payment?

There are lots of folks with “real” insurance, like all you clowns in the Idaho legislature have at our expense, but insurance is how most doctors get paid. Don’t get me started on the stupidity of this ACA/Obamacare system.

But you clowns are considering two stupid things to be spending our taxpayer dollars. You want to cut off payment to doctors and hospitals, and at the same time spend money to bring more doctors to this state. Can’t you see?

Doctors don’t like Medicaid. It pays much less than your gold-plated insurance. But it pays something.

Idaho DOGE should have spent some time on this one. Why do most private insurance companies have >15% overhead and Medicaid and Medicare, the government insurances have overhead costs below 5%? Shouldn’t we be trying to lower overhead costs?

You have been generous. You have allowed me to call my state legislators “clowns” and you have let me get into the weeds of health care policy. I apologize about the clown’s thing. But please, don’t stop thinking about this health care mess we are in. We need to solve it.

The Idaho legislature and our Governor have cut taxes so much we now face a budget deficit while our population grows. I know Governor Little thought this was unwise, but he signed it. Our Republican legislature voted for this whole hog. We will pay. Our population increases and our state funding declines.

Kansas did this. In 2012, the Kansas legislature and Governor Brownback passed huge income tax cuts. The supply side people cheered. Grover Norquist, the pseudo economist who argued he wanted government to be so small he could drown it in a bathtub, was in ecstasy. The Koch Brothers, Texas billionaires who pull Idaho state legislators strings grinned. The Kansas model would prove all their points.

But it didn’t.

Cutting taxes does not make an economy boom. It didn’t for Kansas. They depleted their reserves and struggled to fund schools. Idaho has this on the horizon.

Especially when tax cuts just benefit the wealthy and corporations. Us pogues drive the consumer economy, and we have not gotten these Idaho gifts. We are hurting. But our schools and our roads and our lives will suffer.

So how did the Kansas Experiment work out? Not so great.

Kansas is almost as Republican as Idaho, but Governor Brownback ended up leaving the state to serve as “Ambassador at Large for Religious Freedom”. A Democrat succeeded him in the Governor’s mansion in Topeka.

Idaho would never do that. And we don’t have a Governor’s mansion.

I doubt Brad has international ambassadorial dreams.

He loves Idaho. And he knew these tax cuts were stupid. He said so. But he signed them.

Idaho has seen growth. People love the Treasure Valley. Do they need schools and roads? Maybe they are over 60 and just want a small ranchette. At least they have escaped the liberals in California.

Is this the Idaho Brad Little said he wanted?

No.

He said he wanted this to be a state where the kids born here would find good jobs and want to raise their families. I can’t think of a higher aspiration. Three of my four daughters are Idaho taxpayers. I love this state too. It’s why this Idaho Democrat voted for him.

I realize such an endorsement might not be welcome. That’s his problem.

But then he signed the ruby slippers tax cuts. And he’s holding back money to balance the budget. That’s his job. But he did sign the bills. We will dip into reserves, so the pain isn’t felt this year, but it’s coming. The budget will be balanced. And we will feel it.

Brad knows state finances better than anyone. And he can see the coming crash. But he signed the bills.

The problem is the Idaho legislature, who we elect from these bizarre districts. Our legislators write these laws.

But then Brad signs them.

We, the voters, need to be seeing this issue. Please study Kansas. They did the experiment. Why do we need to redo it here?

Maybe the problem isn’t with Brad or those clowns in the Capitol. It’s with us. We don’t learn.

I try to write about healthcare policy in Idaho, but it seems it’s just déjà vu all over again.

It seems Idaho legislators can’t get enough of the boogeyman Medicaid Expansion. Why do we elect these clowns?

We voters studied the complex numbers. We thought it was about giving people a fair shake. We voted to expand Medicaid coverage to the people in the gap. About 100,000 Idahoans could not qualify for Medicaid and could not go to the exchange to purchase health insurance with Federal income tax credits. These folks were in the gap. We saw this as unfair. So we fixed the problem. What are you crazy legislators now thinking? They talk about dropping this coverage.

We could go through all the numbers again.

But numbers don’t persuade some political consultant once told me. Maybe it’s the image.

Conservatives see loser people out there taking their hard-earned money.

Liberals think everybody needs a hand.

Conservatives think the hand up promotes dependence.

Liberals can’t let go of their empathy.

Both you guys are right.

But we need to build a system. And we’re stuck with the laws we have. Nobody seems to want to talk about the messed-up healthcare system we currently have. Or how to make it better.

I do.

The Affordable Health Care Act (Obamacare for you Republicans) tried to use the current (massive) health insurance industry as a tool to get more people insured. Obama mistakenly thought working with the health insurance industry would buy Republican votes. He ran into the “Party of NO”.

The ACA used state-based health insurance exchanges to give folks access to affordable plans. The marketplace was where you were supposed to go to be able to shop for the plan you wanted and could afford.

Let me tell you how brave our former Governor, Butch Otter was to champion this in a Tea Party leaning legislature. But he did it. So Idaho now has Your Health Idaho.

But the first plan had flaws. Folks above 300% of the Federal Poverty level on the exchange got bit in the butt. The subsidy tapered too fast.

And when the subsidy cliff became evident, our current Governor spoke up. I wrote about this a long time ago.

Then old man Biden got elected and congress “fixed” the cliff.

This is what the current government shut down is all about. Should we keep health insurance affordable for all?

Let me simplify the question.

Do you think American citizens should have affordable health care insurance coverage?

I can tell how our Idaho legislators would answer that question.

Please remember, all of you Idaho voters who elect these clowns, you are paying for their gold-plated health insurance on your dime when they are working a ¼ time job. The health insurance benefit our legislators receive is probably worth more than the salary we pay them. But they grouse about extending health insurance to Idaho’s working poor, most of them doing two or three ¼ time jobs. No (current) legislator has opted out of these high dollar benefits we pay for. But they claim the Idaho taxpayer can’t afford to support Medicaid Expansion benefits.

Do you have any sense of fairness? I hope you do. I know they don’t. But you vote for them.

Let’s not skip over the fundamental question.

Should people have basic health insurance?

Idaho just kicked another 12,000 kids off health insurance.

I’m not talking about getting everything you want. I’m talking about a fall off the roof not costing you your home.

Believe me, it would.

It shouldn’t.

We should all have basic health care coverage.

I can’t believe these clowns we elect and pay for their fancy health insurance don’t share this value. Again. It’s here again.