Idaho’s future belongs
to all of us.

YES on Proposition 2

In the near term we must ask a very practical question: What is the most efficient way to provide care to this populations with the least burden to the general population of Idaho?  The sensible answer to that question is to vote YES on Proposition 2.


The existing Medicaid program is jointly paid for by the federal and state governments.  The costs are split roughly 70%-30%, with the federal government paying the larger amount.  If Proposition 2 passes, the expense of the Medicaid expansion program would also be split between the federal and state governments.  That split would be 90%-10%, again with the federal government paying the larger share.


There really isn’t a less expensive way for us to resolve the short-term problem of access to care.  However, this is not just a matter of compassion. It is prudent finance as well, and we must take immediate steps to do what we can to ensure that more Idahoans can receive the care they need.  Voting YES on Prop 2 is the first step.  The Idaho Center for Policy Analysis, a local non-partisan center for budget analysis, issued their report on the impact of Medicaid expansion here.  They also concluded that YES on Proposition 2 is both smart policy and prudent governance.


There is another reason to approve Medicaid expansion.  According to the current CEO of the Idaho Hospital Association (as stated at the Medicaid forum held on Thursday October 11th at the Yankee Family Research Bldg. in Boise), 19 of 27 rural hospitals in Idaho are operating on zero margin.  This means that those 19 hospitals are hanging on by a thin financial thread. This is not unique to Idaho.  Rural hospitals have been closing down all over the country.  Idaho’s rural hospitals, all with under 25 beds, are the primary economic engine of their communities.  If they go under, the economic engine that sustains these communities will be lost.  If we allow the rural healthcare infrastructure to collapse, the task of actually “fixing healthcare” later will be that much more difficult and expensive.




In God We Trust.  Everyone Else Must Bring Data.

In my campaign, we have asked questions others haven’t asked, like:  “How can we change healthcare incentives to get the system to champion health rather than merely manage illness?”  While the details of answering that question are more complicated than can be addressed on this website, if we adopt a data-driven perspective that an engineer might adopt, the path to creating a less expensive, more rational healthcare system will be illuminated.

In the same way that you wouldn’t finance a “lemon” of a car, why would look to finance patient care that just manages illness?  What matters is that we find out which care does work well, and then direct the healthcare services paid for by the State to pay for that care.  This is not a new concept.  For example, the German government, known for promoting sound engineering principles in the private and public sectors, has been working to identify comparative cost effectiveness for many years

In my administration, we will collect the data that identifies both care effectiveness and comparative cost effectiveness.  Then, the State will ensure that the most cost-effective care for specific conditions will be delivered first.  Many people think the simplicity of this approach is already embedded into how our healthcare system currently operates.  That assumption is wrong.  No data on care effectiveness or comparative cost effectiveness is captured anywhere in the system.  Furthermore, the rhetoric of both major political parties aside, neither party has addressed this fundamental issue.

That is why years after the passage of Obamacare, and years after Republican control of Congress, the cost of healthcare services and health insurance continue to go up and meaningful change has not occurred.

Between existing Medicaid patients and State employees (and their dependents), the State of Idaho oversees the spending of more than $2.5 billion a year to pay for healthcare services.  In every circumstance in which the State bears sole responsibility to pay for healthcare services (about $1 billion of the $2.5 billion), if we were to collect comparative cost effectiveness data, the State’s activities would produce more effective outcomes for patients.  This means that patients will be better off, and the savings to the State will be significant.

In business, this kind of process innovation has been well known for decades.  It is called EVA (Economic Value Added).  In manufacturing, a similar process is called LEAN.  Both EVA and LEAN are processes that drive efficiency into how capital is allocated, and into how efficient operations are implemented.  In my administration we are going to use this type of smart analytical thinking to guide how the people’s money is spent on healthcare as well as other services.

Our data driven approach will be an open system, which means that when a new treatment or care approach comes along that is even more cost effective, we will have the data to reveal it.  Our new open system will adjust to pay for the new treatment instead of continuing to pay for the old one.

In business this approach is considered prudent management on behalf of shareholders.  Shouldn’t State government adopt the same perspective when spending the people’s money?