Member’s Representational Allowance

2017 HON. CATHY MCMORRIS RODGERS OFFICIAL EXPENSES OF MEMBERS. The first column is the Year-to-date, the second column is Quarterly, from the STATEMENT OF DISBURSEMENTS OF THE HOUSE, October 1, 2017 to December 31, 2017, page 1369. You can click on it and scroll around it here.

Dear Group,

Ever wonder how McMorris Rodgers…or, similarly, any member of the U.S. House…can afford to keep an office and manage staff in Spokane, Walla Walla, Colville, and Washington, D.C.? Like other U.S. Representatives, McMorris Rodgers’ personal salary is $174,000. $174,000 might provide a home and support for a husband and three children in Washington, D.C., but that wouldn’t begin to cover district offices, staff, and travel. It turns out there is a whole other pool of money, the MRA, that covers those expenses. Furthermore, both the personal salary and the MRA are supposed to be separate and distinct from all that campaign money McMorris Rodgers raises from entities like the National Rifle Association, Omeros Pharmaceuticals, and benefit auctions of AR-15’s (snideness alert). So what’s this “MRA”? How much is it?

As explained in a richly referenced article, the money is allotted from federal coffers, yours and my tax money, money specified in the Members’ Representational Allowance (MRA). The MRA is a prescribed sum currently budgeted between 1.2 and 1.4 million per House member (in round figures). The actual amount offered a House member depends on the Congressional District’s distance from Washington, D.C. and the local cost of office space rental. The MRA is to defray expenses of the House member’s “representational duties,” those being; the personal expenses component; the office expenses component; and the mailing expenses component.

In 2017 McMorris Rodgers’ spent $1,273,844.71 of her MRA. Her actual expenditures are close to the average allowed. (I don’t know the Congressional District 5 maximum allowed amount she had available, only what she actually spent, and that amount is close to the average MRA.) As you can see from the table above, the biggest share of the money, $1,013,209, was paid as staff salaries. So who are these people and what do they get paid? Look at the two tables below, (copied from the same federal document) for the last quarter of 2017. To figure the annual salary multiply by four (the presented numbers are last quarter of 2017 only).

Each House Member is allowed to employ up to eighteen full time staffers. I count sixteen staffers with annualized salaries over $30,000, including four with annual salaries between $95,000 and $120,000. (For reference, $30,000 is $15/hour annualized. $11/hour is the minimum wage in WA, $7.25 in ID.) There are five “shared employees.” I recognize four or five names as employees primarily located in Eastern Washington, and several that are mostly in Washington D.C. I believe office space in D.C. is not paid for out of the Members Representational Allowance.

A few observations:

  • $1.3 million annually is quite a large amount of money. Much of it (1/2?) is likely devoted to “constituent services,” i.e. helping Eastern WA people and businesses deal with issues they have with Social Security, the Veterans Administration, and other government programs and services. This is help McMorris Rodgers gets credit for, but it is help every Representative is expected to provide. It’s part of the job
  • Most of the staff in Eastern WA seems devoted to interfacing with constituents, not discussing legislation. In fact, my experience has been the local staffers are usually less informed regarding legislation than I am.
  • Whoever holds this office uses the money to help advance like-minded individuals by offering internships and work opportunities. During McMorris Rodgers seven two year terms she has fostered the careers of several. Toppling an incumbent House member changes the political landscape of the District more broadly than one might appreciate.

None of this $1.3 is supposed to be spent on political campaigns, including campaigns to acquire leadership positions in the Congress itself. The Members Representational Allowance (MRA) is meant for just what it says, the Member’s duties as a Representative of the District. By law a Representative is not supposed to benefit personally from the Members Representational Allowance, although a Representative may use personal funds to supplement Representational expenses if the expenses exceed the allowance.

Functioning as a Member of the U.S. House of Representatives includes managing this $1.3 million “representational” budget for the benefit of the Member’s constituents. Lisa Brown, with five years as Chancellor of EWU Spokane, twenty years in the State House in Olympia, experience as Majority Leader of WA State Senate, and a graduate degree in economics is eminently qualified to step into that role.

Keep to the high ground,
Jerry

P.S. The basic information presented here comes from a series of fascinating articles from Thoughtco.com, in particular an article available here. I highly recommend further reading if you have time.

These numbers are for the last quarter of 2017, so for annual salaries multiply by four. This is publicly available information, the same pdf referenced above, pages 1369 and 1370. Use COMMAND (CMD) + to magnify the table if it is hard to read.

CMR buying coffee?

Dear Group,

The Spokesman graciously deigned to publish three letters to the editor last Saturday that were gently critical of McMorris Rodgers representation of eastern Washington. Since they were numbers thirteen and fifteen of fifteen letters that day, many of which were of far less local interest than these, I thought I would bring them to your attention.

Brown and public access

Having recently attended forums for both Rep. Cathy McMorris Rodgers and candidate Lisa Brown, I am struck by the marked contrast between how each approaches their constituents.

Brown arrived early, mingled, chatted and laughed with attendees before the forum began. McMorris Rodgers arrived to her town hall (March 30 in the Valley) after the audience was seated, through a locked side door, under the heavy armed guard of six Valley police officers.

I think this says a lot about the accessibility, ease and transparency of these two candidates with the public. I, for one, prefer my representative not be afraid of me!

Susan Hammond
Spokane

The new McMorris Rodgers

I have to commend congresswoman McMorris Rodgers for meeting with students, news reporters and other groups who are not safely Republican in the last few weeks. I guess a leopard can change her spots.

For 14 years I’ve watched as Mrs. Rodgers has hidden from the Spokane public behind her phalanx of Republican male congressional leaders and safe meetings back home with fundraisers. She showed little interest in communicating with the rabble and those who didn’t agree with her constant votes against our health care and consistent support of an amazingly unstable president.

Is this a new and improved congressional product … or just a cynical attempt to stave off a loss in November?

Bruce Embrey
Spokane

Several have remarked to me they long for the days of Tom Foley, the venerable Democratic Rep serving Eastern WA for the thirty years. He was frequently seen in the gym or in coffee shops in the District. He lost to George Nethercutt in 1994 in an election that is beginning to look a lot like this November. Ironically, a pivotal issue was Tom’s opposition to term limits, the same opposition McMorris Rodgers recently declared. I will never forget the short personal response he sent me once. In answer to a suggestion I made, he calmly wrote, “I agree with you, but such a measure just isn’t feasible in Congress at this time.” Gingrich succeeded Tom Foley as Speaker of the House…and things have gotten more and more infeasible from then on.

It is time to vote in a Representative for the 5th District who spends more time here, who listens, and isn’t afraid of her own constituents. Lisa Brown is that Representative.

Keep to the high ground,
Jerry

P.S. The Spokesman has settled into a routine for letters to the editor: Weekdays, two to four. Saturday and Sunday, fourteen or fifteen on most of a dedicated page. The placement of letters reasonably and gently critical of McMorris Rodgers performance last Saturday makes me wonder if they’re confident that many of their reader’s don’t have the persistence to make it reading that far…

Empowerment or Entitlement?

Dear Group,

On Good Friday I attended the last of McMorris Rodgers’ hastily assembled “Conversations with Cathy.” She arrived with a considerable security detail leading her to the front of the fifty or so people assembled. Her opening remarks made reference to a proud accomplishment, the Steve Gleason Act. She detailed eye tracking devices enabling patients suffering from advanced ALS to communicate. I had heard the story from her before. Why is this story a feature of her every appearance?

Part of the answer to that question is this. Although McMorris Rodgers often lets the words “reach across the aisle” roll off her lips, the Gleason Act is one of only a handful of efforts on her part to actually reach…and, as you will see, even this effort carries a whiff of partisan messaging.

Steve Gleason is familiar to anyone who pays attention to football. He graduated from Gonzaga Prep and WSU; his parents still live in eastern Washington. He went on from local football fame to a career with the New Orleans Saints. There he turned the tide with an outstanding play one afternoon in 2006 just as New Orleans was staggering to its feet after Hurricane Katrina. Then tragedy struck him. Steve was diagnosed with amyotrophic lateral sclerosis (ALS), a horrific disease that finally leaves its victims with little or no voluntary movement except the ability to move their eyes. Steve at the time was only thirty-three, a man recently married and trying to start a family, a football hero with considerable resources. Instead of giving in to despair, he and his family used Steve’s fame, resources, and contacts to become tireless advocates for those suffering from ALS and other neuromuscular diseases.

When Medicare balked at paying for relatively new and expensive technology that allows patients to produce robotic speech by translating their eye movements, Mr. Gleason, his family, his non-profit, and the considerable network of followers pursued a legislative mandate for covering the technology. They enlisted Senator David Vitter (R-LA) and, through Steve’s family in eastern Washington, Cathy McMorris Rodgers to file bills in the Senate and the House. They lobbied. They organized a machine-voice calling campaign to Congresspeople called Robocalls from Humans. They invested themselves, time, and money in the effort petitioning Congress to act to grant money through Medicare to cover the technology.

With all that effort, the Steve Gleason Act passed both Senate and the House in 2015 (unanimously in the House–they did their homework) and was signed by President Obama. The original 2015 Act provided two year funding. In early February this year McMorris Rodgers was able to slip the Steve Gleason Enduring Voices Act as a rider into one of the last-minute, must-pass Continuing Resolutions and secure funding for the devices through Medicare in perpetuity. It is great story of persistence and bi-partisanship benefiting a group with a horrible disease.

A few years ago I would have ended this story here. After all, it’s a story of persistence. Society and government mustered up to do what’s right by a small group of people affected by hideous diseases. We’re all in this together, right?

Then I read this quote out of the Times Picayune:

“I believe our nation has the infrastructure and funds to provide technology for people who truly have no other voice,” Gleason said. “This is not an entitlement bill, it’s an empowerment bill, for people who want to be productive citizens.” [bold is mine]

What is he trying to say? Mr. Gleason is framing his eponymous bi-partisan law for a conservative audience, an audience for whom the meaning of entitlement is money you receive from the government but do not deserve. Apparently, Mr Gleason is sensitive to the idea that payments of money from Medicare to technology companies for eye-tracking devices for ALS patients might be looked upon as an entitlement. He is anxious to reframe his bill as: “empowerment…for people who want to be productive citizens.” Is there a subtext here suggesting that recipients of Medicare Disability or other government assistance are people who don’t want to be productive?

When the Affordable Care Act was phasing in, people who had lacked health insurance kept showing up in my office at the Spokane Eye Clinic with advanced diabetic eye disease, people with chronic diabetes who before the ACA had to choose between feeding their families and seeking care for their disease. I was able to help a good number of them. As a result many could see well enough to remain employed, feed their families…to “be productive citizens.” Mr. Gleason’s tremendous efforts aside, is the average patient with ALS likely to be more “productive” than a cared-for diabetic who is empowered to remain in the workforce? Mr. Gleason’s statement carries an implied judgement that should make us squirm.

The public face of my patients was not the face of a young sports icon with a family and a painfully visible wasting disease, a young sports icon prepared to frame the money spent on speech technology as empowerment. No, before the ACA my patients suffered quietly with their diabetes as it slowly robbed them of their sight and ability to work. Visual disability that degrades the ability to work is not easily depicted like the withering musculature and deteriorating voice of the young ALS patient, but what is more empowering than the restoration of sight?

Yet, in the same Good Friday “Conversation with Cathy” McMorris Rodgers apparently saw no irony in presenting the Repeal of the Individual Mandate of the Affordable Care Act as one of her proudest achievements. It is a theme she also sang in a Breitbart interview. How does she survive the cognitive dissonance of assuring the funding in perpetuity for ALS patients, while chipping away at the health insurance on which millions depend to remain productive, to remain empowered?

She seems able to focus on individual plight, like that of her son Cole or a Steve Gleason, while unable to grasp the plight of the larger citizenry. It is a failing she shares with her Party, and certainly with her President.

I want a Congresswoman with the ability to generalize, to see the bigger picture. It is time for a change.

Keep to the high ground,
Jerry

Silencers and CMR

On March 27, 2017 McMorris Rodgers co-sponsored H.R. 367, the so-called “Hearing Protection Act.” Sounds benevolent, doesn’t it? Certainly that is what she and her 163 fellow co-sponsors, 160 Republicans and 3 lonely Democrats (two from Texas and one from Minnesota), would like us all to believe.

In the 1934, in response to the mayhem of the gangster era and the likes of Al Capone, Congress passed the National Firearms Act. Under that law, which stands up to judicial scrutiny to this day (at least as modified in 1968), fully automatic weapons, aka machine guns (hold down the trigger and bullet after bullet exits the barrel until the magazine runs out of cartridges), certain sawed-off rifles and shotguns, some other oddities…and silencers fell under complicated regulations and taxes but they were not banned or outlawed.

Silencers were defined as “any portable device designed to muffle or disguise the report of a portable firearm.” They are called silencers because they muffle the sound of gunshots. 

If you’re shooting and want to protect your ears, there are excellent noise-cancelling headphones you can wear that require no registration. To argue that we need to reverse an eighty-three year old law so you can muffle the sound of your gun to protect your ears is a bald-faced lie. That such muffling would have resulted in more time to locate the shooter and more deaths in several recent shootings is blatantly obvious, but if you look around on the web you will find folks making that absurd claim. 

Is there a great demand for repealing the restrictions on silencers from a broad cross-section of folks  involved in shooting sports? Will silencers sell like hotcakes if the regulations are repealed? Highly unlikely. Readily available silencers will make us less safe, not safer.

So why is Ms. McMorris Rodgers co-sponsoring this ridiculous and ill-timed bill, H.R. 367? Doesn’t she have better things to do?

She’s co-sponsoring H.R. 367 because this bill is a flag waving in the vanguard of National Rifle Association’s war on any and all regulation of guns. No doubt it pleases those few of the NRA’s membership (guessed to be only around 5 million.) so rabid as to feed on the NRA devotees like the Redoubters. Co-sponsorship of H.R. 367 proves fealty to the cause of “protecting the Second Amendment.” McMorris Rodgers co-sponsorship demonstrates she is either gullible or devious. Gullible if she signed on believing H.R. 367 is actually about “Hearing Protection.” Devious if understands H.R. 367 is a sop to the crazies, an inadvisable repeal of law that works, and further believes her constituents are not paying attention. 

I know many gun owners. I haven’t surveyed all of them, but so far I’ve only met one who would look me straight in the eye and argue for H.R. 367. If he had his way all gun regulation would be repealed and we would all be armed to the teeth. I reject that view of the future and I believe I am in a large majority of reasonable people, gun owners, sportsmen, gun fearers, parents, and students who reject that future, too.

Don’t let the Orwellian framing of this bill fool you. Co-sponsoring the repeal of important, long-standing gun legislation should be a disqualification for public office. To co-sponsor this repeal as we suffer mass shootings of children, students, concert goers, and, yes, policemen, is a stark demonstration of legislative malpractice and a dysfunctional moral compass.

Ask McMorris Rodgers what she was thinking.

Keep to the high ground,

Jerry

A Nice Business Perk With Your Omnibus Spending Bill, Sir?

Dear Group,

The chart above is a screen shot taken of the stock price of Omeros, a small bio-pharmaceutical company based in Washington State. Last week overnight between Wednesday and Thursday its stock price jumped from 11.56 to 16.78 dollars per share, an increase of 45 percent. Wouldn’t you have liked to already own that stock on Wednesday (and maybe sold some of it on Thursday)?

I guess this is the way the real money is made in the stock market. Institutional investors trading overnight had gotten wind of something about Omeros. When the markets opened to the little guy on Thursday morning the price had already popped. What happened?

This is where Cathy McMorris Rodgers and Paul Ryan come in. If you’re pressed for time go to FoxBusiness for the source article, but if you want the expanded version read on. (Versions of this article  also appeared Sunday in the Spokesman and the Sandpoint Daily Bee.) First, some background:

The story of Omeros’ overnight stock bump is the story of Omidria, the company’s main cash cow drug. Omidria is a combination drug (see details in the P.S. below) used only in eye surgery, specifically cataract surgery. The surgeon injects the drug into the front of the eye to dilate the pupil and reduce inflammation and discomfort. Omidria comes in a single use vial. The company priced the drug at nearly $500 per vial. For two years, as is the custom (since Medicare is forbidden to negotiate drug prices with drug companies) Omeros was paid by Medicare as a “pass-through,” i.e. Medicare paid the cost of the drug to Omeros. Without a “pass-through” exception like this one for Omidria, Medicare ordinarily says to the surgery center: “Here, you have this amount of money to do this surgery, everything included, you pick what you use.” That’s what Medicare usually does. So for two years cataract surgeons got to try out Omidria without thinking about the cost of the drug, i.e. the cost didn’t come out of their pockets, their patients pockets or the pocket of the surgery center in which they operated. Instead it came out of our pockets, from dwindling tax revenues. (For perspective Medicare’s “allowed” global fee amount to a hospital for a cataract surgery is $1,921.09.  For an ASC, it is $978.21. That’s before geographic adjustments. It does NOT include the surgeon’s “allowed” fee. Now consider the “passed through” price of Omidria is $500. That’s half again the outpatient surgery center’s global allowable. Drugs pricing is absurd.)

The idea is supposed to be the surgeon will learn in which patient’s eyes the drug is and isn’t useful, consider the cost of the drug, and balance the two in deciding what to use. The drug company bets that enough surgeons will believe the drug offers an advantage also hopes they will incorporate the drug into every cataract surgery while the price of the drug is not an issue. Omera tries hard to insure that use of Omidria becomes the “standard of care.” Then when Medicare drops the “pass-through” payment there will be a lot of whining about not being able to afford to use this wonder drug.

We’re all supposed to forget that the company Omeros got to name the almost $500 price tag at the beginning of all this, and we’re supposed to forget that Omeros is a publicly traded company with a stock price and a lot of money spent on marketing and lobbying. (So far they haven’t offered a penny of dividends.)

After two years we are also supposed to forget older, much cheaper drugs work just fine for the vast majority of cataract surgeries for dilating the pupil and suppressing inflammation.

Take note there is no free market for this drug. The original price is established by the company. Medicare is forbidden to negotiate the price. No patient gets to shop around even if they were knowledgable enough to do so effectively, and until the “pass-through” goes away, neither the surgeon nor the surgery center sees the cost or feels the pinch of the cost. Essentially, the system allows drug companies like Omeros to offer a “free” trial period in which to hook their surgeon customers, all on the taxpayers dime.

Omeros’ “pass-through” payment expired the end of 2017. Its stock price slumped from $20 to near $10 over a couple months where we find it in the above graph last Wednesday evening. What’s a CEO to do? Apparently, he or she goes to their “pro-business” Congresspeople to get a “rider” on a “must pass” bill like the Appropriations bill Trump signed last Friday. If a Congressperson is clever it is pretty easy to tuck away a provision to help out a campaign contributor in one page of text in a 2,232 page bill. Surely no one will notice. Hell, nobody will even bother to read all those pages, will they?

Actually, they will read it. FoxBusiness published an article entitled “Benefits of lobbying evident for small drugmaker” on March 24 from the Associated Press. Particularly considering the conservative source, it is well worth your time to read. McMorris Rodgers portrait is found at the top of the article.

According to the article McMorris Rodgers and Paul Ryan slipped this into the “must pass” bill at the last minute. You can read the pertinent section of the law here. It’s on page 1949 and it’s entitled “TITLE XIII—REVISIONS TO PASS THROUGH PERIOD AND PAYMENT RULES.” To be fair, both Parties have a history of slipping little zingers into “must pass” bills, zingers that couldn’t possibly get enough of attention of Congressional leadership to bring up, discuss, and actually have a separate vote.

  • Omeros spent just over $1 million on lobbying in 2017, up from $645,000 a year earlier as the company brought aboard two new firms to make its case to Congress and the Trump administration, according to lobbying disclosure records filed with the House and Senate.
  • The political money website Open Secrets shows that Omeros CEO Demopulos donated $39,600 in the 2018 election cycle to the National Republican Congressional Committee, the campaign arm of House Republicans. [some of which money will no doubt flow back to our district to defend CMR and smear Lisa Brown]
  • Federal Election Commission records show that Demopulos also donated $5,400 directly to Speaker Ryan’s campaign on Aug. 31, 2017. [That’s the maximum legal direct-to-the-candidate donation.] Demopulos gave $5,000 to Ryan’s political action committee, Prosperity Action Inc., on the same day.

McMorris Rodgers defense from the FoxBusiness article:

  • Nate Hodson, a spokesman for McMorris Rodgers, said she pushed the measure ‘to provide patients across the country access to safe, innovative, life-changing drugs.’ 

Perhaps her heart IS is the right place on this, but even if it is, this rider of hers and Ryan’s doesn’t smell right considering the circumstances. There is NOTHING about the lauded “free market” in this rider. It IS “pro-business,” though, a specific few businesses graced with $26 million of our tax money over ten years.

From another source, The Northwest Arkansas Democrat Gazette. (Rated “Center Right” by mediabiasfactcheck.com) [Bold is mine.]:

  • This provision is the correct policy, was approved by both Republicans and Democrats involved in writing the bill, and was included at the request of members of our conference,” said Ryan spokesman AshLee Strong. “To suggest any other reason is not only false but absurd and insulting.

Sorry, Mr. Paul Ryan, it may be insulting, and properly so, but it is NOT absurd.

This in a time when the public is fed up with drug prices… You choose for Ryan and McMorris Rodgers. Are they hapless victims of their own good intentions or are they trying to pull a fast one to satisfy a campaign contributor? I don’t see another option and I like neither of the alternatives.

Keep to the high ground,

Jerry

P.S. Omidria is a combination of two drugs, phenylephrine 1% and ketorolac 0.3% . Phenylephrine has been around many, many decades, ketorolac more than a decade. To be sure, injecting these drugs into the eye is a new use. Getting that approved by the FDA no doubt required expensive testing to prove safety and efficacy, but these are NOT new drugs.

A Political Journey–My Changing Impression of the Democratic Party

Dear Group, 

In the lead up to the November 2016 election, I had an uneasy feeling as I watched TV coverage of the national Democratic Party, all the glitz, the balloons, the festoons, the fancy clothes, all the symbolism of wealth and power. I confess I felt a little manipulated, a little condescended to, by a national Democratic machine divorced from my reality. (If i channel surfed to the Republican scene the unease I felt over the Democrats was quickly replaced with gut-wrenching revulsion.) 

In my imagination politics in general was always a dirty, messy, and possibly underhanded endeavor, almost certainly manipulated by big money. My mental “frame,” the image that lit up in my brain at the mention of politics, was an image mapped on that old velvet print wall hanging often seen in basement recreation rooms. You know the one. Usually it was on the wall next to the pool table. It depicts dogs sitting like men around a table playing poker, each wearing a green visor and smoking a cigar, the whole scene in a dimly lit, smoke-filled room. That was the Democratic scene for me. My frame of the Republican poker table had the dogs sporting top hats, tails, and cigars, looking like the plutocrat in Monopoly. In my mind’s eye I didn’t have a place to sit at either table. 

Shortly after the Trump minority election, feeling thoroughly desperate, abandoned, and fearful for my country, I started writing this Indivisible Group email to twenty friends I thought might want to commiserate. I did not write as a Democrat. I wrote and continue to write as an independent mind, an “Indivisible.” I am not by nature a “joiner.”

In the last year and a half as an observer and/or participant in the politics of eastern Washington and northern Idaho my mental image, my frame, has changed a lot. I have met dozens of other people who share my same concerns. I have met widows at their doorsteps who confided to me in a whisper that they were Democrats, widows who said hey were afraid to mention politics to their neighbors for fear of a nasty response. I have met Republicans who regret voting for Trump, Republicans who fear for their country in the same way I do. I have had neighbors I thought were probably vehement Republicans make a point to pull me aside and tell me they took heart at my “Repeal Cathy, not the ACA” yard sign.

With my smoke-filled room mental image, imagine my surprise when I showed up at the new digs of the Spokane County Democrats (in the Teamsters Building on the NE corner of Division and Indiana) and found a lot of friendly people, friendly people with my same worries and concerns, friendly people who have been nurturing the local Democratic Party apparatus during dark times in eastern Washington and nationally. There I met a mix of people very familiar with the candidates and races and vote numbers and a lot of folks like myself who for years had overlooked local politics and instead were captivated by the national drama…and had felt helpless, disenfranchised and dismayed.

The local Democratic Party is and will be what we make of it. As individual citizens concerned for the future of our county it is time to throw out that tawdry dogs-playing-poker image of politics, roll up our sleeves, “come out” if you will, talk with our friends and neighbors and use the knowhow and the political scaffold that is the local Democratic Party, use it to get this ship turned around. I can work with this Party and retain my identity. I recognize among the many in this local Party members of my tribe.

Join me tomorrow, Saturday at the Spokane County Democrats at 10:30A-12N to learn more. For details, check out yesterday’s email.

Keep to the high ground,

Jerry

The Myth of the Free Market in Health Care

Dear Group,

Nationally we stagger, punch-drunk from issue to issue, taxes, DACA, tariffs, MeToo. The list goes on. We need to come back to this: Cathy McMorris Rodgers and “movement conservative” ideology is plain wrong and out of touch on many things, but nowhere are they more wrong than in the application of their ideology to health care in this country. On February 21 I sent out the email I’ve copied below.  I present it again today to remind us how unpopular McMorris Rodgers’ efforts to repeal the Affordable Care Act were and still should be. This issue should be front and center on our way to November.

CMR’s Ideology and the Myth of Free Market Health Care

Here in these United States we spend more than $10,000 per year on health care on average for every man, woman and child. Canada and the United Kingdom each spend per capita less than half that per person. In spite of spending less than half as much per person than we do, health outcomes in Canada and the United Kingdom are better than ours. Yes, in Canada you might have to wait, but in Canada people with diabetes have access to treatment. They don’t have to make a choice between getting treatment and feeding their families. They don’t have to neglect their disease for fear of bankruptcy, go blind, and wind up on the Canadian equivalent of Social Security Disability.

While Cathy McMorris Rodgers remains in office this WILL NOT CHANGE. Why is that? It is because McMorris Rodgers has drunk the Republican/Libertarian Kool-Aid. Contained in that Kool-Aid is the absolute conviction that the free market solves all problems and that all government social programs are inefficient and foster dependence.

Facts that don’t fit her mind frame of Libertarian ideology bounce off–if they reach her at all. At a “Coffee With Cathy” in April of 2017 I brought up the Canadian experience. Her response was pure Republican/Libertarian framing: She asserted that Canadians come down to the United States in droves to get procedures done in the United States on account of endless waits and rationing.

Spokane is a major medical center close to the Canadian border. I told Ms. McMorris Rodgers I practiced for 28 years doing ocular surgery, quite a lot of it urgent and emergent. I told her that in those 28 years I operated on just one Canadian patient. I told her that I have many Canadian friends, and that all of them speak well of the Canadian health system. There was a brief blank stare in response, a tiny gap before she pivoted to another angle. Was that the moment my reality bounced off her frame? I’ll never know. 

Did McMorris Rodgers carry this inconvenient fact with her as a result of our meeting? No. On May 4, 2017, she enthusiastically voted for and cheerled the American Health Care Act, the AHCA, aka Trumpcare. There was nothing in that bill that was aimed at reducing the per capita cost of health care or even a glimmer of recognition that other countries have great health care systems that cost half of what we spend. Instead, the AHCA would have moved us further away from national systems.

The Republican House AHCA…proposed major reforms relative to current law (ACA) that would substantially reduce the number of persons covered, moderately lower the budget deficit over a decade, reverse the tax increases on the top 5% (mainly the top 1%), dramatically cut Medicaid payments (25-35%) that benefit lower-income persons, and expand choice by allowing lower quality insurance to be purchased at lower prices for the young and middle-aged.  Wikipedia

Notice the earmarks of Libertarian ideology. McMorris Rodger’s AHCA cut taxes on the rich (a basic tenet of her faith), lowered total government expenditures over a decade (which she later enthusiastically gave to corporations and the already wealthy by voting for and cheerleading the Tax Scam Law), and cut money out of a social program, Medicaid (another of her fundamental tenets of faith). Would it lower the per capita cost of health care? NO! It pretended to lower cost by expanding “choice” (a fundamental talking point), in this case, the “choice” was to buy inadequate insurance and expose oneself to medical bankruptcy. 

Oh, yes, there is one McMorris Rodgers talking point about lowering the actual cost of care. What is it? “Encouraging competition by increasing transparency.” Really? The patient is going to lower the per capita cost of health care in the system by shopping around for the cheapest lab test or MRI? That isn’t just unrealistic, it is absurd. A very few patients equipped to critically evaluate quality and willing to spend the time might bargain for the best deal in this market, but that is a tiny minority. You won’t find Trump or Charles Koch bargaining for a cut rate MRI. They’ll hire the best physician they can find to get the best MRI…and damn the cost. The folks with the least time (working two minimum wage jobs) and in the most dire circumstances (presenting with a neglected and now acute problem) certainly are NOT going to “shop around”. What make-believe planet do these free market true believers live on?

McMorris Rodgers’ slavish devotion to free market ideology blinds her to reality. The unfettered, unregulated free market is the bedrock tenet of the “Republican cause,” the cause for which she hones the sales pitch. Health care in this country is ridiculously expensive because it is not and never will be a “free” market. No amount of pontification by Paul Ryan, McMorris Rodgers and the Freedom Caucus will make it so. Pretending that free market principles will lower cost in a for-profit environment is a delusion from which McMorris Rodgers is incapable of recovering. 

Our country’s problem with health care cost will not be solved while McMorris Rodgers is in office. Her ideological frame prevents her from understanding. Send her home.

Keep to the high ground,

Jerry