Death, not taxes 

Budget cuts could lead to more unnecessary deaths

Attached to every bill that moves through the Legislature is a one-page raison d'etre, the generally unbiased description of the law change and best guess at its cost. It's called the Statement of Purpose and Fiscal Note.

And only rarely does it suggest killing off citizens.

But the SOP attached to a repeal of a state program that helps pay for chronic cystic fibrosis treatments for adults, SB 1082, comes pretty close: "In the 1970s, most individuals with CF would not live to adulthood. Medical literature indicates the median life expectancy is now 36 years of age, and many people with CF live much longer. The cost for care and treatment of an individual with CF now well exceeds the rule cap of $18,000 annually. Due to budget constraints, repealing this law is necessary to allow the Division of Health to meet its budget reduction goals."

Along with great leaps forward in medicine, the Great State of Idaho has, since 1978, helped one group of vulnerable citizens survive into their adult years. We spent a miniscule amount on the program for years, and since 2005, about $211,500 a year to help clear the thick, infected mucus from patients' lungs and keep their pancreases functioning.

If the benefit is removed, a handful of the 63 adults with cystic fibrosis who utilize the funds, eight of whom are uninsured, will not be able to continue treatments.

"One way or another, these patients are either covered or they die," said Dr. Perry Brown, associate director of the Cystic Fibrosis Center of Idaho.

But, according to the Fiscal Note, taxpayers will save $205,000 a year if the program disappears, and the Department of Health and Welfare believes patients will find other coverage.

Children with cystic fibrosis will continue to get help because the federal government pays for the bulk of their treatment. So at least CF patients' lifespans won't drop below 21 again.

Another stark, life-or-death decision that the Legislature is making right now is the delay, if not demise, of a nascent suicide hot line, hosted at Idaho State University's Institute of Rural Health.

ISU won a grant to restart a suicide prevention hot line in Idaho, one of three states that does not participate in the national hot line, called Lifeline. About to launch the pilot program, the Legislature proposed slashing Health and Welfare's available grant funds in half, to $500,000.

"Right now, everything is on hold," said Ann Kirkwood, an ISU researcher and coordinator of the hot line grant.

The hot line was granted $374,000 for startup and pilot project costs, but Kirkwood does not know if she will get half of it, or any of it, and she doesn't know if she can pull the project off with reduced funding.

Idaho has one of the highest suicide rates in the nation, regularly placing within the top 10 states. Kirkwood has said that 14 percent of Lifeline callers reported that their conversation had averted their suicide, according to one study. Another study showed that only 7 percent of callers are at imminent risk for suicide.

So there is evidence that for every year's delay in setting up the hot line, some number of Idahoans will take their own lives unnecessarily.

There is one life-or-death government function that is likely to get more funding this year: fixing Idaho's roads.

Nearly all of the material that the Idaho Transportation Department has developed to sell the public and the Legislature on increasing taxes to pay for roads includes morbidity statistics.

The most frequently cited number is 252 deaths on state highways in 2007.

"It's a big factor for anyone who has had a loved one killed," said Sen. John McGee, chairman of the Senate Transportation Committee and a major proponent of increasing road funding.

McGee recalled a college girlfriend who was killed when her car slid off the road and his brother's two best friends who died in a car wreck in 1996 on their way to attend the University of Idaho.

To combat these deaths and the rising price of liquid asphalt, Gov. C. L. "Butch" Otter is recommending a package of new taxes and fees that will, in five years, raise $174 million a year for ITD.

The bulk of the new funds come from raising the state gas tax, but all of the other measures are transportation-related fees and taxes as well. Otter believes that the user should pay for the service.

But there are plenty of drivers who have never been in an accident, or who never venture beyond their neighborhoods or small towns or who do not need a new shiny interchange to make it easier to get to a shiny new mall.

We are users of the highway system in much the same way we are users of the health-care system—at any minute a loved one could be born with cystic fibrosis or clinical depression.

Or, in another potentially catastrophic public health decision, struck with rubella.

Health and Welfare, in another cost saving measure, is ending Idaho's universal immunization policy.

Up to now, the state has purchased bulk vaccines and distributed them to doctors for all Idaho kids. Health and Welfare has proposed ending that service for kids who are privately insured, meaning that doctor's offices will have to stock two stashes of vaccine—the government shots and the private shots—and start charging some kids for their hepatitis and tetanus and diphtheria inoculations. Or they may quit doing vaccinations altogether.

Again, in a state where vaccination skepticism has already led to a very low vaccination rate, the cuts will mean that fewer kids get their shots.

The state's vaccination rates will drop into the realm of the Maldives or Puerto Rico to save about $2.8 million, Brown said.

"We will pay for that in spades down the road in terms of hospital costs and bad outcomes for our kids," Brown said.

There is one more area in which the state is moving away from killing people. A decline in prison populations means the state prisons actually can afford to make some cuts to their budgets without further endangering prisoners' lives. And in an even more positive step for Idaho prisoners, there is this revolutionary, 21st century bullet-saving proposal on the table: to eliminate the state firing squad.

Which, of course, has been replaced by a cocktail of unnamed lethal chemicals. Because sometimes the state is really in the business of killing folks.

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