Dr. John Livingston 

On charity, Medicaid and Idaho's largest hospitals

On the living room wall of Dr. John Livingston's Boise home hangs a framed, hand-written letter from Mother Teresa.

"It was sent to me when a fellow surgeon told her about my work at a Catholic hospital in Reykjavik, Iceland," said Livingston.

As a U.S. Navy surgeon, Livingston traveled the world for 12 years until settling in Boise, where he served as a general/trauma surgeon for 25 years at St. Al's Regional Medical Center.

His new journey is as a special medical adviser to the Idaho Freedom Foundation, which boasts to be "the Gem State's leading voice for conservative principles." Livingston agreed to a sit-down interview—his first—with Boise Weekly to talk about his opposition to expanding Medicaid in Idaho in order to serve the so-called "gap population," which estimated to be 78,000 citizens, who earn too little to access coverage through the state insurance exchange and too much to qualify for standard Medicaid. We talked for two hours. Here's an abridged version of our conversation.

Can I assume that your faith informs much of your life and your life's work?


Can you layer that faith atop the debate on how we should care for Idaho's uninsured?

It's an individual's responsibility.

Shouldn't a government serve as a reflection of those individuals?

Nowhere in my Bible did I ever find that government was supposed to be a conduit for charity.

But when nonprofits have done everything that they can, shouldn't it be a government's role to step in to make sure more Americans have access to care?

Nonprofits doing all they can? Oh, please.

Let's talk about two of Idaho's largest nonprofits: Saint Al's and St. Luke's hospitals. You've made a point of asking Idaho to take a closer look at how those hospitals should play a greater part of a solution to help the uninsured.

You have two large hospitals in this town with $4.2 billion in revenue per year. Yet, they've been given nonprofit privileges by the citizens of Idaho who have the right to have those hospitals undergo an independent, outside audit.

To be clear, the doctors, nurses, technicians and staff are incredible at Saint Al's and St. Luke's. But I think those resources are being exploited by the administrations of those institutions.

But can't we agree that both Saint Al's and St. Luke's write off tremendous amounts of money to provide care for those patients who have no, or little, financial means?

I don't know that. Do you?

I choose to believe their annual reports.

Be very careful. They have three pots of money: charity care, indigent care and uncompensated government transfers. And they play a shell game with those numbers. One set of books is based on cost-accounting methodology and another set of books is based on something called a charge-master system, indicating how much they would bill an insurance company.

I'm sorry, are you saying that they're inappropriately writing off the differences between those two figures?

I'm not a CPA.

But that's what you're implying.

What I'm saying is simple. If you combine the margins on $4.2 billion of revenue, plus the taxes that those hospitals don't pay, we could go a long way in providing indigent care.

Are you saying that our major hospitals are an untapped solution to serving more of Idaho's uninsureds?

No. I'm saying they're part of the problem.

What will your role be for the Idaho Freedom Foundation?

To represent a philosophy, proven, from the beginning of time, that the best way to allocate scarce resources is with the free-market system.

And charity...

Charity is a personal transaction. What I do for another person is charity. But when the government becomes the conduit of charity it's giving somebody else's money away. It's a very bad thing.

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