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John Livingston

Medicaid is in Trouble

I am John Livingston and I have practiced surgery and medicine in Idaho and the Military for over 47 years. On July 1st I retired from the practice of Medicine and surgery. I am Board certified in Internal Medicine and General Surgery. I was appointed and served on The YHI Health Insurance Exchange Board for […]

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Bob's Words of Wisdom

Will Medicaid Expansion Bankrupt Idaho?

It was back in 2015 that we along with the Idaho Freedom Foundation warned Idahoans about the problems with containing costs if Medicaid Expansion was approved in our state. It was eventually passed by referendum and is now chewing up tax dollars beyond belief. Why are we subsidizing those who are capable of paying for […]

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John Livingston

Bigger is Not Always Better

Everything is getting bigger. In my profession, the doctor-patient relationship has been all but destroyed by “vertical and horizontal integration” with hospital systems buying up medical practices and then employing physicians and physician assistants and nurse practitioners. Then the hospital systems are bought up by insurance companies or vice versa, and then the mega company […]

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Bob's Words of Wisdom

Profits vs Patient Outcomes

When assessing any corporation or for that matter a business entity it is important that you have an in-depth understanding of those personnel who are running it. When we look at today’s medical facilities such as large integrated hospitals, we find many times that management does not understand the problems that must be delt with […]

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John Livingston

Modern Day Lafayettes

I would like to offer a “tip of the hat” to my friends at The Idaho Freedom Foundation. In an article published two days ago, the authors Fred Birnbaum, Ronald Nate PhD., and Niklas Kleinworth outline in a policy paper entitled MEDCAID IN IDAHO: A POLICY PRIMER the predicate, the unfulfilled promise, the financial house […]

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John Livingston

And Now for the Rest of the Story

There is so much political NOISE in the world today that one of my great fears is that the great majority of people in our State and country will just “turn it off”. What would happen if there was a day where there just wasn’t any news? Would all the news channels just sign off […]

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John Livingston

Liberty and The Doctor-Patient Relationship

I spent 16 years practicing medicine and surgery in the United States Navy. Some of the best surgeons and most compassionate physicians I ever met in my 46-year career were in the Navy. Military medicine like the Veterans Administration (VA) system and the Indian Health Service (IHS) is a single payor socialized form of medicine. […]

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John Livingston

Are Today’s Hospitals Big Business or Quality Healthcare?

Over twenty years ago I first was introduced to the concepts of “asymmetry, agency, and scale” while visiting my son’s finance class during parents’ weekend at Gonzaga. The teacher of the class, Mr. Kent Hickman was one of the authors of the textbook FOUNDATIONS OF CORPORATE FINANCE that is used even today at many colleges […]

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Bob's Words of Wisdom

Why is Idaho the 48th State in Mental Health?

As many of our readers may know that three years ago, I moved to New Meadows Idaho from Meridian as the neighborhood I lived in was becoming more congested with traffic and slowly but surely deteriorating and turning into something I didn’t want to deal with. As I told Kevin Miller many times, I needed […]

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John Livingston

Assessing Medical Risk

For the last several weeks I have been reviewing cancer survival statistics from patients that were treated for their disease during the pandemic. My eyes are glossing over from reading Meier-Kaplan curves. The Meier-Kaplan curve is a graphical representation of the survival function. It shows the probability that a subject will survive up to time […]

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John Livingston

Old Soldiers

One of the hardest aspects about retiring, I still hope to volunteer and hope to do mission work, is accepting the fact that I am increasingly becoming professionally less relevant. In some ways, this has crossed over into my personal life. Last Mother’s Day my granddaughter and I approached the maitre d at The River […]

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John Livingston

Racism in Medical Education

Higher education has become obsessed with “woke culture.” I graduated from Medical School at THE OHIO STATE UNIVERSITY in 1976. Already at that time “sensitivity training” and cultural awareness programs were starting up. These were not in the basic or clinical sciences but could be found in Public Health Departments. The Department of Engineering at […]

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