Episode 118– You can also listen on Apple podcasts, Spotify, Stitcher, Google podcasts, and Amazon Music
About the Episode
In this episode of the “I Love New Mexico” podcast, host Bunny Terry converses with Fred Nathan, founder and executive director of Think New Mexico. They delve into Fred’s background and his organization’s efforts to improve education and healthcare in the state. Fred shares personal anecdotes, including his interactions with Governor Michelle Lujan-Grisham. The episode highlights the challenges and successes of Think New Mexico’s campaigns, emphasizing the importance of community engagement and policy reform to enhance the lives of New Mexicans.
Think New Mexico
I Love New Mexico blog page
Bunny’s website
I Love New Mexico Instagram
I Love New Mexico Facebook
Original Music by: Kene Terry
About Fred Nathan and Think New Mexico
Fred Nathan, Jr. founded Think New Mexico and is its Executive Director. Fred served as Special Counsel to New Mexico Attorney General Tom Udall from 1991-1998. In that capacity, he was the architect of several successful legislative initiatives and was in charge of New Mexico’s lawsuit against the tobacco industry, which resulted in a $1.25 billion settlement for the state. Fred serves on the boards of Santa Fe Preparatory School and the Thornburg Foundation, and is a former trustee of his alma mater, Williams College.
Think New Mexico is a results-oriented think tank whose mission is to improve the lives of all New Mexicans, especially those who lack a strong voice in the political process. We fulfill this mission by educating the public, the media, and policymakers about some of the most serious challenges facing New Mexico and by developing and advocating for enduring, effective, evidence-based solutions.
Episode Transcript
Automatically Transcribed With Podsqueeze
Bunny 00:00:02 Hi there. I’m Bunny Terry and I’m the host of the I Love New Mexico podcast. We talk about everything here. There are no boundaries. We talk to people who are from all corners of the state, people who are chefs, who are tourists, who are artists, who are Chamber of Commerce executives, and who are from ranch families that have been here for hundreds of years. New Mexico is enchanting, and it’s interesting. And I can’t believe I get to do this job. New Mexico is so amazing, and I invite you to come along for the ride on the I Love New Mexico podcast. Thanks for being here. Today on the I Live in Mexico podcast, you’re all going to be happy to know that my great friend and one of the biggest advocates for the public in all of New Mexico. Fred Nathan from Think New Mexico is our guest today. And for those of you who don’t know about Think New Mexico. This is a bipartisan, result oriented think tank that has been serving New Mexicans for 25 years.
Bunny 00:01:18 You just had your 25th anniversary this year, right, Fred?
Fred 00:01:22 That’s correct.
Bunny 00:01:24 And I have a very handy dandy, bio of about Fred so that I want you to know who he is. But I also want you to know that we have known each other for a very long time. In fact, I think that it was even. Well, here’s here’s how long we’ve known each other, Fred. The year that we met each other. the governor’s daughters were in a stroller so everybody can figure out what that is. That’s one of the things I remember about that year that I met you is when we went to Greek Fest. And those little Grisham girls were in a stroller. Do you remember that?
Fred 00:02:02 I do, in fact. I took the bar review exam with the future governor. I can tell a funny off color story. You might enjoy this. Yeah, there are many Michelle stories, but, when I came to New Mexico was 1987, and the first thing I did was to register for the bar course, and I sat in the second to last row in the middle, and right behind me was Michelle.
Fred 00:02:32 And the first day I came in and she was giving me a hard time saying, you’re not from here, are you? And it went downhill from there. But she was always teasing me and saying, well, do you know anybody? I mean, do you have relatives here? And I said, no. Do you have any friends? No, I’m just moving here. And anyway, the exam that year was especially grueling. It was three days. I don’t think it’s that long anymore. And there was a huge party. Everybody in the course at a home near the law school, and I really had to study because I went to one of these law schools where it was all theoretical, and I really didn’t know the black letter law. So anyway, I was exhausted, and I was probably the first one to leave the party at at midnight. And I’m driving home in my little Chevy Nova and there’s this clanking noise. And I remember praying that I could get back to my tiny pink apartment.
Fred 00:03:31 And, and and I fixed it in the morning, and I get home and I look under the car to see what it was. You know, I was thinking it was some big part dragging on and there’s nothing there. And then I go to the back and somebody had put rusty tin cans on the back of my car and wrote just Married to rub it in, that I didn’t have a girlfriend in school. And now I wasn’t so, tired anymore. And I knew the only person that could be was Michelle. I drove back to the party, and I’m from New York originally, so I know a lot of bad words. And I said all of them. This is the worst career move of all time to Michelle. She never forgot it. We patched it up, but I remember I went to a fundraiser for her. the first time she ran for governor, I came a little late. It was a restaurant in Santa Fe, and she said, oh, there’s Fred. Nathan, I want you all to know, Fred Nathan does not have a sense of humor.
Fred 00:04:33 And she didn’t explain. And, you know, half my friends were there, and they all said, like, what did you do to her? So anyway, that’s my story from 1987. But never curse out a person who might become a future governor.
Bunny 00:04:50 Well, we’ve done I, I, when we, you know, we do these things every once in a while on the with the Cancer Foundation, where we’re all getting a room and to get better acquainted, they’ll say, tell us three things that, two of which are a lie, and one of which is the truth that you’ve done in your lifetime. And mine has frequently been that I’ve danced the current governor, and nobody ever believes that. But that was it was, you know, we’ve we’ve known her and I’ve known you for a really long time. But you are. Wow. 25 years, I just I have to read your bio because I’m so impressed with you. Who knew when you showed up in that little Chevy Nova, which I remember very well, that you would be such a driving force in the state.
Bunny 00:05:41 But I want you guys to know that Fred Nathan Junior founded Think New Mexico and is its executive director. Fred served as special counsel to New Mexico Attorney General Tom Udall. From 1991 to 1998, and in that capacity, he was the architect of several successful legislative initiatives and was in charge of New Mexico’s lawsuit against the tobacco industry, which resulted in a $1.25 billion settlement for the state. Fred serves on the board of Santa Fe Preparatory School and the Thornburg Foundation, and is a former trustee of his alma mater, Williams College. So, Fred, even though you’re not from New Mexico, you are doing amazing things here. And and I want folks to know that if you don’t, if you’re not familiar with Think New Mexico. Think New Mexico is in the business as a nonprofit, of course, of changing and improving the lives of New Mexicans. I mean, one of the reasons we don’t have a food tax is because I think New Mexico, one of the reasons that predatory loans were. There was reform in that area is because of the work you do.
Bunny 00:06:53 I mean, the list is long for. Tell me what you’re proudest of. It feels like that would be difficult. But in your role as the as the founder and Ed.
Fred 00:07:02 That’s, that’s like asking me to choose between my children because, you know, we spent a year at least on these campaigns, sometimes three years, like the food tax took three years to repeal. Probably the number one was was our first issue to make full day kindergarten accessible to every child in the state. It was such a interesting ride and odyssey to get there. and I can I can tell you more stories that.
Bunny 00:07:32 Well, I it feels like you were in the midst of a huge battle last year when you were working so hard on educational reform. We talked about that, I think, last December. And you had great you had amazing ideas that seem like really. I mean, it seems so common sense to do the right thing for children in terms of education. What what were the advances? What how do you how do you feel about last year’s initiative?
Fred 00:08:00 So, two years ago, we did a report on creating sort of a roadmap for fixing our educational system.
Fred 00:08:08 And we had ten major proposals. we also hired a wonderful woman named Mandatario, who’s a former 2020 New Mexico Teacher of the year, to lead the campaign and be the tip of that spear. And I’m pleased to say that we’ve got about 30% of it done. One was, to get more time on task. it’s really remarkable how little time actually is spent on learning. so we, you know, and that sort of the low lying fruit that’s pretty much worked everywhere. A second proposal that we got to the finish line was to create teacher residences. So rather than what we’ve been doing, which is, you know, a teacher comes out of the College of Education and they immediately get thrown in the deep end and they’re given a class. What other states have found success with, and which we’ve recommended here, are to create these teacher residencies, where new teachers are paired with the seasoned teacher for a year, or at least a semester, so they can learn things about class, you know, how to keep control of the classroom and so forth.
Fred 00:09:19 And what’s been shown nationally is that teachers that that do these residencies stay in the profession almost twice as long as those that don’t have, teacher residencies. Mandy, for example, did two residencies before she ever got her own classroom and then later became a teacher of the year. That’s anecdotal, but anyway, so that’s, Well on its way to being something that every new teacher in New Mexico will have. We’re up to about, I think, 40% of teachers. And then a third thing that we got to the finish line just last year was to improve the training of school board members, which doesn’t sound like that big a deal, but so many, so many of the most important issues really weren’t part of the training. For example, how do you read a budget and and do a budget? These school board members collectively are basically spending about $4 billion. And there’s a lot of jargon and education budgets. And what we were hearing was there was a lot of rubber stamping. And so that’ll now be a part of the training so that they learn to, you know, ask the important questions, like, if we approve this budget, how much will that increase spending in the classroom versus central administrative spending? You know, what really counts is dollar spent in the classroom a governance? There’s still a lot of confusion around what are the roles and responsibilities of school board members.
Fred 00:10:58 The average tenure of a superintendent in New Mexico is two years. And what we discovered is the reason, and obviously that’s part of the problem. If you have the person at the top of the the the district constantly changing, that doesn’t work in business or nonprofits or government. And the reason there’s so much turnover, we learned from talking to superintendents is new school board members get elected, and they immediately go to the superintendent and say, I want you to fire the football coach, the athletic director and my next door neighbor who’s a third grade teacher, and then the superintendent has to explain. Well, actually, that’s my decision, not your decision. you just have one employee. That’s me, the superintendent. And then the superintendent is shown the door. the joke is to be a successful superintendent in New Mexico, you have to be able to count to three. And the reason is because you always have to have three of the five, school board members on your side. But a better approach would be just to train them up on their roles and responsibilities so we don’t create this turnstile.
Fred 00:12:14 and then the third thing that wasn’t in the training is, what can you do as a school board member to lift academic outcomes? For example, in North Dakota, every district has to choose from a menu of school reform issues like closing the achievement gap, increasing high school graduation rates, increasing literacy rates. In New Mexico, we found that many districts didn’t have any academic goals. So anyway, so that was the third. Third issue that we’ve gotten to the finish line. And this year we’re going to try to reduce class sizes and cap class sizes from kindergarten to third grade at no more than 20 students. You know, we’re 50th in the country in in reading by the third grade. And we think part of the problem is and we’ve documented this, about a third of those classes are, you know, 25, 26. There’s some in 2024, there are some classes with 34, 35 students. And we wonder why teachers aren’t able to get everyone reading. And you know, I know because I have a daughter who’s actually not in New Mexico, but she’s got a second grade class of 32 students.
Fred 00:13:31 And she says to me, you know, dad, when it’s just me, she’s sometimes she has a co-teacher, sometimes she does. And when it’s just her, she says, I have to choose between teaching or trying to control the classroom. You know, it’s triage. So we’re certain this is something that would be very effective, not only increase reading rates, but also reduce teacher attrition. A lot of teachers just are frustrated that they’re given so many students. They can’t give each student the attention they deserve and they leave the profession. so this is something that would be good both for the students and for the teachers.
Bunny 00:14:13 I strongly support that because, as you know, I come from a very I mean, I graduated I was in the almost in the top 10% of my class because there were 16, 17 of us and I was number two. So. Uhhuh.
Fred 00:14:26 That counts.
Bunny 00:14:27 So it makes a huge difference. But and this year you I thought education was going to be my favorite reform ever.
Bunny 00:14:35 But this year you’ve really you’re really speaking to something that’s very near and dear to my heart. So explain to our listeners what your initiative is this year.
Fred 00:14:44 So this year’s focus also a ten point plan. And we’ve hired a health care reform director named Alfredo Vigil, who was, Governor Richardson’s health care secretary. And when he found out we were doing this, he came out of retirement to to help lead this effort. And basically, in New Mexico, we have a terrible shortage of basically every kind of medical professionals doctors, nurses, EMTs, the list goes on and on. And we thought it was time to put a spotlight on that and come up with some recommendations. And, so we will be taking four of the ten recommendations. We don’t have the bandwidth to try to do the whole thing. But, you know, I just every time I talk to a Rotary Club, oftentimes.
Speaker 3 00:15:34 They, they.
Fred 00:15:34 Say, well, how do you pick your topics? And I said, well, we look for things that are big enough to make a difference, but small enough to be politically achievable.
Fred 00:15:42 And then I always say, but my best ideas come from groups like this. What do you think we should tackle? And so often I hear I can’t find a doctor, or if I can find a doctor, I can’t get in to see my doctor. And you know, if you’re ever with the rotary group or any group of people, ask those people that can’t find a doctor to stand up and then say, and then those of you that have a doctor and can’t get in to see them, you stand up and pretty soon you have the whole room standing. And it’s just a great illustration of of how monumental this, this challenge is. And we think, you know, better to start now than to wait longer, because it’s only going to get worse. About 40% of our doctors, for example, are 60 or over and they’re going to retire by 2030. So this problem is going to get worse before it gets better. And it’s why it’s so imperative that the legislature and the governor address some of these issues.
Bunny 00:16:46 Go ahead. I’m sorry. It just seems that some of it is very common sense, isn’t it? I mean, some of those some of those fixes seem so doable. I read your annual report and I thought, well, I mean, explain to people why this. I mean, other than we’re somewhat rural and a small state population wise, what are the other what are the real issues?
Fred 00:17:10 Yeah. So you’re exactly right, Bunny, that so many of these issues I joke around when I talk about it, you don’t need to work at a think tank because you’re right. So many of these things are common sense. I’ll just throw out one that we’ll be working on. We’re one of only two states that taxes medical Services like, And so the doctors, here, Hawaii is the only other state that does this. So when you pay your deductible or your co-pay, that your doctor actually pays the tax, the gross receipts tax on that, they can’t pass it on to Medicaid or Medicare because under federal law, the federal government won’t pay it.
Fred 00:17:57 If you’re privately insured. The insurance companies put it in their contracts that they don’t pay that tax. If you look across the state, the average JRT is about 7%. Here in Santa Fe, it’s much larger. I forget what it is. It’s I think higher than 8%. So they eat that. So when when medical students are leaving medical school and deciding where to locate a practice and they do any research. You know that you start behind the eight ball here in New Mexico. if you come here because that’s something you won’t encounter in any other state other than than Hawaii. So that would be an example. Credentialing would be another example. a lot of people don’t understand when you’re a doctor, you have to be credentialed by every hospital where you might practice and every insurance company that might pay your doctor bill. And remarkably, these insurance companies and hospitals haven’t come up with one credentialing document. And these documents are very thick and very time consuming. So one thing I’ve heard over and over from doctors, and we’re going to try to fix this.
Fred 00:19:15 Arkansas, for example, created a law and said, come together and there’ll be one credentialing document so that doctors, when they move to a state, they can immediately start practicing. I talked to a high doctor here in Santa Fe who said it was several months. He was ready and able to practice, but he had to get all these credentials approved by various insurance companies and hospitals, and he couldn’t start practicing for three months. Even though there’s a shortage here of AI doctors and we desperately need them. And there were patients that needed to see this doctor. So that’s another example of what you were talking about. Funny about many of these things don’t, don’t aren’t particularly complicated. It’s just sometimes we lack the political will, to, to address these things so I can go on and on about other issues.
Bunny 00:20:11 So, so I know we are in pretty amazingly good financial shape, right now with, with the oil and gas revenues. I just read the number and I honestly can’t remember it. I just read it this morning.
Bunny 00:20:25 But what’s the hit? If medical services are no longer, If they no longer have to pay grocery seats taxes.
Fred 00:20:36 It’s it’s really not that much. I don’t know, the the if. I guess I’ll get the number wrong. We have an economist now, Katie Gutierrez, who told me the number last week. I think it’s like $20 million, but it’s actually, not very. It won’t be a hit to the budget at all because they suspended, to their great credit, the legislature suspended this tax two years ago. And we’re just simply saying just abolish it. You know, it’s supposed to sunset in three years. There’s absolutely no reason to bring this back. It makes us uncompetitive with with the rest of the country. So when the budget tiers look at our bill. They’re scored as zero because it’s not something that’s currently being paid. Although I have talked to some doctors in certain practices, it’s really complicated if and I think some of them continue to have to pay it. It’s very complicated.
Fred 00:21:41 And so we’d like to just abolish it and make New Mexico like the rest of the country, where doctors don’t have to pay their their patient’s gross receipts tax.
Bunny 00:21:53 Don’t we also have some crazy medical malpractice? I want to hear about that one, because that’s that’s a little infuriating.
Fred 00:22:04 We we have the most lopsided medical malpractice system in the country in terms of patients, doctors, hospitals and lawyers. The best system is one that makes those patients that are harmed whole. That pays lawyers a reasonable amount of money, that doesn’t chase doctors away and doesn’t bankrupt hospitals. Our current system doesn’t do any of those things. So, for example, just to start, we’re one of a state that doesn’t cap attorney’s fees. Even progressive states like New York and California put a cap on attorney’s fees. You know, the system is sort of a zero sum game. The more that the attorneys get, the less that goes to their patients, to their clients, the patients who have been harmed by medical malpractice, that that’s one example.
Fred 00:23:01 A second example, is there something called the patient’s compensation fund. And that’s to take care of examples where there’s a medical malpractice. There are caps right now for hospitals and doctors for hospitals, for example, that goes as high as $6 million. So let’s say somebody’s been harmed and their medical damages exceed $6 million. Well, they can go to this patient compensation fund. And the the legislature created a lump sum payment. It used to be to, to pay the rest of this person’s medical damages for the rest of their lives. But the and it was sort of a pay as you go system. But the legislature created a lump sum payment right at the beginning. Sometimes it’s not enough to pay for those patients. Sometimes it pays too much because they die sooner than expected. So the taxpayer takes the hit. But it’s wonderfully convenient for the trial lawyers because they can take their percentage out of the lump sum payment. Even though this is a patient compensation system, it’s not called the patient compensation Patient and attorney compensation fund, and we don’t think that the lawyers should take any of that money.
Fred 00:24:24 That should all go to the patient. A third a third issue is punitive damages. Punitive damages for your listeners is something that should be rarely awarded in those cases that are considered to be outrageous. In New Mexico, we have the lowest standard for punitive damages in the country. The standard is by a preponderance of the evidence. So if the judge or the jury is, say, 51% sure that punitive damages are merited, they can award those. So, for example, recently there was a hernia case in Gallup gone wrong and $58 million was awarded in punitive damages. That’s going to bankrupt that hospital in Gallup, which now has 340 medical providers, doctors, nurses and so forth that will lose their jobs. It also serves 56,000 people in Gallup. It will create if that hospital is forced to close as a result of these punitive damages, that those people will be in a medical desert where the closest hospital is probably an Albuquerque. And if you have a heart attack in Gallup or if you have a stroke, those are two things where you have to get to a hospital, obviously immediately.
Fred 00:25:48 And someone there explained to me, this is like a death sentence for our community, and it will harm obviously that community. People will leave. It will. So we’ve really got to reconsider how we do punitive damages. other states use a much higher standard. Most of them use clear and convincing evidence. Colorado uses the criminal law standard, which is beyond a reasonable doubt. so that’s something that’s got to be fixed. Another thing that that’s never talked about, that’s in the law is something called venue shopping. So let’s say there’s a malpractice that results in death in, say, hearts or one of our more, conservative areas of the state. What they’ll often do is get a lawyer in Santa Fe or Las Vegas or Espanola, where juries are much more generous than they are in Hobbs. And they’ll move the case. Even though the victim was in Hobbs, the the doctor was in Hobbs, the nurse was in Hobbs. The physician assistant was in Hobbs. They’ll move it to Santa Fe, where the lawyer is.
Fred 00:27:04 and it’s. And then they they can get these larger, more generous judgments. we think that there shouldn’t be any venue shopping. The cases ought to be tried where the actors are, where the witnesses are. And that would help tremendously then. One final thing about this bunny, as you might imagine. Medical malpractice premiums have gone through the roof. There’s this term called the insurance loss ratio, which we got from the Department of Insurance that showed last year for every dollar that medical malpractice insurance companies collected in premiums, they paid $1.83 in claims. So, not surprisingly, we have fewer and fewer insurance companies that are willing to write insurance in New Mexico. That means that premiums go up, sometimes substantially. There’s a hospital in Raton that was just profiled in Searchlight, and I think their premium went up by 500%. They had to find out of the country insurance companies that would. Right these really cost prohibitive policies. I can tell you here in Santa Fe, I talked to Lillian Montoya, who’s the CEO, and she explained, yes, our insurance premiums have gone through the roof, and that cuts into our ability to do charity care because it’s a zero sum game, right? I mean, if they’re spending all this money on insurance, that’s less that they can provide for those patients who can’t afford their medical services.
Fred 00:28:49 So this medical malpractice system, doesn’t make patients whole, chases doctors away. A lot of doctors don’t want to practice here, because if you get sued, there may be no merit to your case. But do you really want to roll the dice, as one explained to me. Because if there’s punitive damages, it can, you know, bankrupt you and take everything that you’ve earned over a lifetime. And so you’re really if you’re a doctor, you really have to think carefully, as to whether this system, you know, makes sense for you and your family. So, so we’re we’re trying to address all of these issues. and there, there are, there are other issues as well that I could we could take the whole show to talk about how lopsided the medical malpractice system is. And we really need to wake up this sleeping giant, because if every doctor would just give $100 to their pack, they’d be able to neutralize how much the trial lawyers give. And then these issues could be heard, you know, on the merits rather than which side has clout and which side doesn’t, and the public needs to get involved, and people need to share their lived experience with their legislators and talk about how difficult it is to find a doctor, or to get in to see those doctors.
Fred 00:30:23 you know, I just went to see my dermatologist this week and found out that he’s retiring, so.
Bunny 00:30:29 He’s mine, too.
Fred 00:30:30 Okay. Doctor Bowden, who’s terrific, I’m guessing. Yeah. So. So we really need to educate the public about why we have these issues and and get the public to talk to their, their, their legislators and the governor and the lieutenant governor. and anyone who will listen.
Bunny 00:30:52 So I, I, I think it’s probably hard for people to hear, although I think if you live in the world today, you should know that, whoever, it’s it’s hard to hear that choices will be made for the good, for the better of the community in which we live. Based on who made the largest campaign contributions. But that just is part of how this works.
Fred 00:31:20 That’s everywhere. I mean, it’s not just New Mexico, that’s Congress for sure. And from what I hear when I talk to my colleagues in other states, you know, there are a lot of special interests out there and they know how to play the game.
Fred 00:31:33 And, it really behooves everybody to, you know, even if you don’t want to or can’t afford to make political contributions, at least call your legislators and contact them. And we try to make it easy to think New Mexico, they can go to the Action Center on our website or websites. Dot think New mexico.org. You just click on the action center, you type in your address and the computer brings up who your state senator is, who your state representative is, and you can write one letter to your governor, to the governor, lieutenant governor, your state senator, your state rep. We make it easy by having a pre-scripted letter, and we have no pride of authorship. We encourage people to write again their lived experience with the medical system and the lack of accessibility to doctors and and other providers. And I want to emphasize the shortage isn’t just doctors, nurses, probably the biggest deficit. we we look at all these medical categories is emergency medical technicians. We’re about 5000 short for the entire state of New Mexico, particularly in rural New Mexico, where they’re desperately needed.
Fred 00:32:56 one thing we’re trying to do there is the legislature did a smart thing several years ago when they created a rural health care tax credit for every sort of medical category, although they left out a few, including emergency medical technicians. So we’re trying to expand that tax credit to EMTs because we have this gigantic shortage. And there’s about four other categories, and I can’t remember them all right now.
Bunny 00:33:26 Well, I know, I mean, where I grew up, all the EMTs still are volunteers. And my my parents were volunteer EMTs for like 27 years. And so they would get a every time they went on an ambulance and they’d get $5 off of their water bill. Wow. So so you’re up all night hauling somebody to Albuquerque. But but I, I guess what I want people to hear is that just saying something and talking to your legislator makes a huge difference. I mean, the first time I went to D.C. with a group called Fight Colorectal Cancer. and I met with my senators and representatives there.
Bunny 00:34:08 I said something I think it was to and I was in Martin Heinrich’s office, and I said, you know, I was so nervous to come here and talk to you about what’s important to me, about changing some of these laws that keep people from getting screened for colon cancer. And I, you know, I just I’m not a professional. And I was told, by whatever authority was that I spoke to at that time that that’s this is a state where, where, where your representatives want to hear from you. I mean, they don’t want to hear from lobbyists nearly as much as they want to hear from the humans. These people, I mean, not everybody runs for office. I mean, I think that everybody who runs for office at least begins with altruistic, service notions. So, those people want to hear from you. Don’t think that what you say or whatever small amount of money. I’m just going to give you a plug, Fred, because I think every year I donate money to your cause because I think it’s so important to have a neutral voice.
Bunny 00:35:18 that’s making a difference. So. So, yes. Go to the action center, write some notes. you know, in those smaller communities, I know you run in, you know, if you live in Mascaro, you’re going to run into your representative, tell them what’s going on and what you care about, because that’s that’s where change is made.
Fred 00:35:36 Yeah. And, you know, I spoke to, a doctor when we were just starting this campaign, and she was telling me, she said, I’m part of the problem threat. And I said, why is that, Julie? And she said, well, in my practice, I see some legislators and they’re very important people, and I always bump them to the front of the line. And I realize that they don’t recognize the shortage because they don’t feel it. So she said, I’m changing my policy now where I just see my patients in the order in which they call, so that my legislative patients understand the shortage. And I wonder if that’s, you know, I do talk to some legislators and they tell me there’s not a problem.
Fred 00:36:26 And I said, no, no, no, no. Read the report. We’ve documented the shortage. And, so part of it’s on us, you know, that, we need to do, I think, New Mexico a better job of talking to each individual legislator. And my goal is to talk to every single one of them, and make sure that they understand the facts around this shortage and how serious and dire it is.
Bunny 00:36:55 Well, Fred, I know people who especially, you know, we at at the Cancer Foundation, we help people from all over northern New Mexico. And I know people who, don’t survive their diagnosis because they waited too long to see their primary care doctor in Taos or wherever they were, Las Vegas or Tucumcari. They had to wait too long. And then by that time they were in late stage something. And so it’s it’s much more dire than, perhaps the average listener would think.
Fred 00:37:33 Can I promote two other policy reforms that please, might be of interest to your listeners? One has to do with what are called interstate health care compacts.
Fred 00:37:44 And there’s ten major health care compacts that essentially make it easier for medical professionals to practice all around the country. It’s kind of like the driver’s license system where you’re licensed in one state, but you can drive in all 50. And this has happened over the last two decades, and most states have joined most of these compacts. Of the ten, New Mexico has only joined the Nurses Compact one out of ten. Just to give you a sense, if you look around our neighboring states, Colorado’s in all ten Utah’s and nine Oklahoma’s in eight Arizona and six Texas and five we’re not even in the medical compact, which 41 states have joined. And what this would do, let me talk about it through the the eyes of a family here in Santa Fe. Their two year old was diagnosed with a very rare and aggressive form of cancer. And they went to UNM hospital. The doctor said, we’ve never seen this type of cancer before and we are encouraging you to get a second opinion. So, for example, they were trying to decide whether it was in the child’s best interest to amputate his hand.
Fred 00:39:08 So the parents, highly educated, wonderful people, did, you know, did extensive research all across the country and found the two best doctors, one in Pennsylvania and Michigan for this particular rare form of cancer. And they called both of them, and both of them said, bring your child immediately. Well, the UNM doctors pointed out he’s in radiation. you know, he can’t go through an airport. So, you know, they called the doctors back in Michigan and Pennsylvania, and they said, well, we can’t advise you over the phone because we you’re not your state is not a member of the medical compact. And we’d be practicing without a license, which is a fourth degree felony. So, long story short, what they finally figured out is they drove to Texas. Texas is a member of the medical compact just to have a phone call with the doctors in Pennsylvania and Michigan. So this is just an illustration. And, you know, you said earlier, buddy, and you’re absolutely right.
Fred 00:40:17 So many of these things are just common sense. We should join all the compacts for the EMTs, audio, speech and audiologists. There’s nine of these that were not a member of. We could become members of these compacts in this legislative session. If we can get the nine remaining compacts that were not members of through the legislature. The argument that’s been this has been tried before, and the argument is, well, if we signed on to these compacts, we lose our state sovereignty. As if our licensing system is so much better than these other states. And as we pointed out, eight of these compacts have been around for ten, 15, 20 years, and all of them have 31 or more states as a part of them. And it’s like, what do we know that these other states don’t know? So anyway, that’ll be a big push to try to get those other nine compacts approved by the legislature. And that’s the single biggest thing we can do to address the medical shortage in the near term.
Fred 00:41:24 and a final, issue that I wanted to to raise is we’re trying to create a health care permanent fund in New Mexico. And as your listeners may know, and you alluded to this earlier, and you’re exactly right. There’s been this huge oil and gas surplus. And the legislature, to their credit, has been using some of that surplus to create permanent funds, like a higher education permanent fund recently, another one for environmental and conservation issues. We don’t have one in New Mexico for health care, and we think it’d be very wise. This is the second largest expense for state government. And significantly, health care expenses grow faster than any other part of the budget. Health care inflation and health care expenses grows at about 7.5% a year. If you go back 50 years, government revenues have grown at about 3%. So there’s that gap. And if everything else is constant, the legislature is forced to either raise taxes or cut spending to keep up with that health care. 7.5% rise year after year compounded.
Fred 00:42:41 And so what we think would be wise wisest to set aside some of that oil and gas revenue to create a health care permanent fund that would be invested by the State Investment Council, mostly in the stock market, which on average it’s volatile, but on average grows at 10%. So we can stay ahead of medical inflation, health care inflation and health care spending. we could get an immediate you know, our Medicaid reimbursement rates in New Mexico are very low relative to other parts of the country. I hear from doctors that on every Medicaid patient, they’re losing money. they see them because they’re their patients. But at least we ought to make it a break even proposition. If we created a health care fund and we’re proposing a $2 billion fund, that would kick off at a 5% yield, like a college endowment, about $100 million a year. That could be immediately matched by the federal government, 3 to 1, because that’s how they match Medicaid funding. So that’s an incredible return on investment that can help to address our very low Medicaid reimbursement rates.
Bunny 00:43:59 Well, I want people to know. Well, while we were talking about that permanent fund, I looked up the the ad that I saw this morning. I’m sorry. The article and its economists estimate the state will bring in a record setting record setting 13.6 billion in general fund income. So, it’s not that we don’t have the money. We just have to figure out how to put it where it needs to be. Right?
Fred 00:44:25 That’s exactly right. And and the, the oil and gas money is sort of different than the other government revenues, in the sense that it’s not necessarily recurring the way GST, for example, is recurring because oil and gas is notorious for being boom and bust. So, I was just talking to a friend of mine, Dominic Garcia, who’s a financial wizard and, used to work at the LLC and then was the chief investment officer for the Public Employees Retirement Association. And his view is the audit. Just take all the oil and gas money and only spend it on one time things, capital outlay and permanent funds and then all the other revenue that comes in.
Fred 00:45:10 That should be the budget. That’s really kind of what they have to spend on recurring expenses. And if they did it that way, there would be, in this year alone, a $2 billion available to place into a permanent fund for health care. And we in our report, we traced the the evolution of the severance tax permanent fund. This was something that the legislature created 50 years ago with $7 million. Fast forward today, and it’s about $10 billion. With investment in the stock market compounding and additional oil and gas monies that went into it over that time. It’s also paid out, last year, about $500 million. So if the legislature hadn’t started that investment with $7,000,000.50 years ago, taxpayers in New Mexico would have to come up with about a half $1 billion, because that’s what it kicked off, this last year. So it just shows and illustrates the power of creating these permanent funds and how it helps future generations. And these problems aren’t going going to go away. I can’t imagine a time when we’ll have our our health care system fully funded.
Fred 00:46:35 And but this would be a step in the right direction to create this kind of a permanent fund.
Bunny 00:46:41 So. So I want, I want I mean, we you and I have talked longer than I, we usually do. But these are, these are this is so important. And we both care so much about what’s going on in the state. So I want folks to know that there is a link in our in the show notes. But it’s also just think New mexico.org go there, go to the Action Center, find out what’s going on, follow what Fred and his amazing, very small and very efficiently run staff are doing. and and let’s I mean, if we get a minute to talk after the session, let’s I want to hear the good news. Can we do that?
Fred 00:47:24 Absolutely. And I hope there will be some good news to share with you. And I’m.
Bunny 00:47:28 Sure there will.
Fred 00:47:28 Be. Yes. I’m optimistic.
Bunny 00:47:31 Thank you. Sounds great for what you do, Fred.
Fred 00:47:34 Thank you for giving me this opportunity to share some of these thoughts with your listeners.
Bunny 00:47:39 Oh, I love it. It’s so important. Thanks to all of you for taking the time to listen to the I Love New Mexico podcast. If you’ve enjoyed this episode, please feel free to share it with your friends on social media, or by texting or messaging or emailing them a copy of the podcast. If you have a New Mexico story that you’d like to share with us, don’t hesitate to reach out. Our email address is I Love New Mexico blog at gmail.com and we are always, always looking for interesting stories about New Mexico. Subscribe, share and write a review so that we can continue to bring you these stories about the Land of Enchantment. Thank you so much.