After all the inspirational speeches, nasty comments , innuendo, innuendo-denial, constituent pandering, constituent dissing and frantic bloggery, its finally the Iowa caucus. Where the first two finishers have a future in the race, and all the rest need to start reconsidering their personal calendars for the next few months. It’s Democracy in action.

If, by Democracy, you mean that you don’t get a vote. That as few as 1/100ths of 1 percent of eligible Democratic voters, from a pool that is 98% white and 100% midwestern will maybe not choose who the nominee will be, but will certainly determine most of the names that won’t be.

And you get no say whatsoever. Aint that nice?

Oh sure, you can send some money, if you’re the type with money to spare. If you have a lot of money to spare, you can even fly out and help convince potential caucus-voters. But you still won’t get a say.

If things go well, your candidate may be in the mix after the caucus – in which case you can rush out to New Hampshire (as I’m planning to do) and bust your butt convincing some of those voters to back your candidate.

But you still don’t get a say yourself.

Even if the race is still in play come Town Meeting Day, you still aren’t going to have much of a vote. Quite frankly, by the time Vermonters vote, if there isn’t a clear candidate, it likely means we’ll be looking at a brokered convention, in which case the real votes will be cast by the superdelegates and the unpledged delegates – and eventually by the pledged candidates who get released by their candidate.

And still no say for you at that point. Just an opportunity to have some generalized influence-by-proxy.

This system sucks. The idea that my candidate may get eliminated before I get a chance to vote for him sucks. Let’s all make it a priority to continue the conversations about change, so tentatively begun at the organizational level this cycle, and blow this system open for next time.

Does this make anybody else queasy?

“This,” is Deb Richter’s new attempt to reinvigorate the single-payer healthcare debate. More power to her for that, of course. In referring to his desire to expand Catamount health, Senate President Pro Tem Peter Shumlin reiterated at his press conference yesterday that he is, in principle, a supporter of the single payer system – and its true, his rhetoric has been consistent for many years on that front. What he’ll tell you is that a small state like Vermont needs help and medicare/medicaid funding flexibility in order to afford it, and without federal action it simply won’t add up.

It’d be interesting to do some creative number crunching and brainstorming in that regard. I played that game myself once, batting around a radical thought experiment that would get the lawsuits flying. But its hard not to have some sympathy to his point. Catamount, he argues, is simply a way to help as many people as possible in the interim (and maybe to warm people up to the idea of government-brokered insurance).

But, really – Take Back Vermont Healthcare?? Whose idea was it to invoke Take Back Vermont, with the same white sign and all? I look at that – I even hear about it – and I reflexively recoil.

If Dr. Richter thinks its a clever way to appeal to the rural voter and tap some of that resentment – let me tell you, it’s not. “Take Back Vermont” is a firmly established – almost archetypal at this point – expression of bigotry and hatred. It’s a hot button for those who feel animosity towards gays and lesbians, stirring it up – and it’s a hot button for those of us who support equal rights – getting our dander up and putting us on the defensive.

It’s a psycho-social hornet’s nest, and whoever thought it was a good idea to resurrect all those feelings (and there are still quite a few “Take Back Vermont” signs out there – make no mistake) and try to pump them into the healthcare debate should not be patting themselves on the back, they should be kicking themselves in the ass.

Much to my surprise, there’s an extensive iBrattleboro post on pharmacy fishing.

Someone sent the following question to the state police:

“Would you please check the veracity of the allegation that the State Police have the right to force pharmacies to release their entire class 2 prescription histories, or, exactly what it was they were doing as referred to in the very recent post here on ibratt. Also, does the Brattleboro police dept have that power? If so, has it exercised it?”

Excerpts from the Brattleboro police department’s response after the fold.

I’m not going to comment on this much for now.  I’ll think about whether or not I have anything to add.  Instead, I’m just going to put together what I think is a fair excerpt and discuss it more when I have time.  I did not edit much, because I think it’s important to keep this in its full context.  

I… can not comment on what the Vermont State Police do and do not request from pharmacies or medical care providers.  However, I will certainly write about the law you mention as well as what the Brattleboro Police do. We are not lawyers here but we do regularly interpret laws to guide our behavior…

The VT law that governs the above issue is Title 18, Chapter 84A – Vermont Prescription Monitoring System (VPMS). The legislative intent of this law is explicitly written into the law… that intent specifically states:

“…to promote the public health through enhanced opportunities for treatment for and prevention of abuse of controlled substances, without interfering with the legal medical use of those substances.”

It is worth noting that law enforcement, prosecution, and similar words do not appear anywhere in the description of the legislature’s intent in passing this law.

Chapter 84A goes on to specifically address the role of law enforcement in its application. First, the only law enforcement officers able to work within it are “Trained law enforcement officer(s).” This is defined in the law as:

“… any officer designated by the department of public safety who has completed a training program established by rule by the department of health, which is designed to ensure that officers have the training necessary to use responsibly and properly any information that they receive from VPMS.”

Again, back to the intent of this law. Our representatives obviously want to make sure the police use the information properly.

…The law allows state licensing authorities to gather prescription information as part of licensing and monitoring health care workers. The law allows these licensing bodies to tell “trained law enforcement officers” if they suspect fraudulent or illegal activity by a health care provider. This section of the law (4282) states nothing about suspected criminal activity by patients.

According to section “e” of 4282, trained law enforcement officers are expressly forbidden from having access to VPMS except for the specific information provided to the officer by the licensing authority, as described above.

All of the above makes it pretty clear that the legislature wants to address public health concerns, but does not want the cops pawing through people’s medical records. However, it is important to note one final mention of police access to prescription records in this law… I think this is where the controversy you mention comes up.

There is an advisory committee set up under this law to help coordinate the efforts that it authorizes… this committee is allowed to determine under what circumstances, if any, the health department can give VPMS data to law enforcement. This would be set up as an administrative rule and seems to be the main concern of most people on this issue. I do not know the status of this committee and whether or not they have made a rule granting the police blanket access to pharmacy records. I can tell you that we (BPD) have not been told by anyone that we now have access to such information.

Now on to the Brattleboro Police. We do not make requests of the health department or pharmacies for VPMS information. However, we do aggressively investigate prescription drug crimes, to include fraudulent attempts to get or distribute pills. When these crimes are investigated it is necessary to access, to some extent, people’s medical records.

When a crime like this is committed, there are many investigative tools available to access medical records. Search warrants, subpoenas, and other methods of accessing information are allowed under VT law Title 18 (Health). These are used on a regular basis to investigate individuals for criminal offenses related to prescription drugs. The Brattleboro Police Department certainly does utilize all of these investigative tools to conduct investigations.

The difference between the actions in the above paragraph and accessing VPMS is what the police might be looking at. VPMS is a database of information on many people. It is maintained by the department of health for purposes that satisfy their mission of maintaining public health. If they become aware of a criminal act they may refer it to the police. The process in the paragraph above this one is different than that. It is designed to give police information on a particular crime and on a particular person who may be committing drug crimes.

To address your final question, The Brattleboro Police Department has not made any requests of pharmacies or the department of health to mine all of their prescription drug data. Requests for information on a particular person, for a particular period, suspected of a particular crime, has occurred and continues to occur.

So, what do you think?