I've written about the consolidation of local health care organizations over the past months.  In preparing for a talk I delivered to an insurance agent's organization last month, I dug a little deeper to see what the trends seemed to be for the future.

There are some very interesting things happening to and with health care delivery and these things are, in part, already on or affecting the local scene.

Retail Medicine...

Several major corporations have experimented with and made commitments to what I'll call 'retail medicine'.  Major drug store chains have had walk-in clinics in their stores, and have gotten so serious about it that they've actually purchased the companies that were supplying the services.  One of those is Walgreen's and we see the result in Germantown.  Our local Walgreen store is 1 of 13 in Wisconsin with in-store clinics and that number is expected to be as high as 19 by the end of 2008.

Wal-Mart is doing similar development across the country along with the CVS drug store chain and several others.  These models all tend to rely upon the Nurse Practitioner and work to establish referral relationships to local physicians for the more serious conditions encountered.  Costs, according to the Take Care Health Systems (Walgreen) website range from $59 to $74 per visit with additional fees charged for vaccinations (seasonal flu shot priced at $24.99).

Physician Shortages... 

There are serious shortages of physicians in America and that is, in part, prompting the 'retail medicine' movement discussed above.  Massachusetts learned this the hard way when it passed laws that required virtually all citizens to have health insurance.  There were simply too few primary care doctors available in the state to handle the new demand that had been created.  The physicians who are moving through the education system today are too often choosing specialties that pay more and that have better schedules so they can also spend time with their families and pay off their loans more quickly.

These shortages are prompting our medical colleges to step up the effort to cause more graduating physicians to opt for primary care service but this will take time and there will need to be some economic push to make it happen.  This is spawning the following effort.

Nurse Doctors...

Minnesota has graduated at least one class of Nurse Doctors who are entering practice across that state.  This is a doctorate level program that claims to produce practitioners that "can do almost everything" a primary care physician can do except for some surgical procedures.  This program is being expanded to be able to graduate more Nurse Doctors every year as the program ramps up.

As we can all understand, the physicians' organizations are not at all happy about this movement.

Dentist Shortages...

The average age of dentists in many states, Wisconsin included, is increasing at an alarming pace and we are beginning to see a shortage of dentists.  Minnesota again seems to have taken a lead position with legislation that was being considered which would permit Dental Hygienists to both drill and extract teeth in addition to their normal responsibilities.

As you would also expect in this situation, this is meeting strong resistance from the organizations representing dentists, but the simple fact that this found its way to the floor of the Minnesota legislature is significant.  Minnesota has been more prone to experimentation in the general area of health care (health maintenance organizations took off very rapidly in this state in the early-1970s), so these trends aren't all that surprising in our neighbor state.

Summary...

Our health care world is changing very rapidly.  If we were to become a Rip Van Winkle and sleep for even just ten years, we'd likely encounter a strange new health care world when we awoke.

Who can say what is good or not good in these regards.  Time will tell which, if any, of these initiatives we will have accepted and which we will have discarded as bad ideas whose time hadn't yet arrived.  Some way needs be found that will permit us to control costs.  If we rely upon government to do that, I'm afraid that the consequences will be heavy-handed control and rationing of services...and I cannot find it within myself to think that is an improvement.

The mainstream media has taken up the fight now that Hillary and Barack have gotten their 'thing' settled; at least until the gathering in Denver. 

The learned political scientists on our college campuses have nearly unanimously opined that Obama is incapable of being defeated.  They have preordained that this election will be among the most lopsided victories for the left that we have witnessed in the entire history of our country.  Polls show Obama up by double digits over McCain.  It is all over but for the voting.

The election of Barack Obama as our next president is, apparently, inevitable.

So...there you go.  We conservatives can simply suck it up, pack it in, and decide how we're going to survive the coming four or eight years.  It is divined: Barack Obama is the next President of the United States...and will create a veto-proof majority for Democrats in both houses of our congress.

But wait.  Is it really inevitable?  Is the smugness of the left such that it will determine the course of history?  Is it really time for undefined change simply for the sake of change?  Are we in such dire straits that we will anoint Obama without so much as a discussion about that inevitable future?  Will the influx of young voters automatically accrue to the benefit of Obama?  Have the liberal professors that dominate our college campuses (98% + and counting) so indoctrinated the student body that inevitability is the only outcome imaginable?

Are 'we the people' so enamored of this man of change as to be taken with his oratorical skills in spite of the lack of depth of our knowledge of the details?  It is commonly discussed in political circles that the 'devil is in the detail', and yet, so far, there is very little flesh to be found on the skeleton of change. 

Will it remain the rule that any question of Obama's positions is akin to unfairly characterizing the man?  We smear him when we reflect upon the pastor that he followed willingly for twenty years.  We smear him when we talk about his very limited experience in politics, let alone on the national scene.  We smear him when we criticize his broadly-brushed position papers.  We smear him when he is forced to restate previous statements, sometimes more than once, to 'clarify' what he originally meant to say.

Obama has created a bubble that seems to surround him.  It is a protective bubble that keeps the hounds at bay.  One is to accept his speeches at face value.  One must not question the lack of substance.  One must not ask from where the money will come (although we know if we but listen to the tax increase rhetoric).  One must not ask which of the ladies in waiting the public would prefer in the White House.

Obama has created a protective bubble with the willing assistance of the liberal media.  Will that media be silent as well when we wake up to the second term of Jimmy Carter?  Will that media be silent when we throw away victory in the war on terror so that foreign governments will profess to like us better?  Will that media be silent when terrorists again begin to strike us in our homeland? 

Is it really Obama the Inevitable?  Or was the only inevitable thing about all this that the liberal media would fall into lockstep?

Two candidates have declared, so far, for the Assembly 24th district seat being vacated by Sue Jeskewitz.  They are Republicans Randy Melchert and Jason LaSage.  I continue to hear that there will be other candidates declaring between now and the deadline on July 8th, however we want to begin the Assembly 'Debate' so as to help voters learn as much as possible about the candidates.  I have posed much the same questions to both candidates as were discussed in the Senate "Debate' series.

The initial question was this:  If you were to introduce yourself to a roomful of voters, what would you tell them of yourself?

Melchert:  I am Randy Melchert, and I am a 5th generation Menomonee Falls resident.  My great grandmother ran a small café near the corner of Main Street and Appleton Avenue.  My grandfather started his law practice near that same corner as well.  My mother practiced law there as well.  I have lived my entire life in this community and I enjoy it.  Except for one thing.

Taxes.  While we have "The Best Care in the Air" nearby, the Packers up the road, and a beautiful wonderland every winter, the tax situation in this state is hurting the families of the state.  The average Menomonee Falls family over the next ten years will send around $77,000 to Madison in state income and sales taxes.  In Germantown a little less, in Richfield a lot more.  We have the 7th highest state and local tax burden, the 8th highest gas tax, and the 11th worst business tax climate.  Unfortunately the tax bill may rise.  On top of our already large spending habit, we could have a $2.3 billion deficit.  That's $1,655 of debt for every family of four in the state.  We need change now.  We need legislators who are responsible, dependable, and accountable.

* * * * * * * * * *

LaSage:  I am a life-long resident, taxpayer and worker in the 24th district, truly grateful for the support I have received from this community throughout my entire life.  When I was a 5th grader at County Line School, residents, led by my Cub Scout Leader, Jim McNally, generously donated money to provide me with a scooter so that I would have a way to keep up with my friends.  At Kennedy Middle School, one of the many special teachers in my life, now principal, Steve Bold helped spark my interest in social studies by demonstrating how serving others is a rewarding enterprise.  While I was a high school student, area parents came to my aid, as I helped lead the way with a group of friends to promote drug and alcohol-free activities in the community through initiating Youth Future's 1st annual lock-in for middle school students-an event that recently celebrated its 14th year.

In 1998, residents embraced my eagerness for public service, by electing me to the Germantown School Board-an office I was re-elected to.  That same year, current outgoing state Representative Sue Jeskewitz was kind enough to take me to Madison for a day to see first-hand how state government works.  As a board member, the MacArthur Elementary School community welcomed me, as I tutored youngsters and volunteered at MacFest events.  I also worked with Keith Musolff's gifted and talented middle school students for two years.  Additionally, as I was focusing on my bachelor's degree in communication and political science from UW-Milwaukee, state Senator Alberta Darling gave me the opportunity to intern for her.

Menomonee Falls also accommodated me for four years at Guaranty Bank and six years at Strong Investments.  I have kept involved with area youth for the past six years (and counting) by part-time substitute teaching in the Menomonee Falls School District.  I am also thankful to have had the ability to learn even more about the area and enhance my leadership skills through participation in Leadership Germantown this past year.

Now, as a 24th district taxpayer and homeowner, I want to be your representative in the state Assembly, taking my rich experience from the area and championing our shared values-creating jobs through lower taxes, spending and regulation; working to achieve more local control of education and municipal government; addressing healthcare with free market, consumer solutions; protecting individual liberties-while being accessible and willing to listen to all constituents.  I realize that some politicians have the tendency to disappoint, letting the lure of outside money get in the way of doing the people's work.  Though, if given the opportunity to serve as your representative in Madison, I assure you that my values and character, my ties to the community, and my aspiration to deliver sound, conservative leadership are not for sale.

* * * * * * * * * *

As always, we thank both gentlemen for taking time to participate in this 'Debate' and welcome readers' questions for future 'Debates'.  Either email those or frame them as comments to this blog.

We have, it appears, survived the presidential primary campaign season. 

During this season just passed, we witnessed the significant defeat of the Clintons.  Yes, of both Clintons, not just Hillary.  There is no 'just Hillary'.  With her comes the other, Bill.  With her comes the remembrances of all that was the Clintonian presidency; the innuendo, the smears, the lost billing records, the huge trading gains, the eleventh-hour pardons and on and on and on.  It wasn't a significant defeat in terms of numbers of votes, but it was significant in terms of the name and the legacy.

During this season just passed, we saw the emergence of a first-term senator from Illinois who is now the Democrat candidate for President of the United States of America.  He is biracial, and that means that a historic 'barrier' appears to have been overcome.  He is inexperienced as compared to the typical candidate for our highest elected position, but he has an eloquence about him that seems to enthrall those to whom he speaks.  He is Barack Obama.  Of that we can be sure.  But, beyond that we are unsure.  There is much about him and his beliefs that needs to be fleshed out between now and November

During this season just passed, we saw the Republicans settle on an elder member of the senate who will be nearly 72 if and when he takes office.  The word 'settle' was chosen intentionally.  The conservative members of the Republican party were forced to 'settle' for John McCain.  They may take up the banner and charge ahead, or they may hold back, contribute little and vote begrudgingly.  We know that he has been bloodied in battle, and that is reality and not simply an expression.  We know the mettle of the man.

So, Hillary is expected to finally make her amends to Barack Obama today by suspending her campaign.  That means that she is still trying to finagle something more for herself.  It might be that promise of a nomination to become a member of the Supreme Court, or it might be the payment of her $20 million campaign shortfall that came from the Clintons' pocket, or it might be the selection as the vice presidential candidate.  We don't know, and we may not come to know anytime soon; but we do know the Clintons and we do know that there will be some price extracted by them.  That is the way it is with them.

And the rest of us are left to make a monumentally important decision as to whom we desire as our next titular head.  I use the word 'titular' intentionally, as well.  The President of the United States influences but seldom decides policy.  The President lives in a world of 'checks and balances' that sometimes seems to be unchecked and imbalanced.  Congress will be very important as it always is.  That is frightening when one steps back and observes the ofttimes childish machinations that come from this body.

As it stands today, we would choose between an elder about whom we know a good deal and a junior about whom we know virtually nothing.  I am reminded of the phrase that refers to the 'devil we know versus the devil we don't know'.  I don't use that phrase in a derogatory manner.  This election is, to my thinking, a classic 'lesser of evils' election.  The campaign will be waged between one who is so far only a passable speaker but whom we know, and between the other who is as eloquent a speaker as any politician in my lifetime but about whom we know next to nothing.

And I confess to great concern since us voters tend to be swayed by eloquence more than substance far too often...and we often pay a dear price as the result.

We are, by all signs, involved in an oil cost run-up driven by demand being greater than supply.  It is exacerbated for us Americans because our monetary policy has seen an intentional softening of the dollar (our money is worth less than other peoples' money, so it takes more of it to buy a barrel of crude oil).  I paid $4.20 per gallon yesterday with the price of crude oil standing at about $130 +/- per barrel.  Predictions of crude oil prices of $150 per barrel or more are seen or heard regularly now.  And, the cost of oil could well be higher than that by year-end.

How did we get to this point?  We got there by congressional law making, by presidents rolling over and signing those bills, and by our country's increasing needs/demand for gasoline and diesel fuel.  Why would we permit ourselves to become part of such a quagmire?

Politics!  Politics played by those on both sides of the aisle.  Conservatives seem to have lost their voices.  Liberals never seem to lose their voices.

Laws were re-written more than thirty years ago to make it nearly impossible for a new refinery to be built.  Those were the result of congress being rolled by the environmentalists and presidents either believing the rhetoric of the day or fearing the backlash should they stand up to the rhetoric.  This has continued to this very day.  We are forbidden from drilling within 200 miles of the California and Florida coastlines but the Chinese are already doing so as we sit on our thumbs.  We are unable to pursue the shale oil deposits that span our northern plains and southwestern states.  We have ample untapped resources that are readily available but our laws don't permit us to make use of those resources.

We see the 'global warming' group and the 'environmentalist group' driving our economy into the ground...and we have not found the moral outrage/courage to stand up to them and say "no more"!  We could easily build new refineries in any number of locations around our country but we're not permitted to do so.  We know how to drill and refine today without ruining our world.  It takes from 6 to 10 years to bring a new refinery on-line so the time to have declared a moratorium on the rules that made it impossible to build new refining capacity has come and gone.  But, the typical congressional response of "that will take ten years" should remind us that if we don't roll back those silly laws today, it'll take ten years from whenever we do roll back those silly laws.  The time to begin is now, not next week or next month.

We witnessed the ridiculous 'hearings' held by congress in the past few weeks.  We watched as Sen. Herb Kohl embarrassed himself by chiding the 'big bad oil companies' for making a profit.  He is a former businessman who certainly understands that profit must be derived in order for businesses to exist and grow.  He knew how that worked when he ran Kohl's Food Stores.  He certainly must have some comprehension as the owner of the Milwaukee Bucks.  His statement to the oil company executives that their profits didn't seem fair gives one a lot of insight.  He knows better but he will play/pander to the crowd he favors.  He 'feels' as do most liberals.  He doesn't necessarily reason.  He has his millions, so he can set out to control everyone else who aspires to similar success.

Sen. Kohl is but one of the 535 members of congress.  Too many of those men and women are too intent on keeping their offices to actually vote the way they probably know they should.  You have probably heard the old phrase that states you must "go along to get along".  That should be inscribed over the doorways leading to the House and the Senate chambers since it is the rule that is followed by the vast majority of people who walk through those portals.  That is true on the national stage, the state stage and the local stage.

The people who go to Washington and who do not give in and play by the Washingtonian rules are few and very far between.

Whose fault is this dilemma in the final analysis?  Yours and mine. 

We're the men and women who have permitted this to happen.  We don't vote in the House or the Senate, but we do elect those who do...and we do not seem to unelect people very often once they've gotten into office.  Rep. Steve Kagen (D) from the Appleton area stands for re-election this November.  He is at his most defeatable point historically.  If he survives the first re-election campaign and keeps his seat, he is likely to be in that seat for so long as he desires without regard to how he votes or doesn't vote.

We're so unconcerned about our vote, it seems, that we don't even think voting is sacrosanct enough to require valid photo identification before we're permitted to cast a ballot. 

So, all this angst has been brought to us by us.  Remember that the next time you buy gasoline or diesel fuel.  Remember that the next time you go to the grocery store and try to make your food budget stretch.  Remember that when you ponder whether or not you'll be able to take a vacation this year, or buy new school clothing for your children, or go out for a fish fry.  Remember that when you try to stretch your retirement income to cover your basic needs.

And, when you've gotten yourself all 'cranked up', if that happens, make a resolution to get involved and stay involved and to talk with your elected representatives at every level of government and let them know what you think and what you want them to do on your behalf.  And, if they fail you, fire them with your vote at the polling place.

Had you and I done that two decades ago instead of simply going with the flow, maybe we'd not be in the situation we find ourselves in today.

Randall Melchert has announced that he is seeking election to the Assembly seat (24th District) being vacated by Sue Jeskewitz at the end of her current term.

He is the son of a prominent Menomonee Falls couple and the family has deep roots in the Falls.  Randy, as he calls himself, declares himself to be conservative and his stated positions suggest that he may be quite conservative.  His campaign site (www.randymelchert.com) contains position statements on a variety of subjects.  He is a member of the Waukesha Republican Party.

Among his areas of expertise is apparently that of debate skills.  That should serve him well in both his campaign and in the Assembly if he is victorious.

I have extended an invitation to him to engage readers by responding to questions that will be published on Curmudgeon's Corner much as we've begun doing in the Senate race.  I hope he will accept that invitation.

There is, so far, no indication of any opponents but that may develop over the coming weeks.

SynergyHealth made its decision to go with the proposal from Progressive Health (Froedtert & Community Health and Columbia St. Mary's) as I had predicted a couple of months earlier.  It isn't that I'm such a great predictor.  This was the most logical decision that could've been taken given the circumstances that existed.

This means that there is a new alliance that will encompass much of the northern two-thirds of the greater Milwaukee market including portions of Milwaukee, Waukesha, Washington and Ozaukee counties.  Doctors in the West Bend Clinic were firmly opposed to becoming a part of the Aurora system.  Aurora worked for the better part of a year to try to convince the SynergyHealth group that it was their best choice.

In the end, Aurora pulled its proposals from the table when it became obvious they were not going to prevail (better to pull out than be beaten).

So, what does this mean for those of us in the West Bend/Jackson/Hartford/Germantown/Menomonee Falls area?  It means that we continue to have a choice in our healthcare system.  It means there are now essentially three systems serving our marketplace: ProHealth based in Waukesha (Medical Associates), Aurora (Advanced Healthcare) and Froedtert & Community.  Our community-based hospitals are given a new opportunity to maintain and grow their service offerings.  We will be able to take advantage of some of the best healthcare in the United States.

What will it cost us?  That remains to be seen.  Aurora is rapidly increasing its presence with new buildings and new hospitals.  Many of those are, in my opinion, unnecessary duplications that mean we're being 'over built'.  Decades ago, a Certificate of Need had to be completed and approved by state officials before a new healthcare facility could be built.  That was known as CON in 'governmentese'.  Since that law was repealed, the only things really necessary are local approvals and the ability to finance the project.

Examples would be the new Aurora complex being built in the Town of Summit between ProHealth's hospitals in Waukesha and Oconomowoc, and the new Grafton location being built less than ten miles away from a new Columbia St. Mary's facility.  The debt service is large and that means that rates may have to be increased to support the needs that were created by building.

Obviously, the remaining healthcare players are fighting for their continued existence.  But we healthcare consumers pay the price for those battles, so we have to remain aware and we need to become much better buyers of healthcare.  Too many people are blaming insurance companies for high health insurance costs when the real problem is the high cost of health care.  These kinds of building campaigns do nothing but hurt us more in my opinion. 

I received a telephone call from Katie Prown late Friday afternoon.  I know...I had no idea who she was either.  But, she advised me that she was calling on behalf of Rep. Wasserman and virtually pleaded for me to permit him to participate in the 'debate' with Sen. Darling.  She apologized for him, said he had been so busy knocking on doors (up to something like 12,905 now), had received such great acceptance....blah, blah blah.  He was obviously too busy to call me himself...or too embarrassed if that is possible for a politician.

She indicated that she is his newly hired campaign manager.  Her email said, "I can assure you that you will receive prompt and timely responses in the future" and I wondered how she could assure me that he would change since she had just assumed her role, but that is for another day.  I told her that I was very disappointed in his performance to this point and that, if I relented, this would be the absolute last time there would be any slack cut for Rep. Wasserman.

She did precede the call with her email to which was attached the responses that I've sought for the past months.  I have her email address and her telephone numbers.  So, we're going to try this one more time.  The series will kick off early this coming week and I hope it will prove informative.

I decided to 'give the guy a break' since a one-person 'debate' isn't terribly stimulating for readers.

Back on March 25th, we discussed the first story that centered on the Wellness Committee within the Germantown employee ranks.  The committee was about to make a request for up to $20,000 to be used in a wellness program for village employees.  This proposal was sent back by the General Government and Finance Committee at that time for more work by the group.  I had mentioned at the time that there seemed little enthusiasm for a $20,000 expenditure but that the committee had been encouraged to formulate more detailed plans and return.

That return visit is scheduled for tonight according to a Journal Sentinel article this morning.  That article stated that the committee will be returning with a proposal for the expenditure of $14,495 this year on wellness activities.  The key here will be the plan of action that they present.

Wellness programs can be very good for employees and their dependents if managed correctly.  Many private sector employers use them and have had good results.  Among the keys is that employees have to be engaged.  They have to be challenged.  Some private sector employers have used incentives to get the employee's buy-in.  The incentives are legal if put together correctly.

In other instances, smaller groups have managed to create sound wellness programs with the expenditure of relatively few dollars.  By few dollars, I am talking about a few hundred dollars that is leveraged using the resources already available within the community.  Many wellness programs have begun on a smaller scale and then expanded as ideas were proved to work.

Other wellness programs see the gradual decline of participation by employees.  That seems to happen when the programs become old and stale; when there are no new ideas or approaches being developed year after year.

And, it is very important that wellness programs are available to dependents of the village employees.  Dependents typically outnumber employees especially in a more mature workforce such as seems evident in Germantown.

Finally, negotiated agreements may need to be revisited should the village decide to proceed with a wellness program.

I hope that we do not see blanket approval without some in-depth study and analysis.  These programs can be good or bad; they are never guaranteed to work.

In the final analysis, the purposes of wellness programs also include a return on investment.  What will the investment of $14,495 this year do, if anything, to reduce costs in the health care programs next year or in the next five years?  Who has put the plan together?  Are they qualified to do so?  If a professional group, does it have a track record that can be reviewed by the Board before moving ahead?

Governor Doyle recently signed a bill that establishes age 15 & 1/2 as the age at which a person residing in Wisconsin can make his or her decision to donate organs if they were to die.  The age until now had been established at 18.  This was included in Assembly Bill 570 that was co-sponsored by Rep. Jeskewitz and Rep. Wasserman, names familiar to our community.

I have close friends who have experienced the life-giving results of organ donors' decisions.  They are passionately in favor of the program.  I am not discussing the pro and con of organ donation.  I am not raising questions about youthful donors; organs have been harvested and donated from infants and children for a long time.

I am raising the question of just when a person should be able to make that decision for oneself.  I am raising the question of when the person has accumulated the knowledge and wisdom to make such a decision without parental consent.  I am raising the question as to when parental consent and parental responsibility is removed from the family. 

What are the things one can do legally at the age of 15 & 1/2 years?  Drive? No.  Drink alcohol?  No.  Vote in public elections?  No.  Join the military?  No.  Own a gun?  No.  Marry?  No.  Go to school?  Yes.

Is it just me or does it seem to you, as well, that our society is gradually eroding the rights of parents and giving those rights over to the state?  Are we truly moving to that "It Takes A Village" thing?

If we think back, there has been a subtle, slow, but inexorable movement in which the parent has lost rights that have been given over to the state (or the schools which is nearly the same).  Vaccinations. Sex education. Corporal punishment. Driver's training.  Abortion.

Am I way off the mark, or do you agree?  Where is this going to end?  Will it end tomorrow, or next year, or next generation or will it end when the parents have given over all their rights to those who know best?  And, do the parents even know that they're losing parental rights?  And, if they know, do they care?

Troubling incrementalism.

The campaign for President of the United States seems, to me at least, interminable at this point.  It has been going on for years now in one or another forms.  We might think that we would, by now, even if trying to avoid the process, know the candidates almost as well as they know themselves.  The answer is that we do...and we don't.

Each candidate is artfully packaged by his or her 'handlers' to be just what the handlers' believe we all want in our next President.  Each candidate has been drilled on the policies and pitfalls.  Each has had multiple lines written for them that have, by now, become their own.  Different questions in different parts of the country elicit responses with slight variations on the central theme.

Every once in awhile, though, there comes the break-through moment when the candidate speaks from his or her heart...and thus reveals more about who and what they really are, their true beliefs and motives in an instant than has been revealed to us over the course of many months of appearances, and things we call 'debates', and countless articles penned by countless reporters.  In these rare moments, we are able to peel away the polished surface and see inside the person.

One of those moments occurred for Hillary Clinton when she 'mis-remembered' the situation the day she and Chelsea landed in Bosnia.  Another occurred when her husband, the former President, mis-mis-remembered on her behalf.  These two are, in my opinion, pathological liars.  They conjure up their own form of the truth and it pours out to we the people.  We the people scratch our heads and wonder if we are 'mis-remembering' or if we have just witnessed another of the seemingly regular prevarications to which we've become accustomed.

Another of those moments occurs on differing occasions with John McCain.  Those moments, for me, are the fleeting glimpses we get of the anger inside the man.  Some would say that is simply the 'set of his jaw' and that he is solid and steadfast.  I want to believe that because he will get my vote, but I still find a bit of concern welling up within me whenever I think I witness that.

Another of those moments occurred on April 6th and involved the 'great orator', Barack Obama when he opined in an off-the-cuff response to a question.  He conjured up the image of America that resides deep with him, and he saw small town middle Americans as being angry, since life was passing them by, since they had seen all their employment opportunities taken from them, etc.  And, he saw those middle Americans as now being relegated to holding on to their religion and their guns.  Barack Obama delivers one heck of a speech.  Speeches that have been pre-written and massaged over and over again.  Speeches that present the Barack Obama we are supposed to think is the real Barack Obama.

I believe we had another of those 'insightful incidents' on that April day, and it turned my stomach...for want of more descriptive terms.  It seemed to play to his wife's 'mis-speak' when she opined about finally finding something about which she could feel proud as an American.  This couple scares me.  I understand that he could easily become our President, and I am concerned for what that might mean to us all.  I know that he is the most liberal person in our U.S. Senate...and that takes some doing.  I know that he has served so little time in any elected office that we know virtually nothing of him and his ideas.

I know that John McCain has been tested as few among us have been tested.  I know that he is, for me, an imperfect candidate and not my first choice, or even my second choice.  I know that he will be a staunch defender of our country, and that is of utmost importance to me.

So, my intention to vote for John McCain has not changed, but my reasons for not voting for either Barack Obama or Hillary Clinton have been reinforced.

Has anyone ever thought that psychological testing might be a good idea before we annoint a candidate and subsequently elect a President?  I'm sure the United Nations would be happy to be the dispassionate arbiter of those test results.

Just kidding....

The Center on Wisconsin Strategy and the Wisconsin Council on Children & Families, both found in Madison, have released a report that reaches the startling conclusion you see in the headline above.

Wow!  What a surprise!  Further into the article in today's Journal Sentinel that discussed this amazing statistic, we find out that Wisconsin actually ranks quite well so far as this measurement is concerned...but apparently not well enough to make these groups comfortable.  The report shows that the gap in Wisconsin is actually smaller than on average across the country.  The report found that Wisconsin actually ranks 11th out of the 50 states in this regard, and that means the gap between top and bottom fifths of the population are lesser.

But, there are the usual suggestions made to 'correct' this terrible situation:

• Increase the minimum wage and then index it to inflation.
• Improve worker skills and education.
• Expand subsidized childcare and health care for low-income workers.
• 'Update' unemployment insurance.
• Make taxes 'more progressive'.

This 'minimum wage' canard is so old and tiresome but it just keeps coming back.  There are positions in the workforce that do not command more than the current minimum wage.  Every time the minimum wage is increased, it displaces workers at the bottom end of society because the jobs simply go away. The majority of minimum wage jobs are held on a part-time basis by students and homemakers, and not be sole bread winners.

Improving worker skills and education is a noble undertaking, it is one that we are engaged in already, and it speaks to the need to get MPS working since it seems intent on not graduating 53% of its students thus relegating them to those minimum wage jobs and/or welfare programs (except that you have to read for many of those, so I guess that is out).

I don't know where the people have been who built this study, but every time we turn around, we are expanding childcare and health care for low-income workers.  Look at BadgerCare and BadgerCare Plus.  Listen to the radio commercials begging people to come in to sign up for welfare programs.

Apparently unemployment insurance should be 'updated' (read increased) so the people who are unable to hold jobs get more money until the benefit runs out.  Maybe a better tax climate in our wonderful state would prompt the creation of more jobs and remove the increasing need for the unemployment insurance program 'update'.

Finally, the ultimate liberal solution for every ill to be found in society:  let's take more money away (tax increases) from 'the rich' and give it to the poor.  This class warfare shot is being heard all too often in the current presidential campaign, and it fails to define just who the 'rich' are; be careful middle class; you may be rich.  We don't need to resort to the use of this class warfare tactic in Wisconsin.  In case the 'ruling class' hasn't figured it out, our taxes are already too progressive.

These studies drive me nuts (as is plainly seen from this Blog).  Lower our taxes as Texas has done for its citizens and employers, and watch what happens to unemployment, etc.

What a surprise.  The rich get richer faster than the poor.  The real surprise is that liberals have yet to figure out how cause and effect function in this equation!

There were two items in the newspapers today that are particularly troubling and those are:

Wisconsin's black 8th graders rank worst in the nation in writing...

This article cited the latest tests that showed our black (African-American) students were actually getting worse than better so far as both reading and writing are concerned.  Other states in the nation have posted improvements in the same time period, so we know this issue can be dealt with positively.  Reading and writing are very basic skills without which these kids will fail in their quest to make it through this life.

This comes on top of the recent report that Milwaukee's public schools graduate only 47% of those who come in as freshman students.  This speaks to virtually a complete failure in my mind.  Yes, the breakdown of family units plays a significant role, but that needs to be overcome.  The kids who grow up to a bleak life are more likely to perpetuate the family breakdown issue and make it worse than it already has become.

Finally, our state Superintendent of Public Instruction, Elizabeth Burmaster, issued this statement, "Our overall student achievement is improving and parallels what we see on other assessments.  We must stay focused on raising achievement for all students, in particular our African-American students, and closing achievement gaps.  We know what works: quality educators in every classroom and strong leaders in every school, early learning opportunities and small class sizes and shared responsibility by parents, schools and communities to support student academic achievement."

What a bunch of malarkey!  It is this attitude that has exacerbated this problem.  It is this attitude, in part, that has seen this problem worsen in the past decade.  If she truly "knows what works", then why isn't it working?  Is it that we need to pour good money after bad?  Is it that we need ten students per classroom instead of twenty?  What is it?

And, where are the rest of the political ruling class members?  Strangely silent and strangely absent it seems.  Why is school choice getting short shrift?  Why are web-based schools such a threat?  Is it because the "we know what works" group fears that choice would prove to be better?  Would relaxation of the residency requirement bring better teachers into Milwaukee schools?  Is it possible that we are failing these at risk kids and that they have no real alternatives?

Diabetes up 27% in state since 2005...

In two years, there are 27% more adult diabetics in Wisconsin.  419,870 adults were indicated to have diabetes in Wisconsin in 2007.  And, the estimate is that about 1 million more are pre-diabetic.  We have something over 5 million citizens, so the combination of diagnosed and pre-diabetic people accounts for about one of every four people in the state.

We have a health care cost crisis in our state and our country...and these statistics are evidence of why that is the case in very large part.  Diabetes carries a huge human cost and a huge financial cost from onset to end of life.

Hospitalizations due to diabetes grew by 11% over the two-year period in this study.  While the number of hospitalizations grew by 11%, the cost of those hospitalizations increased 48% to $2 billion; this can be attributed to the severity and number of cases as well as the general escalation of health care costs.  The overall cost of diabetes among adults in Wisconsin now stands at some $5.2 billion per year.  If the pre-diabetics were to be lumped into this cost today, we'd be spending $15 billion per year or more on the ravages of this disease.

We can be our own worst enemy so far as this disease is concerned, although that isn't always the case.  But, for those who are able to control or moderate their disease through personal lifestyle changes, they need to do that...for themselves and the rest of our citizens.  This disease threatens to bankrupt our state...both in the human toll extracted as well as pure cost. 

An organization that has been very active in the push for national health care is at it again.  Families USA recently provided a series of Press Releases that heralded the number of deaths per state that could be blamed on a lack of health insurance.  Wisconsin's estimate was 250 deaths per year.  This is the same group that was instrumental in 'creating' 47 million uninsured people in the United States.  That has been repeated often enough so as to have become thought of as a "fact".  The real numbers are closer to 10 million as I've discussed before, but bigger numbers help raise awareness faster.  So let us not be constrained by facts.  Let us simply create the facts we desire.

Rep. Steve Kagen (D), congressional representative from the Appleton area, couldn't help but jump on this latest bandwagon just as he had jumped aboard the first.  He participated in a teleconference on this subject and opined that there were between 59,000 and 89,000 uninsured in his district.  I have no idea of how he came to this conclusion; and, it is possible that he has no idea how he reached that conclusion either. 

Families USA has apparently decided that there will be greater impact on people if they now begin to tell us how many people died due to lack of health insurance coverage, rather than to continue to harp about the mythical 47 million any longer.  So, they adopted the study by the Urban Institute done last year that estimated 22,000 people die each year because they lack health insurance.  A health care economist has described this estimate as a "statistical guess".  From this "statistical guess" they extrapolated the "fact" that this equated to 250 deaths in Wisconsin.  And just today we saw the report that Wisconsin ranked second nationally in health care quality.  That just doesn't square with this "statistical guess" scare tactic.

As for 'real' facts, there is an even more interesting study, published by the Hospital Infection group (at www.hospitalinfection.org)  that I would've thought Dr. Kagen could see fit to get behind sooner:

Hospital infections cause five times the deaths attributed to lack of health insurance, and the majority of states keep the rates of deaths by infection per hospital secret.  And that could be prevented in most part. 

Now there's a real cause for the Doctor/Congressman.

The morning Journal Sentinel carried a brief story about Germantown being in the process of considering the approval of a $20,000 employee wellness program.  The General Government & Finance Committee meets tonight at 7:00PM in the Village Hall Board Room and is scheduled to consider this as part of that agenda.

Wellness programs have been with us for some time now, and are quite common in the private sector.  Many are preceded by a Health Risk Assessment as is apparently the case here in Germantown.

I was under the impression that we had more than 46 employees, but that is the number given as those who participated.  If that is only a segment of the full number of employees, then I would have to assume that this Assessment was undertaken voluntarily.  Given the labor agreements in place, that might be understandable, but it tends to defeat the purpose of helping employees identify issues with their health.  And, it tends to defeat the purpose of trying to reduce our taxes through better control over health care expenditures.

I was surprised that some 80% of the 46 employees who did complete the Assessment were found in need of nutrition improvement, weight management, cancer risk reduction and fitness.  That seems a high percentage of a work force contrasted to what one would expect in the private sector.  This could be symptomatic of the fact that municipalities tend to have very low turn-over of employees once hired which would tend to provide for a higher average age in the group.  That speaks to the overall conclusions of municipal employees that they have a very good deal when employed in the public sector.

The idea that the village needs to pony up $20,000 to teach people how to cook or to encourage them to begin to take better care of themselves through smoking cessation or weight-management is counter to what one would expect in the private sector.  Private sector programs tend to offer rewards to those who take personal responsibility rather than to offer up money to pay for the classes necessary.  Health premium contributions might be reduced if one takes steps to improves his or her health risk.  The money involved on the part of the employer is typically the 'seed' money used to get the wellness programs launched thus helping over time to reduce the cost of health care within the group.  Maybe this article was written poorly; I don't know, but the inference is certainly disconcerting. 

I do not know how much, if anything, is contributed by village employees toward their health coverage.  That may also be part of the problem.  We tend to attach little worth to something we don't pay for or for which we pay relatively little.

That $20,000 amounts to some $540 for every employee who displayed health risks.  It does nothing to reward the few employees who were already taking better care of themselves.  Doesn't that seem to be sort of a reverse incentive?  Then again, if the employees are paying little or nothing for their health coverage, this would've helped to create the environment where one would have to think of paying someone to take better care of themselves.

Update: The General Government & Finance Committee approved further study of the village Wellness Committee's request for funding at its meeting last night.  The general concensus was that this seemed a good idea but without specifics, there was nothing of sufficient substance to compel anything other than a furtherance.  Discussion appeared to indicate that this committee was not favorably disposed to a $20,000 initial funding level, but might consider some lesser amount at a future time. 

Who are 'They'?

'They' are the Democrats in the state Senate.  'They' have just passed 'their' version of the state budget repair bill out of committee and it now faces a vote in the full Senate.  The full Senate has a majority of Democrats.  Do we even think there is a chance that the committee's version will not be passed.  No.  That is what we might call "a foregone conclusion".  I'd love to have to print a retraction of this Blog.  Go ahead Dems, make me eat these words!  Please!

So what is it that 'they' did this time?  Well, 'they' raised taxes again.  I know that probably comes as a huge surprise, but that's what 'they' did.  'They' pushed some obligations into the next budget period and 'they' took some money from other places, both of which the Republicans did, as well.  The difference is that the Republicans in the Assembly did not raise taxes.  The Democrats in the Senate are doing that.

Just what taxes are we looking at? 

The KRM commuter rail line is back in 'their' budget repair bill and that, for starters, raises rental car taxes by $2 in Kenosha County and by $15 in Racine and Milwaukee Counties.  Of course, the thought is that this only penalizes visitors.  'They' don't seem to understand that it could very well deter visitors and could figure in decisions by corporations that are considering whether or not to remain or build new facilities in this area.  'They' don't tell us that the long-term operational costs of the KRM commuter rail system will be with us forever.  'They' don't care about that or about us taxpayers.

'They' are increasing the taxes on businesses by some $130 Million in this budget period.  But 'they' say that is only "closing loopholes".  These "loopholes" involve the use of a concept called 'combined reporting' where corporations with operations in other states are required to combine all profits so that Wisconsin can tax everything.  What might this do?  Well, it might convince some corporations to cease doing business in Wisconsin.  Certainly the Wal-Marts of the world will not quit doing business here...but they will raise their prices here to cover the additional cost of these new taxes.  We saw that earlier this year when it became common knowledge that television sets, for example, cost less in Illinois Wal-Marts than in Wisconsin Wal-Marts due to our minimum mark-up laws.

And, 'they' are falling victim to the combined onslaught of the big city hospitals, Wisconsin Manufacturers & Commerce, Milwaukee Metropolitan Association of Commerce, the Wisconsin Hospital Association and Governor Doyle and are raising taxes on all hospitals in Wisconsin by some $416 Million to get 'their' hands on more federal money.  This is apparently thought of as 'free' money but there couldn't be anything further from the truth.  The thrust here is this: the major hospitals have begged to be taxed more because that will result in the state getting more federal money for Medicaid costs and the state has promised the big hospitals a rate increase on Medicaid patients.  Never mind that these increased hospital fees are to be paid by us taxpayers and our health insurance premiums.  Never mind that the smaller hospitals in the state will suffer from the increased taxes because they will not see as many Medicaid patients and thus will not get the benefit of increased fees.  This is, by the way, a visible result of the vertical integration of health care systems, and it is only the beginning of the impact of that movement.

In the final analysis, either 'they' do not understand that all taxes are ultimately paid by us consumers...or 'they' do understand and 'they' just plain don't give a darn about us...the voters... who for some reason persist in re-electing Democrats.  And you and I both know that 'they' are fully aware that we pay the taxes. 

So, the simple deduction is this:  in spite of all 'their' rhetoric to the contrary, 'they' simply couldn't care less about you and me...so long as we're stupid enough to continue to vote for 'them'.  And, unfortunately, we continue to prove 'them' right; we are just as stupid as 'they' think...because 'they' stay in office and we pay ever more taxes! 

The New England Journal of Medicine, yesterday, published results of a study on prostate cancer and the various treatment regimens employed.  I selected this as today's topic since I'm a man, I've had friends who've died from the disease, I have friends who now have the disease, I'm in the target age group and fully one in six males will be diagnosed with prostate cancer.

Prostate cancer is the most common form of cancer in men and the number two killer second only to lung cancer according to the American Cancer Society.  It is predicted that there will be some 186,000 diagnoses this year and some 28,700 deaths are expected from the disease.

The New England Journal of Medicine reported on the study of a group of 1,201 men and their partners after three kinds of treatment had been administered.  Those were: removal of the prostate; implantation of radioactive 'seeds'; and, radiation therapy.  Of the group who had received either radioactive 'seeds' or radiation therapy, one-third also took hormones.  The Journal was careful to note that the patients and doctors had made decisions independent of this study so the conclusions drawn were said to be suggestive rather than conclusive.

The conclusion drawn by the urologist who led this study, Dr. Martin Sanda of Beth Israel Deaconess Medical Center in Boston, was this (as he was quoted saying): "Doctors or their patients should think twice if they're considering hormone therapy.  Most of the cancers treated nowadays are not really that aggressive."

The good news is that more than 99% of patients survive at least five years.  Thirty years ago, only about two-thirds survived that long.

This study showed that too much treatment can make a patient needlessly miserable. Complaints with hormone therapy centered on lack of sexual drive, problems with urination and bowel problems.

I remember very well my conversations with my friend John, of whom I've written before.  He was adamant that the quality of his life was more the issue than the length of his life.  He was encouraged to take hormone therapy and refused to do so after reading of the possible side effects.  He knew that was the right decision for him and maintained his quality of life until very near the end.

What lesson can we all draw from this?  I think the most important lesson is this:  Men should not avoid being examined for prostate enlargement and PSA counts for fear of what might be detected.  That is a very, very small price to pay for the peace of mind that flows for most of us as the result.  And, early detection is by far and away better for the patient because treatment can be begun before the cancer has grown too large to control.

The rule of thumb that I've always heard was that we men should begin to be examined for prostate issues at age 50.  My  feeling is that even earlier would be better.  My friend was diagnosed at about his age fifty and the cancer had already gotten a good start by that time.

This is one of the periods that are often joked about by the citizenry.  With no sessions being conducted in Madison, we all can feel a little less threatened.  The major snag in that logic at the moment is that both houses will continue to debate the budget repair needs given the anticipated revenue shortfall of some $650 Million.  I have discussed the primary differences between the Governor and his Democrats and the Republicans often in past Blogs. 

What got done and what didn't get done during the session now ended?

• We are still without a photo ID law to assure that only Wisconsin citizens who are entitled to vote are voting.
• Thank the Democrats for blocking this necessary legislation again.
• Our elected officials at the State level continue to enjoy the largess of Sick Leave accumulation.
• Thank the Democrats for continuing this little 'cookie jar' benefit at our expense.
• Cell phones are not part of the do-not-call list in Wisconsin.
• Thank the Republicans for mysteriously not taking this up in the Assembly.
• Economic development proposed by Governor Doyle was killed.
• Thank his fellow Democrats in the Senate for this being killed because it supposedly cost too much.
• The gun database still does not carry information about involuntary mental health commitments.
• Thank the Senate Democrats for killing this common sense initiative; maybe they want to simply ban all guns.
• Psychological examinations for new full-time police officers still not a requirement.
• Thank the Republican Assembly for not even debating this change even though it makes sense.
• Property rights won a victory over the anti-smoking groups.
• Thank both the Assembly and Senate for not giving away our personal rights and for letting merchants decide if they will be smoke-free.
• Virtual schools will be permitted to exist after heated arguments for and against.
• Thank both the Assembly and Senate for reaching a compromise that Governor Doyle dared not kill off even though his WEAC money machine dearly wanted this dead.
• The 'Frankenstein Veto' provision will be put to the citizens as a proposed Constitutional Amendment.
• Thank the Democrat-controlled Senate for finally agreeing to let this pass after the Assembly gave it bipartisan support.
• Healthy Wisconsin was defeated.
• This is a great victory of common sense over politics thanks to all elected officials who voted against it, and that is primarily the Republicans in both the Assembly and Senate.

So, how do we grade the overall efforts and results of the Assembly and Senate?  It has to be a mixed grade at best.  Maybe in the 'C+' to 'B-' range.  Our state budget spends too much money even though Republicans did their level best to reduce it even more than they did. 

The two branches again showed us how dysfunctional our government can be.  The bad side of that is that things of value to the citizenry were lost.  The good side of that is that a lot of bad 'stuff' got tossed in the garbage can.

Maybe we can get a decent budget repair bill put together and lessen the hit on the taxpayers' wallets and purses.  That would raise my grade by nearly a full point.

I regularly read the Blogs at Health Care Policy and Marketplace Review.  I know... I should get a life :>)

One in particular caught my attention.  It discussed the phenomenon that is Barack Obama, and the recently energized involvement of youthful voters.  Against this backdrop, the author peered into a crystal ball and opined about some of the implications.  In turn, I began thinking about the issues this could raise:

* * * * * * * * * *

It was recently reported that the cost per senior citizen for Social Security, Medicare and Medicaid in 2007 set a record at $27,289 each.  That equates to about $10,673 per non-senior household.  While the number of senior citizens has remained stable at about 12% of the total U.S. population, the costs have risen by 24% more than the cost of living since 2000.  I suspect most of that increase is due to the cost of health care services since social security payments increase at about the rate of the cost of living increase and a year or so in arrears.

Most of us have been aware that, despite politicians' protestations to the contrary, there is no 'lock box' where previous contributions have been squirreled away for future use.  The money that has gone into this 'Trust Fund' has been removed by Congress and spent on current needs for years and years.  As the result, with longer lives after retirement, there are fewer workers who are being required to support each of the retirees.  This is truly a 'pay as you go' system today.

This situation is now being exacerbated by the beginning of the influx of the 'boomers' who are now beginning to reach 62 years of age and thus qualifying for social security benefits.  I read in another journal that the average savings of the boomers retiring at this point is some $40,000.  If that is the case, there is a real rude awakening due for all of us in the not too distant future, no matter how well we might or might not be situated in our own right.

Senior voters have always pretty much controlled the debate on entitlements for their age group through organizations such as the AARP, the senior voting block and various other groups.  This is about to change, however, as Obama brings more and more younger voters onto the political scene.  That will likely continue if he is elected, and certainly many of those people will stay involved even if he is defeated.

The long and short is this:  there is a much delayed debate due in the very near future about how to change senior entitlement programs so that the remaining 'worker bees' are not driven into bankruptcy in their attempt to make their living and to pay federal, state and local taxes.

As more seniors draw against the promises made to them over their lifetimes, the pressures on the taxpayers will increase unless some changes are made, and made quickly.  This idea that the debate can be delayed for another decade is simply not a correct assumption.  And, the children of the baby boomers who may be moved to take a stand that they want changes made would nearly assure the debate being joined.

35% of all federal spending is for seniors' entitlements, and that was just 32% in 2004.  Something has to give, but what will it be?  And whom in the current political arena is brave enough to face up to the challenge?  We often hear about the 'third rail' of politics...and that third rail is exactly what we're talking about here. 

Changes will be necessary and almost everyone will ultimately feel the impact of those changes.

The time for political demagoguery, if there ever was a time for that, has ended.

We have all heard and read about the Clintons seemingly forever.  We were, as a country, mesmerized by the first 'man from Hope'.  We watched as this former Arkansas governor simply overwhelmed the opposition.  He had all the right moves.  He seemed sincere.  He was, unknown to us at the time, a bit of a scoundrel.  He became our president for eight years.  He built the most vaunted political 'machine' of its time, and that machine ultimately helped to put the former first lady into the U.S. Senate as a New Yorker which was a stretch.  The definition of carpetbagger had to be stretched to accommodate her.

Senator Hillary Clinton was watched as she did her work in the Senate.  She was mentioned early on as the prospective first woman candidate for the presidency.  It seemed to be her destiny.  The press couldn't seem to get enough of her.  And, as it was written, she assumed the mantle and joined the race amid the flourishes that accompany the 'next coming' of a politician.

And now, there seems to be a burn-out factor that she is having greater and greater difficulty overcoming.  Peggy Noonan writes, in her piece 'Confidence or Derangement' about the problems that have beset this campaign.  If you've not read it, I would encourage you to do so.  I am, admittedly, a big Noonan fan.

Barack Obama is a politician's politician.  His rhetorical gift has propelled him into the stratosphere of political approval.  His fans are truly fanatical.  He has just begun to make his actual positions known and yet he is virtually the next Democrat candidate for President.  His speeches have inspired without educating.  He has refused to debate his now sole opponent, as is customary for the leading candidate to