Much is being written and discussed during this Presidential election period about health care reform.  Barack Obama prefers a government-run version of reform.  John McCain prefers a private market reform that would use tax law changes to accomplish nearly-universal coverage...the stated goal of both approaches.

I saw a news report this morning that serves as a great reminder of one of the things we need to be mindful of if we are going to move to government-run health care.  Here is that article:

Medco CEO argues for federally mandated end of life care protocols for Medicare patients.

CQ (9/17, Weyl) reports that in a recent speech at the National Press Club, chairman and CEO of Medco Health Inc., David B. Snow Jr., said that "the federal government should set protocols based on medical science to guide Medicare treatment for patients at the end of their lives." Snow elaborated that "30 percent of Medicare spending -- about $130 billion per year -- is spent on patients in the last year of their lives, often when recovery is no longer possible." But, nearly all of that money could be saved by establishing guidelines "of when to forgo further treatment." Snow also proposed "increasing electronic medical coordination, passing tort reform, promoting healthy lifestyles, and encouraging compliance among patients," which would save an estimated "$1 trillion per year, or half of current healthcare spending."

I have written of the "R" word before.  Rationing is a very common practice where tax dollars are used to fund health care.  I recall the situation recently reported from Oregon where a patient with cancer was not accorded medicines that likely would prolong life, but would be accorded coverage for 'assisted suicide' since that is legal in Oregon.

This isn't intended as a debate on the efficacy of withholding treatment that would extend life.  It is intended to provoke some thought about the need for such decisions if we go down the government-run health care road.  There will never be enough tax money available.  We see that in the debate over a new school building, and in road repair discussions and so on.

When there is not enough money in a government-run health plan, the patient will pay the price.  The organizational structure won't be pared down and taxes won't be increased because it is politically unpalatable.  The weakest link in this chain is the patient who has no way to fight the decision.  A "dispassionate" board who have never met the patient will make "an informed" decision and move on to the next agenda item.

Medicare is government-run healthcare.  Medicaid is government-run health care.  Between the two programs, more than 50% of the people in the United States already have health care coverage provided by the government. 

So, we debate the question all the while that government-run health care grows essentially unchecked.  The next step in Wisconsin, by the way, after BadgerCare Plus is to be BadgerCare Connect...if the politicians on the Democrat side of the aisle in Madison have their way.

Incrementalism is alive and well in Wisconsin.  It reminds me of the old saw that asks how one eats an elephant?  The answer, of course is: one bite at a time.

Oregon has had government involved in health care for quite a few years.  The state electorate also approved the concept of state sanctioned suicide several years ago.

Recently, the board that reviews the medications that are approved for state residents made a determination that was controversial...in my mind if no where else.  The board, in essence, said that, given the cost of a certain medication, it would approve suicide for this patient but would not approve use of the medicine given its relative newness and the lack of convincing data as to the outcome.  It had essentially set a price on the human life involved.

Today I read the story concerning Denver Children's Hospital and heart transplants in infants that use the heart from another infant that died a 'cardiac-related death'.  This differs from a heart harvested from a brain-dead infant in which that heart is beating until removed from the donor body.  A decision has been made that the donor that has been pronounced dead and has been in that state for only 75 seconds, is a valid heart donor for purposes of this new program.  The earlier line that had existed required death be determined only after some five minutes during which time the heart did not re-start itself.  In this instance, the length of time a person had been deemed 'dead' had been reduced to assure that the harvested heart had a decent chance of functioning in the new body.  The three cases in which this approach has been employed resulted in three infants alive today.  The decisions to withdraw life support were made by the parents in all three instances.

We know so much more today than we did a decade ago.  We can do things from a medical perspective that were impossible then, and these procedures have become commonplace now.  We are, in this area, pushing the envelope as it has never before been pushed.

I know there are at least two sides to these issues.  I have good friends whose daughter lives today because of transplanted organs that were available on a timely basis.  I can't even begin to comprehend being placed in the middle of such decisions, and I earnestly hope that never befalls me.

And this leads to my general question:  Is there a line we dare not cross?  If so, where is or was that line?  Am I comfortable with an appointed board making life and death decisions about me?  Who among us can claim the right to make such a decision?  How do medical ethicists deal with these kinds of issues?

I don't profess to have the answers to these questions.  If you do, and you're willing to share, I'd appreciate your comments.

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.

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 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.

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.

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.

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! 

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.

Am I the only person who is exasperated with our state and national political/tax scene?  I doubt that very much. 

As I watch the 'Amazing Obama' versus 'Deserving Hillary' race unfold, I see a real race as to which can promise greater tax increases/profit confiscation to the tune of TRILLIONS of dollars.  What is even more amazing to me is the blatant approach both are taking...coupled with the seeming lack of perception their two groups of supporters have of what they're getting into.  These two people are socialist/populists so far as I can see.  There is the inevitable class warfare coupled with promises that neither will ever be able to keep...thank goodness!  And, it seems, with every passing day, that Barack Obama will wrest this nomination away from Hillary Clinton unless the Clinton 'machine' is able to do him in...and that cannot be discounted.

Then, I read of our state's revenue collection shortfalls totaling something in the range of $650 Million by the middle of next year.  And, I hear the 'solutions' offered by Governor Doyle and by the Republicans.

On the one hand, we are collecting $650 Million less than projected due to an economic downturn.  That economic downturn is, in large part, caused by heavy taxation in our state.  We have all learned, if we'll admit it to ourselves, that lower tax rates increase revenue collections since they stimulate the economy.  Let us keep more of what we earn, and we'll find ways to earn even more than we were before, and tax collections increase.

Governor Doyle would combine his already once-defeated tax on hospitals (which will exacerbate the health care cost crisis), and delay some of the tax decreases that were part of the so-called 'bipartisan' budget passed just a few short months ago.  In essence, his solution is to raise taxes to get us out of our economic slump.

Fortunately, the Republicans are, so far at least, saying there can be no new taxes and there must be spending reductions instead.  Sen. Alberta Darling is releasing today her "Stay In Wisconsin" program.  That program represents her agenda aimed at keeping seniors, students and working families in Wisconsin.  We talked just days ago about Wisconsin's outflow of population.  Her package of proposals would eliminate the Estate Tax, increase the Property Tax Credit for seniors, eliminate tax on Social Security income, increase Tax Exemption limits, make Student Loan interest fully deductible, along with a few other things including evidenced-based health care reform. 

Probably the biggest boost would come from what Sen. Darling calls 'Invest Wisconsin 2.0'.  That includes the following:

• a 1% across the board income tax cut for all Wisconsin taxpayers
• Capital Gains reinvestment
• Angel Investment tax credit
• Education tax credit
• Green Data Center tax credit
• NanoSTEM research initiative
• Nanotechnology tax credit
• Product liability reform
• Expert Witness reform
• Jobs Preservation

The Governor seems intent on raising taxes to increase revenue while many Republicans are pointing in the direction of economic stimulation as the solution. 

I don't know about you, but I am just about at my tax paying limit.  I'd much rather help pay for a new elementary school in Germantown than add more money to the state's tax collection coffers.  The return on investment seems much better if we invest locally while our state stimulates the economy instead of increase taxes.

By the way, the idea of reducing expenditures when income lags is something that just about everyone of us has had to to do at one time or another.  Isn't it the state's turn to practice that simple budget technique for awhile?

It is nearly impossible to avoid finding something having to do with our health care cost 'crisis' in any newspaper we pick up.  There are seemingly press releases offered daily by one or another group extolling the virtues of their plan for controlling this 'crisis', and yet the magnitude of the 'crisis' continues to increase.

Several weeks ago, I wrote about the things that consume half or more of the money we pump into the health care system.  Those issues are all matters of personal control.  We eat too much fat; we smoke too much; we drink too much alcohol; and we get too little exercise.  These are personal issues and they cannot be solved by any organization, nor any government program...yet we stumble-bumble along somehow expecting that the nanny government will do for us what we apparently will not do for ourselves. 

Unless and until we gain control over our own destructive habits, there is no 'solution' to the health care cost 'crisis'.  None!  By the way, it is not a health insurance premium crisis!  It is a health care cost crisis.  Insurance premiums reflect health care costs, not the other way around.

The magic "BadgerCare Plus' program that opened for business on February 1st in Wisconsin will do nothing about the 'crisis' other than to formalize the mechanism to throw more money at a personally-created problem.  It demands nothing from those who are participants other than the continued payment of their share of the 'premium', which is too low to cause any lifestyle changes.

Governor Doyle's newest health care 'solution', to be called BadgerChoice if it sees the light of day, will do nothing about the real problem.  He used a consultant who helped Massachusetts create its 'connector' or 'exchange' for health care.  That program is less than a full year old and already has a $400 Million deficit that nobody knows how to solve.  It uses 'community rating' which causes the healthy to pick up costs for the unhealthy.  That does nothing to promote healthy lifestyles; and, it tends to cause the healthy to stay away from the program because they know it is a bad deal.  It requires, or mandates, that everyone have coverage.  If they don't have it, they'll lose their tax refund or they'll have their wages garnished.  Mandates have never worked for auto insurance where 15% or more of all citizens in states that 'mandate' auto insurance are uninsured.  Why would we knowingly replicate a solution for our state that is already failing.  Yes, Mitt Romney was governor at the time, thus establishing that neither Republicans nor Democrats necessarily really have a grip on the issues.

How do we solve the real problem?  We begin by making individuals accountable for their own health.  If it begins to cost us more money, maybe we'll come around to a better understanding that a six-pack per day isn't the best approach; or that several Big Macs each week could be part of the problem.  People who continue to pursue their unhealthy habits, even after being helped to understand their issues and being counseled as to how to change, would be charged more for their coverage because they're going to use more care.

We make health care costs and health care outcomes 'transparent' for all to see, and we give people a financial incentive to make better decisions.  We reward the providers that deliver better quality at the same or lesser prices.  We do that by making Health Savings Accounts a part of the majority of the health plans offered in Wisconsin, in both the public and private sectors.  Those are not the 'evil' tool of Republicans, by the way.  What they are is the solution that Democrats fear because ultimately they'll help us get over the idea that only big government can solve these problems.

These things have already proved themselves, but we continue to wallow around not getting anything done.  Or, worse, we find some scheme that has already shown it will fail, and then try to import it to Wisconsin.  Without placing responsibility squarely on the shoulders of the individuals, we'll not find a workable solution.  Why not? Because we will spend more money than we can afford while those who refuse to take responsibility for themselves dither at the local bar or fast food drive-through window.

Government entitlements do not cure problems; they perpetuate or exacerbate problems.  Free market forces solve problems.  Let's get on with it!

I had the 'pleasure' of meeting with one of Congressman Obey's staff members, Paul Carver, on Super Tuesday in the Congressman's absence.  Obey is the Congressman who represents Wausau and the surrounding area, and who is the 'Big Dog' so far as appropriations go in the new world controlled by the Democrats.  Congressman Obey has the reputation of a 'pit bull' and it appears that he hires in his own image.  The staff person, Paul Carver, is a native of England and had an attitude that was apparent from the very moment he walked out of his area and stated that ours weren't the names he had been expecting.  We had the pleasure of Mr. Carver's presence since the House of Representatives isn't in session this week.  I have no idea if the Congressman would've been more hospitable, less hospitable or about the same.

We were representing the National Association of Health Underwriters, a well-respected association in Washington,D.C.  NAHU represents 20,000 insurance agents and brokers who collectively handle the health care insurance coverage for some 150 million citizens.  We wanted to discuss the legislation that we expect which will affect health insurance for every citizen of the United States.

Mr. Carver proceeded to rant about how great socialized medicine was, how rotten insurance companies were, and berated us when we said we hadn't watched the so-called 'documentary' Sicko that had been advanced by Michael Moore.  Then he decided it would be more fun if he elicited comments from us that he could flame.  As we each became aware that this man was all about bullying and had no interest in learning anything, since he obviously knew everything, we ended our meeting as graciously as was possible.

During the rant, however, he did say that he believed in socialized health care for the United States, just like that in his old home, England.  We tried to offer information for his consideration, but he had no interest.  It was as if he were saying, "Don't confuse me with facts because my mind is made up."  He based much of his argument on the Michael Moore 'documentary' "Sicko".  He 'knew' that Cuba had better health care than the U.S., as did England, the Netherlands, Canada and a few other countries that flew out in his diatribe too quickly to be noted.

This is but one example of the 'ruling elite' that populate our nation's capitol.  The concept of these people being employed by we voters is simply a concept so foreign as to be laughable from their perspectives.  In defense of most of the 'staffers', they are well-educated, courteous and only too happy to meet with any citizens.  Some, unfortunately, are like Paul Carver.  I hope he is a citizen, but I don't know that for sure.  It certainly seemed that he'd be much happier back in his homeland of England.

We went to Washington. D.C., the capitol of our country, to meet with and discuss health care with our elected representatives.  We were not well-received by Mr. Carver who represented Congressman Obey.  We were actually treated with a rudeness that I've not experienced since my encounter with a former Congressman from the South Side of Milwaukee whose name was Jerry.

These are the Democrats, the very officials who supposedly represent the 'underdog'.  They turn my stomach.  They don't represent, so much as they misrepresent, the down-trodden.  So long as they are able to maintain their personal positions of power, it seems they're very satisfied.  And, we electors seem so gullible that we continue to re-elect these elitists.

As we predicted a few days ago, SynergyHealth made its decision to pursue a formal affiliation with what will become known as Progressive Health.  That, as you'll remember, is the coming together of Columbia St. Mary's and Froedtert and Community Health.

This seemed, from a layman's perspective, to be the best outcome for SynergyHealth and its Board concurred.  The final negotiations remain to be finished and the target for that to be completed has been set at May 1st.  This should bode well for the Menomonee Falls/Germantown/West Bend/Hartford area since there was a very real possibility that Aurora would become the defacto sole choice available.  The results of our race to consolidate healthcare systems remains to be determined so far as price increases or moderation, etc.  Building will continue, and that cannot but help add to costs.  If over-building occurs, some organizations will suffer.  Of course, us patients are going to be caught in whatever happens.

There was, many years ago now, a requirement in Wisconsin for healthcare systems to need to prove that a new facility was, in fact, required if all were to be adequately served.  If that couldn't be proved, permission to build was denied.  That law was wiped off the books a couple of decades ago and the result is quite apparent.  The building boom has had a detrimental effect on the costs of healthcare, and that has caused an increase in the costs of health insurance since one drives the other.  Is it possible that we'll once again see actual controls placed over health facility construction?  I wouldn't be surprised if that were to occur.

Finally, since I got lucky with the last prognostication, what do I do for an encore?  Well, let's take another peek into the not too distant future.

I expect that ProHealth based in Waukesha, that just acquired Medical Associates in Menomonee Falls, will ultimately join in some way with the emerging Progressive Health organization.  ProHealth and Aurora have been in a pitched battle for some time now.  That alignment would result in a very competitive group that could thwart the potential Aurora takeover of healthcare in our part of the world.  It would help to keep both honest and it could help to moderate healthcare costs.  If one or both took the road to hold the rate of increase to cost-of-living and nothing more, that would auger well for us consumers.  Healthcare cost increases have historically been double or more the cost-of-living inflation rate.

I also expect that the few remaining smaller players in this marketplace will need to affiliate with one or the other or run the very real risk that they'll become non-entities...also rans...and will be driven out of business.

Aurora Health Care has withdrawn its proposal to SynergyHealth.  That proposal would've seen an affiliation between the two health systems.  I suspect it was withdrawn because Aurora knew it would not be selected by the SynergyHealth Board during its deliberations this week, and preferred to not be seen as a 'loser' in this quest.  Remember that a large group of that system's doctors had taken a public anti-Aurora position last year.

That leaves, apparently, the proposal from Wheaton Franciscan Healthcare and the proposal from what has now become known as Progressive Healthcare (the new entity being formed by Columbia St.Mary's and Froedert & Community Health).

It seems that the likely result of the SynergyHealth Board review will be the selection of the Progressive Health proposal.  The geography makes sense since the markets are contiguous.  Progressive Health also has created its structure to be attractive to other healthcare entities that might be seeking an affiliation.  All other things being reasonably equal, that is my bet.

The SynergyHealth decision is still expected by January 31st., so we'll soon know the outcome.

Governor Doyle advised his audience last evening during the 'state of the state' message, that we were going to have to make some tough decisions and cut spending.

Then he proceeded to propose a new program called BadgerChoice that would have subsidies of $100 Million in the next budget cycle (beginning in 2009) and that would provide healthcare coverage for employees of firms under 50 employees.  Republicans were quoted as saying that a lot could be done to stimulate the lagging economy with $100 Million, but the governor would apparently rather spend that money on this program. 

He can find $100 Million for this but continues to veto the tax advantages of health savings accounts.  Maybe the idea of consumers being able to make their own decisions is somehow unpalatable to him.

He wants to advance state-run healthcare at any cost and sees this as the opportune time in which to launch the effort...again.  He would have the state design several plans of benefits, and employees would choose the one that best fit their needs.  He would have insurers hamstrung to the point that they could not take health conditions into account.  He would have all insurers in this marketplace use a device known as 'community rating'. 

Community rating means that all people pay one of two things...they either pay too much because they're healthier or they pay too little because they're greater risks.  No one pays the right premium.  This causes something called 'adverse selection'.  If this is a voluntary program, only those who have greater health risks will enroll in large numbers.  Once that has begun to occur, insurers will seek to have the state raise premiums, or reduce benefits and will drop from the program if they cannot run the plans at a profit.

He wants to have the new 'marketplace' run without the employers and employees having the benefit of a licensed, trained and monitored health insurance agent available to handle the inevitable questions, education and problem resolution that is especially important in the small employer marketplace since, as the governor's administrator of the Division of Health Care Financing Jason Helgerson said, "Small businesses can't hire an HR Director".  If that isn't the single most contradictory thing to come out of this, it has to be very near the top of that list.  Small employers are the very area where a licensed insurance professional is needed, and virtually every small business person will attest to that.

It appears the governor is taking a page from the Commonwealth of Massachusetts where the "Connector" program was created.  It serves as a clearinghouse, sets the plan design parameters, gets competing bids from insurers and works without agents except where one might be used to do the initial enrollment.  The Connector has one significant difference, so far, and that is the mandate that everyone have coverage or face penalties assessed as part of the Massachusetts tax system.  Even with the mandate requirement, insurers have already found themselves being hit with adverse selection as the result of the community rating scheme discussed above.  The healthier people are flowing to the least expensive plans while the health risks are more interested in the higher benefit level programs.

This proposal is not only ill-timed given Wisconsin's obvious needs to reduce spending, novel concept that this is, but it is poorly thought.  This is but another example of the fact that Democrats will not rest until Wisconsin runs health care for every citizen it can force into such a program.  BadgerCare Plus is poised to launch on February 1st.  That is a state-run health care program.  It is what we used to think of as the children's health care program, BadgerCare, except that in Wisconsin we spent the majority of that funding to insure adults while some 40,000 children were never enrolled in the system.  BadgerCare Plus doesn't try to hide its intent.  Adults are openly accepted as of February 1st.

The 'nanny state' wants more and more of us wholly-dependent upon it for everything possible.  We apparently should not have to take personal responsibility for our life style habits that account for more than half of all health care costs today.

We are living in an increasingly socialist state.  We can change that if we choose when we go to the polling place.  Or, we simply go another step down the 'slippery slope' to which we've grown nearer over the past decade.

Finally, if the governor were planning to stick with his promise to not run for another term, why would he continue to raise campaign dollars at such a rapid pace?  The specter of another term after this one is indeed frightening.  The only defense will be a Republican majority in both the Senate and Assembly.

The phrase 'collateral damage' is most often associated with military battles when things adjacent to a target get 'broken'.

There is the potential for collateral damage in the world of healthcare, and we see that playing out today between Aurora, Wisconsin Physician's Service (WPS), Health EOS, and employers and employees.  As Aurora has managed to acquire and/or merge its way to the size that it is, it has become a very dominant healthcare entity.  It participates in networks (as well as stand-alone relationships), and network access is sold by Health EOS among others.  Health EOS, a preferred provider organization, is the product of consolidation/acquisition, as well.

WPS and Aurora have been involved in a legal battle for some time now, and some of that 'battle' has leached into what we might call the very real world of day-to-day healthcare.  An earlier suit between the two entities was settled in early 2007.  WPS brought a new suit naming both Aurora and Health EOS in mid-January claiming that Aurora was interfering with WPS in its contract with Health EOS.

WPS is claiming that Aurora has asked that Health EOS not permit WPS patients' access to the Aurora hospitals and physicians at the preferred pricing that has been negotiated between Health EOS and Aurora.  WPS has a contract with the employer, Milwaukee County in this instance, that provides for County employees and their dependents to use the Health EOS network of which Aurora is a part.

When the elephants of the new consolidated healthcare world dance, employers and employees and dependents can be 'trampled'.

We all understood that legal issues tend to play out over a lengthy period of time as each side works with its attorneys and the legal system.  An Aurora or a WPS can sustain this lengthy legal maneuvering, but the covered employee needs the care today or tomorrow.  You can imagine how disconcerting these news items are to those who wonder if they're going to be covered and, if so, at what price.  The union leaders and the employers involved become very concerned because their telephones are going crazy with calls from the members/employees.

As healthcare consolidation continues, there are fewer, but larger organizations left in the wake.  If we get down to a couple of major healthcare organizations, the choices that used to exist become severely limited.  Collateral damage seems bound to occur more often and/or with more severity in that new world as the 'elephants' parry and thrust to gain market share, acquire the few remaining independent targets, and so on.

It is one thing when large companies struggle with each other in the competitive marketplace, but entirely another when we see the patients caught between.  We talk of unintended consequences often; this is one of those.  This outcome may have been thought about but it was not the desired result.  Yet, it can hurt people just the same as it would had it been intended.