Wow, voting day is finally here and my telephone will quit ringing so much, my mailbox will be less cluttered and I can either celebrate or cry in my proverbial beer.  This election 'season' has seemed to go on forever.  Several things are at top of mind this morning...

Milwaukee Police Unit Disbanded...

The special investigative unit of the Milwaukee Police Department that generated the 67 page election fraud report has apparently been disbanded some five days prior to today's election.  The detective who led that operation has, according to the Wall Street Journal, been relegated to the sidelines today.  John Fund of the Wall Street Journal reported this morning that Detective Michael Sandvick had predicted that Wisconsin could see as many as 55,000 illegal votes cast.  He cited the cross-border flow from Minnesota and Illinois since Wisconsin is one of only eight states that have 'same day' registration coupled with the weak verification of eligibility.  His estimate was that as many as 30,000 votes could be cast today in that manner. 

There are only two people of whom I'm aware who could've caused this 'stand down' and those are Milwaukee Mayor Tom Barrett and/or Police Chief Flynn.  Neither has been available for interviews today to my knowledge.

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My Voting Site...

I drove past the site where I vote at about 7:20AM today and was astounded at the number of vehicles parked and at the length of the line of people waiting to move into the building to vote.  I plan to vote in the 9:00AM range and we'll see if this surge was simply caused by people on their way to work as I suspect.

At any rate, it certainly seems that our voter turn-out will be in the range predicted by the Village Clerk's staff which I recall was in the 73 percent range.

On top of this was an inordinately high number of absentee ballots being cast based on my casual observations of parking lot loads during the preceding couple of weeks and of anecdotal comments from people working in village hall.

UPDATE:  I voted at about 9:20AM and was number 580.  The people were still streaming in and there was about a ten minute wait at that time.

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Media Hype...

I am angered with what now seems to pass for the mainstream media so far as their seeming promotion of Obama's 'inevitable' victory.

We have been fed the 'facts' for many days that there is no way for McCain to win.  There are, unfortunately, too many voters who are swayed by this 'stuff' and who don't think for themselves.  If just 1% of potential voters were dissuaded from 'wasting' their time voting, the swing could become a 'self-fulfilling' prophecy.

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Direct Legislation...

Finally, we are witnessing direct legislation in Milwaukee concerning mandatory sick days from employers.  This would create a burden for many businesses that would force them to close or move thus negatively impacting the residents.  But, there are too many who can't or won't think these issues through and simply vote because they like the idea that they can have sick days. 

We are witnessing some 25 to 30 communities across the state that have ballot questions concerning 'mandatory health care plans similar to those afforded state employees'.  These types of issues are done at the state level but grass roots groups have begun to work at the local levels to bring some pressure to bear on state legislators.  The simple fact is that there isn't enough money in the state to provide that level of health care coverage for all the residents.  We would bankrupt ourselves.

Having family members in Colorado, I am reminded of the folly that those voters are subjected to in the form of ballot initiatives.  There are something on the order of fifty individual questions on ballots in Colorado today that require some real effort to understand.  The majority of voters do not take the time to do their own research and, instead, follow the direction of their associations or unions or professional affiliations.

This is a very dangerous thing, in my opinion, that lends some credence to the old saw about us voters getting the government we deserve.

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.

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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.

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?

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. 

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?

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.

Seemingly everytime we pick up a newspaper or periodical we see that health care costs have risen again.  The only real question anymore is 'How Much?'.  Of course, if we still have health insurance, the premium rates continue to go up and up.  What in the world can we do about this?  Would statewide mandatory insurance coverage do the trick?  Can we somehow legislate lower insurance premiums?  Are the drug companies really the culprits?  Maybe we simply need to move to Canada or Europe.

Recent studies show that our national health care spending increased in 2006 by 6.7% to $2.1 trillion.  That means that one out of every six dollars spent in our national economy goes for health care.  The 'good news' in this staggering number is that this is actually slower growth than we saw for 2005.  Apparently we're going in the right direction, even if too slowly.

Another amazing fact, to me at least, is the amount of 'out-of-pocket' spending each of us averages after insurance premiums, etc.  In 2006, we spent, on average, 12% out-of-pocket for our health care expenses.  Know what we spent out-of-pocket in 1960?  We spent 47% out-of-pocket for health care expenses. 

That means that we are shielded to a much greater degree today from our real health care costs than we were in 1960.  Our out-of-pocket costs have decreased steadily since 1960.  We are often at the point today where we think of the cost of health care as being the $10 or $20 co-pay we have to come up with when we go to see the doctor.  Or, the $20 or $30 dollars we have to cough up for medicines.  Those amounts are very small percentages of the total costs.

Why is this important?  It is important because we need to think about what we're spending if we're ever going to be able to bring this cost spiral under control.  If we come to understand that the real cost of the doctor visit is in the range of $125 to $150 or more, we can begin to understand that maybe we shouldn't be running to the doctor everytime we have a runny nose or a cough.

Another very interesting fact is this:  more than 50% of all health care claims costs in America today are to cover lifestyle-related illnesses.  Those are the things that you and I can control to one degree or another.  But, we can't control them if we don't know about it or if we choose not to do anything about it.  What are 'lifestyle' issues?  Smoking, alcohol use, obesity and simply laying around doing no exercise.

Does this apply to us?  Here are the most current facts:  One in every four Americans eat fast food every day!  Six of ten Americans do not exercise or seldom exercise!  Two of every three Americans are classified as either overweight or obese!

This is the real source of our health care cost crisis.  We have met the enemy and it is us!

No mandatory state programs, or profit controls on drug companies or anything else is going to solve this problem.  The simple truth is that this is up to us.  All the rest of these proposals are simply pablum calculated to make us feel good.

That is why this 'stuff' is flowing from the mouths of politicans.  And it does nothing to solve the problem!

Let your politicians know that you understand this.  If they really want to help us, they'll begin an educational program using some of the 'smoker money' to get the true message out.  And, be sure to tell them we do not want laws banning fast food or drinking or smoking.  We need to take responsibility for ourselves.  No one else can do that for us.  The marketplace will make its own corrections just as you've begun to see with the menu changes going on in the world of fast foods, for example.

Maybe if insurance companies were permitted to charge people what we deserve to be charged based on our lifestyle habits, we'd begin to see these changes occur.  If I smoke, I pay more.  If I'm overweight, I pay a surcharge.  Make me feel my wallet lightening up if I don't take personal responsibility (just don't think this is your new way to raise taxes). 

Don't just continue to blame big health, or big drugs or big insurance!  You are doing nothing but pandering when you resort to this, and we're on to you!

Maybe bold is a bit overdramatic; these things are almost certainly going to occur during the next twelve months...and probably during the next twelve months after that.

HEALTHCARE COSTS CONTINUE TO RISE...Of course that will happen as it has been happening for a long, long time now. 

We'll know what our healthcare delivery landscape will look like as we move through 2008.  We will be in the process of building too many facilities and that will ultimately drive costs up at an even greater pace.  We'll see the consolidation wave cresting and then we'll effectively have a couple of behemoths.  And that will ultimately drive health care costs up at an even greater pace.  We'll have continuing debate over the governmental control of our healthcare; and that holds within it forebodings for us all if we take the seemingly 'easy' pathway to universal coverage.  Government will continue to blame health insurance companies while it meddles in the free marketplace to the detriment of us all.  Will we be able to work our way through this coming year in healthcare?

TAXES WILL CONTINUE INCREASING...Again, of course this will happen as surely as the sun rises in the morning.

Our governmental bodies from village to state to federal continue to spend at a pace that simply cannot be sustained without damaging the economy.  Programs once instituted never die.  If funding channels go away (read cigarette taxes), the programs are simply shifted to using 'general purpose funds'.  And, as if the idea of never killing off useless tax-funded programs isn't bad enough by itself, our various government bodies add new tax-funded programs willy-nilly.  Our state budget just approved carries with it unfunded future obligations of something in the range of a billion dollars for the next biennium.  Our federal budget carries within it the same type of mischief.  Our politicos are absolutely addicted to 'earmarks' and those infect state budgets as well as federal budgets.

EDUCATION WILL CONTINUE TO BE DEBATED...And this, too, is a virtual given.

The primary state teacher's union, WEAC, has still not extracted its payback for the massive support provided to the Governor and many elected representatives.  Look for the QEO provision to be attacked and possibly thrown out if Democrats gain control of the Assembly in addition to the Senate and Governor's mansion.  Milwaukee's system will continue to move in precisely the wrong direction so far as numbers of graduates, test scores and almost every other measurable area.  Germantown's petition to move from MATC to another technical college district will be heard by the state technical college board, and only a miracle will see that petition granted.  We will have been accorded our 'due process' but come to realize that appointed boards do not provide 'due process'.  Virtual schooling will continue to be assailed by the teachers' unions...even though union member teachers are employed in those programs.  Why you ask?  Competition seems to be a great idea in everything but education, where the establishment simply cannot tolerate the possibility that we'll come to realize the king has no clothes.  There will be more referenda, and those that are properly presented will be voted on their merits from the electorates' perspective.  'Properly presented' means that the referenda are scheduled during an existing election, and not on some obscure date calculated to bring out only the 'right' voters.  'Properly presented' means that teachers and administrators are not employing taxpayer money to make their case, and that all the facts are presented well in advance to permit reasoned public debate.

ELECTIONS WILL DETERMINE THE WILL OF THE PEOPLE...And that is truly the hallmark of our country.

Our state government will be re-shaped and a Democrat sweep, should that occur, will virtually assure the we'll have universal health care called 'Healthy Wisconsin Two', higher taxes across the board, and fewer freedoms as government sucks up more of the available air.  We'll have more tax and spend programs that will take on lives of their own, and conservatives will trudge through the political wilderness for another decade or two.  Our Governor, who promised this would be his last term, has apparently decided that we need him for another term of four years.  Of course we expected that since other promises like 'no tax increases' have been conveniently forgotten, as well.

The federal scene holds a similar scenario.  People will need to evolve beyond the still-controversial 'hanging chad' feelings.  There was no Supreme Court fiat involved in the Florida race; that was a contrived attempt by the loser to fan the flames and get into office because he 'deserved it'.  So, he then went on to exploit the 'global warming' thing instead, while emitting more pollution that a thousand or more normal folks.  We'll have a new President-Elect by year-end.  The Iraq war seems to be less and less an issue as the press finally tells a more positive story...that has been going on for much longer than has been told.  The attempt to convince people that we're in a recession seems to be failing, but Congress still tries to make that happen with tax legislation.  For the first time since 1952, we have a wide-open race on both sides of the aisle.  What will happen if a strong third party candidate 'suddenly' emerges...like the 'sudden' emergence of Mayor Bloomberg of New York (as has been rumored for months now)?  That will throw everything into the proverbial 'cocked hat' on both the Democrat and Republican sides.  Yet another reason why congressional seats are so important.

2008 promises to be a very exciting and rewarding year, just as all the other years I remember have held great promise coupled with the aura of excitement...if we can but sieze those opportunities.

May you and yours enjoy a most healthy, happy and prosperous 2008...no matter your politics!

An old phrase admonishes..."Physician, Heal Thyself".  There is new meaning to the phrase these days.

More and more, physicians are growing disenchanted with the practice of medicine.  They still love to treat their patients, but they do not necessarily like the manner in which they're forced to practice medicine.  Physicians have long chafed under the mantle of managed care.  The idea that some 'suit' would tell a doctor how to run his or her practice simply galled the doctors. 

Managed health care has changed the way in which doctors are permitted to interact with patients.  Doctors are required to see a certain number of patients each and every hour.  If they don't, they stand out amongst their peers.  If they're part of a large physician group, they become what is known as an 'outlier' meaning simply that they do not fit the norm.  If they fail to correct their status, they are seen as a detriment to the group with which they're affiliated.

Patients have become more or less accustomed to this form of health care.  They are used to waiting and then to seeing their doctor for a few minutes.  The doctors are often harried.  They were accustomed to the continuum of care where they decided when and where to refer patients whom they were unable to help at the primary care level.  Those decisions are largely made for the primary care doctors today.  If someone has a problem with an eye, the referral pattern dictates that the patient see the ophthalmologist that is part of the group practice.  If there is a skin condition, the dermatologist sees the patient.  If there are behavior issues, the patient will be sent to the psychologist or psychiatrist that is part of the group practice.  And on and on in that manner.  The art form today centers on maximizing the billable charges.

In defense of the group practice, it has been forced by managed care companies...the insurers...to adapt if it is to survive.  The practice leaders are likely to sympathize with their primary care physician team members, but that can't be permitted to get in the way of running the business side of the practice.

On top of this phenomenon is the seemingly continual consolidation of practices, and the acquisition of practices by hospitals, and so on.

How then are physicians 'healing themselves'? 

More doctors are moving 'back to the future' by ending their contracts with the insurers, and simply practicing medicine as they thought they would practice medicine when they graduated.  They are sometimes called 'fee-for-service' doctors and they get paid cash upon the delivery of their services.  The patient is given the paperwork to support their own claim filing for reimbursement from the insurer.  In many instances, the doctor can afford to take less money from the patient because he or she is not waiting months to get paid after re-submitting the claim once or twice.  And, because they don't require the large staff they used to need to interact with the insurers.

Some are opting to become what are known as 'Concierge Physicians'.  That is where the patient pays an annual fee of $1,000 or $1,200 or $1,500 in return for being able to call the doctor and see him or her the same day.  Some make house calls.  These physicians do not interact with the insurers either.  They practice medicine as they always wanted to practice medicine.  They take the time they feel is necessary to care for their patient. They see fewer patients for longer times and earn more money.

This movement began 10 or more years ago and has spread steadily throughout the country.  Recruiters are enticing snowbirds to move to Florida or California where they'll become part of the Concierge movement.  They'll still be part of a larger entity, but they'll be guaranteed a maximum daily patient load so they can take the time they need with each patient.

On top of everything else, they often make more money in addition to having the contentment of practicing as they desire.  That is a difficult combination against which to compete.

Will some of the Advanced Healthcare and Medical Associates doctors begin to think about going 'back to the future'?

The announcement concerning the sale of Medical Associates to ProHealth Care has been expected for months and finally was made.  ProHealth will buy Medical Associates for about $40 Million and the deal is expected to close around the beginning of 2008.

ProHealth owns Waukesha Memorial Hospital and Oconomowoc Memorial Hospital.  Medical Associates has clinical facilities in Menomonee Falls, Hartford, Sussex, Germantown, and Waukesha.  The bulk of Medical Associates' 175,000 patients are admitted to Waukesha Memorial Hospital and to Community Memorial Hospital in Menomonee Falls.

Community Memorial is part of the Froedtert & Community Health system.  That system has agreed to consolidate operations with the Columbia St. Mary's system.

Finally, Advanced Healthcare is being purchased by the Aurora system, and Aurora is building a new hospital in Grafton which is the 'backyard' of Columbia St. Mary's.

There are still other smaller systems fighting for survival, but those named will be the major players and are likely to have absorbed the remaining hospital systems and physician practice affiliations.

My earlier blogs have discussed what all this consolidation could mean to those of us in the Germantown area.

First, Community Memorial Hospital is at risk of losing the bulk of its patient load.  Aurora has promised the doctors at Advanced Healthcare that their admitting patterns will not be changed for at least two years.  (Read that to say, we'll shift patient admissions from Community Memorial Hospital to other Aurora hospitals in two years.)  I don't have any idea of the language of the deal between Medical Associates and ProHealth.  But, ProHealth is buying Medical Associates to gain doctors and to get added patients admitted to its hospitals.

Clinics usually are cost centers for hospital systems.  Hospitals tend to lose money on the clinics they buy and operate, but make that back plus with admissions to their hospitals.

There have been continuing rumors of discussions involving ProHealth and Froedtert & Community.  If those systems were to consolidate, there would emerge a new 750 lb. gorilla to take on the existing 800 lb. gorilla named Aurora.

Again, I have no knowledge of those discussions, if they are even continuing.  If I were running any one of those remaining systems, I'd certainly have determined that my only real chance of survival would be to consolidate with others to get the scale needed to be a true competitor to Aurora.

This bears watching.

So far as those of us in the Germantown area, we're in for a bit of a roller coaster ride over the next few years so far as healthcare is concerned.  Not only will admitting patterns be involved that will determine where we are hospitalized, but the price of healthcare will hang in the balance.  Will consolidation lead to true price competition....or will it ultimately end true price competition?  It could go either way.

Junk mail is driving me nuts. How about you? Is there a real solution that we can use or are we doomed to continue to wear out our delete keys? I’ll be happy to pass along your recommendations.

Perpetual campaigning is robbing us Americans of our rightful expectations of government. This is vividly clear when we look at the federal government. It seems to be getting more rampant on the state level, as well. Every move at the national level is one of posturing, rather than governing, for the majority of our elected officials. And, too many moves on the part of our elected state representatives smack of the same.

General Petraeus, the commander of our forces in Iraq, delivers his assessment on conditions there in a week and one-half. However, both sides appear to not have the courtesy to let us decide what to think of his report. Instead, they have been positioning for weeks to tell us what he’ll say and what it’ll mean. No matter your persuasion, you can make up your own mind; I doubt that many of us need such assistance.

The Presidential candidates for both parties will likely be chosen by very early in 2008, and maybe even before the coming New Year’s Day. On the heels of the “perpetual” campaigning mentioned above, we have this rush to decision being thrust upon us by a handful of states. Would we be further ahead to have a single national primary to be followed in 120 days by the national election, as I’ve begun to hear discussed?

Governor Doyle’s hand has appeared as expected in the budget debate. Unfortunately, he is resorting to fear-mongering by citing this and that calamity about to befall all us Badgers because there is no compromise as yet, on a terrible budget I would add. According to him, our schools won’t be able to run, our state Medicaid system will fail the folks who depend upon it and the Republican’s failure to acquiesce will cause your property taxes to rise precipitously. His budget, even without the addition of Healthy Wisconsin which he does not support, has us paying 23% more than before. With Healthy Wisconsin, it only doubles! What a choice we have. The opposition must not cave in, but instead must continue to work to advance its more rational version of our next biennium.

Our Warhawks football team ran into the seventh-ranked team in the state last evening and came away with a much better understanding of its own weaknesses. Coach will build on this experience and our players will improve having gotten such a solid lesson so early.

Our new motorcycle patrol is having the desired effect. I have been amazed at how invisible that cycle and officer can be, and also marvel at my good fortune to have been at or under the speed limit each time…so far. If you’ve not given thought to the effectiveness of this unit, do so before you pay good money for a transgression.