Milwaukee Biz Blog

Healthy Wisconsin is on everybody's lips, primarily because health care is into everybody's wallet. It's getting worse, but doesn't have to be that way.

Healthy Wisconsin changes the way medicine is paid for; not the way it is provided. Its only problem now is political.

Healthy Wisconsin's strengths:

• Its biggest change is in the structure. Rather than employers paying a middleman insurance company, they instead pay a flat 10.5 percentage of wages (which replaces the 15 percent many are now paying for employee health insurance). That's a 4.5 percent savings.
• Employees would pay 4 percent of wages, which would be offset by a 16-percent increase in benefits, such as adding limited vision, dental for children, mental parity, pharmaceuticals, and the extension to family coverage for all. Complete portability is provided when changing or losing jobs, and pre-existing diseases are a thing of the past.
• Employers are no longer involved in heath care, and Wisconsinites are no longer obligated to take an employer plan or even a family plan. Every family member can make their own choice between either a health care network (HCN) or the traditional fee-for-service (FFS).
• Doctors and hospitals remain private and send their bills to a central payment administrator rather than to the 450 statewide insurance companies (or 1,500, if we allow cross-border insurers). This drastically reduces their billing overhead and these savings are included in the total $1.8 billion projected.
• The systemic changes eliminate the costs that add nothing to health care, like insurance broker commissions, actuarial costs, costs for cherry-picking and gatekeeping, high executive salaries and the ever-rising shareholder profits. Even the insurer's high costs for lobbying and campaign contributions to politicians that were passed on to the patient are eliminated under Healthy Wisconsin. These are all gone, though it also explains the massive opposition from the insurance industry and their politician supporters.

Healthy Wisconsin provides major savings to most businesses and therefore fewer will outsource jobs to countries that have no employer contribution for health care. More businesses will open, remain open and relocate to Wisconsin as a result. The Wal-Marts and McDonald's of the world will now start paying their fair share, but few taxpayers will object to that.

 

While some small business owners objected to the earlier version of HW, the new version provides a three-year phase-in period, which should be quite palatable. As well, a cap of $102,000 in wages taxed has been placed on two-earner families.

In spite of the frivolous scare tactics used by the proponents of a status quo approach to health care, Wisconsin would not become a magnet for the unemployed or immigrants. Most already have free Medicaid coverage in their own state, thus relocating families is a foolish option.

No matter how important the Healthy Wisconsin proposal is to the people and businesses in Wisconsin, there remains an insurance industry that wants to continue drawing profits from the medical field, and politicians who receive their contributions. Hopefully they will all realize that as Healthy Wisconsin improves the state's economy, other insurance markets will emerge and the state will grow accordingly.

Prior to retiring four years ago, I owned a company with 70 employees in four states (40 in Wisconsin). Had Healthy Wisconsin been in effect at that time, I would have indeed closed my offices in three states and moved the jobs to Wisconsin.

Importantly, after selling my company, the buyer did move offices. They closed Wisconsin and moved the jobs to the East Coast. Had HW been in effect at that time, I seriously doubt that would have happened.

How many more jobs are we losing because of our high health care costs? My guess is, a lot.

Jack Lohman is a retired business owner from Colgate and publishes http://MoneyedPoliticians.net. He is the author of "Politicians - Owned and Operated by Corporate America."

Liberals want Medicare-for-all and conservatives say it's too costly. Some like the free-market "for-profit" system, others don't want profit driving medicine. Some don't want the government involved, others trust elected politicians more than unelected CEOs.

So, let's have both. How can anyone argue against that?

For those willing to pay the extra costs of the insurance bureaucracy, let them. That 31 percent of the dollars includes broker sales commissions, marketing and advertising costs, high executive salaries, bonuses and stock options, ever increasing shareholder profits, and even lobbying and campaign contributions that are added to the price of the policy.

If the conservatives want to pay it, let them. That's the free market they espouse, and it keeps some people in jobs.

But for those who want health "care" instead of health "insurance," let them opt into the federal Medicare system and reimburse Medicare for its actual costs. Employers can give employees the choice, and if one is more costly they pay the difference.

For those unfamiliar with Medicare, it's simple. You get sick, you get care and the caregiver gets paid. But the providers get paid by the Medicare administrator - which is Madison's nonprofit WPS - instead of the insurance company the employer has chosen. This year, anyway.

The hospital or doctor doesn't have to fight to get paid – the payment is guaranteed and there is little or no bad debt. And they remain as private contractors to Medicare, just as is WPS. It's the same private hospital and doctor you see today, just a different payer and it's portable if you change jobs.

Here's what's interesting. If Medicare truly is too costly, as its opponents claim, there'll be no takers. But if Medicare is cheaper, the private insurers will have no takers! How's that for competition and consumer choice?

Here's the rub. Medicare IS more efficient and private insurers will not want to compete with them. They can't compete now, as private Medicare HMO contractors, and it won't be any easier under this system.

However, one thing must be changed. Whether HSAs or not, private insurers must provide the same level of care as Medicare does. No pre-existing disease exclusions. No limits on coverage. No gatekeeping. No denials of care. No cancelling when costs start increasing. In other words, no playing games, no under-insuring and no cheating. Patients get care when they need care. Always!

This doesn't get us to a perfect system, just a more efficient and competitive one. There remain problems with both the fee-for-service Medicare system and the “flat rate” HMO/PPO models typically in the market. With FFS the physicians receive more income as the amount of care and ordering of tests increases. Sometimes too much care can be as bad as not enough care.

Conversely, with the fixed-rate HMO/PPO models, as more tests are ordered those costs come out of the bottom line profits. So depending on the financial relationship between the physician and HMO/PPO, needed tests could go undone so the profits increase.

All of this can be fixed if politicians have the will. Doctors and clinics should not be allowed to profit from expensive testing. Hospitals should not be able to employ physicians. The certificate of need should be reinstated and hospital overbuilding should be restrained.

Why are we hesitant to proceed? In short, we could fix the system if we removed the insurance industry and hospital campaign contributions being paid to politicians to protect the status quo. Unfortunately, private interests can give campaign contributions and Medicare can't, so the politicians will be a hard sell.

Jack Lohman is a retired business owner from Colgate and publishes http://MoneyedPoliticians.net. He also is the author of "Politicians - Owned and Operated by Corporate America" and can be reached at jlohman@execpc.com.

John Torinus has it wrong in his recent assessment of Healthy Wisconsin, and business readers are left with a misleading analysis that could send them down a more costly path.

Torinus said, "…high payroll taxes paid by employers inevitably put a damper on wage increases." Of course he's right, but very incomplete. He ignores vital, offsetting factors that good business leaders would surely include, an accuracy he would expect from his own managers.

First, the 10.5-percent employer tax (for Healthy Wisconsin) replaces the 15 percent most employers are currently paying for employee insurance premiums, thus wages are more negatively affected today than after the 4.5 percent of wage savings in HW is applied.

Since when does a 10.5-percent cost have impact but a 15-percent cost doesn't? Most business leaders would swap the higher for the lower any day, but obviously not John Torinus.

Secondly, he points to the 4-percent employee tax and doesn't mention that it offsets part of what they are already paying - and additionally, it includes coverage of limited vision, dental for children, mental parity and pharmaceuticals employees are not currently getting paid for. A 16-percentincrease in coverage, and there's no additional cost for a family plan!

Torinus scoffs that David Riemer ignores the "consumerism" in his earlier plan, which included health savings accounts. But there's a rather simple reason: according to the Bell Policy Center, "HSAs coupled with high-deductible health plans increase cost-consciousness among enrollees, but have little effect on overall health care costs."

That's obviously not what Torinus wants to hear, because he uses HSAs in his own company. Health costs will indeed decrease for his company but they will increase for employees. That's the pay cut he argues against! When employees realize that, will they then demand higher wages to compensate for lower benefits?

Healthy Wisconsin makes a systemic change that Torinus apparently doesn't like, nor does the debater he cites - Rep. Leah Vukmir (R-Wauwatosa) - and the other Republicans who share in the $600,000 of campaign contributions they've received from the insurance industry. When an industry gives this kind of money, you just know they are on the losing side of the argument. But money talks.

HW eliminates the 31 percent of wasted middleman costs that are consumed by the current insurance bureaucracy. For the same dollars we are spending today to cover 90 percent of Wisconsinites, we can provide greater coverage to 100 percent instead, so it's hard to understand why Torinus doesn't see the forest through the trees.

These systemic changes eliminate the costs that add nothing to health care, like insurance broker commissions, actuarial costs, costs for cherry-picking and gatekeeping, high executive salaries and the ever-rising shareholder profits. Even the insurer's high costs for lobbying and campaign contributions (to Vukmir and others) that are passed on to the patient are eliminated under Healthy Wisconsin.

It would be a disservice to the business community to not include all of these tradeoffs, and corporate leaders should quit listening to both sides and do their own math. Simply multiply current payroll by 10.5 percent and compare the result with what is now being paid for employee health care and its associated administration costs.  Now you have your answer.

Torinus deserves great credit for being ahead of the curve on health care, but in this writers' view, he's not far enough ahead. While he has reduced his costs, he could reduce them more because at least some of his employees are still stuck with the 31-percent burden. Torinus owes it to the business community to get all the facts on the table. Readers may not agree with mine or his facts, but they are experienced business leaders and can sort them out for themselves.

Healthy Wisconsin is not perfect, as David Kliber pointed out in his Milwaukee Biz Blog entry. But we should fix it, not trash it, and the Republicans should take that responsibility. We need a small business transitional tax break, and we should have the health board selected by the new, independent ethics board rather than the governor.
Winston Churchill once said, "Americans will always do the right thing, but only after failing at everything else." Let's prove him wrong.

Jack  Lohman is a retired business owner from Colgate and is a founding member of www.BusinessCoalition.net. He is the author of "Politicians - Owned and Operated by Corporate America" and can be reached at jlohman@execpc.com.

 

 

 

Recent news coverage by the Small Business Times has provoked excellent debate in the Milwaukee Biz Blog about the benefits and drawbacks of the State Senate's Healthy Wisconsin (HW) plan. This plan would eliminate the several billion dollars Wisconsinites spend on the health insurance bureaucracy, and spend it instead on direct patient care. It'll also include those who are currently unemployed.

HW is as close to a single-payer system as we can really get, politically, and it combines staff-model health care networks (HCNs) with traditional fee-for-service (FFS) care. There are advantages and disadvantages to each approach, and at least HW will allow them to compete, which both gives patients a choice and the public the opportunity to sort out the differences.

HCNs would receive a fixed per-patient dollar amount from the state and thus have the financial incentive to keep costs low and their "spread" high. Spread is equivalent to profits in a for-profit entity, and it is simply a surplus in a non-profit entity. In both cases it allows investments in new staff and technology.

Critics complain that the flat-fee incentive can work against the patient's best interest if expensive testing is needed because it drives up costs but not revenues. But just the opposite is true of the fee-for-service arrangement, where revenues increase at a rate faster than costs. FFS is legitimately blamed for at least some of the medical inflation because physicians are paid for what they do whenever they do it.

With FFS there is the opposite incentive to overutilize expensive testing, especially when the physician owns the lab or equipment. Overutilization can be as bad as underutilization because it can create problems that didn't exist. Conversely, there is an incentive to underutilize when the physician is employed by a health care network. But here the so-called "market forces" will play out as patients select or deselect on the basis of perceived quality of care.

Medical mistakes often have a perverse affect as the HCN suffers losses from the additional corrective treatments while the FFS providers continue to be paid for the additional services that they themselves caused. As a result HCN's are more likely to monitor the lesser skilled physicians.

In any event the FFS program needs to be updated. The once-effective Certificate of Need (CON) program must be reinstalled and physicians must not be allowed to self refer patients to their own testing lab. Actually, sending patients to independent hospitals worked quite well in the past, and that should be reinstituted. Alternatively there are very qualified independent labs that apply excellent competitive pressure on the entrenched health care market.

How to pay for it

By now most business leaders know that the HW costs will be borne by a 10.5% tax on the employer's wages, which in most cases will be more than offset by the elimination of the 15% they pay for health insurance premiums today. Another 4% tax on wages is paid by the employee, which in most cases is offset by the additional coverage of vision, dental and mental parity.

But not everybody is happy with this, especially those businesses that currently provide no coverage or inadequate coverage. The Wal-marts of the world will have to step up to the plate and begin paying their fair share. Even Aurora Healthcare is high on the list of companies whose employees receive taxpayer-funded BadgerCare.

HCNs will also be required to guarantee coverage and not be able to cancel the more costly patients, which the Blue Cross plans on the west coast have been charged with doing.

Most common is the legitimate complaint by small business leaders who by necessity have sought coverage on their spouses plan, or they simply go without. Our politicians must find a solution that allows them to survive this much-needed guarantee of public health care, and the best way is to provide an offsetting small business tax break, which the Republicans should love. That can be their contribution.

Actually, when you think about it, small businesses shouldn't pay taxes at all. They simply pass them on to the public and we reimburse them at the cash register, thus it becomes a regressive tax that affects lower income families more. That said, large corporations should pay taxes depending on factors that prompt good corporate citizenship, like the CEO-to-worker pay ratio, the ratio of local to outsourced jobs, etc.

In time I'd like to see healthcare morph into a totally taxpayer-funded service, because we are paying for it in the price of goods and services anyway. There is absolutely no reason why this should burden businesses who must compete with foreign companies that do not have health care built into their product prices. But I digress.

Suffice it to say that we should modify HW and not let the small business dilemma delay or prevent progress on fixing Wisconsin's healthcare mess. Its exorbitant cost is driving jobs out of the state, Wisconsin companies out of business, and preventing entrepreneurs from starting new businesses. Our state's economy can only be helped by this progressive movement.

The alternative is not pretty

Business and political leaders seem to be ignoring what will happen if we do nothing. It's a basic rule in life that he who owns the gold, rules. And today that's the businesses and their shareholders.

Business leaders and shareholders are now demanding change -- and they own the gold so I expect they'll get it. Those not forcing employees into high-deductible health savings accounts (HSAs) will be moving to managed care systems. Or they'll become members of a business consortium that contracts its health care to the lowest bidder.

HSAs are decent investment tools for the young and healthy and wealthy, but they are not a useful healthcare policy for the average family. According to credible studies by the Rand and Kaiser Foundations, the high deductibles can deter care until it is more costly to treat or becomes untreatable. Mothers will opt to put food on the table before buying their blood pressure medicine, and then have a costly heart attack or stroke. Or worse, die.

Those who can afford HSAs can find other ways to invest their money, but those who can’t need a solid health care program. Unfortunately, some employers are using HSAs as a means to transfer their healthcare risk to employees, and this promises to backfire in time. HSAs cannot reasonably be melded into a single-payer plan, but that does not prevent those capable of investing elsewhere.

Business healthcare consortiums are already forming in Milwaukee, but too often they are just a hair above being uninsured when uncovered catastrophic diseases strike. Not even the insurance industry will like this solution because ultimately they won't be needed there either. Its best option is to see Wisconsin grow and benefit from new markets.

FedEx moved on when Fax and eMail took over the overnight document delivery market, and they survived just fine. The insurance industry should take some lessons.

Doctors will not fare well either, as giant hospital chains buy up as many of the independent physician clinics as they can, specifically for their patient referrals. In either case physicians will soon become employed by a corporation and likely with lower salaries, competing more with foreign doctors, and facing higher demands for production-line efficiency. Get used to the five-minute office visit, because there’s more to come.

Nor will the hospital association like the new shareholder-managed-care system as they are beat down in prices with nowhere else to shift costs. It is not a pretty picture ahead. We need to fix it fast, and we need to fix it correctly.

The scare tactics have also begun, including the potential issue of unemployed people migrating to Wisconsin for care. This is a red herring. They already receive free health care through the Medicaid program in their own state, so waiting a year in Wisconsin would not benefit them.

Illegal immigration should indeed be dealt with, but not through the process of denying health care.  Especially when many of those immigrates become employed here and will be paying for their health care, and adding to the state's economy at the same time.
                                                                                      
Opponents of Healthy Wisconsin like to label this a $15.2 billion tax increase, and they conveniently -- no, purposely -- ignore the elimination of the $17 billion corporations are now paying in health insurance premiums. That distortion, naturally, comes from health insurance companies and business associations that sell insurance to their members. Wouldn't you know it?

And beware the dreadful words “government-controlled health care,” they are creeping upon us. In fact HW uses private health care networks, hospitals and clinics just as does Medicare and Medicare Advantage, and that "government" system is one of the most successful public-private ventures ever. Yes, its per-patient costs are higher because it almost exclusively covers seniors and end-of-lifers. But fold in the youngsters and the average is 20-30% less than we are spending today.

In the end it will be a political decision, and former Senator Joe Leean has it exactly right. The Democrats want it and the Republicans don't, favoring their campaign war chests and the insurance industry that fills them. More importantly the voters want it, so we should see it either passed this session or a different political party in control of the Assembly in 2008. That's called forced term limits. We need more of it.

Jack Lohman is a retired business owner from Colgate and is a founding member of www.BusinessCoalition.net. He authored "Politicians - Owned and Operated by Corporate America" and can be reached at jlohman@execpc.com.

 

 

http://www.biztimes.com/blogs/milwaukee-biz-blog/2007/07/23/insiders-try-to-sabotage-health-care-reforms

 

 

 

 

By Jack E. Lohman

The assembly Republicans are absolutely wrong to oppose the senate's Healthy Wisconsin plan, but I suspect they know it and would rather confuse the public to give them cover to kill the bill. Their insurance industry contributors will love them for that!

And we wonder why Wisconsin is the third highest cost state in the nation for health care? Thank the moneyed interests and the politicians who open their pockets.

The health care proposal by the Senate Democrats is a very reasonable plan. It will replace the 15 percent employers currently pay for premiums with a 10.5 percent tax on wages. And a 4 percent employee tax on wages will offset much of what they now pay and still leave them with a net 15 percent savings. Of course the Wal-Marts of the world will have to start paying their share, and sending their employees to our taxpayer funded BadgerCare will no longer be an option.

The public and most business leaders are behind this plan; the state's Republicans and insurance industry are not. But some of the business associations oppose it because they both have insurance industry members and they sell insurance policies to their members. So much for an unbiased debate on that side.

The senate health care plan will decrease corporate costs and will attract companies and jobs to Wisconsin. Not the reverse as the Republicans erroneously claim. It leaves some services for the insurance industry to provide, but not at the same level of profit they are accustomed to, so their opposition is understandable.

This plan will eliminate the issues of changing jobs with pre-existing diseases, and paying for COBRA between jobs, so it's a win-win for the state's economy.  

The Canadian horror stories the Republicans spew are simply not true. Over 80 percent of Canadians prefer their system to ours, and their medical outcomes are better than ours. It is admittedly underfunded and they have wait times for non-urgent procedures, but the senate proposal is not underfunded as the Republicans will quickly charge. In a survey of 18,000 Canadians only twenty -- TWENTY -- purposely traveled to the U.S. for care that was non-urgent.

We enjoy the best physicians, hospitals and technology, but our method of providing health care is the most inefficient in the world because 31 percent of our costs are total waste created by the insurance bureaucracy. This is money that should instead be spent on patient care, and the Democratic plan fixes that.

But we have politicians who receive massive campaign contributions from the insurance companies who want to retain the status quo. And some even want to switch to a high deductible system whose tax write-offs will benefit the wealthy but poorly provide for the mainstream Wisconsinite. Like the early HMO system that failed, health savings accounts will go down in flames when patients who deter care until it is untreatable start costing more rather than less.

All of this brings up a major problem in Wisconsin politics. And it is bipartisan. When these issues are being debated, wouldn't it be nice to know that the politicians on the opposing side are not taking cash from the industry being affected? Campaign finance reform must be the legislature's next agenda item, but that too, is not a Republican priority.

Perhaps killing the health care bill is what we need to guaranty a Democratic win in the assembly too. And while I am an old-version Republican, sometimes your own kids' hands must be slapped before they learn.

The Republicans have simply not gotten the message yet. Maybe they will in 2008.

Jack Lohman is a retired business owner from Colgate and a founding member of www.BusinessCoalition.net. He authored "Politicians - Owned and Operated by Corporate America" and can be reached at jlohman@execpc.com.

 

How many more uninsured Wisconsinites must die before our politicians get out of the pockets of the insurance industry and fix our health care crisis?

Sorry to be so blunt, but that is exactly what is happening today. Over $1.4 million per year in campaign contributions flows from the health care and insurance industries that want to keep the status quo. Inefficiency breeds profits, and they want the profits to continue.

Hundreds of thousands in campaign dollars come from the banking and credit card industries that benefit from health savings accounts - that incidentally are great for wealthy investors but terrible for patients and families in need of care. Worse, HSAs (health savings accounts) will ultimately help drive up health care costs as they keep patients away from care until it is more expensive to treat or becomes untreatable. Be careful of what you wish for.

A million more in campaign dollars from the bankruptcy attorneys that also like things just as they are, with over half of all bankruptcies involving exorbitant health care debt.

And all of this because campaign contributors are willing to share their profits with the politicians that make it all happen, and the pols that are willing to oblige. What a wonderful world.

Will it ever end?

Not just the deadly health care crisis, but also the political corruption that sustains it. When are politicians going to say enough is enough, and do what is right for the public?

A single-payer health care system would be a windfall for businesses, the state's economy and our citizens. Perhaps the insurance companies will have to make their profits elsewhere, as will the bankruptcy attorneys, bankers and credit card companies. But with a stronger Wisconsin economy there will be plenty of opportunity for that.

We now have three health care proposals, all designed to satisfy a certain constituency. But only one is aimed toward all citizens and away from the insurance bureaucracy that is consuming 31 percent of health care dollars without ever spending a penny on direct health care.

Sometimes you have to spend money to make money, and that's exactly what Sen. Mark Miller (D-Monona) and Rep. Chuck Benedict (D-Beloit) do with the Health Security Act (SB51/AB94). A small additional payroll tax for employers eliminates the 10 to 15 percent they currently spend on health care benefits, and a small additional payroll tax for employees eliminates costs of co-pays, deductibles, dental, vision, and scores of other expenses.

This should be called the Improved Medicare-For-All system, because it's modeled after Medicare, the only part of our health care system that does function efficiently. Yes, Medicare currently costs more per capita, because it covers almost exclusively seniors and end-of-lifers. But fold in the younger, healthier population and the average becomes lower than our current system. U.S. Rep. John Conyers' proposed HR676 at the federal level does the same.

If you are hung up over the government's involvement, get over it. There are some things best left to the government to fund. Fire and police protection, building public roads, and funding health care are just a few. Political campaigns are another, but that's a story for a different day.
Or maybe not. If you pay taxes you experience on a daily basis the costs of privately funded campaigns. Outrageous health care is just one of them.

Where are the non-healthcare business leaders on this? Many with their heads in the sand. They are trying to reduce costs in this so-called "free market" system, all while turning their heads when their fellow healthcare businesses pick their pocket. Their business associations that claim both as members, are siding with the insurers and actually selling their insurance to members.

Where's Business Ethics 101 when you really need it?

 

Jack Lohman is a retired business owner from Colgate and operates for www.ThrowTheRascalOut.org. He authored "Politicians - Owned and Operated by Corporate America" and can be reached at jlohman@execpc.com.

 

Here we are again. Health care is at the forefront with three state plans to choose from. Let's create a workable and fair solution, because people are really dying for us to get this done.

According to the World Health Organization, France is ranked No. 1 in health care. Better outcomes and lower costs, all with a public-private system and public-private funding. So let's steal some ideas.

Let's establish our own state-run Medicare-for-all system, which is 20-percent co-pay or optional Gap insurance. We'll provide 100-percent vouchers to those under the poverty level and a 50-percent voucher if under twice the poverty level. Throw in 100-percent relief when a family is hit with a catastrophic illness, and let's develop a reasonable end-of-life solution (ie, automatic no-code on people over 90 unless the family is able and agrees to absorb future costs).

Just 5 percent of the population consumes 70 percent of our health care, and most of that is by us old geezers. We need to cut that.

Let's mitigate the overbilling and fraud by moving those displaced from the insurance industry to a Medicare oversight commission. Even let private insurers bid on this, since they will no longer benefit from the current inefficiencies. Let's create medical courts to lower tort abuses and excessive costs of defensive medicine, and give any punitive damages to the health care fund rather than to the attorneys and patients who have already been compensated.

I'd keep an option like Medicare Advantage. Even though it costs 12.5-percent more than Medicare, it gives patients other choices and private insurers a role. They could even bid on the Medicare administrative contracts.

The fraud in nursing homes and home health agencies must be eliminated and prosecuted, and we should pass a law that requires employees to be educated on the whistle-blower statutes and rewards. Let the employees provide the oversight, though with such a law I expect the owners to clean up their act fast.
Reimbursements in Medicare (or our version of it) should be increased to ensure top pay for good doctors. State sponsored rebates of medical educational costs should go to all resident students who finish in the top 10 percent of their class, providing they agree to a two-year state internship.

We also need a patient database for transparency of physician utilization, best practices, practice variations, medication conflicts, and etc, with patient names kept secure unless released by the patient for travel purposes. That software is already available, free, from the Veterans Administration.

I don't like co-pays and deductibles, but it may be the only way to achieve political acceptance. Eliminating these is not a liberal giveaway, and in time we'll find that they cost more money than they save. Studies already show that they deter care until that care is more expensive to treat or becomes untreatable, so they have a long-term negative cost value. Some mothers even go without their blood pressure meds to save money, then they have a costly stroke or die. We can do better.

What we have is not working, and those standing in the way of change should be sidelined. This is the most business-friendly and public-friendly solution available, and even the insurance industry wins something here. It would reduce the maze of physician and hospital paperwork, and substantially reduce our excessive administrative costs. For the same dollars we spend caring for 85 percent of the population today, we could care for 100 percent.

While initially we'd need the employers' help in transitioning - say, with a payroll tax - we should phase them out over five years and make it 100-percent taxpayer funded. As it is employers just add their costs to their product price and we reimburse them at the cash register. We don't need these middlemen because they don't really reduce our costs, and by making them more profitable, more jobs would move to Wisconsin and fewer will leave. At least until other states catch on to us.

Jack Lohman is a retired business owner from Colgate, author of "Politicians - Owned and Operated by Corporate America" and founder of http://www.ThrowTheRascalsOut.org. He can be reached at jlohman@execpc.com.