Milwaukee Biz Blog

Out of all the public programs I get wrangled into emceeing or moderating during the course of the year, the BizTimes Health Care Heroes Awards program is undoubtedly my favorite. That's because the winners of the awards tend to be real people - make that real humble people - who are just doing the right things that make this world a better place.

Do you know someone who is making a positive difference on the front lines of health care? BizTimes Milwaukee is accepting nominations for the 2009 Health Care Heroes Awards, honoring companies, individuals and organizations for their contributions to improving health care in southeastern Wisconsin.

Health Care Heroes Awards honor those who epitomize the spirit embodied in the word "hero" in the delivery of health care to the community. The goals of the program are to recognize excellence, promote innovation, encourage emulation of successful programs, educate the general public, contribute to the enhancement of the value and quality of health care and, ultimately, give recognition to those deserving.

Entries are judged on accomplishments in the following categories:

• Corporate Achievement in Health Care - Honors a company that has successfully implemented an innovative health benefits plan or a company that has solved an acknowledged problem in health care administration. Judges will consider the uniqueness of a benefits plan, its popularity among enrollees, its cost-effectiveness, the complexity of the problem solved and the effectiveness of the solution or solutions.
• Advancements in Health Care - Honors a company, organization or individual primarily responsible for a scientific discovery or for development of a new procedure, device or service that can save lives or improve quality of life. Judges will consider the potential impact of the innovation.
• Community Service - Honors an individual or organization for leadership in focusing on solving a particular health care issue.
• Physician - Honors a physician whose performance on the job is considered exemplary by patients and peers. Judges will consider evidence of positive clinical outcomes, patient satisfaction and testimonials from peers and administrators.
• Nurse - Honors an individual from the nursing field whose performance on the job is considered exemplary by patients, peers and physicians.
• Health Care Staff - Honors an individual who works in the health care field and is committed to providing quality comfort and care. Winners could include therapists, technical support staff, specialists, certified nursing assistants, activity assistants, caregivers, etc.
• Volunteer - Honors an individual who has done volunteer work for the good of one or more people or the entire community. Involvement can be past and/or present.

Nominees must perform their service in Milwaukee, Waukesha, Kenosha, Racine, Walworth, Ozaukee, Washington or Sheboygan counties.

Recipients of the Health Care Heroes Awards will be profiled in a special section of an upcoming issue of BizTimes Milwaukee and will be honored at a breakfast on Thursday, Dec. 10, at the Crowne Plaza Milwaukee Hotel in Wauwatosa.

To nominate a person or an organization for a Health Care Heroes Award, visit www.biztimes.com/hero.

Steve Jagler is executive editor of BizTimes Milwaukee.

In the midst of the Great Recession, the most serious economic downturn since the Great Depression, companies are clamoring for ways to cut costs, particularly when it comes to skyrocketing health benefits.

There are a number of measures employers can take to stretch their benefit dollars further and realize cost savings with investment in wellness infrastructure. Although counterintuitive, now is the time to make investments in employee wellness.

While improving employee health is a concern among businesses as a matter of corporate social responsibility, perhaps the greatest motivator for companies to invest in employee wellness programs is to decrease corporate health care expenses. Approximately 50 percent of injury and illness costs are lifestyle-related, according to the Partnership for Prevention's Healthy Workforce 2010, presenting significant opportunities to improve productivity and reduce costs.

Improving and promoting employee wellness boosts productivity by making people happier and healthier, and it can reduce insurance premiums for companies if healthier employees are filing fewer medical claims. Case studies suggest that for every $1 spent on wellness programs, a company can save approximately $4 on health insurance costs.  For example, employees who report having high blood glucose levels have 35-percent higher expenditures than an individual who does not, and employees at extremely high or low body weight have 21 percent higher expenditures than individuals who do not, according to the Health Enhancement Research Organization.

Worksite wellness programs are showing a significant return on investment among companies across the U.S., including:

• Johnson & Johnson's Healthy People program, which saves an estimated $9 to $10 million per year from reduced medical utilization and lower administrative expenses.
• Citibank's comprehensive health management program, which demonstrates for every dollar invested in programming activities, $4.56 to $4.73 was saved in reduced health care costs.
• Union Pacific Railroad's medical self-care program, which shows a cost savings of $2.78 for every dollar invested by reducing inappropriate emergency room and outpatient visits.

Here in Milwaukee, Robert W. Baird & Co. Inc. launched its wellness program in 2006. In the past three years, Baird's health care cost trend has decreased from 13 percent per year to 7 percent per year, and it is expected to be lower in 2010 as well. In addition, preventable health risks, which are closely associated with health care costs, have decreased for Baird employees.

There are many organizations in Milwaukee taking steps to help encourage workplace wellness and work toward a broader goal of creating a more vibrant and productive workforce. Baird is a member of Well City Milwaukee, a workplace wellness-focused coalition of local employers, led by the City of Milwaukee, the Greater Milwaukee Committee and the Metropolitan Milwaukee Association of Commerce. More than 50 local employers are working together through Well City Milwaukee to achieve a Well City USA designation for our city, creating a call-to-action for all employers, large and small, to work together by investing in workplace wellness.

I urge employers to make a commitment to improving the health and quality of life of the workforce and their families. Not only is the workplace a logical venue to encourage and support healthy lifestyles, but workplace wellness is the right business strategy to achieve bottom-line results that can significantly reduce health care and benefit costs. It is clear that investing in an employee wellness infrastructure is a win-win for all.

Janet McMahon is the executive director of Well City Milwaukee. For more information about Well City Milwaukee, visit www.wellcitymilwaukee.org.

Strong emotion surrounding the health care reform debate makes it difficult to consider the facts. Laden with political rhetoric, it's difficult for any of us to roll up our sleeves and carefully conduct a cost/benefit analysis, which is common in corporate environments prior to making important and costly decisions.

I believe that system reform must reduce costs while also improving the user experience.  As a business executive, I know this is possible.

In my role, I view health care reform from two perspectives - as an employer and as a service provider to a health care industry facing enormous change.

As an employer, I see how the current system dramatically impacted health care coverage for our employees. Our insurance premiums skyrocketed after a few catastrophic cancer-related claims. In the end, we had to drop our group insurance because premiums were prohibitively expensive. Therefore, pre-existing conditions negatively affect certain employees who seek to purchase private policies.

We need a solution that increases both accessibility and affordability for employers like us.

As a service provider, I have seen health care providers use technology to become more efficient, reduce costs and improve results. We have worked with patient-centric providers who are changing their billing practices to improve service for patients and at the same time reduce costs.

Health care billing is an area that confounds most patients and has failed to keep pace with today's technology. For example, suppose a patient is admitted to the hospital for knee surgery. After the surgery, the mail begins to pile up from the physician, the hospital, the lab, the physical therapist, and others. Patients can be overwhelmed and confused when they are sent so many bills after receiving care in one location.

If patients have a question, they may need to call multiple locations for answers and, adding to the confusion, the customer service representatives cannot access the actual statements that were sent.

While this is the way it works for most providers, it isn't true for every health care organization. Bellin Health of Green Bay is so focused on improving the patient experience that they re-imagined the entire billing process. Bellin first combined invoices for hospital, behavioral health and most clinic facilities onto one, easy-to-read statement.

Patients can view these statements online through their secured patient portal; they can also pay online. Patients can even view their current outstanding balance online within 48 hours of transactions completed. Further, Bellin consolidated their internal customer service departments, so patients have a single point of contact for answering questions across facilities and providers. And those exact same patient statements are available online for Bellin's service representatives to field patient questions. Revolutionary.

Electronic statements are not new. Our banks, phone companies, and other institutions with our confidential information have been doing this securely for years. In fact, most consumers expect to be able to "go online" to see activities and amounts due, and they are surprised when an organization does not offer this service.

Yet, unlike other industries, patient-friendly health care billing information is not widely accessible online.

Why is that? It's primarily because health care providers have focused their technology resources on assuring portable electronic medical records, a federal mandate by 2010. Of course, medical record portability is important.Yet Bellin managed to improve the billing process at the same time.

Our health care system needs to be streamlined.  As we move forward with reform, there are significant ways that technology can improve patient access to information that will help inform decisions. Using technology, I know we can improve results and reduce costs in many areas of our system.

In more ways than one, I have a vested interest for reform that doesn't mean "worse." It can and must mean "better."

Ane Ohm is president of Green Bay-based LaserNet, a print and mail services company that also has an office in West Allis.

Prevention and early detection are the keys to fighting breast cancer. Yet many women are putting off breast cancer screenings due to economic hardships and changing health care plans, according to a community profile commissioned by Susan G. Komen for the Cure's Milwaukee affiliate.

"Prevention in these economic times kind of falls by the wayside," said Jessica Bergstrom, associate researcher for the Center of Urban Population Health, a partnership of the University of Wisconsin School of Medicine and Public Health, Aurora Health Care and the University of Wisconsin-Milwaukee.

This should be a significant concern for businesses. 

The price can be high as employees lose substantial time at work as they go through treatment if breast cancer is not caught in its early stages. Any business is adversely affected by employee absences, but this is also a matter of saving lives.

It is also more cost-effective to catch breast cancer early, when lower levels of treatment are needed. That's why screening is so important.

Underwritten by Aurora Health Care, the community profile covered the Milwaukee Komen affiliate's eight-county area of southeastern Wisconsin, showed that:

Under-insured women - those with high deductibles, high co-pays and age restrictions - often skip screening because of the cost or because they cannot afford time off work.

There is a need for more free mammograms and financial support for screening.

Uninsured and under-insured women require preventative care that is often not available to them because of financial and work-related factors.

More focus on preventative care is needed.

The stakes are high for both women and businesses in southeastern Wisconsin, as more than 1,300 women will be diagnosed with breast cancer by the end of 2009. Of those, more than 260 will die. Milwaukee, Waukesha and Racine Counties have both the highest incidence and highest mortality rates.

It is important for screening to be readily available to all women regardless of their insurance status. The barriers to early detection simply must fall, and businesses can play a role by encouraging employees to get screened and requiring health insurers to provide screening coverage and preventative care.

Based on the findings of the community profile, Komen for the Cure Milwaukee Affiliate recommends:

• Regular testing - screening tests and clinical breast exams - lowers the risk of dying from breast cancer.
• Early diagnosis. As screening increases, it is crucial that women have access to diagnostic tests following an abnormal breast cancer screening to ensure early diagnosis.
• Continuum of care throughout treatment. Treatment plans vary for each woman, depending on a number of factors. It is important that women receive proper support throughout her treatment to address all of her needs.

Screening and treatment of breast cancer can save lives. But it can also save businesses lost employee productivity and possibly the cost of increasing health insurance premiums, especially for smaller businesses.
Screening and testing for breast cancer needs to be readily available to all women. It's good for employees. And it's good for business.

Sally Sheperdson is executive director of Susan G. Komen for the Cure, Milwaukee Affiliate.

The health care debate continues with the latest statistics indicating the majority of Americans like the healthcare they have. Eighty percent of the population has health care provided through their employer, and of those people, 70 percent rate their health care as good or excellent.

Knowing that, is an extreme makeover of health care really needed?

The State of Wisconsin ranks third in the nation for number of residents with health insurance. We’re garnering attention from federal and state legislators who feel that perhaps we have a model for health care modernization.
Having recently been in Washington to meet with our congressmen and their legislative leads for health care, I can tell you that things are changing by the hour. There are real reform opportunities and modernization that can help address both access and cost without creating a new overwhelming federal bureaucracy. 

The State of Wisconsin has programs that have demonstrated they can work, including BadgerCare, BadgerCare Plus, Senior Care and HIRSP (Health Insurance Risk Sharing Pool which offers health care to residents who are unable to find adequate health insurance coverage in the private market due to their medical conditions or who have lost their employer-sponsored group health insurance).

By leveraging an undeniably successful program in HIRSP, where all stakeholders contribute equally, we believe we can stabilize the "guarantee issue" (which means individuals must be able to obtain health insurance regardless of their health history), in the small group market by bending the cost curve and providing multi-year rate guarantees.

The programs that have been in place in the State of Wisconsin for years prove that we can effectively insure more individuals while controlling costs. Representatives at both the federal and state level are starting to promote moving this idea forward.

The government says they need to keep private industry honest, but who is going to keep any potential public program honest and affordable to those who already have health insurance coverage?

The public options referenced above still need to be refined to pay the physicians and hospitals equitably when compared to private plans and eliminate fraud. Let's address what needs fixing in the existing public options and use the proven Wisconsin model to reform health care in the country. This approach worked successfully with welfare reform.

Let us pursue reformed health care that leverages existing programs, and not a government takeover or extreme makeover of our health care system.

Daniel Burkwald is president of Burkwald & Associates Inc. Pewaukee-based provider of consulting on employee  benefits, communication,  education and wellness.

The health care debate truly came alive in August. Over the past two weeks, my employers - the residents of Wisconsin's First Congressional District - demonstrated a remarkable level of engagement on this critical issue, along with considerable respect for all sides of the debate.

I want to thank the thousands of Wisconsinites who shared their views with me at one of my health care listening sessions throughout Southern Wisconsin.

When Congress reconvenes this week, I will bring with me a message made clear at each of my listening sessions: let's fix what's broken in health care; not break what's working.  Wisconsinites have expressed a number of serious concerns with H.R. 3200, the Majority's health care overhaul: millions of Americans would lose their current coverage and be dumped on a new government-run plan; Washington bureaucrats would seize unprecedented decision-making power over their health; and a struggling economy would be hit with painful new taxes and a debt burden that we simply cannot afford.

I believe that Congress should scrap this bill and start over. I will continue to echo the calls from Wisconsinites that the status quo in health care is unsustainable and unacceptable. Contrary to the false choice offered by the President, nobody is defending the current system that keeps quality, affordable coverage out of reach for millions of Americans, has resulted in the explosion in health care costs, and causes Americans with preexisting conditions to be denied coverage. There are serious problems that need to be fixed, but the Majority's go-it-alone approach to give more power to Washington would only make matters worse.

At each listening session, my employers expressed more fundamental concerns about the proper role of government in our economy and in our lives. Wisconsinites are rightfully anxious about the unprecedented growth in the federal government this past year - from trillion dollar spending bills and bailout fatigue to a budget that doubles our debt in five years and triples it in ten years. Most of us simply can't stomach handing over our energy and health care sectors to the federal government as well.

Washington has been infected with an ideology that believes that for society to grow, government must grow. The American ideal - rooted in individual liberty, self-determination, and limited government - is under attack like never before. This is the real issue bringing record numbers to town hall meetings across the country, and Washington needs to wake up to this reality if we are to preserve our unique American identity and restore the promise and prosperity of this great nation.

Those that run Washington owe the American people a serious debate on health care this fall. There are better solutions - fiscally-responsible, patient-centered alternatives - that could help open a bipartisan chapter to this debate and bring about real reform.

U.S. Rep. Paul Ryan (R-Janesville) represents Wisconsin's 1st Congressional District.

As a former executive with a major health insurer in Wisconsin, I have thought for many years what I would do if I was asked to reform health care in the United States. In my role as a communicator and lobbyist for this organization, I've explored the points-of-view of providers, insurers, legislators, regulators and patients.

I've concluded that any reform legislation need not be 3,200 pages. There are plenty of "best practices" to explore and incorporate in any reform plan. Also, much of this need not be legislated. Just rely on the best resources of the private and public sectors in using common sense in attacking reform.

I don't think we need to "blow up" the current system. It does need work, and is not perfect by any means.

My 12-point plan is based on years of observation of how the system works and how it could be improved. I've worked in upper management of a major health insurer and two of Wisconsin's larger hospitals. During the past 20 years, I've also consulted with many fine funders and providers of health care, and have been a patient myself. Some of my points may be considered unconventional, and not in the mainstream of thinking of current health insurers. For what it is worth, here are my thoughts.

First, revise medical liability laws to make them more realistic so more medical students are attracted to the primary care specialties of family practice, pediatrics and internal medicine. Currently, malpractice insurance for these specialties is excessive, and may deter students from pursuing these specialties.

Second, to improve competition and lower prices, remove the current provision that we may only purchase health insurance licensed by the state in which we live. Set national standards for health insurance and let us purchase plans anywhere in the United States.

Third, self-insured (ERISA) plans do not have to include state mandated benefits, although many do. Let the individual or employer purchasers have the same freedom to select a plan free of some or all of the state's mandated benefits such as chiropractic, AODA, birthing services, acupuncture, etc. Premium costs could be reduced substantially.

Fourth, go back to a community/age-rated system popular with some plans 30 or 40 years ago. Premiums would be based on the community's providers' actual charges. Comparisons could be made to other communities' charges by employer and individual purchasers. These purchasers could put pressure on local providers to accept best practices and qualitiy initiatives from the lower-cost communities to reduce costs.

Fifth, insurers must remove the pre-existing condition provision and include that risk in the community/age rating system of determining premium. This could provide incentives for communities to initiate and support well city/community health programs aimed at reducing utilization.

Sixth, hospitals need to develop a better triage system for people, especially the uninsured, who present themselves for care at emergency rooms. Only true emergencies should be treated there. Work with all levels of government to set-up 24-hour clinics down the hall or next door to treat the non-emergent patients at a much reduced cost. Today the cost of care for these patients is often passed on to the people who have insurance, thus raising their premiums.

Seventh, many of our non-insured are illegal immigrants. Have the State Department explore ways to work with the offending countries who allow their citizens who enter our country illegally to take more fiscal responsibility for their lack of emigration enforcement. Perhaps a substantial reduction in foreign aid to those countries could be rerouted to help pay for illegal immigrant health care. This is a very controversial area, so much thought needs to be considered in how to do this. The current system is not working.

Eighth, develop a better tax incentive program which encourages all individuals to purchase health insurance. Have the tax benefit based on the annual income of the health insurance purchasers, with better tax benefits for lower income individuals.

Ninth, develop premium lowering incentives for people who show marked improvement in their health like weight loss, lower blood pressure, blood sugar, smoking cessation. Do not continue to punish people for past health care sins with higher premiums if they make positive changes.

Tenth, another "must do" for reform is the development of an easily transportable and easily updated electronic medical record system. This alone, could save hundreds of millions of dollars in duplicative or unnecessary tests each year. (A friend of mine is in the process of trying to patent and market these flash drive-type devices for your keychain or in a credit card format).

Eleventh, as a condition of getting health care coverage, each individual should have to register his or her advanced directives for end stage of life health care. The family anxiety and waste in the area are staggering. This would go a long way to provide ethical health care in the final stages of a person's life.

Twelfth, take personal responsibility for your own health and the health of your loved ones.
The resources are all around you. Take advantage of them and you will lead a longer, healthier and happier life.

Alan Gaudynski, president of Alan L. Gaudynski & Associates Inc. in Pewaukee, formerly was the vice president of corporate communications for Blue Cross & Blue Shield United of Wisconsin.

Last week, I had the honor and privilege of moderating the Milwaukee Press Club's Newsmaker Luncheon, featuring a discussion on health care reform by U.S. Reps. Gwen Moore (D-Milwaukee) and Paul Ryan (R-Janesville).

The event at the Newsroom Pub in downtown Milwaukee was packed to capacity. The room was divided, somewhat evenly, between supporters of Moore, supporters of Ryan, the working media and people with professional or personal stakes in this debate.

However, unlike many other town hall-like settings taking place across this country, where people are screaming and jeering to drown out the other side of the debate and some are even bringing loaded weapons, our event here in Milwaukee was civil, polite and informative.

And I have little doubt that one key reason for the civility at the luncheon was the character of the featured guests.

We seated Reps. Moore and Ryan side-by-side at a table in the front of the room. Before the start, considering the contentious tone of the nation's debate over the issue of health care reform, I wondered how that would play out.

Any concerns there were immediately put to rest when Moore walked in and threw both of her arms around Ryan. He reciprocated.

During the discussion that followed, they made their case for their political viewpoints. As expected, Moore argued on behalf of President Barack Obama's plans for health care reform.

In speaking with her afterward, Moore said her stance on this issue is rooted in a core belief: Health care should be an American right, not a privilege reserved for those who can afford it. (Note the Declaration of Independence, which seeks to protect the right to "life, liberty and the pursuit of happiness." I don't know about liberty, but how can one sustain life or pursue happiness without health care?)

Of course, the political rub comes when we get to the part of how health care is delivered and paid for.
As expected, Ryan argued against the Obama plan.

To Ryan's credit, he did more than just argue against it. He has proposed a plan of his own, which he calls The Patients' Choice Act. Ryan says his plan is modeled after the Swiss health care model.

Ryan fully acknowledges that America's current system is flawed and is in need of reforms, and issues such as the lack of portability and pre-existing conditions are serious problems. Ryan says the status quo in health care is not sustainable for consumers or businesses.

The discussion ended with Ryan and Moore agreeing on some aspects of reform, with Ryan even saying, "Amen, sister. She was right on that point." As he walked away, I overheard Ryan as he called Moore, "Sweetie" and said he'd see her on the same plane back to Washington, D.C.

"I enjoy being with Paul Ryan. He and I really are good friends, and I appreciate and respect him because he's a policy wonk. I think what I've taken away from this is the importance of just continuing to listen to people and trying to find out where you can find some agreement," Moore said after the event.

It is obvious the two of them have mutual respect for each other. You get the feeling that people such as Moore and Ryan, left to their own devices, could come together with some sort of meaningful health care reforms.

Unfortunately, both of them are drowned out in Washington by their acerbic party leaders in Congress. Senate Majority Leader Harry Reid (D-Nev.) and House Speaker Nancy Pelosi (D-Calif.) have no desire to engage the arguments from the other side of the aisle.

At the same time, Sen. Minority Leader Mitch McConnell (R-Ky.), House Minority Leader John Boehner (R-Ohio) and Minority Whip Eric Cantor (R-Va.) have no desire to negotiate any type of reform that could give Obama any political capital in 2010.

Perhaps the abrasive party leaders could learn a lesson in civility and civics from their Wisconsin counterparts. The country would be better off for it.

Steve Jagler is executive editor of BizTimes Milwaukee.

Click here to watch a Wisconsin Eye webcast of the Milwaukee Press Club's Newsmaker Luncheon featuring U.S. Reps. Gwen Moore and Paul Ryan.

The membership of the Independent Business Association (IBA) recently participated in a survey regarding the pending overhaul of the United States healthcare system. While it is universally recognized that something has to be done with the spiraling costs of health care, there definitely is not a consensus on how a palatable solution is achieved.

As we have watched the health care debate take shape throughout the nation, the small business community is left waiting and watching as the reforms that are (or aren't) implemented by Congress and  President Obama will certainly impact the business community.

The health care debate has shaped up to be one on the more polarizing policy issues that has been vetted in some time and while the IBA survey did produce agreement amongst a majority of members, there were several thoughtful dissenting points of view that were presented as well.

To recap some of the more heated questions, IBA membership responded with a 67-percent "No" ratio to the question of "Should the government be allowed to develop a public option to compete with the private sector health insurance?" In the comments section of the survey, we did receive several relevant points including the following:
In favor of:  "A "one payer" system would actually be much more effective and efficient, and this option provides an alternative to employer-provided health care for those who don't receive such access through their work. “
Opposed to: "Allowing the government to compete with private industry would be unfair competition as the government could easily subsidize their coverage to make it more economical.  This would eventually drive private industry out and allow the government to take over all health care. This would inevitably increase the cost of health care and lower the quality of health care. Government cannot do things better and more efficient than private industry. Mail service is a prime example."

In regards to the proposal of any employer with a payroll north of $500,000 would be required to provide health benefits or face up to an 8-percent tax of payroll as a penalty, 80 percent of the IBA membership was against this proposal. Once again, we see opposite ends of the spectrum when it comes to the arguments:
In favor of: "Those employers do not offer these benefits now? Tell me how you justify treating valuable employees in such a way. Or are they not valuable? If you tell me that such a firm cannot afford to provide these benefits, what does that say about the company's priorities over the last 10 to 20 years? Maybe we should have consumers demand that all products they buy come from responsible firms - including foreign ones."
Opposed to: "This will force small businesses to unload their plans onto the public option because the 8-percent tax will be cheaper in the short term than funding benefits. This will lead to a surge in the public option with even higher taxes to come."

From the macro viewpoint our membership was also asked "Do you feel that the insertion of the government into medical decisions and funding of health care is an appropriate role of the government?" Eighty-four percent of our membership answered "No" to this question. A couple of comments that stood out:
In favor of: “The private sector has demonstrated that it can't handle all the citizens' needs and simultaneously has shown that showing a profit is more important than improving the health of those citizens."
Opposed to: "Our government cannot administer any social program effectively, and I expect health care would be the biggest blunder in history."

The consensus is that the small business community cannot afford to accept the status quo when it comes to the cost of health care. One of our members indicated that there were no material changes in the status of their employees over the past year and their health care provider came back with a 35-percent premium increase year over year.

The hyperinflation of health care costs is unsustainable and if a solution is not executed properly, the continuance of these increases will ultimately be crippling to the U.S. economy.

The passage of comprehensive health care reform is going to take real leadership. The main concern of the IBA membership for the proposed health care plan plans are related to the funding mechanisms to cover the costs.

The concept of more care for less cost was met with great skepticism and the belief that there will undoubtedly be higher taxes to come for the business community. In regards to solutions, the majority of the membership of the IBA believes that a free market approach that focuses on a consumer driven model, increased pricing transparency, encouragement of company wellness programs, allowing for many unrelated small companies to join together to obtain better rates from insurance companies and tort reform would be great first steps in the process to defeating the health care crisis as well as the most business friendly model.

Jeff Hoffman is the president of IBA-Wisconsin, the Commercial Association of Realtors Wisconsin Government Affairs Committee and is a vice president with Pewaukee-based Judson & Associates S.C.

A spirited debate on the future of health care and on the proper role of government in our society has come alive in recent weeks. I welcome the debate, and look forward to the 19 listening sessions and community forums I will be holding across southern Wisconsin in the days ahead.

I invite the residents of Wisconsin's First Congressional District to actively participate at these listening sessions - and to respect the fact that your neighbors may disagree.

The widespread disrespect, and even violence, from the extremes on both sides of this debate is regrettable. I am disappointed by the attacks leveled by the White House and leaders in Congress against those raising the legitimate concerns and questions raised by citizens. To hold a differing view does not make one a "tool of special interests," and to voice those disagreements is not "un-American" or a sinister "scare tactic."

There is room for common ground on common sense reforms - but this will require responsible leadership to trump partisan gamesmanship.

My staff and I will make every effort possible to accommodate your participation and to ensure that your voice is heard. Anticipating larger turnout, I'm working to move some of the listening sessions to larger venues. The Kenosha Listening Session, for example, has been moved to the Madrigrano Auditorium at Gateway Technical College (3520 30th Ave.). For an updated schedule, please visit www.house.gov/ryan.

I'd ask that all attendees respect your fellow citizen's desire to communicate with me.  Shouting down your opponents at a listening session is not only ineffective, but quite simply rude.

Arguments are not won by the volume of one's voice, but rather the merits of the idea. I will work tirelessly in the days ahead to conduct these listening sessions with civility and respect for all views, and trust that the residents of Wisconsin's First District will do the same.

U.S. Rep. Paul Ryan (R-Janesville) represents Wisconsin's 1st Congressional District.