Milwaukee Biz Blog

We need real reform in the financial markets. This reform should include how we regulate and how we audit and enforce these regulations.

Reform will not prevent another crisis that we have just witnessed or the S&L/Mutual Savings Bank crisis some three plus decades ago or frauds such as Madoff's. But reform can catch these problems before they get out of hand, which will reduce the impact on our economy.

• First, we must restore confidence to the secondary mortgage market. Liquidity in mortgages provided by the secondary market is essential to our economy. Banks and S&Ls should not be holding mortgages for long periods of time and should have a market to which they can sell.
  Require escrow for real estate taxes and homeowners insurance for all homes where the home buyer does not have a 20-percent down payment.
• Require that the buyer have a 20-percentcash down payment or that another entity, such as a mortgage insurer, the VA, FHA or Farmers Home Loan Agency, is covering the 20-percent difference between appraisal and mortgage.
• Forbid financial institutions from lending borrowers their 20-percent down payments.
• Ensure that income and assets listed are verified.
• Ensure that appraisals are realistic
• License all appraisers and mortgage brokers nationally, or at the very least, create a standardized system for appraisers and mortgage brokers, including the personnel of any firm issuing paper to be sold on the secondary market.
• Strictly regulate mortgage insurance companies. There have been too many incidents where these firms have had conflicts of interest (using subsidiaries as collateral) or have made risky business decisions that affect their contingent liability funds.
• Require that all use the standardized underwriting and forms issued by Fannie Mae and Freddie Mac.
  Make full disclosure and other paperwork simple to understand. Reduce this paperwork to one or two pages that are understandable.
• Where possible, require that homeowners with less than a 20-percent down payment receive counseling so that they have a budget and so the mortgages they receive are fair, that charges required of them are reasonable and that the property they are buying is worth what they are paying.
• Restrict such practices as "interest only mortgages," balloon mortgages or variable mortgages with teaser rates.

In regards to regulation of the financial industry, it is important to separate the audit and enforcement functions from the influence of politics and business as much as is possible. Politics influences enforcement.

A recent example was the firing of Gary Aguirre, an Securities & Exchange Commission (SEC) attorney lauded for his excellent work. He was fired because he wanted to interview John Mack for allegedly giving inside information to Pequot, a hedge fund. (I could have used examples from both Democratic and Republican administrations).

The New York Stock Exchange, the Nasdaq, the Federal Reserve Bank and the SEC did little to go after abuses on Wall Street. For years, Eliot Spitzer was a lonely crusader against Wall Street abuses.

"Self-regulation" by the industries themselves has been not been successful. The Federal Reserve failed to stop abuses in the banking industry through its audits. Their "objective" is to protect banking, but too often this means avoiding confrontation by the few banks that control most of the country's assets.

My suggestion is to create an independent agency that has many features of an inspector general or the General Accounting Office. Fund their budget for seven years at a time. Give a single 10 or 12-year year term to its leadership. Forbid its civil servants from becoming lobbyists or working in the industries they have regulated for five years.

This will not be perfect, but it will go a long way in isolating political influence on the agency.

Furthermore, I suggest that we separate regulation and oversight by an industry's function. Credit, life, health and property-casualty insurance companies manage risk; banks, S&Ls and mutual savings banks lend money. Mutual funds and annuities deal in collective investments. Money managers, hedge funds, financial advisors and stock brokers manage money or offer advice.

Multiple and contradictory regulations need to be reduced, but there should continue to be competition in enforcement. National tests, continuing education and licensing should be national. Licensing by states based on the national model should continue.

Bob Chernow is a futurist who predicted the S&L/mutual savings bank crisis, the future of mortgage backed bonds and the recent sub-prime crisis. He works in the financial industry. His opinions are his own.

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.

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.

Over the past several months, people in Washington have been working to carefully craft a health care reform package. Though progress has been steady, there are still several proposals in flux. Please be aware that neither the House nor the Senate has formulated one bill, and that no final decisions have been made about what will be included in health reform.

Most of us agree that reforming and improving our health care system is necessary, and we cannot afford to wait another 10 or 20 years until health care costs consume an even greater percentage of the economy and the budgets of American families.

Consider this: The United States spends $7,290 on health care per person, per year - while the average spent by the 30 most developed countries is $2,960. It is unacceptable that we have so much more of our money tied up in health care, yet we are not delivering demonstrably better health care than many of these countries. Studies show that the U.S. ranks below average on major health indicators, including infant mortality and life expectancy, when compared with the rest of the world.

We currently rank 44th in infant mortality and 30th in life expectancy, with the average American living to 78 years of age. By comparison, Japan spends $2,550 on health care per person each year - just over a third of what the U.S. spends - and boasts a life expectancy of 83 years.

There is no doubt that American health care is breaking the bank and making us less competitive in the world economy. Money that should be going to wage increases and helping to make our businesses more competitive is instead going to pay for increases in health care costs. This will not change until we get a handle on those costs.

Controlling costs is a goal we can all support in principle, especially when other countries have demonstrated that quality health care can be delivered at a much lower cost. We can start controlling costs by paying for value of care, not volume, and eliminating duplicative testing and over-treatment. If we can do that, then our health care system - and America's patients - will be in better shape. We need to ensure that all health care systems provide better care in a more efficient way, and reward those systems that already do so, such as the ones we have in several locations in Wisconsin.

America's health systems should expand the use of health information technology, which has been shown to save lives by reducing medical errors and save money by promoting efficiency in testing and communication. We can support the use of generic drugs and get generic equivalents on the market faster. And we can encourage Americans to engage in preventive care and healthy lifestyles.

Many of these money-saving ideas are not controversial. The fact is that there is a lot that we can all agree on. We agree that we need to expand coverage to most, if not all, Americans. We also agree that people should not be denied insurance because of pre-existing conditions. The principles we agree on far outnumber those on which we differ.

In addition to saving costs, health reform can do so much good for the average American. We want to limit your out-of-pocket expenses and co-pays. We want to make sure your coverage is not dropped just when you get sick and need it most. We want to eliminate caps on coverage, offer free preventive care and protect small businesses from the crushing costs of health care.

Despite all these positive changes that will benefit individual Americans, the debate surrounding health care threatens to get out of hand. False reports about what will be included in health care reform have taken on a life of their own. We need to strip away the rhetoric and dispel some of these rumors, many of which are meant to scare older Americans.

The most important thing for seniors to know is that health care reform will not diminish Medicare, the health care program those 65 and older have come to value. As we all know, Medicare provides older Americans with quality health care at a cost that is affordable.

Seniors are happy with Medicare. In fact, Medicare, a government-run program, boasts a satisfaction rate even higher than private insurance. The reform proposals to date are intended to strengthen Medicare, and will not make any significant changes to the way seniors receive their health care services.

As for the rumors out there about how health care will be drastically changed for the worse, you can rest assured: Health care reform will not limit choices, take away treatment options, ration care, eliminate private insurance, or tell you how or when to die. These things are not going to happen.

In the meantime, we hear you. We hear your needs and we hear your concerns. Your perspectives are invaluable, and we will continue to keep American families in mind as we work to complete a health reform package that starts to get costs under control, continues to provide high quality care, and begins to expand coverage to include most, if not all, Americans.

Democrat Herb Kohl is a U.S. Senator from Wisconsin.