Milwaukee Biz Blog

It is hard to believe that we are in the final weeks of summer.  By now, many of us have already registered our kids for school. I think some parents will be surprised to learn that, contrary to the claims made by those who fought our successful efforts to eliminate a massive $3 billion budget deficit, our reforms are working and school districts are benefiting because of them.

School districts from every part of the state are coming forward indicating the tools we gave them to offset the necessary cuts are giving them the flexibility to plan for a bright future.  Modest concessions from teachers on their health insurance and pensions are allowing the districts to maintain or expand services, maintain or lower class sizes and avoid layoffs. 

A recent investigative report from WITI-TV in Milwaukee says it all: "Budget Repair Law Leaves Most School Districts in Good Financial Shape." In an e-update at the end of June, I wrote that “The sky is not falling.” More than a month later, the Milwaukee Journal-Sentinel published an editorial that used that very headline.

The examples can be found statewide:

* Lower property taxes - School districts across the state are indicating that their tax levies will hold steady and many, such as the Beaver Dam School District, announced lower property tax levies and mill rates.  In Beaver Dam, administrators tell me the school portion of homeowners’ property tax bills will be going down a whopping 10 percent.
* Lower class sizes - Opponents of Act 10 warned of higher class sizes.  We are seeing just the opposite.  Many school districts, like Kaukauna, are able to hire additional teachers and greatly reduce class sizes.
* Lower health care costs - Dozens of school districts across the state are saving millions of dollars because the teachers’ union insurance monopoly, WEA Trust, has been broken.  Examples include Appleton’s $3.1 million in savings, Baraboo saving $660,000, and Edgerton getting $500,000 back.
* Avoiding layoffs - We said all along that without the changes to collective bargaining, layoffs would be inevitable.  For the most part, those layoffs have been avoided such as in Hustisford.  West Allis called off 200 layoffs and instead gave teachers a raise.
* Merit pay - Using the flexibility Act 10 now provides, school districts like the Menomonee Falls School District were able to institute merit pay.  Raises will go to the best teachers rather than those with the most seniority.

Of course there is one glaring exception. Before it became clear that Act 10 would become law, unions representing teachers said they would accept concessions on benefits. Actions speak louder than words. Because the Milwaukee Teachers Education Association is refusing to open up its contract with the district (as the state budget allows it to do) and make those modest concessions, MPS faces layoffs.

Not only will school districts have more flexibility to better educate their students, taxpayers in those communities also will also benefit. Milwaukee Mayor Tom Barrett, a loud critic of our reforms, predicted the budget repair bill would cause their structural deficit to “explode.” The reality couldn’t be further from the truth. His own budget office crunched the numbers and discovered the city will likely save $61 million over the next two years because of our reforms.

The flexibilities the municipalities now have even allowed the city of Horicon to give its employees a 3-percent raise to offset increased healthcare and pension costs.

As our kids head back to school, the fall session will begin in the legislature.  Our top priority hasn’t changed.  We will continue to reform government in ways that help the private sector grow our economy and create jobs.

If you have any questions regarding this or any other issue, please do not hesitate to contact me at P.O. Box 8952, Madison, WI 53708, call my office at (608) 266-2540 or e-mail me at Rep.Fitzgerald@legis.Wisconsin.gov.

Assembly Speaker Jeff Fitzgerald (R-Horicon) represents Wisconsin's 39th Assembly District.

This year, Milwaukee County's expenditures total more than $1.3 billion. While there has been much discussion about how to plug the $51 million budget deficit projected for 2012, we believe a powerful tool has not yet been exercised: restructuring county government on the basis of efficiency and innovation. 

Roughly half of the County’s budget ($585 million) supports health and human services. This is a huge source of potential savings. We have quantified savings of $38 million that can be realized in 2012 by applying market principles to two health care programs: mental health care for County residents, and health care benefits for County employees.  

Mental Health
Board Chairman Lee Holloway and others have made the case for urgency to act, to better serve those who use the Behavioral Health Division. Last year, the Human Services Research Institute released its voluminous, two-year study of Milwaukee County's mental health care delivery system. The HSRI study found that the system is uncoordinated and dysfunctional, with a very heavy reliance on emergency detentions and inpatient psychiatric services.

The HSRI study calls for moving from a provider to a purchaser of mental health services. This requires redesigning the system to one that is decentralized, relies primarily on community-based residential and outpatient services, and reduces the current adult psychiatric hospital from 96 beds to 16-24 beds.  The 2011 budget for Behavioral Health is $188 million. We estimate that, in 2012, we can identify $20 million in efficiencies and reinvest these savings in improved care for an expanded group of people.  This is a smarter way to provide care, and its puts less pressure on increasing usage of the tax levy in future years.

Employee health benefits
The Wisconsin Legislature and Governor Walker have ended collective bargaining on healthcare benefits, effective last month.

The cost of employee health benefits is estimated at $126 million in 2011. The program has a rich benefit design, with minimum premium-sharing, co-pays and deductibles. In fact, the base plan has no deductibles, and provides for 100% coverage except for minimal co-payments for office visits, emergency services and prescription drugs. County employees pay for only 5-7% of health care expenses compared to 15% for federal employees and 20-25% for private sector employees.

The current County health plans encourage employees and their dependents to over-utilize the plan. We advocate shifting to higher-deductible, consumer-driven healthcare (CDHC). This encourages consumer awareness, informed choice and decision-making based on open, transparent and credible information. CDHC empowers consumers to take greater control and achieve greater satisfaction from their healthcare experience.  It turns consumers into customers. CDHC is the norm in the private sector.

Research suggests we could save 14 percent under a higher-deductible plan. After four years, the cumulative savings would be $32.8 million or 26 percent.

Moving County employees to a higher-deductible consumer-driven healthcare plan will inject market discipline into employee health care benefits. The cost to employees will be slightly higher than what they pay now, but this is already required by the new state collective bargaining law. Redesigning and streamlining the plan will yield significant cost savings, while continuing to provide employees with high-quality health care.

There is no time left for more bureaucratic studies, meetings, task forces, and committees. The County is faced with a serious fiscal crisis. What is required now is the political will to take the action that is necessary to implement change.

Milwaukee County Supervisor Johnny Thomas is chair of the Finance and Audit Committee, and
Supervisor Joe Sanfelippo is chair of the Personnel Committee and chair of the New Behavioral Health Facility Study Committee.

When confronting legal issues associated with family and medical leave laws, many employers generally focus their attention on the requirements of the federal Family and Medical Leave Act (“FMLA”).

Wisconsin business owners need to remain cognizant, however, of Wisconsin’s Family and Medical Leave Act (WFMLA), which is often a trap for the unwary employer because it commonly provides rights to employees that are greater than those provided by the FMLA.

The following tips will assist employers and HR leaders on family and medical leave matters.

Employee eligibility
Eligibility for leave is calculated differently under Wisconsin and federal law. To be eligible for leave under the FMLA, employees must meet a threshold of 1,250 hours, whereas under Wisconsin law, the threshold is only 1,000 hours. In addition, the calculation of hours to determine employee eligibility under the FMLA and WFMLA differ. Under the federal law, eligibility is determined by calculating the number of hours worked by employees during the previous 12 months. In contrast, under Wisconsin law, eligibility is determined by the number of hours for which the employee received pay during the previous 52 weeks. Accordingly, an employee may be eligible for WFMLA leave if he or she worked less than 1,000 hours but utilized other paid time off from work.

Types of leave available
Generally, the types of leave provided for under the FMLA and WFMLA are similar (e.g., leave for a serious health condition, leave for the birth of a child, leave to care for a family member). However, the following forms of leave are only covered under one law; therefore, employers may not concurrently designate these leaves as both FMLA and WFMLA:

• Placement of Foster Children. An employee may take leave for the placement of a foster child under the FMLA but not under the WFMLA.
• Care for an In-law. An employee may take WFMLA leave to care for a “parent-in-law,” but he or she may not take FMLA leave for such a purpose.
• Servicemember Leave. Under the FMLA only, employees are entitled to 12 weeks of leave for a “qualifying exigency” related to a call to military duty and up to 26 weeks of leave during a single 12-month period for leave to care for an ill or injured service member.

In light of these differences, all leave requests should be closely reviewed under both federal and Wisconsin law to determine coverage.

Treatment of domestic partners
Domestic partners may be eligible for leave under both federal and Wisconsin law; however, the nature of the leave entitlement varies under the laws. As of June 30, 2009, Wisconsin employees are eligible for WFMLA leave to care for a domestic partner with a serious health condition. In addition, employees may take WFMLA leave to care for the parent of a domestic partner. The WFMLA, however, specifically excludes from coverage, employee leave to care for the child of a domestic partner. To complicate matters, the FMLA does not provide covered leave to care for a domestic partner who is ill, but a 2010 Department of Labor Administrator’s Interpretation effectively ensures that non-traditional caretakers, such as same sex partners, may take leave to care for their partner’s child under the in loco parentis provision of the federal regulations. Accordingly, if an employee provides financial support or provides day-to-day care for his or her domestic partner’s child, such employee is eligible for leave under the federal law (but not the WFMLA). 

Amount of leave available
Under the federal law, an employee is entitled to up to 12 workweeks of unpaid leave during a 12-month period for any covered reason. The WFMLA, on the other hand, apportions the amount of leave that an employee may take for a particular reason.  Under Wisconsin law, an employee is entitled to 10 workweeks of unpaid leave during the calendar year as follows:

• Six weeks for the birth or placement for adoption of a child;
• Two weeks to care for a seriously ill child, spouse, domestic partner or parent (includes parents-in-law); and
• Two weeks for the employee’s own serious health condition.

The different apportionment of leave will require administrators to track WFMLA and FMLA leave entitlement separately, and there may be occasions when leave cannot be concurrently designated as leave under both laws.
 
Intermittent leave
One of the most frustrating aspects of family and medical leave is administering intermittent leave.  Employers often forget that intermittent leave is treated differently under the federal and Wisconsin laws, and this can create liability for employers. With the exception of family “bonding” leave that is taken in association with the birth of a child, all federal leave may be taken intermittently when the leave is deemed medically necessary by a health care provider. “Bonding leave” may only be taken intermittently at the discretion of the employer. This means that employers retain the discretion to deny federal intermittent leave if the leave is not necessary.  In contrast, Wisconsin law allows for intermittent leave at all times, subject to the reasonable scheduling requirements of the employer. Accordingly, parents may take their 6 weeks of WFMLA paternity leave on an intermittent basis even though their employer can restrict their federal leave.

Margaret Kurlinski is an attorney at Godfrey & Kahn, S.C., Milwaukee.

How does the lack of transparency impact the success of the strategy? As U.S. health plan premium increases continue to outpace inflation, employers have shifted costs to employees, offering them difficult choices such as:

• Pay higher premiums every month for a plan with lower out-of-pocket costs when using the services of doctors and hospitals.
• Pay less every month on premiums but face higher deductibles and out-of-pocket charges when services are used.

Fact: When consumers don't have to pay for the services they use, they won’t care what those services cost.

A critical component to the success of consumer-directed health plans, such as high-deductible plans coupled with employee-owned health savings accounts, is getting employees to think like purchasers. When employees have to pay at least part of the cost of the services they use, they will begin looking for low-cost/high-quality provider options. As a result, their health care costs, and their employer’s costs, will decrease. That, at least, is the theory.

Theory vs. Reality
Consumerism experts often bemoan the fact that shopping for health care is not like shopping for cars, appliances and shoes. If someone else is paying the bill, why wouldn’t consumers buy the most expensive car, refrigerator, Manolo Blaniks or knee surgery? Isn’t the most expensive car going to be the “best” car? Isn’t the highest cost health care going to be the best quality health care?
In many markets, the theory of creating smart consumers by increasing out-of-pocket costs has collided with the reality that engaged and frugal consumers often cannot get the comparative cost and quality data that they need to make smart purchasing decisions. That is one reason why buying health care is not like buying a car.

Fact: The complexity of health care/insurance pricing is a mystery to most health care consumers. In network/out of network. Reasonable and customary charges. Billed charges. Contracted pricing. Global pricing. Procedural pricing. All of these technical and overlapping ways of charging users of health care services make comparing costs from one facility to another extremely difficult. Most providers do not see the need to provide straightforward pricing information to their potential patients, your employees.

Fact: Health care costs and quality can differ widely from one provider to another in the same network and same market.
Recommendations

There are, however, steps that employers can take to help their employees benefit from cost and quality data:

• Design their health care plans to give employees a financial incentive to choose doctors and hospitals that provide contracted pricing data by procedure. Employees should know what their choices are and what those choices cost.
• Let local doctors and hospitals know that their plan favors low-cost/high-quality health care services that have transparent pricing.
• Continue to educate employees every month that they have choices within their network and that those choices will impact how much everyone spends on health care.

Jane Cooper is founder, president and CEO of Patient Care, a Milwaukee-based patient advocacy company that provides health care cost and quality information services for over 1.5 million members across the U.S. She has more than 25 years experience in the health care industry. Follow her on Twitter:@PatientCare4u.

In my magazine column last week and my blog earlier this week, I issued a “heads up” that the Republicans in the state Legislature will soon be moving forward on several pet issues that they had tentatively put aside to allow the focus to remain on Gov. Scott Walker’s job creation efforts.

However, now that recall campaigns are going forward against nine GOP state senators, and their Senate majority may soon be threatened, the Republicans are moving ahead with those bills while they have control of both houses and the governor’s mansion.

The latest GOP pet issue is conceal and carry.

Rep. Jeff Mursau (R-Crivitz) and Sen. Pam Galloway (R-Wausau) introduced two bills Wednesday. Galloway’s bill would allow people to carry concealed weapons without having to undergo any safety training.

Mursau’s bill, which is far more likely to be approved, would require people to undergo some training before obtaining a permit to carry concealed guns.

In a letter to his GOP caucus colleagues seeking co-sponsors for the bill, Mursau said, “It has been statistically demonstrated that crime goes down in a correlation with an increase in the ability and actual number of citizens who can and do carry concealed weapons.”

Hearings already are planned for the bills on May 12 in Wausau and Madison.

Wisconsin and Illinois are the only states that do not allow people to carry concealed guns and other weapons. Republicans in the Wisconsin Legislature approved concealed weapons bills in 2003 and 2005, but both were vetoed by former Democratic Gov. Jim Doyle.

Under both new bills, guns and other weapons would be banned from police stations, jails, prisons, courthouses, schools, airports and other government buildings. Local governments also could prohibit guns in their buildings.

The bills drew immediate criticism from some, saying that at minimum the state should ban guns from more places, including domestic abuse shelters.

"It's ironic that legislators would exclude guns from their workplace, the state Capitol, but not think about the safety risks inherent at locations where some of the our most vulnerable community members seek safety and help," Patti Seger, executive director of the Wisconsin Coalition Against Domestic Violence, said in a statement.

Rep. Donna Seidel (D-Wausau) said no one should be able to carry concealed weapons without training or having to qualify for permits.

"I have had concerns about enacting concealed carry in the past and the fact that the bills being circulated go beyond previous versions such as eliminating training requirements only adds to my previous objections. This is another example of the Republicans fast tracking their agenda because they are nervous about the political landscape with the results of the special election in La Crosse this week and the upcoming recall elections," Seidel said.

The bills would allow businesses to prohibit people from carrying guns in their facilities.

However, businesses that prohibit or otherwise restrict their employees or their customers from carrying concealed weapons on the premises would do so at their own risk, in terms of legal liability. In other words, employers that do not restrict weapons would be granted immunity from legal liability by the state. But employers that do restrict weapons would not be granted that immunity from legal liability by the state.

In effect, if a disgruntled employee or customer were to walk into a business and begin shooting, an employer could be held liable if the company restricted its employees from carrying weapons to defend themselves.
So, the bill, as it is written, provides a financial incentive for employers to allow weapons in the workplace.

Steve Jagler is executive editor of BizTimes Milwaukee.

As the economy slowly emerges from a devastating recession, managing health care costs among private and public employers remains a top priority as a way to maintain profitability and balance budgets.

Businesses, public entities and individuals are at a common point where it’s more important than ever to work with health care providers to better manage health care costs through innovative technologies and resources. 

Research shows that properly informed individuals who are engaged and encouraged to practice healthier living could see a dramatic improvement in their health.

At a time when budgets are tight for public institutions, businesses and families, it is imperative to take advantage of programs available to manage personal health and provide cost-efficient health care plans.
Fortunately, health plans, hospitals, well-being companies and health care trade associations have introduced a host of new initiatives to help people better manage their health care.

The Internet is playing a significant role in making information available on matters involving healthy living and best care practices. Even more so, in some cases individuals can now easily access ongoing documentation of their own health care histories, regardless of the physician or health care system that provides treatment – something UnitedHealthcare makes available through its Personal Health Record program. 

There are Web sites that contain rankings of hospital performance, allowing individuals to gauge the quality of care available. One example is the Wisconsin Hospital Association (www.wicheckpoint.org). The Web site ranks hospitals for performance and patient satisfaction based on criteria such as death rates, infections, a variety of common procedures and patient safety practices.

The federal government makes similar information available to consumers through its “Hospital Compare” Web site (http://www.hospitalcompare.hhs.gov), and private organizations such as the nonprofit “Consumers' Checkbook” use government statistics along with their own research to compare and rank hospitals.
As health care continues to be a focal point of discussion on the local and national levels, being literate in and understanding of health care terminology is critical. Consumers can learn how to navigate health care’s many entities by visiting www.healthcarelane.com.

The site provides insight about online health tools and calculators, Health Savings Accounts, common health insurance terms, and information about wellness programs and healthy lifestyles.

Increasingly, employers and individuals are embracing new programs designed to improve wellness or better manage prescription drugs. Wisconsin leads the country in implementing UnitedHealthcare’s half tablet program, which encourages individuals to purchase larger dosages of certain medications in smaller amounts and splitting the pills for consumption as a way to save on prescription drug costs. 

Many insurance companies are developing targeted plans to help better coordinate care for individuals with specific illnesses. UnitedHealthcare, for example, now offers a health care plan designed to help the rapidly growing numbers of diabetics and pre-diabetics manage their conditions more effectively while controlling employers’ escalating costs of insuring them.

The first-of-its-kind Diabetes Health Plan requires participants to comply with evidence-based guidelines for treatment of their illness. Individuals who meet their plan’s required guidelines receive significant savings on out-of-pocket expenses such as lower co-payments for related doctor visits and even free diabetes supplies.

People who take a more active role in their health care improve their path to healthier lifestyles and play a more collaborative role in decision making. When patients and doctors have a more open dialogue and utilize technologies that empower them to adopt healthier lifestyles, they can improve medical outcomes.
Resources are available on many fronts to help manage health care costs. Employers should identify resources available through their health plan and other outlets, and encourage employees to take advantage of the information and services available. Ultimately, such resources can lead to healthier lifestyles and better management of health care costs.

Wendy Arnone is president and CEO of UnitedHealthcare of Wisconsin.

Impressionist artists were excluded from top official exhibitions because their “fuzzy paintings” did not fit the mold (i.e., set of assumptions) of what constituted great art of its time. So Monet, Van Gogh and others formed their own association, held their own exhibits, and attracted an art dealer who needed to differentiate himself from established art sellers. And that’s how modern art was born. Do these century-old reinvention patterns feel familiar?

Treating an assumption as a fact can be very dangerous, as dealers of classical art discovered. Great leaders are willing to unearth hidden assumptions and challenge their validity.

Consider the watch industry, at the edge of creative destruction with the explosion of digital communication devices telling time. If you’re like me, a millennial generation parent, you may know that look of disbelief when you ask your child if she’d like a watch for her high school graduation gift. If watch industry leaders assume watches are purchased to tell time (an assumption that was true for decades), the industry will shrink dramatically into a few niches like sports watches.

One company that will avoid the trap of holding onto old assumptions is Switzerland’s The Swatch Group, Ltd., world leader in manufacturing finished watches. Thirty years ago, as digital technology disrupted mechanical watches, the company made watches cool with Swatch plastic watches, saving Swiss jobs. Today, the company is transforming upper-end watches into exquisite jewelry that flaunts wealth and style.

Will an emphasis on fashion and prestige be enough to save watches? Or will the industry have to diversify? The fact that the Swatch Group purposefully leverages its microelectronics and micromechanics competencies to supply components to multiple industries is telling.

All great business model innovations emerge when leaders operate under a different set of assumptions about how to create customer value and company profits. I recall conversations with Bob Drane and Peter Dunn, who championed Oscar Mayer’s Lunchables. They discussed the challenge of winning investment dollars for a new business model, a competition that pitted them against internal divisional lunchmeat leaders who threatened, “We’ll lose share by cutting investments” - which was a palatable argument against Drane and Dunn’s untested value promise of offering a “fun lunch solution” for kids (containing crackers no less).

Drane and Dunn had a new assumption about moms: they and their kids were bored with the same old lunch and working moms wanted to please kids. The CEO listened to the innovators, leading the way to the most successful grocery store introduction of recent years.

Great business model strategy requires that you test the validity of assumptions too often taken as industry “facts.” Wal-mart challenged the need for middlemen. Trader Joe’s challenged the need to sell well-known packaged food brands to succeed as a grocery store. All kinds of nonprofits are challenging the assumption that you solve social problems with donations and grants; in the process they are building break-through earned income business models.

Economic policy is also subject to hidden, mistaken assumptions that keep us locked into policies that no longer work. My favorite example is health care policy. As pharmaceutical companies, providers and insurers keep ratcheting up our prices, the bologna guys in the national debate fight change by holding onto false assumptions.

Rick Ungar, a blogger for conservative business magazine Forbes, acted like the Lunchables champions in refuting “facts” that Wisconsin Senator Ron Johnson presented in his recent Wall Street Journal column arguing we should abolish Obama Care. Johnson said great health care innovation can only occur in our free-market system, referring to procedures that saved his daughter’s life but which, as Ungar then demonstrated, were developed in health care systems far less “free market” than our own.

Ungar also called Johnson to task for calling the U.S. health care system the “greatest in the world,” when many of the uninsured and underinsured cannot get similar care to Johnson’s daughter’s care, and others go bankrupt or become uninsured when they reach the dollar limits of their insurance policies. In fact, without Obama Care, Johnson’s daughter will have pre-existing conditions impeding her insurance coverage options. Obama Care, Ungar argued, addresses these problems.

Johnson is right to care about maintaining cutting edge care. But his mistaking false assumptions for facts and then basing policy positions on them is as dangerous to our nation as a naysayer leader clinging to a dying core business is to a company facing a changing customer base or disruptive technology.

What assumptions underpin your business model(s)? Which of them do you treat as fact versus regularly test (as all assumptions should be)? What external changes could make your assumptions no longer valid? These are the questions that strong strategic leaders regularly ask, be it in the for-profit, nonprofit or government sector.

Kay Plantes is an MIT-trained economist, business strategy consultant, columnist and author. She served as chief economist for former Wisconsin Republican Gov. Lee Dreyfus. Plantes provides expertise in business model innovation, strategic leadership and smart economic policies. She resides in Madison.

Why are health care costs skyrocketing? Because they CAN! Thank our unregulated free-market system…that exists in no other country.

Emily Ramshaw writes in The New York Times that too much use of the neonatal intensive care units (NICU) exists, but that’s just the beginning. Doctors that were once independent and controlled hospital cleanliness and quality, are now employed by the hospitals and are thus obligated to their employers. In fact, some receive “productivity bonuses” when they increase patient admissions and the ordering of expensive MRI testing and NICU admissions.

Get used to it!

Conservatives call it Free Market health care; others simply label them commissions; I call it “kickbacks” and a blatant conflict of interest that must be made illegal.

Don’t get me wrong. Doctors and nurses should be paid very well, and they would be under a Medicare-for-all system. But they should not be paid on the basis of how many patients they admit or tests they order or don’t order.

Where to start?

Hospitals succeeded in killing state Certificate of Need (CON) programs which prohibited unwise building in an area, so they can now do whatever they want. They can now buy up the doctor-clinics in the area and take their (previous) business elsewhere, leaving the established hospitals naked. (In Wisconsin this happened in Summit and Grafton, and is about to happen in Menomonee Falls.)  They can double beds by building in areas that have not doubled population, all because they now employ the doctors that fill those beds. It’s a good racket, but it eliminates the competition for physicians to bring their patients there. They are required to by their hospital employer.

And get this: in 100 percent of the cases, equipment utilization and hospital efficiencies go down and health care costs increase. It has never happened any other way.

The Fix: Reinstate the CON and prohibit hospitals from employing physicians who admit patients or order tests. They must remain independent. Some hospital-employed physicians are OK, like those radiologists or specialists who only interpret X-rays or nuclear studies, and who themselves do not order or admit.

Administration by private for-profit insurance companies is a total waste of dollars, like giving your pizza delivery guy a chauffeur. Health care is health care, and it does not change with the mode of payment. But private insurers drain costs for CEO salaries, bonuses, shareholder profits, marketing, broker commissions, legal fees to defend denials, actuarial costs, and even political costs that are passed on to the patient. These are not needed to provide care, and wouldn’t be present under a single-payer Medicare-for-all system.

The Fix: It is clearly a Medicare-for-all system like Canada’s but without the wait times. And since we spend 17 percent of GDP and they only 10 percent of GDP, it’s easy to do. (They could eliminate their wait times by simply upping their expenditure to 12 percent of GDP, but they haven’t yet done that.)

Tort Reform is a very small piece of the pie (like 2 percent), but easily we could replace the 12-man jury of idiots with a three-judge panel of experts. Allow legal appeals with the loser picking up the court and legal costs.
Fraud exists in both Medicare and private insurance, but more so with private because it is more profitable and involves less jail time. But rather than “fraud police” we should strengthen whistle-blower protections so the employees themselves become our eyes and ears.

Yes, yes, I can hear you say it: “Now THAT all makes sense; let’s just do it!” But hospitals and the insurance industry and liability attorneys all fund the political campaigns.

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

More people than just teachers are mad. I want to clarify the impact this dangerous bill would have on people with disabilities.

The program my daughter, Kimber, belongs to is Family Care, funded by Wisconsin Medicaid. It was formed to replace the institutions and nursing homes that were "housing" our state's seniors and the disabled. It saved the state millions of dollars by not paying these places up to $500 a day to take care of our loved ones, and instead took the funds and let the families find services to allow them to keep them at home.

We use ours to provide a day program for my daughter and provide "respite care" to help us pay for special care to look after her if we have to be gone somewhere. This is something we could never do on our own...and the older I get, the more difficult it is to lift her and take care of her. Families with disabled loved ones have costs that exceed normal medical costs to care for their needs, (and in many cases, like ours, our insurance won't cover.)Family Care helps us to afford to care for them. It assures me if my husband and I pass away or no longer can care for her, this program is there to assist her brother and sister with her care as well.

The program works beautifully. That is because the people who are directly affected by it went to the legislature and helped determine eligibility, services provided, and the people it serves. Now they want to take that all away from us and have the Governor and a Joint Finance Committee control it, and NOT allow our input. This is a power grab to control the money...and make deep cuts to "balance the budget." They don't really care about us. If they did, they would allow us to be there to make the decisions about what a program like this should do for the disabled and the seniors of our state.

This is the scary part of what is going on in Madison. We are up in arms, because our government is removing our "voice" from making decisions about our lives. A true measure of a good government is how they provide for those who cannot take care of themselves. Family Care is a highly successful program because the voice of the people it serves are heard. Can you honestly tell me the Governor and a Joint Finance Committee are better equipped to take care of Kimber, than I am??

I am asking you to ask yourselves...Is this the government you want? One that won't listen to you, and makes laws to make sure your voice isn't heard either? Because that is just what he did to my child. If Scott Walker gets away with making laws that control - no, silence - our voice, and prevent us from having any say as to what the effect of these laws are on our lives, imagine what he will do to you next.

Sherry Schultz resides in Burlington, Wis.

Lawmakers in opposition to the Affordable Care Act have been calling one Congressional hearing after another in their attempt to discredit the new law. But research we’ve submitted for hearings this week and last month on how the law impacts the economy clearly shows the ACA holds tremendous benefits for small businesses and the economy as a whole.

If the law’s opponents want to help rebuild our struggling economy and create jobs like they claim, they should focus on strengthening the Act instead of trying to tear it down.

Our testimony for members of the House Education & the Workforce Committee, the Committee on Oversight & Government Reform and the House Ways & Means Committee outlines the ACA’s impact on small employers and the economy and details the consequences of repealing it. We show that without reform, skyrocketing healthcare costs would continue bankrupting small businesses and impeding our economic recovery.

Small business owners are already taking advantage of provisions in the Affordable Care Act, particularly the small business tax credits that they can claim on their 2010 taxes. As other components of the law are implemented, including state health insurance exchanges, small businesses will see even more relief in the form of lower costs, more choice and less administrative hassles.

Based on the many benefits the ACA offers small businesses and the economy overall, opponents of the law should stop playing political theater staged as hearings and instead concentrate on its smooth implementation. The time for recycling old debates has passed. We need to roll up our sleeves and get to work. 
 
John Arensmeyer is the chief executive officer of Small Business Majority,  a national nonprofit organization focused on solving the biggest problems facing America’s 28 million small businesses. The organization conducts extensive opinion and economic research and works with small business owners, policy experts and elected officials nationwide to bring nonpartisan small business voices to the public policy table.