The Wisconsin Magazine; 722

The federal government's proposed next year. We need your help. 2 6 3 4 0 4 0 is the number area code is 608 if it is a toll call, call collect 2 6 3 4 0 4 0 Thanks for being a friend. This is WHA TV Madison Wisconsin. As I've read this report I have a suspicion and it may not be as Christian as I'd like. But I have the suspicion that the fish have been mandated to vanish in order that the whales might flourish. The whales are the health care giants and the fish the small hospitals. A battle of big vs. little on tonight's magazine. This is the Wisconsin Magazine reporting from Madison, Dave Iverson. Good evening welcome to this week's magazine. We'll spend some time tonight talking about large

versus small a topic of debate among health care planners and providers as we'll see in just a moment. Then Dick Goldberg is back again this week talking about the value of thinking small. Dick will have some financial advice for less than big time spenders. Later on we'll have a point of view on child care its cost and importance. Then if the weather along with the economy has got you down. Carol Larson has a cure for the between season blahs. That whales might flourish has nothing to do with ocean going mammals it does have something to do with a battle between small hospitals and big regional facilities between places like Children's and Family Hospital to old Milwaukee institutions and the city's newest facility Froedtert. But our story also has to do with another big ticket item health systems agencies. Federally supported HSAs plan hospital growth or hospital closings as the case may be. But now the planners are being planned out of existence by the Reagan administration. If the future of health planning is uncertain now it was

also a confusing process last fall when a regional HSA hurriedly recommended the closing or consolidation of several hospitals including Children's and Family. Public outcry over those proposals combined with the potential demise of HSAs forced the abandonment of those plans. The older hospitals may survive now along with Froedtert. But the argument over the now defunct proposal tells us something about where HSAs and health planning went wrong. It is a complex important and emotional process whose future is still uncertain. Today I'd like to tell you that she's been off of chemotherapy for two years. She goes to kindergarten and she plays the violin and her teacher says she's as peppy as chili con carne. I know another boy in the hospital at the same time that wasn't so lucky. He was sent to another very fine hospital but not a children's hospital. He spent 10 days in there for tests and he was told there was nothing wrong with him. He went home until it was so bad that when he was sent to Children's they immediately found he had malignant inoperable

brain tumor and it was too late to help him. He could have been saved. Children's is in desperate need of a new facility. And yet it seems that Froedtert is out there in the clouds. Well Froedtert will help you but it won't reach us in the city. Save Children's Hospital save Family Hospital words heard often at this public hearing. But the health planners who sponsored the meeting claim there may not be a threat. They did not really look at the plans for example and Children's Hospital. They use out of the plans we had about four alternatives in the plans they used one of the altar that is fragment Children's Hospital. They did not rally round where we said they'd need a 200 bed freestanding hospital. So they took the most radical point and rallied the people around Children's Hospital the Family Hospital did exactly the same thing and plan A that we had in there that family hospitals should be retained but however they should be working close together with downtown hospitals. They

chose the plan that would recommend family hospital closing. Of all the hospitals involved this one Family probably kicked the hardest and screamed the loudest. A lot of the people at those public hearings were family hospital employees. They weren't just worried about their jobs. They almost seem to be religious about what they were doing. But then as a matter of fact, so are some of the patients at Family. Now she's got an opportunity to come and meet this baby and she becomes part of the whole experience and that's just great. And my sons too. They took it very well very easy. She's the youngest and so she's the hardest you know to understand what's happening. But this is great when she can sit here with little sister like this and hold her, she's part of it now. Much of Family Hospital's promotion is centered around its New Life Center. It offers a more relaxed atmosphere for childbirth both before and after delivery. Family staff members feel these options may be the reason why the number of live births at the

hospital has gone up 300 percent over the last 10 years during a period when birth rates overall have been declining. But families overall occupancy rate huvers around 60 percent. Other hospitals in the area are less than half full. The health system's agency takes the position that mergers and closings would save money. But patients and staff at the hospitals that would be affected wonder why, if there's a surplus of beds and facilities Froederts hospital was built adjacent to the County General Hospital on Milwaukee's west side. But if you meet a volunteer on your future studies I'll offer my time and so on because I think I can I can reason with you brothers and sisters. And as I read this report I have a suspicion and it may not be as Christian as I'd like. But I have the suspicion that the fish have been mandated

to vanish in order that the whales might flourish. [Cheers] Several health professionals in the Milwaukee area said that building a Froedtert hospital was unnecessary and would only accentuate the bad problem that we had in Wisconsin as a whole. Well they had Systems Agency here in Wisconsin in Milwaukee did not accept those views and actually did not approve of the building of Froedtert hospital. They really couldn't make up their minds. The result was a tie vote. It went to the state for their final decision. And state arriving at it's decision the Medical College brought political pressure on to the governor. The governor got involved in this decision as well as they then the secretary of Health and Human Services up in the state. And based on all the pressures brought forward by the businessmen in this community

by the governor the planning process was not followed. It really down to the end. That landed the the issue in the lap of the secretary of Health and Human Services Dr. Ralph Andriano. I've heard that story for almost five or six years now. There's absolutely nothing to that story. The larger factors are these long before I came on the scene, the state made a decision to make the Medical College of Wisconsin a viable medical school. A viable medical school needs a teaching hospital. The administrator at Froedtert, Dean Roe questions whether his hospital is really in competition with the others since it provides so called tertiary care. That means it treats only the severest medical problems gallbladders, tonsils and hernias in need of mending are left to other facilities. But opponents of HSAs feel the hospital is a hospital. They feel that building a Froedtert despite the planning effort

is a prime example of what's wrong with the current system. HSA supporters on the other hand point out that 28 percent of the fifty million dollars worth of projects that the agency reviewed last year were blocked saving patients an equivalent amount of money. But Family Hospital's president contends the planning was done in a vacuum and in a hurry. The power constituencies in the community felt disenfranchised and by that I mean there were several of us in the community who were simply left outside the discussions. Some of the staff for example said we're not sure you would have participated if we'd given you the chance. Well that's double think that I'm really not sure needs to go on. Sure we would have helped. We had planned we had an operation a two year study to develop a hospital service plan. We did not create the crisis the hospital community created by submitting all of these applications in the late fall for our all this modernization of their

hospitals. If that hadn't happened this all of our plans would never have went out. Everybody agrees there are too many hospitals in the community. Everybody agrees there are too many beds but whether or not it was politically realistic, of course I think it's proved that it was not that there was a lot of forces that were active in a community that wanted to maintain these hospitals. They say everybody agrees on closing hospital beds. You talk to people at Family you talk to the people at Children's and they say not us. How can you say everybody agrees on that. It's always a case of whose ox is being gored and once a hospital is threatened with closure or merging then there's an awful lot very large struggle to survive. And it's natural normal and it's occurred in every community in the nation where these attempts have been made. The hospitals cannot in and of themselves affect a closure. I think that's been proven here and in other communities also. There must be some external forces at work in addition to hospital planning.

But if the force is no longer with us and the HSAs vanish, a new force will have to be found. Dr Andriano now chairman of the deparment of economics at UW Madison contends just regulating buildings isn't enough. Cost should be regulated too. Is one better able to achieve that by essentially laying some plan out on the table and says let's close A and B and merge C and D or is it better to essentially put the screws on at the rate setting level at the reimbursement level where essentially it's a different strategy of regulation if you will. Competition may be a part of that strategy of regulation. Hospitals like Family that come up with successful programs like the New Life Center will attract patients. Hospitals that don't will lose patients and money and will get caught in the net of cost controls. But economist Andriano warns that somewhere in the background there will still have to be some sort of planning effort. We asked HSA

director Julian what would happen if there were not. I think you'll see a tremendous bulge in capital expenditure in the next couple three years. I think that all these hospitals will come in and they're going to build everything they want to build. The only thing that will stop them is the capital market. Absolutely not. I think that Mr. Julian if he believes that is expressing that from his vantage point of having been isolated from the real world. I don't think that that's a really achievable for in terms of if our hospital wanted to go out and do something that was beyond our scope beyond our mission beyond the commitment of the people that we have here we would be silly. The state of Wisconsin is now considering a moratorium on health facility construction. The state and federal governments now pay just under half of all hospital costs. But as Medicare and Medicaid wind down, if they do patients and private insurers may wind up picking up more of the bill. Shopping around

may become more common. Perhaps the pressure of the marketplace may be a far bigger club then the health system's agencies ever were. Hospitals and health planners are of course not the only ones concerned about planning and money. We all are and we've asked money planner Dick Goldberg back for more free advice. Dick a week ago you said find out what other people are doing and then do the opposite. And one of those opposite things was stocks. Now the next day in the State Journal I want you to listen to this now, there was a little article that said on the front page stocks skyrocket. I want to know how much you know about what we're doing here. My understanding was it was mainly the Iverson TV fluctuation that plowed into the market after the interview but besides that I think the big reason is that stocks have been under priced so long that people are starting to realize it. They've been saying for years stocks aren't a hedge against inflation real estate diamonds gold is and avoiding stocks, but meanwhile stocks represent interest in companies that have assets and these assets keep growing in value with

inflation. So other companies that want to expand instead of going out and building new plants and equipment say gee I know a cheaper way to do this. Let's buy the stock in another company so they make an offer for the stock and that usually drives the price of stocks up. Now there are hundreds I suppose thousands of stock market opportunities. When I look at the financial page in the newspaper not something I commonly do but when I do I mean it looks like so much hieroglyphics to me. Yes. How do you begin translating that and distilling that so that it can work to your advantage? There's all kinds of courses offered throughout the country and certainly throughout the state extension courses six evening courses on investments how stocks work stock brokerages firms offer this for free and there's zillions of books on the subject of understanding investments. No simple rules no like you can't tell me. Well "Planting Your Money Tree" is my favorite book as a primer because I wrote it. But there are lots of good books on the subject but the basic idea I feel for the small investor is take advantage of buying small stocks. Learn how stocks work.

Learn the mechanics of common stocks things like price earnings, ratios, multipliers and so on so you can talk the language. Is the language one of the barriers? I mean to me that's part of it you know you start using those terms and I think wait a minute this is beyond me. I'm going to go back to my passbook savings account. Is that what you have to get beyond that sort of barrier? Well, in one chapter in my book I say sit down with a hot fudge sundae to get through these terms so you can learn what these terms are and it won't be so painful so you can have a bite of your ice cream and then read the next term. But it's not that hard. Six hours can educate you to most of this what you see as hieroglyphics so it becomes understandable to you can become investment literate if you read the right book or get the right lectures on the subject. And the key is again thinking small? Is that the starting point? There are lots of opportunities but I think for the small investor the most fun and the best angle is to find companies that are very small that have publicly traded stocks that have been ignored by the experts because the experts have too much money to move into companies that are small. They can't afford to move their big pools of money into the little tiny companies because they disrupt the market then and they have to pay too much for the shares.

So it's again really sort of looking for the unexpected just like you said last week. You know find out what other people are doing and do the opposite. Similarly with stocks look for the things that may not get so much attention. The over looked. They're there. They really are. I think pretty much if you just use a dart board and throw it and buy stocks you're going to do all right anyway. But read "Planting Your Money Tree" first and that will help your accuracy. It'll help me, sure. Alright, thanks Dick very much. Stocks are not the only investment we're going to review on tonight's program. Our point of view segment focuses on something else that's a good investment: Childcare. According to research done by a foundation in Michigan childcare pays off. Kids in Head Start and other programs wind up less in need of special education and less prone to juvenile delinquency. The 20 year study also found that childcared kids also wound up making more money in later years. But child care costs money. In Madison for example average weekly fees range from $50 to $90. So while the economy often means that there must be a two family income quality child care is still unaffordable for some. The solution says B.J. Schwartz is

government funding to create sliding scale fee arrangements. Here's tonight's point of view. The need for quality daycare is especially high now because by 1990, 75 percent of all two parent families will need child care. The economics of the situation is such that both parents are out working. But many of our middle income people have to resort to makeshift arrangements that are absolutely horrendous. And it seems such a shame to have children subjected to this. The sliding scale is important to help serve a broader range of clients in the daycare community. Right now there's some assistance for lower income people and people with higher incomes can afford the type of care they want. People with

middle incomes can't afford quality care without some assistance. And because of this large expense for the people who have no vote in this country our children and they are our greatest national resource. We need to do something so that all of those people can have quality care. And for more information on how to support the sliding scale concept you can contact Community Coordinated Daycare in either Madison or Milwaukee. And if you have something you want to express on any topic contact us right to point of view, Wisconsin magazine 821 University Avenue Madison Wisconsin 5 3 7 0 6. Time now for weathering the weather. In fact I have tonight's forecast for you. It calls for a continued cloudy with snow flurries lows in the upper teens. Officially tomorrow is the first day of spring but that doesn't mean much in Wisconsin. Mother Nature doesn't

always keep the same calendar as we do and March is still very much a winter month. As Carol Larsen reports late winter colds aren't the only ailment that strikes weary Wisconsinites this time of year. Some people have been heard to say recently that spring is just around the corner. But I'll believe that when I see it. Even the aforementioned optimists are not yet shedding their coats in springtime anticipation even though those coats do seem to be getting heavier after three or four months of wear along with the hats and the mittens and the boots that have to go on just to take a walk across the street. About this time of year you start to wonder if a law was passed against warm weather. Winter is too long there's no way around it. January is OK you kind of skate by on the coattails of the holidays. And February is short. There's no problem with bad. But March, never mind that in the middle of March is the first official day of spring. Anyone who has lived through a blizzard in late April or even May will tell you that March in Wisconsin means winter

and winter means the blahs. Basically what has happened is that people feel that winter is going to drag forever that they're not going to ever see the sun shining and the warm weather again. And they begin to get depressed. It's interesting because people can tolerate often cold weather as long as the sun is shining but if it's a gray day even if the temperature is not as low as other times people then react to the grayness to the lack of light to the lack of sun. So even psychiatrists recognize this ailment called the blahs. Dr. Silva says he can set his watch by it or at least his calendar. No vacations for mental health workers during the infamously busy month of March which in turn can't be very healthy for them. You stay in the office and you begin to feel trapped and entrapped and you feel that the other people comments or reactions might be almost personal

or nasty whatever. The solution to that closed-in feeling says Silva is to get out. But what fun is getting out in winter if there's hardly any winter stuff to be found. Can't even make a decent snowball out of what's left. The temperatures have been what they call unseasonably mild. Even those crazy people who like winter for the sports have been depressed this year. But to make up for it some have been spending more time in another cold spot. It seems that cold weather and depression causes people to overeat and eat all the wrong things. Which of course only goes to make you feel worse. Then add to that what could be called the clothing store conspiracy. March is when they hang out all the new spring outfits. Light little shirts and things which now being overweight and without the proper exercise one can't fit into anyway. But the cruelest blow of all is thrown by Mother Nature herself in the form of the occasional sunny spring-like day. The appearance of warm bright skies will bring out Wisconsinites in droves turning those

perpetual grey day frowns into almost hysterical glee. The blahs now turn into a fever. Spring fever, but like feeling low this new high still prevents us from getting any work done. Anyone that can is out living it up. Stripping off whatever clothes they can. It's my bet this fellow will have plenty of work to do tomorrow as well as a cold but the psychiatrists say this is healthy. You should take advantage of the sunny days even though most of us will do so without realizing that while we lull in the brown grass that nearby pond is still frozen over with winter's late staying reality. But OK doctor we'll swallow the prescription and take a forgetful walk in the sun with the other springtime hysterics. It won't last. You'll see. It will snow again. Wisconsin is very interesting because it fluctuates. It goes from those cloudless perfectly blue sky days and then you have the very gray oppressive days. So you have Mother Nature's nasty little trick of giving us nice days. Mother Nature

always plays tricks on us, yes. And then we feel worse because now we we've had a good day. Precisely. A worsening diagnosis just when there looked to be a cure for the blahs. But Dr. Silva does have one more prescription. If you can't go out physically do it mentally. I'm a very firm believer in fantasizing. Children of course are the super fantasizes. And unfortunately as we grow older we are discouraged from fantasizing. For example go to a travel agency pick up brochures begin to plan a vacation if you can take one during the summer. If you cannot take one for several years begin to plan it now anyway. But it's something to look forward to and that's something that really gives you hope and allows you to deal with the discomfort of today. Maybe I'll go to Mexico. Maybe Jamaica. Hmm, that's not such a bad tasting pill. Outside it kind of helps keep the chill off as nature once again is predictably doing its unpredictable

best to hang on as long as possible but we'll be able to shed the winter coats eventually. The trick to surviving winter is just not letting it get the best of you. But don't jump the gun. Changing the snow tires or taking down the storm windows will almost guarantee you another snowstorm. But I'm afraid that I probably jinxed it for everyone. You see I lost my last pair of gloves. And where can you buy mittens in spring time. And that's this week's Wisconsin Magazine. Next time we'll continue our review of government supported programs that are now being threatened by government budget cuts. We'll be taking a ride along the train the Empire Builder and we'll talk to both Amtrak and state officials about the future of passenger rail service in the state of Wisconsin. Also next time Carol Larson will be back she will not be in Jamaica and she'll have a report on Delayed Stress Syndrome and what that means for Vietnam era war veterans. That's this week's Wisconsin Magazine program I'm Dave Iverson. Have a good week.

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