Larry Zanoni, Group Health Cooperative

We spend $2.2 trillion in health care every year. Why? "Because we're not spending it in the right way," said Larry Zanoni, executive director at Group Health Cooperative of South Central Wisconsin (GHC-SCW). With the potential for Medicare payments to doctors being cut, and 30 million uninsured, Zanoni considers it a cost conundrum. "It will cost money to insure them," he said. "But we don't need more money; we need to spend the money we have better."

At GHC-SCW, Zanoni explained, doctors are salaried and receive additional incentives based upon their ability to achieve patient satisfaction and care scores. It's about quality, rather than quantity, and it's a model he wishes more organizations — including the government — would emulate.

Zanoni, 64, has been a fixture at GHC-SCW since its inception in 1975, and has held the top spot since 1987. The first 10 years were especially trying, he said. "Early on, we were running out of funding, and had a letter drafted by an attorney announcing that we'd be closing our doors. Luckily, we got some immediate funding, and then became eligible for a federal loan."

The health maintenance organization-concept was new back then, and GHC-SCW had a new name and just a few doctors on staff. Within a year, the not-for-profit had attracted 478 members. Today, GHC-SCW has 48 doctors at five clinics, 700 employees, and 62,000 members. It was hard work, he recalled, but then, he'd been raised on hard work.

Zanoni, one of nine children, was raised in the western suburbs of Chicago. In 1930, his father opened an Italian grocery store — an amazing feat, considering the times. "Somehow, this immigrant Italian gentleman was able to convince a big bank to allow him to start a business, one year after the [stock market] crash," Zanoni said admiringly. "I remember standing on an old wooden pop case in order to reach the register so I could wait on customers." The experience taught him about hard work and customer satisfaction. When the business closed in 2008, after 78 years, Zanoni admitted to a tinge of sadness. "I always knew [that if everything else failed] I could get a job there making sausages!" he joked.

In 1968, after graduating from Chicago's Loyola University with a Biology degree, Zanoni taught math and science briefly at a Catholic elementary school in Glen Ellyn, Ill. before heading off to grad school. "Boy, that was fun!" he said of teaching. "The space program was in full swing, we were landing on the moon …" and, he introduced animal dissection to his science classes.

"I had to convince the nuns to buy a specimen (a cat) to dissect. I spent three days explaining that the cat wouldn't come from the local neighborhood, so I told them it would come from Wisconsin or Minnesota, not from Illinois," he laughed, ever the story-teller. (In fact, specimens came from biological supply houses.) Zanoni earned $5,000 teaching that year. He was also living at home, had no expenses, and used $2,000 of the money to purchase his first car, a Camaro. Life was good.

Eventually, he left home to pursue a masters degree in public health from the University of Michigan.

Today, Zanoni agrees health care reform is needed, and he bristles at the waste he knows exists. "No matter which way you turn, someone will be ticked off," he said of reform. "[Health care] is just so complicated and the politics run so deep …" Which reminded him of another story:

"A long time ago, I was with a corporate attorney downtown and I was admiring the Capitol building. 'Yes, it is beautiful,' my friend said, 'but there are two things you never want to see made: legislation, and sausage!'

"I took some offense at that. I did make sausage, and it's a lot cleaner than some of this legislation!"

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