YOUR COMMENTS

The government tells people what to do when they don't follow the most basic of commonsense rules. Our current situation cannot be sustained. We are paying now for all those people who had huge deductables. Surprise, surprise, emergency rooms still serve them. One part of this puzzle is to get these free loaders to contribute to the cost of their own care. They float along in their libertarian haze until it is time for the rest of us to pay the bill. All that will happen, bureacracy wise, from this bill is the bureacracy that is now so extremely costly and hidden from view inside health insurance corporations will be outside where it can be supervised and controlled. And that is the rub. Republicanics want to contine at the government trough of no bid contracts and hidden taxes. Their boat houses on the money river are already built.
- Robert, Deerfield

Even using the States as laboratories denies freedom for individuals. In fact Romney's idea that States should be the breeding and testing ground for plans that, if they work, could be adopted by our Federal masters is still not reasonable. Where in the U.S. Constitution is Congress permitted to provide insurance, mandate it, run it and hurt you if you fail to comply? Nowhere! In fact under these concepts people (me, my family, my friends, neighbors and fellow countryman) are prevented from helping themselves and their families in the ways they deem best. In other words they are being denied the natural right to defend themselves. Somehow a modification of the right to take care of myself has been confiscated by government under a banner of compassion for some and at the expense of so many. This is a form of tyaranny the likes of which we have never before seen in this County.
- task, Westbury, NY

What the RNC and every Pub organization has to do now, is to immediately put out a list of bullet points where the public can easily see the horrors of this 2074 page monstrosity. Today, Gov. Jindal put out his own 10 pt. Care plan at the Gov's Conference. One can be short and sweet and to the point with facts that would show the voters just where this mess is going to raise taxes, deficits, curb care, doctor choices, have a public option-Fed. run, have more taxes....and people could still flood the Senate before the Sat. vote. It must be done to stop the murder, literally murder of our free enterprise healthcare system.
- Glenn Koons, Long Beach, Ca. 90814

Jim from Portsmouth, sorry I didn't read your message carefully enough. But I do think the point of the 70% figure is to take aim not only at the uninsured but people like you with catastrophic-only coverage.

And why, in such a charitable nation? Because, having promised we will dispense free care to the "needy," we need to take away your freedom so that you can never claim you are needy. Having chosen socialism, we must remove remnants of freedom. Health care reform was created to further protect the permanent welfare state that has swallowed America.
- Spike, Brentwood NH

Jim from Portsmouth, I'm not sure if it counts or not. I know that HSA advocates are concerned. I agree with you that they are part of the solution for reasons Spike describes. Something we should all want clarified before a final vote. I do however hope it will become legal for people who choose to purchase a plan that merely provides catastrophic coverage and pay out of pocket for the rest. It isn't today.

e from londonderry, we don't know the final version yet. That's the point of writing now. The more egregious things might be taken out if people are aware of them or clarifications inserted for people with concerns like Jim's.

I'm happy to add some comments that provide information people are seeking if I know it like the data Jerry from Londonderry was talking about. I hope to provoke discussion rather than just getting to people to agree or disagree in total. Good luck.
- Charlie Arlinghaus, canterbury

You would think that we should spend more on preventative care rather than paying higher costs for defensive care. But now we may have less frequent mammograms covered. This would follow the theme of no longer selling Medigap policies under Plans E, H, I, J after May 31, 2010. I purchased my Plan J specifically so that I would have some supplemental coverage for home health care and preventative care. As of June 1, 2010, people won't be able to buy those supplemental plans. Why have we not had more publicity about those plans being eliminated?
- Florence, Manchester

A big part of the reason the health plan proposal is 1000+ pages is obvioius: lobbyists. Drug companies, insurance companies, and other special interest groups want to make sure their particular agenda is provided for. Politicians in BOTH parties are at the mercy of the incessant calls and demands of those who have the most money to spend and the best organized propaganda machines. Would that we could have a committee of both parties sequestered to create a truly sound plan.

We don't allow cross-state insurance purchasing, which creates monopoly-like market control in each state. This is especially a problem in small states like NH. We need to end that ill-advised regulation and let free market principles lower insurance prices.

Let's also keep in mind that we can't "go back to the good-old-days." Health care has advanced far beyond what was even imagined when our current system was developed back in the early 20th century. You can't pay your doctor with eggs and chickens for delivering a baby. We need a total makeover; we may need to build a new system from scratch, maybe not. IMO it needs to include some regulation in the malpractice arena; not in the award to the victims, but in what the lawyers can reap in profits (but then we are getting into tort reform in general and that's a whole separate topic).

Health care reform SHOULD be to the benefit of business, taking away the requirement of what is for many the burden of providing prohibitively expensive benefits. Maybe this would be a step toward bringing business and jobs back into the US.
- Deb, Raymond

To Jerry in Londonderry: You should also note that once upon a time there were no MRI machines or CAT scan in Emergency Departments at little cottage hospitals like Exeter and the the like. There are now. It's called progress and innovation, pursued by people seeking a profit. Get your head out of the sand.

Eventually insurance companies with bad options and poorly designed plans and coverage will go out of business, because people won't buy them. Allow for purchasing insurance plans across state lines to help spread risk and increase choices.
- Jim, Stratham

Spike says "Paying cash puts me in charge of the treatment choices and puts me on the front lines of reducing treatment cost. Jim knows that and that's why he blurs it with odd rhetoric."

Spike - I think we agree on the self-reliance part and I'm not trying to blur anything. I do not want to lose my high-deductible plan or pay a penalty for choosing to be self-reliant for the small (and medium) stuff.

BTW, when I say "going naked" I'm referring to people with no insurance at all. I didn't make the term up, it's a finance/risk-management term. People like myself with a high deductible plan are NOT going naked. We pay for the small stuff and we're hedged against catastrophe by insurance.
- Jim, Portsmouth

I'm amused to read that the author of the column is writing in the comments section to clarify and defend his column. It's remarkable how much he knows when the final version of the law is not even settled yet.
- e, londonderry

This isnt an add its true. I have a high deductible plan. Look on www.ehealthinsurance.com

I pay 103 per month with a 1500 deductable. Hardly unaffordable, oh by the way its because I am in AZ not NH. Shop over state lines and we solve half our problems. My same plan to move back to NH drives my costs up 150 more a month because I cant shop over state lines.


Pre existing happens when you get your insurance from a job rather than direct. I have had my insurance for over 3 years now and there is no such thing as pre existing yet I have held 3 jobs and became a student graduating soon and still covered.
- Matt, Derry

PS--The scary prospect that Jim of Portsmouth describes as "going 'naked' with respect to insurance" is in fact arrangements under which we pay cash for the small stuff--including abortion and stomach-stapling--and only insure against catastrophes--that is, a world where "insurance" is sharing huge risks, not getting other people to pay for everything. Paying cash puts me in charge of the treatment choices and puts me on the front lines of reducing treatment cost. Jim knows that and that's why he blurs it with odd rhetoric. Individual self-reliance is the real enemy of Obama-care.
- Spike, Brentwood NH

Mr. Arlinghaus says: "However, under the proposed reform, high deductibles are not allowed. New plans must cover at least 70 percent of value."

IMO, that's not accurate. The 70% floor is on something called the actuarial value of the plan. Most suggest that contributions to HSA's by either employers or employees should be included in the actuarial value calculation. If that's the case, most high-deductible plans would easily meet the 70% floor.

Given that the goal of this 70% floor is to make sure people aren't going "naked" wrt health insurance, it only makes sense to include HSA contributions in the floor. IMO, even if no HSA contribution is made, a high enough HSA balance should also alow one to avoid penalties for having a too-low actuarial value policy.

I'd bet (and I hope) that's how things will play out and there will be little to no impact on high deductible plans with HSAs.

If that's not correct, I'll be very bummed out, since I have a HDHP and an HSA myself, and I believe that these plans, along with their cost sharing, are an important part of the solution.
- Jim, Portsmouth

Mr. Arlinghaus says: "However, under the proposed reform, high deductibles are not allowed. New plans must cover at least 70 percent of value."

IMO, that's not accurate. The 70% floor is on something called the actuarial value of the plan. Most suggest that contributions to HSA's by either employers or employees should be included in the actuarial value calculation. If that's the case, most high-deductible plans would easily meet the 70% floor.

Given that the goal of this 70% floor is to make sure people aren't going "naked" wrt health insurance, it only makes sense to include HSA contributions in the floor. IMO, even if no HSA contribution is made, a high enough HSA balance should also alow one to avoid penalties for having a too-low actuarial value policy.

I'd bet (and I hope) that's how things will play out and there will be little to no impact on high deductible plans with HSAs.

If that's not correct, I'll be very bummed out, since I have a HDHP and an HSA myself, and I believe that these plans, along with their cost sharing, are an important part of the solution.
- Jim, Portsmouth

Having Washington take over health care with the express goal of covering more people while driving down "national spending" on health care ensures that people will be denied treatment. Democrats think they see economies as they are smarter than we are: More preventive care (but fewer mammograms). These economies won't overcome the effects of a new promise of free goods, nor the corrupting power of standing between us and our doctors.

Corporations have the Constitutional right to "petition...for redress of grievances," and if Washington decides what an insurance policy must be, the only way to increase sales will be to lobby. The Founders knew this and wrote the Constitution to take off the table certain tasks they knew government could not do well, including a system of "universal health coverage."
- Spike, Brentwood NH

Our Government is already setting the stage for socialized healthcare.
Yesterday they announced that Mamograms should only be given to women starting at age 50 and also recommended women to stop self examinations.
This is just the beginning of the endless "recomendations" that will lead an increased death rate but will "lower costs".
Get ready America. These "recomendations" will become protocol and our Mothers and daughters will pay the price.
Hey, at least my Mom will be able to get a free abortion.
- Greg L, Hudson

I appreciate the comments. A couple notes on profit margin. Of the 26 hospitals in New Hampshire, 24 are non-profit and only 2 are for-profit (Parkland and Portsmouth). In America, half of all insurance companies are non-profit covering a slight majority of patients. NH has both for-profit and non-profit insurance companies. I don't have the data but I think a majority of us in-state are covered by for-profit.

According to the congressional budget office, profits account for less than 3% of premiums.
- Charlie Arlinghaus, Canterbury

Once upon a time the health care industry in general was community based. Many small towns had a small hospital with a few doctors on call. Now most of the community based hospitals have been bought up by large corporations and too many of them shut down for not being profitable enough. We are now forced to use the larger hospitals for routine evaluations and non life threatening emergency care. Many of the small community hospitals were not-for-profit...the larger regional hospitals are for profit (not all but most).

The insurance providers have always been for profit but those profits were only a fraction of how much of our money they keep now. The profit is spread among shareholders and executives. The more the company makes, the more the executives make and the larger the return the shareholders see on their investment. There is no incentive to actually provide funding for health related services when the insurance corporations are all about profit...we, the consumers, lose in the end. If a person gets sick they are dropped from the system as a "dog" that cost's too much to keep on or dropped because of the so called "pre-existing condition". There can be no insurance reform without the profit being reduced or completely eliminated from the picture. This is the sole reason for the public option. If you really like your for profit insurance provider, keep them.

The free market is a wonderful thing when it comes to making a profit. It's a terrible thing when it comes to covering health related costs to consumers. We need the public option to hold the large insurance corporations feet to the fire and force them to actually do what they have been paid to do. Provide insurance coverage when it's most needed.
- Jerry Conner, Londonderry

"Instead of Goldilocks making these judgments, we'll have a health choices commissioner. The commish will be assisted by the creation of more than 100 new bureaus and federal programs, including the Health Benefits Advisory Committee."

Example A came from yesterday's news where the government panel decided that women should no longer perform self-exams for breast cancer and that women should wait until they are 50 to begin receiving mammograms. This government panel surely can accurately be called a death panel for some.
- Rick, Hampton