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My Turn: Affordable Care Act is eroding meaning of New Hampshire’s motto

FILE - In this 1990's file photo, crews work on the symbolic Old Man of the Mountain in Franconia, N.H. New Hampshire awoke May 3, 2003, to find its stern granite symbol of independence and stubbornness, the Old Man of the Mountain, had collapsed into indistinguishable rubble. (Photo/Jim Cole, File)

FILE - In this 1990's file photo, crews work on the symbolic Old Man of the Mountain in Franconia, N.H. New Hampshire awoke May 3, 2003, to find its stern granite symbol of independence and stubbornness, the Old Man of the Mountain, had collapsed into indistinguishable rubble. (Photo/Jim Cole, File)

New Hampshire is small and mostly rural. We have a well-known motto, “Live Free or Die.” Until May 2003, we had a famous landmark, the Old Man of the Mountain.

From 1,200 feet, the Old Man crashed down in the darkness of night and became a memory. Thousands of years of hard weathering eroded its place on the granite cliff.

With the implementation of the Affordable Care Act in New Hampshire, our motto, our creed, suffered similar erosion. We have become less free – with scarcely a fight, let alone a battle cry.

According to Fortune magazine, WellPoint is “a massive health insurer.” In late 2013, WellPoint, through its subsidiary, Anthem Blue Cross and Blue Shield, was granted total control over access to health care for those of us with no other option for health insurance.

From its exclusive position, WellPoint-Anthem dictated where, and from whom, tens of thousands of us could receive medical treatment. Health insurance does not equal health care.

“Dictated” is the proper word because in no way was this a fair fight. Key elements of “live free” include fairness and equality and inclusion. But in this instance, size mattered. Money mattered.

In 2013, WellPoint reported revenues of $71 billion or roughly more than 13 times the budget for the state of New Hampshire. That same year WellPoint acknowledged spending over $11 million on lobbying – more than our state’s Insurance Department’s budget.

Dictated is the proper word because the “legal” process was inherently inconsistent with the first principle of our constitution – that all legitimate government is “instituted for the general good.” For all. Equally.

WellPoint-Anthem eliminated insurance coverage for 12 of our state’s 26 hospitals and for the health care providers associated with them. As widely reported, Anthem lobbyist Paula Rogers told the Joint Health Care Reform Oversight Committee: “We’ve got 26 hospitals. Do we need 26 hospitals to serve the population we expect to see and still provide quality of care? We decided that we didn’t.”

It is safe to assume that the “we” in this statement represents duty to shareholders not to caregivers or care-needers or communities or to constituents. Or “to doing no harm.”

We were repeatedly assured from the beginning of the ACA that we could keep our doctors and our hospitals. We were promised choice. We were promised affordability. WellPoint-Anthem added a footnote to those promises to exclude our state – promises made by some important and powerful people in our national and state government. An asterisk was working its way next to our “live free” creed to denote its compromise, exception, erosion.

Our state is made up of caring communities. Many have hospitals that have served multiple generations and that have been supported by those generations to grow into comprehensive, contemporary, health care and wellness facilities. They save lives, restore lives, and through preventative care, enhance lives. Every day. Throughout our entire state.

One of those hospitals not deemed necessary by WellPoint-Anthem is Monadnock Community Hospital in Peterborough. On the afternoon of Feb. 10, an industrial accident resulted in an explosion at a factory that sent more than a dozen injured employees to MCH. Two were so severely injured that they were airlifted to major medical facilities in Massachusetts. All survived and have been released from hospitals.

Contrary to the assessment by WellPoint-Anthem, most of the injured, their families and first responders are probably very certain of the value MCH delivered that day and for days afterward. They do not doubt its “necessity.”

Community hospitals save lives everyday – and will continue to save lives unless we allow them to become financially crippled by entities that dictate who gets saved and where.

Whether you call it Obamacare or the Affordable Care Act, the operative word is care. And while many of us now pay health insurance premiums to WellPoint-Anthem, many still do not have access to health care, to new providers or to our own doctors who delivered the continuity of care that is widely applauded for both its effectiveness and efficiency.

Now is the time for a leadership that delivers the solution to this injustice imposed on our state. Anyone who thinks that waiting for next year is an option has never set foot in an emergency room or an urgent care facility.

Now is the time, before Election Day, for any incumbent or challenger to free our state from a corporate stranglehold that limits our access to our own health care providers and excludes thousands of us from the promises of the Affordable Care Act – promises made from the highest levels of elected office that were broken in the boardroom. Promises made to everyone in the country, including New Hampshire.

Now is the time for candidates to exercise their best leadership skills. Craft the solution for now – executive orders, legislation, court injunctions, whatever. Deliver this now. Save lives. Earn votes.

Or change our motto to “Live Free* or Die.”

(Michael Justice lives in West Peterborough.)

Legacy Comments50

6 Million Brits have private insurance. 52,000 travel out of the country for care. Half a million Swedes have private insurance, and that figure is rising. 1/3 of Primary care Doctors in the US have already dropped Medicaid patients. 1/4 of Specialists will not take Medicaid. 52 of Doctors have limited their practices for Medicaid and Medicare patients. Concierge Practices are rising every year. As the Govt lowers reimbursements, these figures will grow even larger.

Your careful editing of the WSJ article is not terribly honest. Here's the actual quote: " six million Brits—two-thirds of citizens earning more than $78,700—now buy private health insurance. " Yeah, isn't that to be expected? When people have money, they want something "better" than the average person. As for Sweden - half a million is 5% of the total population. Not a staggering number by any means. ------------- and finally how about this from the CDC: "It's estimated that up to 750,000 US residents travel abroad for care each year. Many people who travel for care do so because treatment is much cheaper in another country. In addition, a large number of medical tourists are immigrants to the United States returning to their home country for care. The most common procedures that people undergo on medical tourism trips include cosmetic surgery, dentistry, and heart surgery."

I did not carefully edit anything FOF. I put the stats out there and did not comment on them. I noticed you did not comment on Primary care Doc dropping Medicaid patients, Specialists and that fact that over half of Doctors in the US have limited there taking ion Medicare and Medicaid patients.

I didn't address those because I don't have any facts about it, and didn't have the energy to research it. Since then I found the original study, which didn't offer any reasons for those doctors cutting back on Medicare patients. I don't, at this moment, have an opinion.

by the way: 52000 Brits is .08% of the population. 750K Americans is .2% of the population. So, we traveling for medical care at almost 2.5 times the rate of Brits.

Not how it works FOF. There are 5 times as many Americans as there are in the UK. So you are comparing countries where one has 5 times the population of the other. Who is carefully editing now?

Rabbit - read it again. I know how to do percentages. Divide 52000 by the total population of GB ( and you get .08%. Divide 750K by the total population of the US and you get .2%.

In other words, the rate for Americans is 2 per 1000. For Brits it's less than 1 per 1000. Doesn't matter what relative populations are, the rates can be compared apples to apples.

The 8 million number of signups that Obama claims is a canard. 30% of those signups were people who lost their insurance because of Obamacare. Only 67% have completed the process and paid their first payment and only 24% are 18-35, which is the group Obama claims he needs to make the system work. This was about progressives who want others to "chip in" and pay for their insurance. Moreover, adding more bureaucracy, adding more IRS staff, etc. will not cut medical costs at hospitals, etc. It IS about government control.

"This was about progressives who want others to "chip in" and pay for their insurance." It must be comforting to live in such a simple, uncomplicated world. Now for some reality: I have been a strong supporter of the ACA. I would have been happier with a single payer system, but this is a decent start. For me, it has NEVER been about getting someone else to pay for my health care. I do not qualify for a subsidy. I don't even come close. My insurance doesn't change under ACA. With a single-payer system, I would probably pay more than I do now. There's nothing in it for me personally - and yet I support it. Can you explain this with your simple black and white view of the world?

A great read in the WSJ is "The Coming Two Tier Health System" Chock full of info.

Newsflash for the rabbit: We've been heading for a two-tier society for 30 years, thanks to neo-liberal laissez-faire policies of free trade, deregulation, and tax cuts implemented over this time, that have gutted our industrial base, weakened the middle class, and syphoned wealth to the top tier. Your sympathy for those who'll be underserved by virtue of being in the lower tier is misplaced and a little late. Without serious reform, our healthcare system increasingly rationed by income,always fine with the right, since wealth equates with virtue in the minds of many. A system that cost one and half times more than any other, yet left millions underserved, was and is unsustainable.

The author's main point seems to be that NH's motto used to contain the implicit promise that one could "Live Free [of health insurance] or Die". The absence of insurance and its consequences--less healthcare, and an increased likelihood of ill health, ties this quaint notion of freedom directly to one's economic status. This has always been the way we've rationed healthcare in this country--by social class and race--both tied to how much healthcare you can afford, or can't afford. But the idea that providing health insurance to a wider segment of the population means the end of "freedom" in NH is bizarre and perverse. Just the opposite is true: better health thanks to better healthcare via better insurance coverage opens up more options for individuals to live their lives fully--the epitome of real freedom.

sorry to tell the liberal progressive socialist democrats but providing one with health insurance is simply not a govt job and the polls prove that real Americans say that the liberal progressive socialist democrats are way out of bounds on this issue.

The Constitution is not a straitjacket, justifying blind obedience to far-right notions of freedom that are limited to the economic sphere, nor was it intended to be a dead hand on the rudder of state that some claim it to be. Providing its citizens with health insurance may or may not be a "government job" but blind obedience to a short-sighted,self-serving supposedly 'free-market' approach has gotten us to this point: survey after study after survey shows we spend more and have poorer outcomes on most indicators of health than many other nations. What are they doing differently, that might be worth copying? "Americans are below average on most measures of health — from obesity to infant mortality — when compared with other rich countries, and they're falling behind on lifespan, too, according to the latest survey. The annual survey from the Organization for Economic Cooperation and Development has been used for years to show that the U.S. spends far more than any other comparable country on health care, yet gets far less for its money — and the latest survey is no different. Americans are fatter, die younger and don’t get particularly good treatment for many diseases, with the exception of strokes and cancer." The right has no good answers to these straightforward and incontestable facts, and have to fall back on their crabbed and distorted readings of history and the Constitution to justify their antediluvian views.

In your opinion, of course. Your opinion $3.29 will get you a really good coffee at Starbucks. Please don't preach about how I ought to live my life, what I should eat or do based on your dream scape reality. One or two years difference in life spans between the Unites States and other countries which have socialized health care is a couple of rotations around the sun. The rest of your post is manipulation of statistics, I will send you $3.29 for that coffee.

Feel free to take issue with the facts on international comparisons of healthcare that you claim are "manipulated statistics" at any time. But spare us the strawman construction that's supposed to make us feel pity for you and your diminished freedoms. No one is forcing you to live your life differently, or change your diet. Feel free to eat all the fast food or soda you want, if that's how you define freedom. And while, if you go to NYC, you may not be able to get that 32 oz soda, you can still buy TWO 16 oz. sodas in that oppressive city. This is why we fight wars, so Americans can savor the joys of eating all kinds of unhealthy food--after corporations have spent millions advertising on our free and publicly owned air waves, extolling the virtues of their wares, programming us to want what they're selling. BTW: one or two years is a "couple of [REVOLUTIONS] around the sun". And ask the person hoping to live long enough to see a child graduate from high school or college if those "one or two years" matters.

QUOTE : "No one is forcing you to live your life differently".....I guess to a liberal "FORCING" one to buy NObamaKare " or taxing them to death has a different meaning

Infant Mortality rates are calculated differently in Canada, Germany, Austria, Norway and Hong Kong than they are in the US. Those countries consider still births and babies that die within the first 24 hours as unviable or a miscarriage. Not live births, so they are not counted in their infant mortality rates. The US does include stillbirths in their in their stats, premies, etc. Yeah we have have an issue with a lot of premies being born, due to poor diet, drugs, and fertility measures that cause multiple births. We have an obesity issue that is being passed on to our kids. The obesity issue is junk food and being inactive. very few people have health issues that cause them to be fat. We also drug ourselves and our kids. Drugs cause weight gain. The US is hooked on a pill for everything. Fat people do not get that way from eating too many veggies, fruits and being active. We are enablers in the US. As long as we take the attitude that folks are victims, nothing will change. By, the way, allowing your child to become obese is child abuse in my book.

Thanks for adding your customary level of obfuscatory detail to the thread. Had you continued your research, and deferred posting, you might have discovered that despite differences in the ways other countries calculate infant mortality rates, it would not make much difference--the U.S. is still WAY down the list, due mostly to our far higher rate of pre-term deliveries. "In 2005, the United States ranked 30th in the world in infant mortality, behind most European countries, Canada, Australia, New Zealand, Hong Kong, Singapore, Japan, and Israel. There are some differences among countries in the reporting of very small infants who may die soon after birth. However, it appears unlikely that differences in reporting are the primary explanation for the United States’ relatively low international ranking. In 2005, 22 countries had infant mortality rates of 5.0 or below. One would have to assume that these countries did not report more than one-third of their infant deaths for their infant mortality rates to equal or exceed the U.S. rate. This level of under-reporting appears unlikely for most developed countries.

My post did not imply that differences in reporting was the primary cause for the US high infant mortality rates. read my post Bruce, I also included many other reasons. We have a huge issue with babies being born early. That is because of diet, drugs, obesity and women having babies at older ages. We also have fertility care adding to multiple births. The infant mortality rate also covers up till the first birthday, which also includes SID deaths.

Then what did it imply? It was intended to fog the issue--distracting from the facts on U.S. healthcare, which too many sweep under the rug, blithely claiming we're number one, when we're far from it. Good healthcare is comprised of proper diet, exercise, pre-natal care, ready access to family planning, having a PCP. For too many of our citizens, these have been lacking.

You are stating that one element in the mix I stated was intended to fog the issue. That is not the case. All issues are not black and white Bruce as you stated. yet your judgement is black and white of my post. I have never approached anything based on black and white. You get to a point, no matter what it is, poverty, drug abuse, poor diet, and lack of exercise for many reasons, not just one. But that is how your party rolls Bruce. They again treat the symptoms, not the causes. The number one cause of everything gone bad is money in their eyes. They apply it to everything. FYI, for your information, I and most folks also feel there are some good things in the ACA. But the plan was poorly written, did not want to be honest in their stats, and refused to address many issues that contribute to the costs of healthcare. Basically tort reform is out because the left are own by lawyers, abuse of the ER for non emergency issues is never addressed, buying insurance over state lines is not addressed, and the fact that we are losing doctors because of low reimbursements are never addressed. Those are just a few, the rest of the equation is based on social issues. Out of wedlock pregnancy rates, poverty rates and the breakdown of families. Those issues are not addressed, they are just getting worse.

The issue with health in America has nothing to do with healthcare Bruce. it has all to do with bad behavior, bad choices, and the breakdown of the family. Choices are not free, you pay a price.

Carper Line of the day: " in America has nothing to do with healthcare."

The worst of NObamaKare is yet to come. 45 of the harshest items were extended because of the massive hardship they would have put on Americans that would have sunk the democrats and NObamaKare before the election.

First - Anthem was the only insurer to apply in NH. It's not like anyone purposefully gave them a monopoly. I understand that Minuteman will likely joining the exchange for next year. ------ Second, Anthem will pay for emergency care at any hospital, even those that are "excluded." So, for those who live in Concord, you do NOT have to travel to Manchester if you're having a heart attack. Anthem will pay Concord. But, after being stabilized, if you need to be admitted, you'll have to be transferred to another hospital. No, it's not convenient, but it's not as dire as the writer makes it out to be.

A bit of a stretch to blame the narrow networks on the Reps. Did it ever occur to any of you that keeping the networks narrow was deliberate? Just goes to show you how the uninformed will buy anything.

I felt like humming the Battle Hymn of the Republic while reading this piece of tripe. Well we all would probably die before the GOP ever did anything about healthcare costs. Let's see, if you had a pre-existing condition or were in the wrong age demographic - you were attached to another object by an inclined plane, wrapped helically around an axis - in short screwed. Boy we sure had it good when we were free to go without........

You can prattle all you want but my daughter now has health care she did not have before. Secondly if the Republicans hadn't tried to put every roadblock imaginable in the path of the Affordable Care Act we might have had more than one insurer in the state.

Well, goody goody for you. I am soooooo happy to be paying for that insurance. Next year, I will pay even more and get less coverage for myself. But as long as she has care and you are relieved, I guess that is all that is important. My hope is that after November we put the stake through the heart of Obamacare once and for all.

Just exactly who do you think was paying for all those uninsured before Obamacare? You and I. So exactly why are you now suddenly upset?

We paid more but this will cost us even more once the employer mandate goes into effect. There was nothing wrong with the previous system, Obamacare just shifts the burden from health care providers on to others who never had their hand out for assistance. There are other reasons, including many of the rules of Obamacare. Health care is not about everyone having the exact equal plan or it is "broken".

Laugh of the day: "There was nothing wrong with the previous system...." Nothinfg except it just cost one and a half times more than ANY other healthcare system, with worse outcomes on most indicators, AND left millions with limited access to regular, preventive care.

more people uninsured today than in 2008 - simple FACT

Another random fact divorced from logic and the real world. It has what to do with the ACA, which is only just kicking in? If anything, it's yet another reason for the ACA, and the reason real reform of our healthcare system is necessary.

obviously you don't understand the difference between a fact and a distortion. The numbers for 2008 were indeed lower until the economy tanked. When millions lost theirs jobs they lost their insurance as well. You cannot ignore the reality of an issue and pick and choose numbers. However as of April 7th of this year the numbers of uninsured has dropped to 15.6%. At the end of 2008 during the recession the rate was 15.4% and rising. So by not factoring in the collapse your statement while factual by .2% is certainly misleading in every sense of the context you were using these figures for. Another figure to chew on a bit is; from mid 1999 thru 2010 the number of businesses providing health insurance has dropped from 64.1% to 54.6% this also need to be factored into the equation.

We hear a lot about the ACA that is just not factual. The ACA is suppose to cut down use of the ER by the uninsured. But I have read quite a bit about who uses the ER, including articles in the NY Times. Medicaid patients use the ER 40% more than folks without insurance. More folks on Medicaid means more ER use. That is because we have a lot of folks who go to the ER for non emergency issues like, ear infections, colds, etc, as opposed to going to a doctor at a clinic. Another topic never discussed by the left is, who are the uninsured. That never comes up, because the census bureau actually broke it down by illegals, folks who qualify for govt insurance, etc. That reduces the 43 million that are supposedly uninsured to single digits. Why does the left avoid facts, but instead pushes their agenda based on falsehoods?

The use of the ER by Medicaid patients can be changed, and some hospitals are starting to do that. All it takes is proper triage, and a willingness by the hospitals to redirect Medicaid patients to primary care. At this moment, they probably don't have much incentive, since they'll get paid for taking care of an easy issue. If Medicaid were willing to deny payment to ERs for non-emergency care, you'd see that stop pretty quickly. NH now has Managed Care for Medicaid patients. It would be in the Managed Care providers' best interests to curb ER use for non emergencies, and I suspect they will.

Spoken like a true Tea Partier. Someone else's gains--especially if they're poor or a member of a minority, are inevitably at your expense. Life after all is a zero sum game. At least that’s what they’d like you to think. The pie is shrinking, and rather than look at the real culprits, those in the top one percent for whom and by whom the rules are increasingly written, blame the victims, and hope you continue to get tossed the table scraps from your betters until retirement. It's the economic version of the Stockholm Syndrome--identifying with the aggressor in hopes of currying favor to survive another day. This sums up the Tea Party world view--one in which their own entitlements--which they have in the main earned and justly deserve-- are at risk or gone. But rather than face the fact that fairness, hard work, and the American Dream have been betrayed by the corporate and governmental elites who've let greed become their principal obsession, the TPers have chosen to throw in their lot with those responsible for their plight. And double down on all the 'right' words to say, words that mask the truth the American dream has been stolen by those who most benefited from it.

thats funny..I HAD healthcare before obamacare...and after I didnt. I guess I dont count

Well I had insurance, all my adult children had it - and surprise we all still do. So there is probably a bit more to your story........

Wait for the employer mandate to kick in. Then you will certainly come up with another excuse why it is sooo good.

I never had said it was good. I said it's a start and like any new program needs to be tweaked. Tweaking by the way does not mean elimination. We had to start somewhere. One of these days you may learn to look at both sides of an issue and it's goal, instead of relying on information from groups that have an agenda.

I'm willing to bet you exercised a choice not to get health insurance. Like GC, I had health insurance, and I still do, at the same price. My adult daughter did not, but now she does.

Good for her! Next year once the employer mandate goes into effect we all will be paying for her. Have her practice holding her arm out and palm up.

the loss of self esteem associated with the gimmie crowd is legendary. When one cant adhere to the basic rule of life - self responsibility - their image of worth is shot.

Great Snark Its! Very nasty, worthy of a Bill OBrien put down! Masterful. As JC would say " What you do for the least among you has to be paid for"!

Itsa - why do you refuse to acknowledge the FACT that all of us with health insurance have ALWAYS paid for the health care of people without insurance. We've been paying for a whole lot of emergency care, and for serious conditions that might have been avoided if people could have gotten primary and preventative care. Now, all taxpayers (not just those with insurance) will be subsidizing some people's insurance. We expect that overall the costs will be less, because people can get that primary and preventative care. Why do you refuse to acknowledge this? Just so you can continue to claim victimhood?

And by the way Itsa, why did you assume that my daughter got a subsidy? She did not, as a matter of fact.

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