letters to the editor – Despite gerrymandering, both Pappas, Kuster will be re-elected to Congress

New Hampshire Republicans have been intent on gerrymandering state and federal district maps in brazen pursuit of their partisan interests. Perhaps the most egregious example was the GOP-proposed map for our two congressional districts, which would have moved three Seacoast towns into the second congressional district which borders Vermont. As a resident of Portsmouth who would have been adversely impacted, I agree with Bill Bowen (March 30 LTE) that Gov. Chris Sununu's decision to reject these gerrymandered maps is a good thing.

Mr. Bowen failed to note that it was the GOP majority in Concord that came up with these gerrymandered maps. As recently as the last legislative session, when Democrats were in the majority, the legislature passed a bill to create an independent redistricting commission intended to avoid partisan gerrymandering. Gov. Sununu vetoed this popular bill twice.

Unfortunately, Mr. Bowen then proceeded to attack our Democratic incumbents in Congress with stale right wing talking points.

Both Chris Pappas (NH-CD01) and Annie Kuster (NH-CD02) won re-election in 2020 so apparently the voters thought they were doing a good job. I suspect, regardless of the final congressional maps, both will be reelected in 2022. They are working hard on behalf of the people of New Hampshire. They have been supporting legislation that is improving the lives of Granite Staters such as: lifesaving pandemic relief for renters and small business, lowering the cost of childcare and prescription drugs (limiting insulin costs to $35 per month), and rebuilding our crumbling infrastructure. Moreover, they are committed to protecting our democracy by ensuring that every qualified voter gets to vote and have their votes counted. They deserve reelection in November.

Joan Jacobs, Portsmouth

The world is on fire, and we're worried about hair discrimination?

Let's see now, we have the Russians, the Chinese, the foreigners at our border, the fuel crisis, higher costs for just about everything, the pandemic, and the House just passed the CROWN Act which tackles the problem of hair discrimination. I am not kidding. Look it up. Yes, indeed. First things first.

Let's grow up. We all have to make allowances of one kind or another in our lives. During my working career, I had to abide by all sorts of restrictions and requirements and didn't mind. If the company had an image to project, then I knew I would have to fit in. The company was not going to change to suit my manner of dress or hairstyle. They paid my salary, and I was delighted with that arrangement. I could look wild on my days off.

Mary Weston, Dover

US spends more for worse health outcomes than its peer nations

Thank you, Dr. Fieseher, for your very comprehensive and compelling article, "We deserve a better and new health care system."

Dr. Fieseher clearly explains how and why the current for-profit insurance system results in very high administrative overhead costs, costs much higher than in any other industrial nations, and still ranked 37th in outcomes.

For example, administrative spending as a percent of total health expenditures for the U.S. is the highest at 8.3%, France 5.7%, Austria 4.8%, Canada 2.7%, and the lowest, Norway 0.6%, (Organization for Economic Cooperation and Development 2019).

The National Academy of Medicine reports that 66% of administrative costs for private insurance and 50% of provider administrative costs are excessive. They also report that the administrative costs in the U.S. healthcare system in 2019 was $282 billion for providers (physicians, hospitals, others), private insurers $158 billion, and public programs (Medicare, medicaid, VA) $56 billion. Administrative costs overall for private insurers range from 12-19%, while Medicare is about 2%.(POLITIFACT 9/17/17) As such, billions of dollars that could be directed toward providing health care to individuals is being spent on excessive administrative overhead.

Every other advanced economic country has been able to control costs while providing quality care to all of their citizens. They do so through a variety of means, such as global budgeting which reimburses based on expected costs, not fee for service, universal coverage of all citizens and all payer reimbursement rates.

The means to control costs, improve outcomes and to cover every citizen are already here, and they work elsewhere and can also work here. Unfortunately, politics and misinformation have prevented such success in the U.S. And as a result, not only do we have the highest administrative overhead costs, poorer patient outcomes, and the largest amount of GDP going toward healthcare than any other country, we still have over 26 million or 8% of our population without health insurance coverage.

The private insurance companies, their lobbyists and receptive politicians have been extremely effective in distorting the role of a universal healthcare system in the U.S. They have effectively painted any form of universal healthcare system with the evil "socialized medicine" label. Most nations with universal healthcare, including Canada, are not socialized medicine systems. They are more like our own Medicare system for seniors and the disabled, which is also not a form of "socialized medicine." Like Medicare, they collect premiums from citizens through payroll taxes, premiums from retired persons, business contributions and other taxes. Their revenues are used to pay private healthcare providers, hospitals etc. for the services they provide. In most cases, patients have a choice of which providers they wish to see or which hospital to see, just as with our Medicare system. This is not "socialized medicine."

A socialized medicine system such as in England, means that the government not only pays for care, but employs the providers and owns the hospitals etc. The closest we have to a true socialized medicine system would be military healthcare, the VA and the Indian Health Service.

Another argument used by the private healthcare industry is that under a universal system the government would control your health care, telling doctors what they can do or not do etc. Under traditional Medicare as an example, providers have much more freedom than when negotiating services with many for-profit insurance companies.

Their system of managed care, as explained by Dr. Fieseher, is designed to keep costs down by limiting the care and services people can access. It is more of a managed profit system than a managed care system.

Eventually the United States will wake up and join the rest of the other wealthy industrialized nations in providing affordable quality health care to all our citizens as a basic human right, because our current system is not sustainable economically or medically. Unfortunately that day is not coming soon, and too many people will continue to suffer the excessive burden of high cost health care and millions will be unable to afford even basic coverage. As Winston Churchill said: "You can count on America to do the right thing, after exhausting every other alternative."

Rich DiPentima, RN. MPH, Portsmouth