The Wall Street Journal, December 20, 2007; Page A15

Congratulations to Merrill Matthews ("A Health-Insurance Solution," op-ed, Dec. 12) for pointing out the tragedy of state governments forbidding citizens from exercising the basic right to buy health insurance from other states. These regional regulatory monopolies drive up health costs by making their residents pay for expensive mandates that benefit determined interest groups at society's expense. They also drive up health costs and taxes in less regulated states because over-regulated states continuously lobby the federal government for more money to bandage their self-inflicted wounds. That is why New York Gov. Eliot Spitzer and New Jersey Gov. John Corzine are suing President Bush for his clearly responsible policy of ensuring that states enroll poor kids in state children's health insurance plans (Schip) before enrolling middle-class ones. The federal government's out-of-control spending on Medicaid and Schip bails out states that drive private health insurance premiums sky high through over-regulation. Because of this, residents of states where health insurance is still affordable should be just as outraged as those in over-regulated jurisdictions, and support Rep. Shadegg's bill to create a national market in health insurance.

John R. Graham
Director, Health Care Studies
Pacific Research Institute
San Francisco

There is another side concerning states mandating what an insurance plan must cover. As a resident of New Jersey I could not buy the private catastrophic health insurance policy issued in another state that fit my needs because the policy I preferred was considered inadequate by the New Jersey legislature. I had to wait three additional years to retire with coverage under my employer's retiree policy that was suitable to the legislature, thereby cheating me out of three years of early retirement.

Doug Hartlove
Somerville, N.J.

I have been watching with some interest the development of a market for health savings accounts, which were supposed to be targeted toward employers like myself. Earlier this year, I visited a former medical school classmate in California, a self-employed psychiatrist. I was pleasantly surprised to learn that he was able to set up a health savings account ($5,000 deductible) for himself and his family for no more than $4,000 per year in expenses and premiums. When I returned to New Jersey, I called my insurance representative, but was told that very few HSAs are sold at all in my state because all the mandatory coverages imposed by the legislature had made them all but unaffordable. Many of these mandates were undoubtedly passed at the behest of special interest groups in my own profession. I would urge Congress to co-opt this issue by passing legislation allowing a nationwide health insurance marketplace for both individuals and businesses. I for one would love the opportunity to buy my classmate's policy at his price.

Sam Litvin, M.D.
Long Branch, N.J.

I read with disgust Mr. Matthews's misguided suggestion on health insurance. The only true way to improve health care is to adopt a single payer universal health care plan. The U.S. spends much more than other countries. We could have the Cadillac of national health plans. Right now we have the Edsel.

Mr. Matthews blames state mandates as the cause of our collective pain, especially chiropractic care and mental health benefits, which together probably account for less than 1% of all health care costs. Both are preventive in nature, low tech and low cost. They often lead to fewer hospitalizations and less drug use.

The true drivers of health care costs are the back-door-mandated benefits that get in with no public hearing, such as new drugs, new high tech testing and many hospital costs. The drug Vioxx is a prime example of a back-door-mandated benefit.

Mr. Matthews's proposal is disingenuous and would not result in lower health care costs. It would just eliminate benefits that save many states and people money.

Peter G. Hill, D.C., M.P.A.
Boston