Greetings. Recently in Will Congress Wreck the Internet? I outlined certain similarities between the battles for better U.S. broadband and the current health care reform debate.

Perhaps not surprisingly in retrospect, many people responded to me regarding the health care aspects of that posting, with a variety of often very strong opinions.

Odds are that the House will approve the Senate version of health care reform sometime today (or perhaps in the wee hours of tomorrow morning). Whether or not the Senate will really follow-through with the reconciliation-based "fixes" the House wants applied to that legislation is still an open question.

And just as nearly anything the FCC does related to broadband is likely to trigger a cascade of court actions, the litigation response to the health care legislation if and when passed is likely to be nothing short of ferocious.

With that in mind, there are two questions -- I would have originally thought relatively simple ones -- regarding the current health care reform legislation that I have not been able to get reasonably answered. Maybe someone in the readership can help me with this.

The legislation appears to virtually immediately impose a number of new mandates on medical insurance companies regarding pre-existing conditions (for children, initially, later for everyone), annual and lifetime benefit limits, plus other provisions that in general most observers (including myself) would consider to be quite laudable and long overdue.

But those mandates are going to immediately increase insurance companies costs significantly. The new state-based "insurance exchanges" (of more use in big states than small ones) called for in the legislation don't get started for years. The dominant insurance companies successfully killed the "public option" or a Medicare "buy in" plan. Promised health insurance tax credits (which temporarily boost to higher levels under the reconciliation plan, then drop back to Senate levels a few years later) also apparently don't even begin until years from now. The talked about "National Rate Authority" to help control insurance companies premiums has -- last I heard -- been dropped from the current legislation.

I'm one of those people who got a letter recently informing me of a 40% increase on the already extremely expensive premiums for my very bare-bones health insurance policy with poor coverage and high co-pays -- not due to any changes in my situation, just because the company wanted to increase rates across the board. I've been struggling to afford keeping my medical insurance even at the previous rate.

Though I'd much prefer a conventional full-time job, I'm self-employed in a terrible economy -- which in my case is only a tiny notch above being totally unemployed.

Given the new costs that the insurance companies will immediately need to cover under the health care legislation, why wouldn't they further boost premiums even more than before -- especially on people like me who must buy insurance on our own without employers to help -- a particular problem in states like here in California where state officials do not have regulatory authority over those premiums.

Specifically, during the gap of years between the passage of health care legislation (and the triggering of mandates on the insurance companies) -- before the later starting up of insurance exchanges and tax credits -- what's to protect us all from being utterly reamed by a series of even more massive premium increases? That's question number one.

The health care legislation also contains a requirement that ultimately, we all have to buy health insurance, or pay penalties to the government. Personally, I'd gladly pay whatever I could toward a government-funded public option, Medicare buy-in, or true single-payer system.

But I find it remarkable in the extreme that the legislation insists that we individually must pay to further enrich enormously lucrative insurance giants who have played such a large part in making a terrible mess of the health care system in this country in the first place, and who have ruined (and even prematurely terminated) so many lives.

Like the FCC Broadband Plan, which seems to have been carefully designed to avoid stepping too hard on the toes of the giant, dominant ISPs, the health care legislation apparently was purpose-built to protect insurance giants and Big Pharma.

I'm not a Constitutional scholar by any means. But I can't think of another instance where the federal government has ordered citizens to buy a service from commercial private parties in such a manner as is required by the health care reform legislation.

Yes, you typically need to purchase private insurance to legally buy a home or drive a car -- but you aren't required to be a home owner or driver in the first place!

What am I missing here? Can anyone provide an example of previous U.S. legislation that ordered ordinary citizens to contract with commercial, for-profit firms in such a manner as the health care reform legislation demands? That's question two.

While it certainly can be argued that Congress could theoretically fix problems in the current legislation via other legislation down the line, there is no guarantee that they'll be willing and able to do so, especially in the current toxic political environment. Meanwhile, there's little in the current legislation to seriously control the current medical costs upward spiral.

I am extremely concerned -- frankly bordering on terrified -- about where this "perfect storm" of medical needs and political theater may be leading us.

--Lauren--