THE ANTHEM SAGA Health insurers in many states have been seeking double-digit premium increases from people who buy their own policies directly from the companies rather than obtaining group coverage at work. In states where regulators have the power to curb excessive rate hikes, the increases are often rejected or negotiated down. In others where the regulatory laws are weak not much can be done beyond jawboning. This hodgepodge of controls over premiums needs to be backstopped by a national law that would allow the federal government to block unjustified rate increases where state officials lack the authority to do so. Attempts to include such powers in the newly enacted health care reform law failed. And while the reform law does have provisions that should help restrain premiums, they lack the necessary teeth. The story of Anthem Blue Cross' effort to impose big premium hikes on people who buy their own policies in California, a state with weak regulations, shows why that is so necessary. It also shows how difficult it is to measure what's reasonable and how a confusing melange of factors can affect the setting of premiums. Anthem outraged its enrollees and much of the public in February with a plan to raise premiums for individuals by an average of 25 percent. The company argued that it lost money on the individual market in California last year, that medical costs were escalating far faster than inflation, and that the recession was causing relatively healthy individuals to drop coverage, driving up average costs for the remaining, less healthy enrollees. Anthem could have spread its losses more broadly to protect its individual buyers. The only reason the company lost money on the individual market is that it lost heavily on policies issued to participants in two state programs that required Anthem to cover people with pre-existing conditions and capped the premiums it could charge. It chose to offset further losses by imposing big hikes on other individual purchasers. For competitive reasons, it is unwilling to pass the costs on to employer-based group plans. Meanwhile, an actuarial review commissioned by the state's Department of Insurance found that Anthem also miscalculated the costs it would face in the individual market and the premiums it would need to offset them. Had the calculation been done correctly, Anthem would have needed an average increase in the individual market of only 15 percent, not the 25 percent it proposed. There is no evidence that Anthem deliberately cooked the books. The errors were not detected by an internal company review or by an outside consultant hired by the company. They were found only when an independent firm hired by the state, Axene Health Partners, assigned four actuaries who spent 500 hours over 10 weeks analyzing calculations that it described as 'extremely complex.' It is daunting how much effort was required to dig out these discrepancies, and revealing that it required a truly independent review to find them. Regulators everywhere are now on notice that they can't assume company calculations are accurate and that they may need to hire their own consultants to probe deeply. Anthem and its parent company, WellPoint, are scurrying to make amends. WellPoint has announced additional layers of internal review and will commission outside reviews of all of its 2010 rate filings in 14 states. Anthem is revising its rate proposals. But regulators won't have a lot of power to force reductions beyond the rhetorical threat of further embarrassment. Meanwhile, it is important to realize that the prime culprit in rising premiums is the escalating cost of medical care; the prices charged by health care providers and drug companies and the ever-wider use of medical services, much of it unnecessary. Until those costs are contained, it will be hard to truly restrain premiums. A GOOD ELECTION WOULD HELP HAITI With all that Haiti lost on Jan. 12 -- and all that it has to do to rebuild -- it needs a strong and legitimate government. That means it needs national elections. Haiti was supposed to elect a new Parliament in February and a new president this November. The earthquake made the February vote impossible and the November vote uncertain. The current Parliament's term ends today, meaning Haiti is entering a period of uncertainty, with enormous obstacles to overcome for a transparent, honest and peaceful vote this fall. Power is concentrated for now in just one person, President Rene Preval, whom Parliament granted emergency authority to govern without a legislature. Given Haiti's long and destructive history of one-man rule, that emergency period should be as short as possible. Preval has insisted that he will leave when his term ends on Feb. 7, but he sent tremors last week by announcing he might stay on until May 14, the technical end date of his five-year term if the election is delayed and looming chaos demands that someone remain in charge. It's up to everyone in Haiti now, Preval in particular, to make that unnecessary. The U.N. mission in Haiti (Minustah) and the Organization of American States have pledged security and technical support. The task will be extraordinarily difficult: 1.5 million people -- more than 15 percent of Haiti's population -- are homeless, living in shelters or with relatives. Their identity documents were destroyed along with the schools used as polling places. The electoral council is working in makeshift headquarters: a gym. Huge logistical obstacles must be overcome, and decisions made about registration, voting procedures and candidate qualifications. The process must emphasize the greatest possible flexibility and participation by voters and candidates. Displaced people should be allowed to vote where they currently live, not their old destroyed neighborhoods. Opposition parties will need aid to organize and campaign. In a country where transportation and communication are difficult and expensive, Preval's Unity Party should not be given undue advantages. If fair elections can held in Iraq, amid war, terrorism and ethnic feuds, they can be held in Haiti. The last thing Haiti needs is to lay a political catastrophe atop the natural one. Haiti needs a legitimate government chosen in a legitimate election. Let the campaigning begin. ON THE CRIMINAL JUSTICE SYSTEM, THEY AGREE Politicians who do not agree on much else, agree that the nation's broken criminal justice system needs to be fixed. A bipartisan group of House members introduced a bill recently that would establish a blue-ribbon commission to study the issues and propose solutions. The United States has the highest reported incarceration rate in the world. Prisons and jails are filled to bursting with nonviolent offenders. There are a wide array of approaches, including drug treatment programs and prisoner re-entry projects, that could bring these numbers down, save taxpayers' dollars, and give prisoners a real chance to get their lives back on track. Some of the resources being wasted on incarcerating minor law-breakers should be redirected to more serious threats to public safety, including violent gangs. Some of the money should be put back into badly overburdened federal, state and local budgets. A commission of respected criminal justice experts would examine these problems and come up with an action blueprint. That could overcome the inertia in Congress and state legislatures. When Sen. Jim Webb, D-Va., proposed creating such a commission, his idea quickly attracted wide support. It is a rare cause in Washington that has the backing of the Fraternal Order of Police, the International Association of Chiefs of Police, the ACLU and the Marijuana Policy Project. Webb's bill passed the Judiciary Committee in January, and he has been pushing for a vote from the full Senate. The House bill, sponsored by member in both parties, closely tracks his. Given the current fiscal pressures and rare bipartisan agreement, there is a real chance to address the justice system's very serious problems. The Senate majority leader, Harry Reid, and House Speaker Nancy Pelosi should seize the moment and move these bills quickly. A SPREADING PERIL FOR WOMEN'S PRIVACY AND FREEDOM Supporters of abortion rights held a lunch recently in honor of a momentous victory for their cause: 40 years ago, New York became the first state to fully legalize abortion. That 1970 law began to reduce the death and injury toll from back-alley abortions and set the stage for the Supreme Court's Roe v. Wade decision in 1973, which made abortion legal nationwide and recognized a constitutional right to privacy. But abortion-rights groups are newly anxious about new assaults on women's reproductive rights, including a fight over abortion that snarled the last days of the health care reform debate. Anti-abortion groups are newly emboldened. The health care reform law contains advances for women's reproductive health care, including enlarged access to insurance coverage for maternity care, contraception, and other services. But President Barack Obama and pro-choice congressional lawmakers made abortion coverage vulnerable as part of the effort to secure the measure's passage. Kelli Conlin, head of Naral Pro-Choice New York, told guests at the lunch that 'anti-choice forces are mobilizing in every single state to limit a woman's access to abortion in more insidious ways than we can imagine.' As Conlin was speaking, members of the Oklahoma House were getting ready to override vetoes of two punishing abortion measures. The state's Democratic governor, Brad Henry, rightly viewed these intrusions into women's lives and decision-making as unconstitutional. One of the measures, which seems destined to spawn copycat bills in other states, requires women to undergo an ultrasound before getting an abortion and further mandates that a doctor or technician set up the monitor so the woman can see it and hear a detailed description of the fetus. The other law grants protection from lawsuits to doctors who deliberately withhold fetal testing results that might affect a woman's decision about whether to carry her pregnancy to term. Several states have either passed or are considering bills that would ban abortion coverage in insurance plans sold through the state exchanges established by the federal health care law. A new Utah law criminalizes certain behavior by women that results in miscarriage. Embarking on a road that could lead to the Supreme Court, Nebraska last month banned most abortions at the 20th week of pregnancy based on a questionable theory of fetal pain. About two dozen states have bills pending to increase counseling requirements or waiting periods prior to abortions. Nearly 20 states are considering expanding the use of ultrasound. This is on top of an onerous regimen of state restrictions that has drastically cut down on abortion providers and curtailed a woman's ability to exercise a constitutionally protected right. 'One in three women in this country will have an abortion in her lifetime, and yet we're having exactly the same discussions and debates we were having 40 years ago,' Conlin said. Anti-abortion forces aim ultimately to make abortion illegal. So far, by reducing the number of abortion providers, making insurance coverage more expensive and harder to get, and throwing up other obstacles, they have primarily succeeded in making it harder for women of modest and meager means to obtain a safe and legal medical procedure. The painful decision to end a pregnancy should be made in private between a woman and her doctor -- not in politically driven debate among members of Congress and state legislatures. 