In His Own Words . . .

​

Dr. Nagel returned his 2026 Citizens for Belknap General Election Questionnaire with these responses:

 

Citizens for Belknap Questions

Rep David Nagel, MD

 

1. Give three examples of waste you would cut in our NH state or county government.

 

The challenge of this question is defining what waste actually means, and this is not a question that should be taken lightly.  There were several cuts made in 2025 HB 2 and the most recent county budget on this basis that have had substantial ramifications for the people or our county and state.   I would argue there is no clear collective definition, and I think it is irresponsible to answer this question without background which I provide below.  My only suggestions for both State and County, after serving 4 years in the legislature and more than 30 years as an advocate and advisor are

 

• dramatically improved communication between legislative, executive, and community commissions to avoid duplicity and unnecessary cost

• Dramatically better thought out LSR’s through more rigorous stakeholder discussion prior to submission.

• Providing County delegates with a more intimate knowledge of the workings of county agencies and allied agencies as well as effects on stakeholders and those with lived experience and dramatically invigorating the delegation process.

 

Consider the following as an example of conflict.  In 2025 HB 2, some viewed the New Hampshire Council of the Arts as a waste.   Its share of the budget was $1,560,000 all of most of which was given as grants to local artists. There was very little overhead.  The Colonial Theater was one of the recipients.  Its renovation played a huge role in the re-vitalization of downtown Laconia.  The multiplier effect of a small investment is huge.  In fact, the Arts contribute nearly $3.3 billion revenue to our state, accounting for 3.3% of the state’s GDP, surpassing industries such as construction and education services.  To some, this was a waste.  To me it was a common-sense investment that pays huge dividends to our communities and our State.  We are now the only State in the country without a Council of the Arts.  49 states have seen the value of such an investment.  I am not sure why we do not.  This is one of many examples of questionable cuts made in HB 2.

 

Related, it is critical that legislators learn how to create legislation in a way that maximizes investment value, looks at long term value, and minimizes un-intended consequences.  For example, superficially, a work requirement for expanded Medicaid recipients would seem to make sense.  However, it makes a lot of assumptions that there is waste in the system, the cost of enforcement is reasonable, and the unintended consequences are minimal.  None of these assumptions are true, and we already know this from past individual state experiences.  Of the able-bodied individuals on expanded Medicaid, 65% are working. In one state, the number is 90%.  Many are between jobs, and the typical amount of time an able-bodied person is on the program is about 9 months.  The basis behind creating this policy was the assumption that there exist extreme amounts of fraud on the recipient side which is not true.  When the proponents cited issues in California and Minnesota as justifications, the fraud investigated in those states was on the provider side.  As a result of a poorly thought-out policy including a costly and inefficient enforcement mechanism, the Congressional Budget Office estimates 7.8 million Americans will lose their Medicaid, and this is not limited to able-bodied individuals.  Most others who have reviewed projections believe this is an under-estimate.  The health care sector is already bracing for the ramifications from the loss of Medicaid funds.  Doctor’s offices, federally qualified health centers, Hospitals, Nursing Homes, and many others are already being affected by a policy that has not officially started yet.  Currently, it is estimated that 50% of hospitals are in danger of insolvency because of loss of insured patients and absorbing un-insured costs.  To mitigate this, there already is a shift away from poorly remunerative services to those that pay well.  This will amplify mental health, rural health, obstetrical health, rehabilitation medicine, and primary care crises that already exist.  A hospital in Buffalo is closing its Rehabilitation unit to shift to cardiac care.  Primary care doctors are being required to see more patients per unit time and only seeing one problem/visit.  A hospital in Maine is closing.  Two clinics in New Hampshire have already closed.  There will be affects on our County Nursing Home and, most certainly, our local hospitals. 

 

The ripple effect of what seemed like a simple solution is now threatening our entire health care system.  While the effects will be felt most by our most vulnerable, the ramifications go far beyond, and will affect primary care, behavioral medicine, obstetrics, complex care for all of us.

 

And it started with policy makers not taking this question seriously and dramatically over-estimating the amount of waste.  I did have the opportunity to go to the White House and ask them how they were going to deal with these ramifications.  They gave a long-winded answer that clearly said they had no answer.   That is not the way to make policy.

 

In 2025, Governor Ayotte created the Commission on Governmental Efficiency, which released its report in 2026 (coge-chairmens-report.pdf).  It is quite clear from reviewing this that waste is not the problem, but inefficiency.  Acting on this report will require investment in what we have, not removal of programs.  And it will cost money.

 

How we create a bill is critical in avoiding waste.  When I create a bill, I review it with all stakeholders.  This takes a lot of time.  We start with idea, review it with all affected in town hall type meetings, develop cost estimates, etc.  There is a lot of give and take.  In my bill SB 561 on prior authorization reform, several hundred people were involved.  This type of legislation had failed in our state and others innumerable times by a failure to include all stakeholders in the discussion.  By including all and creating unity, we succeeded and I am proud to say I have proved that we can be fiscally and socially responsible.  Our bill SB 561, one of the first in the country, was used as a model for prior authorization reform by CMS, and they estimate it will save health care consumers $15 billion nationwide at a savings to the taxpayer and insurers as well.  It will also dramatically improve cost, access, and efficiency of our health care system.  We did this by communicating and including everyone.  

 

Furthermore, I would strongly recommend better communication between government entities.  I chair the New Hampshire State Health Assessment and Improvement Plan.  Our role is to look at the big picture of our health care system, what do we do well, what do we do poorly, identify where gaps exist, and find ways to close them.  Based on our findings, we make recommendations to the Department of Health and Human Services and the Legislature.  We have identified multiple plans being developed through various commissions statewide that greatly overlap, occur at the executive and legislative levels, yet have no communication between.  This results in a huge amount of wasted time through testimony, hearings, etc, that could be greatly streamlined avoiding duplication of or conflict in findings, recommendations, and outcomes.  I am happy to share a short list of what we found.   This conflict can be harmful by creating unnecessary costs, time for volunteers, inefficiencies for those who enact policies, and outcomes for those affected.  It is not a difficult problem to solve, but it begins by identifying all who are looking at a specific issue and building bridges between.  

 

Finally, At the county level, this would begin by the delegates being intimately more aware of the services provided by county agencies and allied agencies, meeting with those who provide the services and those affected.  Delegates need to look beyond the bottom line and look at expenditures as an investment with both short- and long-term ramifications on cost and outcome.  In order to achieve this, there needs to be a dramatic change in the how the county delegation functions.  

 

 

 

2.   Do you believe New Hampshire needs to explore additional sources of state revenue, or do you believe the state’s current approach to taxation and revenue is working? Please explain.

 

Our current approach is not working.  New Hampshire is the only state in the Nation which relies on one broad-based tax to support itself.  That is not economically wise.  Including the District of Columbia, 41 states rely on all three (income, sales, and property).  9 rely on two.  That statement is very telling.  Balance is the key.  Each of these taxes harms different groups.  Creating balance spreads the harm out, in effect minimizing it.  Most of the states that do this are Red states, and they do it quite successfully.  Our state tax policy is quite regressive harming disproportionately those least able to pay.  I am not a fan of progressive taxation.  However, I do believe in neutral taxation, and we should look to that as a goal.  The challenge for our state is we have a relative competitive business advantage by not having a sales tax, and there is a general reluctance to create an income tax.  However, relying on a single tax makes our revenue side quite vulnerable as was the case in the current budget cycle.  There was a substantial decline in Federal funding, a decline in alcohol revenue combined with the effects of inflation and the elimination of the income and dividends tax which left the state with a substantial deficit which needed to balanced.  The ramifications for the balancing act were huge especially on Health and Human Services and our University system.  We currently have a state wide hiring freeze.  Many of the supposed balls being dropped, as they say, are the direct result of labor force shortage in State employment.  That creates huge ramifications.  Whether removing the interest and dividends tax was a wise decision is a separate discussion.  The timing could not have been worse.   When small communities lose economic drivers such as a university/college, which will happen, the effects on those individual communities are huge.  

 

I recommend a bi-partisan, multi-stakeholder commission to study how we finance our state with all options on the table.  It is critical we look to other states who do this successfully in a socially and fiscally responsible way.  We need to start by accepting what we are doing is not working, and we need a change.

 

 

3. Do you support having an AI data center located in Belknap County?  Explain. 

 

We are currently not in a position to answer that question, and I would suggest we do as many other communities have done and create a moratorium on a local Data Center in order to give us time to better understand the ramifications in terms of tax-payor cost, environmental impact, community impact from noise, etc.

 

In doing so, we need to understand that we are talking about mega data centers and define very specifically what we are talking about.  Micro centers exist in individual businesses with minimal impact.  We also need to know that the presence of AI necessitates these mega centers.  However, the technology is evolving very fast, much faster than our ability to think through all the ramifications.  Our failure to do this with other evolving technologies such as the internet has created preventable problems.  It is critical we learn from our mistakes and not blindly follow a path being inflicted up on us.

 

I would also add that this is an issue of both national security, vulnerability, and economic security. It is not trivial.  The duration of the moratorium is open to suggestion, but, in many communities, they are looking at two years.

4. Because Laconia hosts more city and county services for the homeless, it also shoulders more of the impact and financial burden. Would you support a county-wide plan to offset those problems and costs? Why or why not?

 

Historically, those economically challenged have typically migrated to urban centers.  New Hampshire rates as the worst state in the country for public transportation, so this factor is amplified here.   While this migration may off-load more rural areas of this challenge, it should not remove their role in supporting our most vulnerable.  Thomas Jefferson stated that the measure of a society is how it treats its weakest members.  One Nation Under God needs to understand this.   We are in this together.

 

I would add that we should not assume that Laconia serves a higher relative percentage.  This issue affects all communities.  I would ask we verify this before we consider such adjustments, and such a study would not be difficult to do.

 

I do believe that each community needs to have a plan, and that these plans should be inter-related with county, state, and federal plans with preservation and support of local control.   With inflation, increasing cost of housing, lack of affordable housing, and increasing costs of basic services such as food, health care, medicine, etc necessitating individuals increasingly make choices between each of these needs, the pressures on homelessness are increasing and the diversity of this population is increasing.  What is concerning, is we are seeing that many of our homeless do work full time.  It is critical, then, we work together to solve this issue, not artificially fragmenting solutions by borders.

 

5. Should Belknap County towns heavily impacted by out-of-state visitors receive a higher share of Rooms & Meal tax revenue?

 

I would be happy to listen to a discussion of the pros and cons of this issue.  However, my gut feeling is no.  This issue has been discussed for quite a while.  Currently, 30% of the total is distributed to municipalities based on population.  Superficially, this seems fair, but that is open to discussion. Tourist towns already benefit from tourist income through lower property taxes and an ability to charge other fees such as parking.  Also, just because you don’t live in a tourist town does not mean you are not affected by tourist traffic.  Yet, those towns have no ability to capitalize on it.  For example, in Gilmanton, we are affected by traffic from leaf peepers, motor cycle weekend, and NHIS that creates costs for us, yet we have no ability to capitalize on that.  I would argue, then, that the formula to distribute that money in such a manner would be overly complex, necessitate innumerable potentially conflicting assumptions, and create many un-intended consequences.  A separate argument could be made for increasing the share of the rooms and meals taxes to municipalities.  In a state that values local control, this may make more sense.  With all that said, I would look forward the discussion. 

 

6. By 2030, what would be your vision for education, and its method of funding? 

 

I would begin by saying that an educated population is our best resource.  It needs to be right of all our citizens to a public education, and the responsibility of all to take advantage of that.  In saying that, I am paraphrasing both Thomas Jeffeson and Benjamin Franklin.  Furthermore, Franklin stated that “an education is the investment with the greatest returns.”  That is true both for the individual and society.  

 

With that said, the following points should be concerning for all of us

• NH ranks last in the country in State support of education

• While NH students do well nationally on outcomes as a whole, NH has one of the worst disparity rankings in education in the country defined as gaps between communities.  This was the basis for the Claremont decisions more than thirty years ago which has largely gone ignored.

• UNH is one of the most expensive state universities in the country for both in state and out of state tuition.

• NH teacher salaries are below average nationwide; the number not corrected for cost of living.

 

These are not admirable metrics.

 

I would argue we are not adequately investing in education in this state.  The question is how we do this in a better, more equitable manner.  I would refer the reader to my answer to question 2 in which I proposed a commission to look at how we, as a state, fund our government with education high on the list of variables to be discussed.  Going forward, I think we need to:

 

• Continue our increasing focus on student-centered education.  Not all students learn the same way, and a variety of options and settings can have great value.  We have made great strides in this area, and this needs to continue.

• While I think home-schooling and similar educational options can have great value, it is of great concern there is very little oversight of this practice.  There used to be.  This needs to change, especially in an EFA system which creates an economic incentive.  

• Pubic schools need to remain our focus and our priority.  Every child has a right to a good education and has the responsibility to take advantage of that.    

• One of the often-forgotten advantages of a public education that is missing from other options is the opportunity for each student to work (and play) with others of various socioeconomic backgrounds where each learns to solve problems together and can learn of the challenges each faces.  In a nation that views all as equal with the same rights to life, liberty, and the pursuit of happiness, this is a critical part of education that is rarely replicated in any other aspect of our lives. It is also the way we create Unity.  In alternative education formats, this opportunity needs to be replicated for the benefit of our citizens.  I have learned much more from others who don’t think and look like me, and I am very fortunate to have been able to be in that situation often in my life.

• While I may not be opposed to the concept of an education freedom account, I struggle with this in a state that contributes so little to local education, does little to address disparities between communities, and has little oversite over individualized forms of education.  If his practice continues, it needs to be financially addressed in a dramatically different way that does not adversely affect the function of local schools.  There also needs to be substantially more oversight of the practice and guardrails of how the funding is used.  

• I would defer discussion of funding to the commission I have recommended that I think needs to happen.  The property tax disparity between communities is a huge problem that needs to be addressed.  We feel this acutely in our school district where there is such a large disparity between the sharing towns of Gilmanton and Gilford.  While the partnership is of great value, the disparity creates unnecessary and avoidable conflict.  

 

Thank you.

Rep David Nagel, MD  

 

 

Dr. Nagel returned his 2026 Citizens for Belknap Primary Election  Questionnaire with these responses:

​

Rep David Nagel, MD
PO Box 120

Gilmanton, New Hampshire 02337
davidnagelmd@gmail.com
(603)491-5708 (C)
July 22, 2026

To: Citizens for Belknap County
CitizensforBelknapCounty@gmail.com
Re: Candidates Survey
The following are the answers to your questions. Thank you for the opportunity to share
my thoughts.
Dave

1. How long have you lived in Belknap County? If you moved to the
county, why did you choose to do so? If you have always lived in
Belknap County, why have you stayed? If you’ve been a resident for one
year or less, what prompted you to run so soon?

My family moved to Gilmanton in 1995. I moved to New Hampshire first in 1985,
then for good, with my wife and sons in 1989. I was recruited by Easter Seals to be
the Medical Director in 1989. A year later, I joined Concord Orthopaedics in 1990
where I was a partner until I began my service as State Representative in 2022. I
continued at Easter Seals until 1994. Since I was a child, I always advocated for the
rights of the disabled, the stigmatized, and the vulnerable, and it was important to
me that I come to a place where that was my primary responsibility. I grew up in
rural upstate New York. I valued the opportunity to make a difference in other
people’s lives both on a micro and macro level, something that I could never see
doing in New York. For a time, I worked with the Indian Health Service in Alaska. I
loved Alaska, and I loved my work, but it was too far from home. I spent part of my
training at Dartmouth and I came to love New Hampshire in the same way I loved
Alaska. I really loved the idea that I could make an impact here, so we moved here.
We lived in Candia for the first few years. That was too far from the rustic part of
New Hampshire I loved. We moved to Gilmanton for a few reasons. First, it was
closer to my identical twin sister-in-law. Second, it had a very interesting historical
reputation, not just in terms of being Peyton Place, but also the story it was
considered as the first state capitol. Third, I had met Doug Towle and Henry Page
and came to admire the work they did on home renovations, and we really wanted
the privilege of owning one of their homes. Finally, the schools had very good
reputations. The minute we saw downtown Gilmanton and the views from Friske
Hill, we were sold.

 

2. Why are you running, and what is the most important legislative issue
you hope to tackle the next legislative term?

​

This is my third term, and my goals remain the same. First, as a physician with 40
years’ experience locally, regionally, and nationally on health care policy, I ran to save a
dying health care system by improving access, cost, efficiency and equity. Our country
ranks dead last in the developed world on these parameters, and 69 th out of 119
worldwide. While we rank higher in New Hampshire relative to the US, we still rank
poorly worldwide. Through legislation I have passed, chairing the State Health
Assessment and Improvement Plan (SHASHIP), chairing two committees on access to
integrative care, vice-chair of the Opioid Abatement Advisory Commission (OAC) where
I chair to sub-committees, we have done a lot in the last four years to advance these
goals. It is my intention to be both fiscally and socially responsible, something we have
proved you can do. Second, I ran to serve as a voice for the 70 percent of Americans
who have no voice in the current system, 51% of whom identify as independent, and
20% who identify as politically moderate, equally divided between parties. I believe this
is a national tragedy, and I have done what I can by including them. All my legislation
has passed with bi-partisan sponsorship and support. Everyone is welcome in all I do,
with one requirement. You come to solve problems with an open mind. I am honored
by how well we can work together when we put differences aside and work for the
greater good. Third, to continue to advocate for the disabled, the vulnerable, the
stigmatized, to empower them and create opportunity. This involves attending to the
social determinants of health including economic security, food security housing
security, family, health care access, education, community, social connectedness, etc.
There a lot of moving parts, but that is what we do through the SHASHIP, the rural
transformation project, the OAC, the legislation I have written, etc.

​

3. What do you see are the biggest needs or issues in Belknap County,
and what would you do to fill that need?
Superficially, the biggest issues according to constituents are housing, education, and
property taxes. These are all important, but I would add several others including health care cost and access, mental health care access, substance use care and access,
primary care access, food security, child care costs, and labor shortages affecting all of
issues. There is a lot of inter-relatedness between all these issues. For example, if you
have a limited income, do you choose food, medicine, or housing for you or your
children? Your choice will create a ripple effect, not just for you, but for all of us. If you
can’t eat, you can’t learn, etc. 85% of our county inmates have a substance use
disorder, and a substantial percent have a mental health disorder. If we address these
issues as a primary problem in a preventative fashion, we can create a productive
population and save a substantial amount of public money on incarceration, etc. How
we treat those in need says a lot about our society.
In my various roles as chair of the SHASHIP, vice chair of the OAC, member of HHS EA
and through all my legislation, we are addressing all of these issues. Our goal is to
bring people together who are developing both public and private solutions, in a
coordinated way, to minimize cost and maximize access and efficiency. We have
prioritized primary and secondary prevention for opioid abatement dollars, with a focus on kinship programs to support those addicted and families of those individuals, sober housing, diversion programs, educational programs for first responders, in addition to harm reduction programs. As the NH representative to the NCSL and the State Opioid Settlement learning network, I am proud that we are way ahead of other states in
getting dollars to those who do this work. I have created two programs which I chair to
increase access to integrated care in a financially responsible manner, projects that are
being watched nationwide as nobody does this well now. This will help those of us with
complex health care problems.
The biggest gift we give to our children is an education. While I am not opposed to
EFA’s in the right setting, New Hampshire is not that setting with our current funding
system. EFA’s with their lack of oversight and home schooling with lack of oversight are
recipes for educational disaster for our society as a whole, and individuals who do not
receive proper educational access. I was honored to be endorsed by the NEA for my
positions and work on education.
Lack of affordable childcare and childcare workforce create a huge detriment to the
productivity of our labor force and adversely affect quality of life here, and the ability to retain our young people and attract others to move here. I was honored to be
recognized by the Moms Rising with the Moms’ Seal of Approval for my work on Child
Care Also under the radar were the huge budget cuts in HB 2 to the State University System and the Department of HHS which has resulted in forced layoffs, program cuts, and perhaps closure of part of the university system. I spoke with the governor about this when the budget proposals were given. It was disturbing that a certain portion of the legislature was able to engineer these cuts while also unnecessarily cutting state funding that would have allowed these programs to continue. The Governor and I made it a priority to address these issues.

4. What distinguishes you from the other candidates running in your
district?
I have a 40-year experience in advocacy work for our most vulnerable, and have been
creating non-partisan, fiscally and socially responsible solutions to address largely the
health care needs of our community while serving those needs as a practitioner. I have written a book on pain care policy which addresses both health care access and primary and secondary prevention of addiction which was described as a self-help book for society to change the way we, as a nation perceive and judge those in pain.

 

The book is sold all over the world, and has guided pain care policy including opioid abatement policy all over the country. My role in the legislature is to make proposed solutions real. My approach to integrative solutions is unique, but something I have been doing since I was an adolescent. I bring people together, not divide them, to create meaningful solutions, something I refer to as bringing sensibility to government. I have proved this can be done in a socially and fiscally responsible way, and I have done it despite attacks from certain partisan groups. Most of all, I give a voice to the socially and politically vulnerable whose exclusion is a national tragedy, one I am determined to address and correct.

5. A recent independent report found deficiencies in the current Belknap
County jail. Would you support construction of a building that meets modern
standards? Or should the existing jail be renovated?
One of the important things all legislators need to accept is we are not experts on many things we are deciding. It is critical we develop relationships with subject matter
experts. I am disturbed we are not doing that at the county level. I have not been to the jail, but I have seen pictures and interviewed people who work there. The facility issue is disturbing and needs to be addressed. The economic analysis is not complicated, putting patches on a sinking ship may be a viable short-term solution, but not so in the long term. I would rely on economic experts to advise me (us) on which direction is financially more expedient looking at this from a long-term perspective.

6. Do you agree that traditional public schools are essential to attracting
business and retaining employees in Belknap county? Should our students’
education be funded at ‘adequate education’ levels as defined by the NH Supreme Court's  ConVal decision? Why or why not? 

Yes and Yes. One of the most important functions we, the people do, is provide all of
our children an education, and each child needs to be offered an adequate base
education which respects their individual needs. Two facts are disturbing. First, NH
ranks last in state funding (support) of education. Second, we rank near the bottom in
education disparity which is directly related to the first point. That is not anything to be
proud of. The Supreme court decisions were designed to guarantee this right to our
children and correct this disparity. The legislature does not have the right to pick and
choose which judicial decisions is wishes to obey. We have been given a directive we
need to address. Fortunately, many smart people have created strategies to resolve
this issue. Now it is up to us, as a legislature, to make that happen.

7. The Belknap County Nursing Home continues to operate under
capacity, yet it has a waiting list of Belknap clients. What will you do as a
member of the Delegation, to assist the County Commission to maximize our
nursing care facility?
This is not an issue unique to Belknap County, or to Nursing home care. Labor force
shortages are ubiquitous in health care, home care, child care, mental health care, etc.
There is serious competition between these groups for this labor force. For many years, I sat on the health care board of Catholic Charities. This issue was a problem for them as well. The difference was CC had a more favorable payor mix than County Nursing homes have. The Federal and state Medicaid cuts will only harm this situation as Medicaid is a primary payor. I think there are two main strategies to pursue. First, we need to undo the harmful Medicaid policies of the big, beautiful bill. There is public
support for this, and it will require state and federal cooperation to do this. Second,
rather than punishing immigrants and refugees for trying to make a new life here, we

need to welcome them here, offer them training and opportunity. Historically, labor
intensive jobs such as Nursing home jobs, have been a source of employment for this
group. They are here. We need to use them. We also need to make sure benefit and
salary packages are competitive not just with other health care options, but also with
non-health care options such as Walmart, etc. We need to include subsidized training
for our workers to retain them, not just within the Nursing home, but also within the
state. The nursing homes that are most successful recruit and train from within,
creating continuity and a happy workplace.

 

8. The county nursing home and the Belknap Mountain Recreation Area,
including Gunstock Mountain Resort, are revenue streams owned by Belknap
County. As a County Delegation member, do you support leasing out the
property to a private company, or selling those operations? 
No. I think We, the people, have spoken loudly that We do not support any such effort,
and it is my impression that this is bi-partisan. My concern remains that a small group
would pursue such plans while denigrating those who run these programs. That is
nothing short of poor management. We need to support those who do great things for us. Furthermore, those of us with knowledge of the ski industry are quite aware of the harmful effects that mega-corporate purchases of local areas have had on those
facilities, whether it be a skiing facility or a nursing home. One of my friends owned a
few local nursing homes, each with a sterling reputation. As he entered his 90’s, he
realized it was time to sell. He sold to a mega-corporation, and he went to his grave
regretting that. He viewed his staff as family. The general perception is these groups
buy these entities to ruing them. Our people here deserve a lot better.

9. Opioids and other drugs continue to be a problem in our communities.
What are your ideas to reduce the impact of these drugs in our community? What resources are you willing to commit?
I have worked tirelessly on these issues for almost 40 years. Our goal is to create a
balance between the needs of those who need these medications for legitimate medical reasons, and those who suffer from addiction, a balance the has proven challenging to achieve.

 

I wrote the state’s opioid policy in 1998, and have been involved in most of the state and national efforts to address this balance. My book, Needless Suffering, has several chapters that offer constructive solutions that have proven important. I co-authored the priorities for the NH Opioid Abatement Advisory Commission (Guiding Strategies for Use of Opioid Abatement Funds), and have worked with the OAC and the SHASHIP to put these priorities in practice.

 

Coordination is critical. We have created several cross-talks which look at what entities provide what services, what gaps we have, and what we need to do to fill those gaps. That is how we focus our opioid abatement and rural transformation dollars. We just completed a substantial opioid abatement grant process. I chaired the sub-committee. We focused money on primary, secondary, and tertiary prevention.

 

Also, in a bi-partisan effort, I created HB 73 which defined harm reduction in our state to include not only those with addiction in our funding efforts, but also those affected by those with addiction. For example, we have an epidemic of grandparents raising their grandchildren because of the opioid addiction  of their parents. We have created and supported novel programs which support the grandparents in this process, but also work with the grandkids so they do not go down the same road as their parents. These are referred to as kinship programs.

Transportation is a critical problem, especially in rural environments, and we have
worked to fund novel transportation programs to get those with addiction to their
programs. Elder addiction is an increasing problem, with a variety of causes including
social isolation, self-medication from insufficient medical care, etc. We are working on
efforts to study the severity of the problems and funding solutions. This is a short list of what we are doing. Our priority list is unique nationally and we, as a state, should be very proud of what we are doing.

​

10. Belknap County’s delegation of state representatives has the poorest
rate of attendance in the state at 78% for the 2024-25 legislative session. It’s so
bad that the 2nd lowest, Strafford County, is 89%. Do you commit to attending at least 80% of committee meetings, and 90% or more of Session vote days?
Yes and yes, and I have done this for all 4 years I have been there.

11. The Belknap County Sheriff’s Department has entered into an
agreement with U.S Immigration & Customs Enforcement 287(g) program
agreement with Immigration & Customs Enforcement (ICE). Do you support this, and why?
Since the Dillingham Commission report of 1911 which created the first experiment in
eugenics to the present, this country has struggled with the promises emblazoned on
the Statue of Liberty and the need to protect our borders. The lack of a coherent
immigration policy is a problem.

 

There is not a nation on earth that does not protect its borders, and, in our country, ICE plays an important role. With that said, immigrants and refugees have a right to be here and enjoy the same opportunities we have citizens have. It is our responsibility to welcome them here. I would love to say my grandparents were, but they were not. Had they come here after the Dillingham Commission report was released, they would not have been allowed here. We cannot go back to that era.

 

Furthermore, the current administration has stated that agriculture is an issue of national security. 80 percent of our agriculture labor force is migrant, only ½ of which is documented. Without them, we do not eat. We need to acknowledge their contribution. Immigrants and refugees have the right to feel secure here. Too
many don’t. We employ a variety of immigrants and refugees in my workplace. They
are wonderful people who work hard. They escaped horrible situations. We cannot add to their suffering here. That is not who we are supposed to be.

While I believe that ICE is critical to protecting our borders while supporting our
immigrants and refugees, recent policies and behavior have called their integrity into
question beyond mere hyperbole. Until that issue is resolved, I would be concerned
with any blind agreement with them.

​

12. The county nursing home and the Belknap Mountain Recreation Area,
including Gunstock Mountain Resort, are revenue streams owned by Belknap
County. As a County Delegation member, do you support leasing out the
property/operations to a private company, or selling the property/operations?
See number 8

13. Affordable housing continues to be a problem, causing challenges for
our county economy, including limiting the worker pool, attracting business, and attracting younger families. If elected, what will you do to increase the stock of affordable housing?
Historically, this has been done in 3 major ways.

 

First, large employers create a stock of housing for their workforce. The first home I lived in was actually created by Bethlehem Steel for such a purpose. Tax incentives or subsidies can be provided to encourage these practices. This may be challenging in New Hampshire is our business community is largely small business.

 

Second, there are federal dollars available to help create low-income housing that we are turning down. We can no longer do that.

 

Third, governments can subsidize builders of low-income homes. That actually is supply side economics. To that, I would add that we need to re-think what housing actually is. There are new models of low cost, easy to build, transportable housing that can be used to address these issues. It does require a little thinking outside of the box. My first home was 800 square feet for 5 of us. Do we really need 2000 square feet or more?

Finally, housing speculation is a huge problem in creating exorbitant cost. I would
support any reasonable effort to control this including using anti-trust legislation.

 

14. Without clean lakes and rivers, the Belknap County tourism economy
would be in jeopardy. Should the county financially support pollution control and water quality monitoring programs? Why or why not?
Yes. An ounce of prevention is worth a pound of cure. We are now looking at
strategies to save Shellcamp Lake. The question is whether the damage is too far and
whether earlier intervention could have prevented the existing problems. Supporting is a relative concept. In investigating this issue, we found there were both Federal and
State dollars that could be used. You don’t always have to come up with the dollars
yourself. That is why partnerships with the Department of Environmental Services, the
Belknap County Conservation District, and the NH Cooperative Extension are so
important and why cutting their funding was penny wise and pound foolish. They know how to provide the monitoring and how to obtain funds to pay for it. We know that for every dollar spent, several dollars are saved. Every level of government, including the county, needs to be involved.

15. Do you agree that the tax reduction for State revenue streams
(Business Enterprise Tax, Rooms & Meals, Income & Dividends Tax, et. al),
resulted in downshifted costs to Belknap county and local schools, and
increased local property taxes? Why or why not?

Yes. The paper trail is obvious that is what has happened. The question is whether this
is by design or not.

16. Would you favor reforming the Delegation’s meeting format? Should
the Delegation conduct monthly meetings? Would you increase public input
opportunities? Continue with Roberts’ Rules?

These meetings need to be dramatically different, and need to include the following:
 Shortly after election, the delegates must attend a half day orientation where they
tour county facilities and meet with leadership from each entity. This would also
include meeting with the Commissioners and the Gunstock Area Commission.

 I am not sure the meetings need to be every month, but a minimum of 9/yr. Each
county agency including ancillary agencies, should present quarterly.

 The way public input has been used is disturbing, and, contrary to what was said,
is not like we do in Concord. No decision should ever be made until after public
comment pertinent to the issue. If, in the discussion among delegates, a
question arises which is best answered by a subject matter expert, that must be
allowed, even if that person is in the public. County delegates are not experts on
many issues we decide. It is critical we have the optimal information. To not
allow that, in my view, is legislative malpractice.

 I am not sure if the problem is Robert’s Rules, but how they are put into action. It
is my view now that these meetings are dysfunctional because of the way the
rules are employed. For example, other business must be determined by a vote
at the beginning of the meeting. It is common in such meetings that issues arise
over the course of the meeting that warrant discussion, and to exclude that
merely because of an obtuse set of rules is counter-productive, especially in a
group that meets so infrequently. Furthermore, we do not apply strict Robert’s
rules in Concord, and I do not use any formal rule process in any of my
commissions and committees. We encourage discussion and a wide range of
opinion. Robert’s rules were actually created to encourage expression of
minority opinion. The fact that is discouraged would suggest we are not following
those rules. It is my observation the process used actually discourages
discussion and proper information gathering, and that I most certainly not how we
do things in Concord. Every bill gets public testimony. Every person present can
talk. We are not done until the last person talks, and in none of the committees I
have testified or sat on was the presenter limited to any time frame, and
everyone else had at least 3 minutes. Wise decisions are only made with optimal
information.

​

​

​

​