In His Own Words . . .

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

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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?

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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.

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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.

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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.

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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.

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