Each week Editorial and Opinion Editor Jeanne Mariani-Belding hosts The Hot Seat, our opinion-page blog that brings in elected leaders and people in the news and lets you ask the questions during a live online chat.

On The Hot Seat last week was Michael Stollar, vice president of HMSA. He answered questions on healthcare issues and HMSA's new 24/7 online service, which links consumers with doctors for consultations via computer or telephone.

Here is an excerpt from that Hot Seat session. To see the full conversation, go to The Hot Seat blog at www.honoluluadvertiser.com/opinion and click on "The Hot Seat." (Names of questioners are screen names given during our online chat.)

Julie: Will this new service actually ease the strain on our doctors, or cause more of it? How do you determine which doctors are on call? Will they be inexperienced ones without thriving patient lists? Otherwise, I can't see how doctors will have time to participate. What's the incentive for them?

Michael Stollar: We believe that HMSA's online care will ultimately ease the strain for many doctors and the healthcare system in general, particularly in areas where there are not enough physicians.

Doctors determine for themselves when and how they want to practice with Online Care. When it is convenient for them they make themselves available. We don't know which doctors will find this service the most appealing. What we do know is that a broad cross-section of doctors, young and old, urban and rural, from a variety of specialties have expressed interest and many have already signed up.

The ultimate incentive for the doctors is that this system offers them freedom and flexibility to practice as they choose and to get paid for services they normally don't get paid for today.

Jason K.: Can you tell me what percentage of all the folks that have insurance have HMSA? It feels like we have little choice here in Hawai'i in terms of our insurance providers. What do you see as your biggest responsibility to service the community better, being that you have an overwhelming share of residents here?

Stollar: We believe that approximately 50 percent of the residents of the state have selected HMSA as their health plan. We believe this is because we offer great service and great value. Part of that value includes serving the community in a variety of ways. The introduction of Online Care is an example of one important way we serve all the residents of the state.

John: It's a good thing that someone can call up to get a doctor's advice on something, but to charge HMSA members $10 a call and non-members $45 is too much. How do you justify this fee?

Stollar: Well, just like another well-known company, there are certain advantages to membership. As for the $45 charge for non-members, this actually is a tremendous value. Normally an office visit that is less than 10 minutes long with a physician would cost almost double that amount.

There are costs to the system, including payments to the physicians who provide the care, malpractice coverage, technical system costs, telephony etc.

Peter M.: I wanted to have a colonoscopy done as a preventive measure to colon cancer and I was told that HMSA does not cover preventive procedures. This does not make sense. Does a person have to wait till they get cancer before they get covered by HMSA? No wonder the premiums are going up so high. Can you answer me why HMSA does not cover such preventive procedures?

Stollar: I'm not a physician but I can tell you that preventive services are covered depending on national best practices and evidence-based standards determined by medical doctors.

Your physician can best guide you as to what those standards are and which services at which ages and for which risk factors you may get coverage.

Greg: Will this new service eventually result in higher rates for customers, who or why not? How is this being paid for?

Stollar: The investment in this service is being made by HMSA from reserves, not rates.

In the long run, we actually hope that this service may have a positive impact on healthcare costs. According to a study by Milliman (actuaries), costs may actually be mitigated when people seek appropriate care from a physician rather than seeking very expensive care from the emergency room unnecessarily.

Jason: My company has just dropped HMSA for another provider because the premiums are getting too high. And I was talking to my neighbor and he said his company is also dropping HMSA. What is your take on this? Are you seeing an increase of customers leaving HMSA?

Stollar: The vast majority of losses we see today are the result of the slowing economy, particularly in tourism and construction. Employers do leave HMSA; often times they will come back for a variety of reasons, but we think that the fact that there are options for employers ensures a healthy health-plan marketplace.

Alex: There needs to be more done to PREVENT illness. The biggest criticism of HMSA is that it does not cover annual checkups, or other preventative things. Why not cover annual checkups? It seems short-sighted to wait until people go to the emergency room. I know many, many people with HMSA that feel the same way.

Stollar: There are plans like our HMO plans that cover physicals. We also offer our very popular and successful HealthPass program for people very concerned with prevention. We also publish our Island Scene magazine that is full of information regarding living healthy lifestyles.

Rocketman: What is being done about the problem of doctors not getting reimbursed fully or in a timely manner?

Stollar: Not only is HMSA the highest payer for services overall in the marketplace but I would venture to say that we are also the fastest and most reliable payer by far. Unfortunately there are times when misinformation is spread. Our physician surveys tell us differently.

Kyle: I'm a student interested in a career in healthcare. What would be your advice in terms of career options or where do you see growth in this field?

Stollar: Hawai'i, like so many other states, needs as many healthcare workers as it can get. Whether you want to be a physician, nurse, PA, CNA, technician, etc. there will likely be great opportunities. This is even more so if you are interested and willing to relocate to a Neighbor Island or a rural community.

Study hard and keep plugging away. Your success will be good for Hawai'i.

Victoria: I keep hearing about the healthcare crisis here. Not enough doctors, uninsured people, all that stuff. Please give us your take on what the problems are and how we can fix it once and for all.

Stollar: That may be a bit of an overstatement. Are there issues? Certainly, just as there are throughout the country. We actually have an abundance of medical resources within the urban corridor of Honolulu, and far fewer resources available in rural communities. Again very similar to most of the country.

We feel the best way to try attack these issues is by working together as a community to solve real problems. Our investments in rural residency training programs for physicians and programs like Online Care, that can make healthcare available in areas that might be underserved, are examples of our commitment to offering real lasting solutions.

Regarding the uninsured, we are fortunate to have one of the lowest uninsured population rates in the country. We work with many government, social and community organizations to help bring that populations size down even more.

Hildegaard: How do you justify the big increases in co-pays charged senior citizens in the 65 C Plus plan? The co-pay started at $10, increased to $15 this year, and jumps to $22 in 2009.

Here's how it works: Doctor who orders chest X-ray will get $22 co-pay. Lab will get $22 co-pay for taking X-ray. Person who reads the X-ray will get $22 co-pay. Return visit to doctor to find out X-ray result will take another $22 co-pay. The co-pay is in addition to the monthly premium and parking.

Stollar: Thank you for your question. As I'm sure you know, Hawai'i has the fastest growing senior population in the nation.

Seniors for obvious reasons utilize a tremendous amount of healthcare resources. The increase in co-payments is a direct reflection of the increase in costs in this population and is one means of ensuring that the overall rates charged remain affordable.