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 Hawaii Medical Association President Dr. Cynthia Jean Goto, who answered questions about healthcare in Hawai'i. The following 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.)

Ghc: As a practicing orthopedic surgeon in Honolulu, my impression is that the main problem our physicians face in Hawai'i is the declining reimbursements from insurance companies. While tort reform would be nice and malpractice insurance premiums need to be kept under control, these are not our primary obstacles to getting physicians to come and live in Hawai'i.

Our state mandates health insurance for employees but does not mandate what level of care the insurance must provide. The primary private insurance company, HMSA, is uncontested in determining their premiums and their payments to physicians.

What is the HMA doing to counter the state-sponsored monopoly of HMSA, which although it should be improving medical care for the people of Hawai'i is actually the root cause of the problem affecting the healthcare access and lack of physicians?