This document provides advice on finding the easiest and most affordable way to connect your computer and modem to the Internet. For most health care reform activists, U. S. Health Care Reform recommends that you obtain a flat-rate, 56k dialup PPP connection with a local Internet service provider.  Small offices in urban areas (and eventually all small offices) may wish to investigate high speed, low-cost DSL service instead of traditional dial-up.  Most groups will also want to get Web and email hosting services from a separate, Web Hosting provider.

As the Internet has moved into the mainstream, providing Internet services has become something of a commodity business.  Although the Internet Service Provider (ISP) business has expanded greatly over the past several years, prices have generally stabilized at around $20/month for basic dial-up access, and there is enough competition in the market that service is generally pretty good.  It's hard to make a really bad ISP choice. 

Here are some considerations to keep in mind when choosing ISP:

• Connection speed..... The faster the better. Virtually all ISPs now use 56k modems.  Good ISPs don't charge extra for 56k access.

• Flat-rate vs. Per-hour Charges.... Internet access is typically billed either at a flat monthly rate for unlimited access or at a flat rate for a given number of hours (often around 30) plus a per-hour charge for any usage over the limit. Most ISPs offer you a choice of service plans. USHCR recommends that you obtain a flat-rate unlimited access Internet connection. You will want to spend time online, especially as you first begin to explore the Internet, without worrying that the "meter is running."  Some ISPs are backing away from low cost flat-rate unlimited access; that's OK, but be sure to get an account with at least 60 hours a month.

• User-to-Modem ratio.... The number of simultaneous Internet connections an ISP can provide to its customers is limited by the number of modems it has (i.e., if an ISP has 100 modems, only 100 of its customers can be online at any one time because 100 modems can only answer 100 users' phone calls). There's nothing more frustrating than trying to dial up your access provider, only to be stonewalled by a busy signal because they don't have enough modems to answer their calls. The lower the user-to-modem ration, the greater the chance that you will be able to connect when you want to, rather than waiting for off-peak hours. USHCR recommends that you choose an ISP with a user-to-modem ratio of 10-1 or less.  Be sure to ask any prospective ISP what their user-to-modem ratio is.

• Staying power.... If an ISP has been around for more than a couple of years, they've probably proven themselves able to provide acceptable customer service and keep in step with technological advances. USHCR recommends that you avoid very new ISPs; their rates may be attractive, but there is a greater chance that you will be disappointed with their service when you require technical support.

• Personal Web Pages.... Many ISPs offer customers space on their servers to create personal Web pages. Generally you will receive five  megabytes of disk space for free. Personal Web pages that are offered in conjunction with an Internet account are generally slower for other people to access, but they're a terrific place to practice creating Web pages, and an easy way for your organization to establish "Web presence."  

• Support.... ISPs can be extremely good sources of technology-related information--or not. Try to get a feeling if they will be willing to take the time to answer your questions. Some will stand on their reputations for good user support and others will do their best to avoid the issue.  Word of mouth is a very important way to judge an ISPs service and support.  Your ISP's ability and willingness to work with you to solve problems is critical, especially if your organization needs or will need services that go beyond a single dialup account.

Local & Regional ISPs
Local Internet Service Providers, once a phenomenon of the 's major urban centers, are springing up around the region like mushrooms after a spring rain. There are now dozens, maybe hundreds of local ISPs throughout the . The main advantages of choosing a local ISP are price (often cheaper than regional or national providers) and personal service. USHCR recommends that you choose a local ISP that offers unlimited flat-rate PPP access via a local phone call, has been in business for a while (a couple of years is "a while" in the online world) and provides a high level of user support.

Cost, level of service, and reliability vary widely, but are generally improving; you will want to do some shopping around for the best deal, as rates change rapidly.  The best place to start is by asking friends or other local organizations about their experiences.  References go along way in the search for a good ISP.   Furthermore, many local ISPs are willing to offer discounts to non-profit groups.

If you are unable to find an acceptable local ISP-for example, if you live in a very rural area and there are no local ISPs within your local dialing area, you should investigate a national or multi-regional online service; they may prove a competitive alternative.   There are very few places in the region that don't have an ISP with a local dialup number, even if the ISP is located far away.

Many large ISPs offer access through an 800 number. Unlike most 800-number services, these calls are not free. The ISP bills you a per-minute rate to cover their long distance costs, but large companies can usually get a much better rate than you can as an individual (around 8 to 10 cents per minute). See ISPs.com's guide to toll-free access rates for the least expensive alternatives.

To search for other ISPs in your area, to compare prices, and to learn more we recommend you visit ISPs.com  (http://www.isps.com), a Web site with an extensive, searchable listing of ISPs and ISP related information.

National ISPs
National ISPs provide Internet access through local dialup connections. If you travel frequently outside of the region, you may find a national ISP with local dialup numbers in many major cities a convenient choice for staying connected on the road.

Over the last year, there has been some consolidation in the ISP business, and there are now a fair number of ISPs that offer PPP dialup in urban and suburban areas across the nation.  If you live in an area that a national ISP serves, you may find this an attractive option.  Service and support can vary widely.  Some national ISPs may be able to provide good service; others may have grown too quickly to adequately service a national customer base.  Unfortunately, there are no reliable ways to measure the quality of major national ISPs.  For now, word of mouth may be the best indicator.  We've heard good things about Earthlink (contains Mindspring, which contained Netcom) and GTE.net .

� U. S. Health Care Reform. All Rights Reserved.