I have previously commented on some of the historical advantages Hawaii has had in terms of providing health care coverage for its citizens. It seems the New York Times has finally stumbled upon it as well.
Here is the Link with a view observations below the fold.
The article starts of with this to the point fact and quote:
Imee Gallardo, 24, has been scooping ice cream at a Häagen-Dazs shop at Waikiki Beach for five years, and during that time the shop has done something its counterparts on the mainland rarely do: it has paid for her health care.
Ms. Gallardo cannot imagine any other system.
"I wouldn’t get coverage on the mainland?" Ms. Gallardo asked. "Even if I worked? Why?"
If you have had the opportunity to read T. R. Reid's "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care" - you would immediately recognize Ms. Gallardo's puzzlement as the same expressed by any citizen of any other economically developed country - "What do you mean I wouldn't have coverage?" This is because, as Reid points out, every other developed country has made the MORAL decision that ALL its citizens deserve access to health care, just like they do to police protection, education, safe water, public roads a national defense and numerous other indicia of a civilized society.
After a very brief comment on the history of the law that mandates such coverage, the Times goes on to note that despite being an incredibly expensive state for everything else, health care is relatively inexpensive, compared to other parts of the country.
But perhaps the most intriguing lesson from Hawaii has to do with costs. This is a state where regular milk sells for $8 a gallon, gasoline costs $3.60 a gallon and the median price of a home in 2008 was $624,000 — the second-highest in the nation. Despite this, Hawaii’s health insurance premiums are nearly tied with North Dakota for the lowest in the country, and Medicare costs per beneficiary are the nation’s lowest.
Having lived in the Aloha State for twenty years, I can attest to the prices - and having worked as a physician and health plan executive in the state, can attest to the relatively lower costs - at least in reference to the cost of everything else.
The article references our state's healthy life style, but touches on two other aspects that I think are important as well. Whatever one might say about private (vs. government) coverage, in Hawaii the two largest payors are HMSA - a not for profit Blues affiliate, and Kaiser, the well known not for profit HMO. HMSA ran an admin overhead in the neighborhood of 7% when I lived there, and Kaiser was equally efficient (although their structure made it harder to parse out the exact admin overhead). As not for profits, I believe both were also exempt from the State's 4% General Excise Tax.
And as the article states - both HMSA and Kaiser are relatively innovative and tend to have good outcomes on the usual measures of effective health care.
The Hawaii Medical Service Association, the state’s largest insurer and a Blue Cross Blue Shield member, recently offered the nation’s only statewide system whereby anyone for a nominal fee can talk by phone or e-mail, day or night, to doctors of their choosing.
Kaiser Permanente Hawaii, which covers about 20 percent of the state’s population, screens 85 percent of its female members ages 42 to 69 for breast cancer, among the highest screening rates in the country.
Of interest, while some employers skirt the law by keeping their part-timers under the 20 hour threshold, and there are some out and out cheats, the overall sense of the business community is that it is a good thing, and in fact they worry that the Hawaii law might be preempted by a weaker national law.
One thing that the article doesn't mention -- physicians - on the whole, and relative to the cost of living, make much less in Hawaii than elsewhere. In a different context, I saw a statistic showing that the average primary care physician in Hawaii made $155,000 per year. Now living in North Carolina, I can attest to the fact that that is less than many of our PCPs make here, and the cost of living in NC is probably 30% to 40% less than Hawaii. But as those of us who have live in Hawaii are well aware, there is a Price of Living in Hawaii, which we all learned to live with, reminding ourselves "Lucky we live Hawaii" as we made it through another shitty day in Paradise. And for all the threats of "physician flight" - Honolulu does just fine keeping excellent physicians practicing. The outer islands have more difficulty - but that difficulty is not really any different than any other rural part of America - not enough resources, too few patients to support the number of specialists needed to make life professionally bearable, and the usual problems of remoteness from the assets of the city and suburban areas.