Hawaii's Health Care Model

July 20, 1993

According to Hillary Rodham Clinton, Hawaii is "the only place in our country that even comes close" to providing universal coverage for health care, no matter where you work or what your health condition. Does that mean the Hawaii system will figure large in the health care reform package the First Lady is developing? You bet it does.

Does that also mean Hawaii is paradise? Not exactly. Not if your ask small businessmen who complain they can't compete with the mainland or chisel around a system that mandates employer-provided health insurance only for employees who work more than 20 hours a week. Not if you compare the hospital care provided for those with private insurance with what the state offers persons with neither insurance nor Medicaid eligibility.

So what may be in the works is some sort of nationwide marriage between the Hawaii plan and the Maryland plan. While Hawaii has probably done the best job in providing universal coverage, as Mrs. Clinton suggested, Maryland is one of the nation's leaders in containing hospital costs in a system that delivers the same standard of care to all patients. The two states also have been moving toward one another by banning "cherry picking" by insurance companies -- the practice of offering coverage only to persons with no existing health problems. Hawaii's approach has eliminated a lot of small insurance companies and narrowed the field to two large insurers which pretty well dictate rates. Maryland, with its new "community rating system," is heading the same way.

Dr. John C. Lewin, Hawaii's health director, describes his state as "the nation's undiscovered model, a demonstration project that works -- with a 17-year track record (and) the price tag is zero." He can point to wide popular satisfaction, an insurance-coverage record twice as good as the national average and price restraint that compares favorably with most mainland states.

All this mightily interests Mrs. Clinton, who has resisted the Canadian single-payer plan because of its central government controls and high tax costs. She insists the "managed competition" plan she will present to her president-husband will require little more than a cigarette tax. Nothing major.

We shall see. Meanwhile, watch for a Hawaii-Maryland connection on health care reform.

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