Lessons From Hawaii

Grace-Marie Turner explains how, "Hawaii's Keiko Crash Offers Lesson for All".

Fortunately, Hawaii's "universal coverage" plan for children collapsed quickly before it could destroy private insurance in the state. But it offered a good example of the phenomenon known as "crowd out".

Will the other 49 states learn the right lesson? Or will we duplicate this error on a national scale?

Hawaii Ending Universal Child Health Care

After only 7 months, the state of Hawaii is discontinuing its system of "universal health care" for children (emphasis mine):

Gov. Linda Lingle's administration cited budget shortfalls and other available health care options for eliminating funding for the program. A state official said families were dropping private coverage so their children would be eligible for the subsidized plan.

"People who were already able to afford health care began to stop paying for it so they could get it for free," said Dr. Kenny Fink, the administrator for Med-QUEST at the Department of Human Services. "I don't believe that was the intent of the program"...

We've seen similar problems in other states such as Tennessee, where a government "right" to health care undermines and eventually destroys the private market. This in turn leaves patients and physicians at the mercy of government bureaucrats.

Fortunately, Hawaii learned this lesson before it was too late. Will the rest of America?

(Via multiple readers, including Brian Schwartz, Kelly McNulty, and Robb LeChevalier.)

Hawaii: Trouble In Paradise

The Commonwealth Fund praises Hawaii as a model of how a state can implement "universal health care". However, they are committing the common fallacy of confusing "health insurance" with "health care", according to this story from the 6/17/2007 Honolulu Star Bulletin:

"Doctor Shortage Belies Top Ranking"

Many islanders can't find a doctor, especially on the neighbor islands and in rural Oahu areas, despite the state's top ranking nationally for access to health care, says the Hawaii Medical Association, a local physicians association.

A Commonwealth Fund survey said Hawaii has the best access to health care in the country, primarily because of a high number of residents with health insurance. But the study didn't consider availability of doctors, Hawaii Medical Association members say.

"If we don't have doctors available to see them, what good does insurance do you?" said HMA President Linda Rasmussen, a Kailua orthopedic surgeon. High malpractice premiums and low insurance reimbursements have created a "state of crisis" in Hawaii with physician shortages limiting access to health care, she said.

..."If I have a patient who needs a total joint (replacement) and has an abnormal EKG (electrocardiogram) and needs to see a cardiologist, it's almost three months to get an appointment before he gets cleared," she said.

"If a person calls when they're 50 for a colonoscopy, they're almost 51 before they get in."

..."People are frustrated," said HMA Executive Director Paula Arcena. "They have insurance coverage but they can't find doctors." The neighbor islands and rural Oahu are affected the worst, especially in specialty and trauma care, she said.

David Hogberg of the National Center for Public Policy Research makes a similar point in his recent article, "'Health care,' more or less".

(Via KevinMD.)