Can the Hawaii Health Care Experience Be Generalized To All of Us?

Last month, The New York Times published a piece by Cory Lum on health care policy and financing in Hawaii, “In Hawaii’s Health System, Lessons for Lawmakers” in which Hawaii's system was described. Since 1974, Hawaii has required all employers to provide relatively generous health care benefits to any employee who works 20 hours a week or more. 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 telephone or on-line, day or night, to the physician of their choosing.

The article goes on to describe the health care landscape in Hawaii. 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. Hawaii residents live longer than people in the rest of the country. One example given was that, although Hawaii has the nation’s highest incidence of breast cancer, it has the lowest death rate from the disease.

Are the low health care costs in Hawaii due to mandated coverage? Certainly, the scientist in me agrees you can't conclude that the policy causes the low cost without a rigorous scientifically controlled study. But the seasoned professional in me can 'connect the dots' from universal coverage to better health—and lower cost.