Author touts isles' health focus
Though not without its problems, Hawaii can be a model for other states, a lecturer says
Hawaii has advantages over other states that make it "a perfect location for a demonstration project" to reduce the medically uninsured population, says a nationally noted independent writer, lecturer and health policy and ethics analyst.
Being an island chain helps because not many people will migrate here from other states to get health insurance, said Emily Friedman, author of hundreds of articles, editorials and books, including "The Aloha Way, Healthcare Policy and Finance in Hawaii (1993)."
Hawaii also has a long tradition of social compassion, she said, noting a major Hawaii company executive once told her, "What people here know is you can't throw sand up in the air without some of it getting in your face.
"It's an environment in which there is a sense of mutual protection, and the third thing, which cannot be overstated ... your big (health) plans are all nonprofit and the hospitals are virtually all nonprofit. ... You don't have major players who have to produce huge benefits for stockholders.
"That's why I hold out considerable hope that Hawaii could reduce the number of uninsured probably by half."
Hawaii is better than most states in the health insurance area, Friedman said, but it has slipped to second place in the nation with 10 percent of residents (about 120,000) without health coverage. Minnesota holds first place with about 9 percent uninsured.
The Hawaii Uninsured Project is working hard to improve the system, she said.
Editors of Modern Healthcare magazine chose Friedman as "one of the top 25 women in healthcare" last year. Readers in 2004 and 2002 selected her as "one of the 100 most powerful people in the healthcare field."
She discussed national health-care problems and reform this week at a Health Care Summit held by the National Alliance on Mental Illness -- Oahu and elaborated on the issues in an interview.
An important lesson from Hawaii in health planning, she said, is to "keep it simple because people are not going to jump through all the hoops that the Medicaid Program, for example, requires just to get health insurance."
It is cheaper to build on existing insurers and programs to subsidize coverage, and "whatever you do, you must rigorously prohibit discrimination against the sick," she emphasized.
When she goes overseas or talks to people from other countries, she said she cannot explain to them why millions of Americans have no health insurance "and we allow insurers to discriminate against sick people.
"They wonder what we're smoking here. It's health insurance. It means you're supposed to be insuring people's health."
Friedman said Hawaii's original State Health Insurance Plan, developed under former Gov. John Waihee and former state Health Director John Lewin, was a model for the country.
It maximized enrollment in public programs and the eligible population for Medicaid, put money into outreach and enlarged coverage to include cabdrivers and other self-employed people and dependents of insured workers, she said.
She liked the state plan because it was simple and easy for people to sign up, she said. "It eventually got disrupted by inflation and politics, but I think the model still was good."
Hawaii's Prepaid Health Care Act, mandating employer coverage for employees, "prevented the calamity that has occurred elsewhere," Friedman said.
But with skyrocketing costs, she added, "Private insurance is unraveling, even in Hawaii. ... It is almost impossible to insure against something whose cost doubles every five to seven years."
Because Hawaii employers are required to cover people working more than half time, she said, "They're getting clobbered."
Describing "enormous waste" in the nation's health care system and "enormous profiteering," Friedman said, "There should be something resembling responsible resource allocation, and billions and billions of dollars should not be sucked out of the health-care system to investors."