The (media) Mystery of Hawaii's Low Health Care Costs

by: Pacific John

Mon Oct 19, 2009 at 17:29:22 PM EDT

What's (not) the matter with Hawaii: On the front page of Saturday's New York Times, Gardiner Harris' presentation was almost refreshing.

How does Hawaii manage to provide such low-cost health care? No one really knows, Harris said.

Here are the facts, as Harris presents them:

Hawaii has a very high cost of living. Despite that fact, Hawaii has the lowest Medicare spending of any state in the union. A typically bewildering New York Times graphic shows Hawaii spending about $5300 per Medicare beneficiary in what may have been the year 2006-as compared to a national average of $8300.

That is a major distinction.

And not only that! "Hawaii's health insurance premiums are nearly tied with North Dakota for the lowest in the country," Harris reports. Turned into English, this means that Hawaii has the second lowest insurance premiums among the fifty states-although Harris never says how low Hawaii's premiums are as compared to the national average.

Good lord! Hawaii would seem to hold the answer to one of the central questions driving the health care pseudo-debate! How can we reduce our nation's absurdly bloated health care spending? It seems that Hawaii has already accomplished this task-has done so to a substantial degree, to judge from that Medicare figure. But how has Hawaii accomplished this task? Harris is almost refreshing:

   

HARRIS (10/18/09): Why is Hawaiian care so efficient? No one really knows.

   In dozens of interviews, doctors and hospital and insurance executives in Hawaii offered many theories...

By now, you'd almost think that some health care expert would know how Hawaii has managed to do this-would have some major "theory." No such luck, Harris quickly says.

[...] No one knows how Hawaii has done this, Harris quickly says. He doesn't seem to be struck by the hints of idiocracy found in this situation.

What's not the matter with Hawaii? Refreshingly, Harris seems to take it for granted that no one much knows or much cares.

more:

I vividly recall one televised forum presenting everything from libertarian think tank laissez-faire utopia to single payer. At the time, the Harry and Louise's death knell for reform could already be heard, and there was a lot of talk about how we should turn the states loose as 50 experimental labs. Hah.

A public health expert from Hawaii took his turn in utter exasperation: "We've already run the experiment and come up with the solution! All you have to do is see what we did and copy it!" In short, what Hawaii did was cover nearly everyone, funded by a modest hike in the payroll tax. The last I knew, they offered all people of working age three major options: an HMO for little or nothing aside from the payroll tax, a fee for service plan with very modest premiums, and a version of Medicaid for those who would otherwise fall through the crack. Hawaii would put the private plans up for bid every couple of years, with intense competition for price and quality.

Oh yeah, Hawaii covered nearly everyone for substantially less per person than on the mainland where we don't cover 10s of millions. Cheaper insurance, better quality, everyone's covered, and all within the free market. It seems like a Blue Dog dream.

I've heard it argued that for various reasons, Hawaii has a healthier population, but still! Why the media blackout?

Who knows why Hawaii, with a relatively comprehensive solution and intense regulation has Medicare costs that are only 63% of the national average?

Goodness knows, the media won't tell us. They'd have to do investigative journalism and interview a Hawaiian or something.