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BY LAURA BROWN– The Hawaii Primary Care Association, a non-profit organization with representatives from each member community health center and the Native Hawaiian Health Care Systems that is supported by State and federal funds, sponsored a general election candidates’ forum at the Hilton Hawaiian Village in Honolulu on Friday, October 8, 2010.

The forum featured Gubernatorial Candidate Neil Abercrombie, Lieutenant Governor Candidate Brian Schatz and Congressional District 1 Candidate Colleen Hanabusa – all Democratic candidates in the 2010 General Election.

Though organizers say Republican candidates were invited, Gubernatorial Candidate Duke Aiona, Lieutenant Governor Candidate Lynn Finnegan and Congressman Charles Djou, HI-1, did not participate.

Abercrombie, a former congressman, distributed his plan for “Healthcare for Everyone in Hawaii” that outlines a vision of state and federally-funded community health centers as the primary system of care for Hawaii residents.

Abercrombie says that in 1974, at the time Hawaii’s Legislature passed the Prepaid Healthcare Act, the monthly premium for a single plan was $15.96 per month with most workers already receiving insurance through their employers before the plan took effect.

Hawaii had – and still has – one of the healthiest overall populations in the country, he says.

But now, 36 years after Hawaii government officials implemented the so called “reform,” he says Hawaii’s healthcare system is fragmented. He argues doctors are having a difficult time building a career in Hawaii, with critical shortages in orthopedists, obstetricians and oncologists. He says insurance costs are crippling business, retirement systems are becoming insolvent and it’s difficult to even make an appointment with a doctor.

“The majority of our graduates and residents are leaving the state for work,” says Abercrombie. He suggests that Hawaii exchange the Prepaid Healthcare Act for a new scheme: Universal Healthcare or the Obama plan for American healthcare.

Sen. Sam Slom, R-Hawaii Kai, who also serves as the president of the Smart Business Hawaii advocacy group, says Hawaii’s politicians should be listening to what the doctors have been saying for many years at the Hawaii State Legislature. “What they have said over and over again is that Hawaii’s tax burden is too great, its regulatory structure too burdensome, and the lack of tort reform has been a professional destroyer. Instead, we heard shrill voices calling for more government intervention, less patient choices, even higher taxes and costs, and no relief for either small businesses or doctors.”

Abercrombie strayed from the topic at hand during the forum into political campaigning – the General election is set for November 2, 2010: “This is totally politics and if you don’t understand that, you’d better wake up.”

The problem has been the opposition of the Republican Party, Abercrombie says. This despite Democratic control of both the Presidency and the Congress and solid Democratic control of both Hawaii’s House and Senate for nearly 5 decades.

Countering Abercrombie’s claim that the problems are largely due to Republicans, Slom says: “The heavy Democrat-controlled legislature has done nothing to alleviate our healthcare problems and their ‘new proposals’ are no solutions at all.

Sen. Colleen Hanabusa, a Democrat candidate for the 1st Congressional seat now held by U.S. Rep. Charles Djou, R-HI, says that the state has an exemption to the federal health care law because the Hawaii Prepaid Healthcare Act is superior for now, until the rest of the country catches up through a universal healthcare system.

“The underlying principle as to why Hawaii’s law works is everyone is pooled together and this spreads risk and keeps costs down. Are we getting to the point of Universal Healthcare – a single-payer system? Other industrialized countries spend only about 10 percent of their GDP because of a single payer system versus 17 percent in the U.S.,” says Hanabusa, who advocates a single-payer system.

One improvement to Hawaii’s healthcare plan may be tax credits for family coverage, because the current law covers only the worker, Hanabusa says.

Schatz, a candidate for lieutenant governor, did not offer any specific solutions, but adds: “We know what we don’t know,” says Schatz. “We need to sit down and talk to you (health care workers) about the system.”

One solution to the lack of providers in Hawaii could be through grants, as currently done in the dental field, Hanabusa says: “Used in dental, you can practice in an underserved area without a license.”

Dr. Linda J. Rassmussen, MD, an orthopedic surgeon, said that idea is just “bad policy.”

“Most people just won’t go to a community healthcare. If you take people without the education, experience and training and put them on the frontlines, you’ll have trouble,” she says.

Abercrombie returned to his solution of Community Health Centers. “The State, working with you (health care workers) could be the fulcrum through which the Affordable Care Act can thrive.”

Rassmusen says, “That may sound find, but, in reality, if a patient goes to the Waianae Coast Comprehensive Health Center with a broken bone, for example, they will not be able to find a orthopedic surgeon.”

Hawaii is scheduled to receive over $10 million out of $2 billion nationally set aside for Community Health Centers under the new federal healthcare act.

Schatz assured the audience that the State is trying to hold the Hawaii Health Care System (HHSC) to a standard that is higher than private hospitals, by expecting them to “operate in the black.”

A comprehensive independent review and evaluation of the Hawaii Health Systems Corporation — a network of State-funded hospitals — revealed that the HHSC had an operating loss each year from 1998 to 2011. That includes more than $80 million in losses in acute care in 2008, and yearly losses of around $100 million.

The report found that HHSC is “in a financially perilous condition as a viable going concern.” See the draft report here.

Slom says the HHSC has been a wasteful economic black hole subsidized by the taxpayers of Hawaii for more than a decade, and that despite local Republican suggestions for deregulation, decentralization and competitive medical delivery in Hawaii, such as the private investor financed Maui hospital, these suggestions were killed in part by heavy lobbying on the part of the HHSC and the Democrats in the legislature who support them.

Asked about tort reform, Hanabusa says that claims account for only about 2 percent of costs and so that is a red herring. “Obama says claims should be addressed through a specialty court.”

Abercrombie suggested that under a federally-qualified health center, you would be fully covered for costs. Federal tort claims would be handled similar to the way they are handled through the Veteran’s Administration. “This has less to do with budgets and programs than values and priorities. It depends on what you value,” says Abercrombie.

When asked about the Compact of Free Association of States, which requires States to cover healthcare costs for Micronesians, Hanabusa said that is a huge, unfunded federal mandate.

Gov. Linda Lingle’s administration says the Micronesian population influx costs Hawaii an estimated $100 million a year, with only $10 million coming from the federal government.

Abercrombie said that he was on the Resources Committee in Congress when that law was passed, explaining that he tried to get $300 million to bring that treaty to a conclusion, but he says President Bush wouldn’t agree. “We’ll have to get Obama and Clinton to help us,” he concludes.

Abercrombie’s opponent in the governor’s race, Duke Aiona, is running on a platform that includes access to more affordable, high-quality healthcare.

Though Aiona did not attend, he has issued a statement about his healthcare plans for Hawaii: “I will work to expand health care options available to Hawaii’s families and encourage a greater number of providers to ensure we have a competitive, robust market that gives our citizens meaningful choices when choosing health insurance,” says Aiona, who has served as the lieutenant governor for nearly 8 years.

John Goodman, President and CEO of the National Center for Policy Analysis, in his Health Affairs blog, says that in a new study by the Office of the Medicare Actuary, costs under the new federal healthcare law will continue to rise.

The main problem, he says, is that demand will exceed the supply of medical providers, because, under the law, demand for services will double.

Laura Brown is a reporter for Hawaii Reporter. Reach her at LauraBrown@hawaii.rr.com

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