Breakdown of National Healthcare Coverage (Graph)

As this graph shows, public government programs make up nearly half (46%) of the federal money spent nationally on healthcare. Already deep in debt, this just puts further burden on the government.
This graph also mentions the fact that most private health insurance is provided by employers.
Source: http://www.citizenshealthcare.gov/healthreport/healthreport.php

National Healthcare Graphs

As both of these graphs illustrate, spending on national health services is expected to continue growing over the next decade.

Source: http://www.citizenshealthcare.gov/healthreport/healthreport.php

National Healthcare: What Needs to be Done, and how "We" can do it.

The United States is one of the richest countries in the world, so SAK finds it surprising that our national healthcare plan ranks thirty-seventh in the world. We are barely ahead of our communist neighbor, Cuba. What can be done to improve our international standing? There is something wrong with our nation’s healthcare system, and since our nation is ruled by (idealistically?) we, the people, it is our job to fix it.

Our nation is a staunchly capitalistic democracy, and it therefore fears nationalized healthcare. Nationalized healthcare is a system in which the government plays the role of our current health insurance companies and “Covers” all of its citizens. The system is working in first-world nations like Great Britain, France, and Canada, providing virtually all of their citizens with inexpensive healthcare. According to the National Coalition on Healthcare, fifty percent of all bankruptcy findings were partly resulting from medical expenses, and every thirty seconds someone in the US files for bankruptcy after a serious health problem.

The simple solution for the financial medical burden placed on the American populace is to switch to a nationalized healthcare system. According to the NHC, “The United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens.” The NY times published an article that said that, “Viewed strictly in terms of dollars and cents, the government already accounts for more than half of the nation’s health care spending.” Why not raise taxes and remove our need to pay our rising premiums to insurance companies. Since our government is by the people and for the people, shouldn’t it decide our premiums rather than a health insurance company that uses our money for profit? Even hospitals support nationalized healthcare because they would never be forced to treat an uninsured person. The government would insure everyone.

Another perk from a nationalized healthcare plan is the price reduction of prescription drugs. As you can see from the chart, drug costs are much higher for the average American than they are for an average Frenchman under his nationalized healthcare plan. Under such a plan, elderly Americans would easily be able to afford their now expensive medications.

The argument against nationalized healthcare is that it reduces our much-loved healthcare “Choices.” Unless you’re willing to pay extra, you lose the ability to handpick your doctors, and therefore lose a lot of control over your own healthcare. Another problem with a nationalized plan is that people are forced to wait longer for preventative healthcare. If you have a heart attack, you will be treated quickly at a small financial cost, but if you need a non-emergency surgery, you could be on the waiting list for months.

Of course, if you can afford good health insurance and also can afford to pay some of your own medical bill, the actual healthcare offered in the United States is superb. We are a technologically advanced country, and our medical facilities reflect that claim. According to CNNMoney, patient survival rates in the United States are increasing, while at the same time hospitals are treating sicker patients. Basically, they are improving upon their old statistics with patients who are harder to treat.

The major problem we face regarding our hospitals is a nationwide nursing shortage. Nursing school graduate numbers are declining, and hospitals cannot run without a qualified nursing staff. To fix this problem, hospitals can give better job incentives for nurses (pay, benefits, vacation…). This would, of course, make hospitals more expensive to run, and we, the patients, would take the brunt of the cost.

As far as national healthcare is concerned, most of the changes necessary will need to be spearheaded by the federal government. There are certain things in our communities we can do to help improve the nation’s healthcare statistics. Small health clinics exist in cities all over the United States that cater to the poor and downtrodden who lack the financial backing to afford medical insurance. These centers rely on donations and government aid, and they offer the nation’s lower class cheap healthcare. Donating money to these organizations is a great way to toss your hat into the healthcare-improvement ring.

These community organizations are, however, running into problems. According to USA Today, the rising demand for their services is putting a large strain on their resources. From homeless people wandering in acquire get free prescription drugs, to the unfortunate, out-of-luck unemployed, these understaffed centers are so swamped with patients that they often, “Beg specialists to take on patients.” Volunteering ones time to work at one of these centers is another way to become directly involved in improving the nation’s healthcare.

Another possibility is to simply volunteer your time at organizations like the Red Cross. The Red Cross, for example, runs programs where volunteers escort elderly citizens to their various appointments. This reduces a senior’s total cost for an appointment because they won’t need to pay for transportation.

All in all, we are a country founded on the people’s voice. If we want our nation’s healthcare system to improve, we have to shout it at the top of our lungs. If enough Americans call for a nationwide healthcare system, the government will have to listen. For SAK, it all starts with a blog…

http://blogs.usatoday.com/oped/2007/09/whats-wrong-wit.html
http://www.msnbc.msn.com/id/10842565/site/newsweek/page/0/
http://www.ahrq.gov/news/press/pr2006/nhqrdrpr.htm
http://www.nchc.org/facts/cost.shtml
http://www.nytimes.com/2006/12/03/business/yourmoney/03view.html
http://query.nytimes.com/gst/fullpage.html?sec=health&res=950DE3DF1F38F937A1575AC0A96F948260
http://nhperg.org/
http://www.familiesusa.org/issues/minority-health/
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1276629
http://www.usatoday.com/news/health/2007-07-17-health-main_N.htm
http://the.honoluluadvertiser.com/article/2007/Sep/28/ln/hawaii709280359.html
http://money.cnn.com/news/newsfeeds/articles/prnewswire/CLTU07711092007-1.htm
http://www.redcross.org/services/volunteer/0,1082,0_423_,00.html
http://www.nursingshortageinfo.com/
http://www.deionassociates.com/comment/valium.gif
http://www.osc.state.ct.us/reports/health/hcrpt2/images/hcr2ch19.gif

The History of Healthcare in the United States

Healthcare has been an ongoing issue in the United States for quite some time. In fact, in 2004, it topped the list of America’s most worrisome issues, ranking higher than terrorism and second only to jobs. Healthcare is under constant attack from the public. It is often criticized of its sharply rising costs – we spend more on healthcare than most other industrialized nations, and these increasing trends don’t seem to be subsiding. It is also criticized for being inaccessible – healthcare services are not available to everyone, and even when they are available, many cannot afford to pay for them. Hopefully by studying the history of our healthcare system, we can get a better understanding of how we ended up in our present situation.

Currently, we consider healthcare to be the responsibility of a third party separate from ourselves, and expect that others to provide it for us. But up until a hundred years ago, healthcare was considered to be a personal and familial responsibility. At the end of the 18th century and beginning of the 19th century, society was mainly agrarian. The majority of people lived in rural areas where access to doctors was limited. Thus, many came to depend on local homeopaths, herbalists, midwives, and barbers, and home remedies were regularly administered. In other colonies, where religion was very prominent, there was little demand for practitioners since sickness was thought to be punishment for immoral conduct.

Medicine was still quite primitive at this time – it was not regulated, and anyone could become a “doctor”. Yet these doctors were not highly regarded, for their treatments could not be depended on to be successful. These treatments were often based on four humors – blood, phlegm, black bile, and yellow bile – where stable health was thought to be due to a balance between these humors. Thus, in order to cure illnesses, they would withdraw amounts of these bodily fluids to try to achieve a balance. Since medical treatments were often provided by under-qualified practitioners, healthcare was rather affordable.

Yet gradual progress took place during this time. In 1751, the first hospital in the nation, Pennsylvania Hospital, was founded by Dr. Thomas Bond and Benjamin Franklin “to care for the sick-poor and insane who were wandering the streets in Philadelphia.” Then, in 1765, the first medical school was established at the University of Pennsylvania. Thus launched the idea of having an educated medial field. By the mid-1800s, the healthcare market had slowly become professionalized by college educated doctors. Yet there were still a number of under-qualified practitioners still in the business, which caused medical standards to remain low. So in order to instate professionalism, the American Medical Association (AMA) was founded. Laws were passed that made medical licenses a requirement for physicians. Since the few legally practicing doctors no longer had to compete with un-qualified practitioners, they were free to increase their costs. This marks the beginning of the high prices of healthcare, as comparable to our modern system.

During the Civil War period, a few advancements were made. The first health insurance plans were introduced during this time. Although they primarily covered accidents related to rail or steamboat travel, the paved the way for more comprehensive plans, including the first individual disability and illness policy established in 1890. Also during the Civil War, doctors began to specialize in various fields, beginning with the start of ophthalmologists in 1864.

One great development of the 19th century was the understanding of the cause of infection. With the introduction of antiseptic procedures, rates of infection related with medical care were drastically reduced. Also, doctors were no longer relying on balancing humors, but were instead focusing on symptoms and demographics. As medical treatments improved and cures proved to be more successful, the fear of medical care lessened, and respect for and trust in doctors improved.

Significant progress towards modern healthcare became obvious during the Industrial Revolution. The Industrial Revolution marked the beginning of the need for modern healthcare. Society became much more urbanized, moving away from its original rural state. These denser populations concentrated healthcare needs. People began to work away from home, which made it more difficult for families to supply home care. Specialization increased the dependence on others for services. In other words, now that an individual was being trained for and working solely in a specific job, he had to rely on others to provide him with what he was unfamiliar or inexperienced with. Also, industrial accidents and illnesses increased the need for healthcare services. For instance, the railroad industry developed the leading employee medical program (keep in mind that building railroads was a very dangerous job).

Many more advances were made in the beginning of the 20th century. According to PBS, the AMA’s membership increased from 8,000 in 1900 to 70,000 in 1910 (half of the country’s doctors), furthering the concept of organized medicine. Also during this decade, doctors no longer provided free services to their patients. Hospital improvements were made –there were only a few hundred in the nation in 1900, but by 1930, there were 7,000. They also became much cleaner, since the rise of the nursing profession improved hygiene and quality of care. But with the growing prices of healthcare, groups such as the American Association for Labor Legislation (AALL) began fighting for federally provided health insurance. Yet many of their efforts were unsuccessful.

By the 1920s and 30s, the federal government started limiting its healthcare coverage, which was especially evident following the Great Depression with the Social Security Act. Also during this decade, the Blue Cross offered the first privatized health insurance coverage. Then, during WWII, companies began to provide health benefits in hopes of attracting more workers, which led to our current employer-based system. Following WWII, President Truman proposed the first national healthcare program, but it received little support from the public, which viewed it as a “communist plot.” Thus, the healthcare system adapted into our modern system, where many Americans receive private coverage from companies and the poor rely on welfare. Then in the 1960s, President Johnson passed the Medicare and Medicaid Act, which provided healthcare to low-income people. But since his presidency, healthcare costs have continued to escalate.

As we can see from the history of America’s healthcare, our modern system is a product of various fundamental factors, the most important and reoccurring ones being economic competition, private practice, and government regulation. Hopefully we can learn from our previous courses of action and use this knowledge to better our current situation.

Sources:
http://www.pbs.org/healthcarecrisis/history.htm
http://72.14.253.104/search?q=cache:o4j5qhSy3OsJ:www.chernoffdiamond.com/academy/appendix%2520c.pdf+healthcare+history&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a
http://www.citizenshealthcare.gov/healthreport/healthreport.php
http://select.nytimes.com/gst/abstract.html?res=F40717F93D5C1A728DDDA90B94DE405B808AF1D3
http://www.californiaspine.com/en/medical_history_and_ethics/history/history_of_health_insurance.htm
http://select.nytimes.com/gst/abstract.html?res=F50E12F73B5B157493C0A8178AD85F448785F9
http://www.uphs.upenn.edu/paharc/features/creation.html

National Healthcare Cartoons

Sources:
http://www.solidarity.com/hkcartoons/images/mike3aug.gif
http://www.healthcare-now.org/images/jonikeveryfixfix.jpg
http://www.gwinnettforum.com/images/Index_images/06.0824cartoon_large.jpg

The Current U.S. Healthcare Situation

Compared to the rest of the countries in the world, the United States is actually at the top for providing healthcare in one form or another for her citizens. The United States spends more on healthcare than any other industrialized nation. The healthcare in the United States is a combination of privately and publicly funded programs which cover nearly 60 million Americans. The publicly funded programs are those provided by the government, but they very rarely cover all the health needs of the average citizen. The privately funded programs are the ones that are run by private, medical corporations and hospitals (i.e. Kaiser Permanante). The privately owned medical programs are usually better in terms of providing patient needs, though the costs are considerably higher. Of course, there are many things that health insurance and premiums don't cover, such as some prescription drugs or illness and injuries that just so happen to fit through a loophole in the premium's coverage. So what I'm really trying to say here is that everything comes down to money. The healthcare in the United States is getting increasingly expensive and although the medical technologies and programs is better in the U.S. than in other countries, it's begin to seem more expensive than it needs to be. At this point, there are families in the United States that are choosing healthcare over proper food.

At the moment, the United States is leading the way in the field of medicine and its related technologies. From developing innovative ways to cure cancer to finding out how to enlarge specific parts of the human body, the number of different types of medical processes that an American citizen can participate in are almost infinite. However, as stated before, the costs are simply getting out of hand. Americans are not getting value for the money that they spend on healthcare. Currently, almost 45 million people in the United States don't have proper health insurance simply because it's too expensive. Most of those 45 million are workers who aren't provided with health premiums because their companies either don't pay them enough or are using the Wal-Mart-Part-Time-Pay ruse to cheat their. Furthermore, 27 million of those 45 million are senior citizens who don't have a steady income anymore because they've retired. A study showed that the average healthcare cost per American was around $6,700 a month, which totals to over 2 TRILLION dollars promptly paid to public and private health organizations. At the current rate of health cost increase, the total healthcare cost of all Americans is projected to reach 4 trillion dollars by 2015.

Although it seems as if the government needs to take a larger role in all this, most of the fault actually goes to employers and the health care organizations. Employers need to stop concentrating only on their profit and worry about their employees. If some employers would stop abusing their part-time workers, such as Wal-Mart, then a good chunk of our healthcare problems would disappear. Healthcare organizations are also to be blamed. Many privately owned hospitals are increasing their charges not simply because hospital running costs are rising, but because they want more profit. Some hospitals are putting money before their patients' well-beings. As for the government, President George W. Bush and a large number of employers and insurers have met up and agreed to do a complete overhaul of the US Healthcare System. These past few decades, the US Health System has been dragged down by government-imposed mandates, wasteful bureaucracy, and massive distortions in the US tax code that punish self-employed and low-income worker. The government is going to try to increase the number of publicly funded health programs and decrease the costs of healthcare. Bush and co. are focusing on the measures that are sensitive to medical care making a difference, such as infant mortality and healthy lives after the age of 60.
To conclude, healthcare in the United States is the best in the world, though the costs are getting outrageous. At this rate, many people soon won't be able to afford healthcare. The main goal that our government and other medical organizations are trying to make is to keep the quality and standard of US medicine and treatments while keeping it affordable.



http://en.wikipedia.org/wiki/Health_care_in_the_United_States
http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/03/a_free_market_cure_for_us_healthcare_system/
http://www.aflcio.org/issues/healthcare/whatswrong/
http://www.consumeraffairs.com/news04/2005/medical_errors.html
http://www.nchc.org/facts/cost.shtml
http://healthfieldmedicare.suite101.com/article.cfm/universal_health_insurance_in_us
http://www.msnbc.msn.com/id/18674951/

Local Healthcare Premium Costs Graph

As this graph illustrates, while Hawai'i's health insurance premium costs have risen drastically in recent years, benefits have not risen as rapidly. Thus, it now costs more to receive the same (or fairly similar) healthcare service.

Source: http://www.hapta.org/images/graph.gif

Local Health Insurance Coverage Graph

Although Hawai'i's uninsured percentage has risen over the last decade and a half, it still has significantly fewer uninsured than the rest of the nation (about 6% fewer).

Source: http://www.healthtrends.org/healthmarket_uninsured.aspx#graph

What is the current situation regarding healthcare in Hawaii?

In general, Hawaii has ranked fairly high for healthcare over the past few decades. In fact, an article published by WebMD (via CBS News) on June 13, 2007 revealed that Hawaii is currently the best state for healthcare – it scored two to three times higher than the lowest ranked states. The poll, taken by the Commonwealth Fund, was based on many factors, including access, quality, cost, insurance, preventive care, potentially avoidable hospital visits, and premature death. Hawaii's top ranking is probably due to its increasing number of insured adults. "In general, states that did well in the overall rankings had the lowest rates of uninsured in the nation," Cathy Schoen, the Commonwealth Fund's senior vice president, said. Hawaii was the first state to make it mandatory for employers to provide health insurance. This, along with our relatively low unemployment rate (2.6% in July), means that Hawaii has a fairly high number of employed, insured people. In fact, a related Star Bulletin article regarding the Commonwealth Fund poll stated that nearly 90% of Hawaii’s working adults are now insured. Furthermore, the rate of uninsured children was cut from 10% in 2000 to 5% in 2005. As long as Hawaii's number of insured residents remains steady or continues to increase, Hawaii may maintain its leading rank in healthcare.

Another aspect of Hawaii's healthcare that stands out is its accessibility (Hawaii ranked first in this category). This can be largely attributed to the state's prepaid health care act. Furthermore, a report from the National Center for Health Statistics (NCHS) showed that from 1994 to 2003, Medicaid took action to increase the number of healthcare recipients in Hawaii, resulting in a jump from 41,000 to 209,000. Also in the last decade, the percentage of the population registered in Health Maintenance Organizations (HMOs) has grown to 37.5% (final estimate made in 2005), which is higher than ever before. These accounts illustrate how Hawaii is taking steps towards making healthcare more accessible. Another strong point for Hawaii is its inpatient care. For example, Hawaii ranked fourth for avoidable hospital use and costs, eighth for healthy lives, and eighteenth for quality of care. It also has the lowest rate of breast cancer deaths and came in sixth for lowest in colorectal cancer deaths.

But Hawaii is not without its faults. As the Commonwealth Fund study showed, even for the highest ranked states, the performance fell "far short of optimal standards" in key areas. There are some noticeable categories in which Hawaii lacks strength. Our state was 49th for surgical patients receiving appropriately timed antibiotics, 47th for heart-failure patients given written discharge instructions, 44th for hospitalized care of patients with myocardial infarction, congestive heart failure and pneumonia, and 41st for the percentage of 50+ adults receiving recommended preventive treatment “We fell down in the area of patient education and hospital discharge planning and we need to look at a better job of screening and preventive care for adults over age 50,” said Loretta Fuddy, the state Health Department deputy director for administration. We should focus much of our efforts on improving and fixing these issues if we want to improve healthcare for the state.

Another issue Hawaii has been challenged with is having a large number of waitlisted patients. We have one of the lowest ratios of beds per population in the country (approximately 1.9 beds per 1,000 people in 2005). This allows for little flexibility, which causes dilemmas during heavy situations such as the flu season. This problem greatly affects the elderly, as they make up the majority of waitlisted patients. Currently, the Healthcare Association of Hawaii is trying to ease this problem. Another issue is the decreasing number of local doctors. An article from The Honolulu Advertiser sites that there has been a 29% drop in the number of orthopedic surgeons and a 9% drop in the number of obstetricians in the past few years, and these percentages are expected to increase. This is mainly due to doctors quitting and retiring because of the high cost of malpractice insurance and the risk of being sued.

(above: Tripler Army Medical Center). Hawaii also faces financial issues with its hospitals. As programs such as Medicare and Medicaid have made themselves more available to Hawaii’s residents, the quality of healthcare has seemed to drop. Between 1995 and 2006, the number of hospitalizations for Medicare and Medicaid patients increased by 35% and 56%, while private payers decreased by 18%. By 2006, private insurance represented 30% of the annual discharges and Medicare and Medicaid represented 49%. Currently, Medicare and Medicaid patients comprise half of all hospitalized patients in the state. And with government payers paying considerably less than the cost of providing care, this has most likely contributed to why Hawaii’s hospitals struggle financially. In fact, hospitals were paid 7% below costs in 2006. This was found to be especially true for Molokai and East Hawaii, where many people are covered by Medicare, Medicaid/Quest. On the other hand, patients on Lanai, Maui, and North Hawaii are generally better off, since many of them have private insurance. Yet, even though Medicare and Medicaid contribute the most to hospitalization charges, more of the population is covered by private health insurance. Thus, Medicare and Medicaid patients prove to be disproportionally demanding on Hawaii’s taxpayer money and healthcare system.

Below is a graph based on national figures. As it shows, Medicare and Medicaid (government run medical insurance programs) are predicted to exhaust more of our resources in future years. Although these are crucial programs, they are quite expensive. If recent trends continue, Medicare and Medicaid will account for approximately 30% of our nation's government spending by 2020, and 36% by 2040. This reflects locally as well.


While many of Hawai'i's healthcare issues seem difficult to fix, there are some possible means of action. We could reduce Medicare expenses in the hope that it would allow those with a real need to receive adequate care. We could also allocate more money to preventative care. Approximately 12% of hospitalizations in 2005 were preventable through immunization, common education, or improved outpatient care. If we invest in these areas, we may end up saving money overall.

Sources:
http://www.hhic.org/ (specifically "past articles")
http://www.healthtrends.org/
http://starbulletin.com/2007/06/13/news/story01.html
http://www.cbsnews.com/stories/2007/06/13/health/webmd/main2923760.shtml
http://the.honoluluadvertiser.com/article/2005/May/09/ln/ln03p.html
http://www.bls.gov/news.release/laus.nr0.htm
http://72.14.253.104/search?q=cache:6czOicnwZlwJ:govinfo.library.unt.edu/ota/Ota_1/DATA/1993/9327.PDF+govinfo.library.unt.edu/ota/Ota_1/DATA/1993/9327.PDF&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a
Tripler image: http://en.wikipedia.org/wiki/Tripler_Army_Medical_Center
Graph image: http://www.citizenshealthcare.gov/healthreport/images/figure5.jpg

What needs to be done?

Actually, Hawaii is doing extremely well in terms of making sure its citizens get the proper health care and medical insurance. The island chain was the very first state to make it mandatory that employers provide medical insurance for their workers. Most of the employees in Hawaii are granted avoidable hospital use and other medical costs. Because of this, Hawaii boasts a healthier workforce and population, and thus, has the longest lifespan of all 50 states.
However, as good as Hawaii's rankings are in terms of health care coverage, there is a rising problem at hand. The cost of health care and insurance premiums for employers is get increasingly expensive. In order to counter such an inflation in prices, the employers are left with only two options: cut employees or find ways around having to provide health insurance for their workers. Cutting employees is pretty self explanatory. In order to make sure that money is not being siphoned off too quickly from their vaults, employers will lay off their workers. Finding ways around having to provide health benefits for employees is something completely different. Employers that are usually trying to beat the system are the larger companies who have hundreds of employees working for them. Obviously paying for the health benefits of hundreds of workers puts quite a dent in the pockets of the employers. One way of avoiding having to pay is by hiring only part time workers. The law states that employers only have to cover the health costs of their FULL TIME employees. By allowing their workers to work only in 4-5 hour shifts, companies don't have to pay for health premiums.
So what exactly is causing the prices of health care to rise? Factors such as new, more expensive technologies, medical lawsuits, lack of "reinsurance", inflation, and economic fluctuations all affect the costs of health premiums. Reinsurance is, to put simply, insurance for the insurance companies. The number of companies willing to provide insurance for other insurance companies is falling since the number of lawsuits are increasing. Health insurance companies need the reinsurance to prevent catastrophic losses (i.e. mass lawsuits). Economic fluctuations are changes in the market for health premiums. An insurance company needs to find the right balance between cost and risk. If risk, the chances of something really bad happening to the client, rises, then the cost must also go up.
At the moment, there is only one sure-fire way of reducing the costs of health premiums. The government must provide some money to companies to help cover the health costs of their employees. There should be some sort of system where, based on the number of workers who are being covered by the company, the employee gets a certain amount of money to help pay off health care costs. The government should also do something about companies who are hiring only part time workers (i.e. Walmart). Those companies should at least give partial coverage of health care if not whole coverage.

http://www.nal.usda.gov/ric/ricpubs/RHNsprsum02.htm
http://www.hawaiihealthguide.com/healthtalk/display.htm?id=580

A History of Healthcare (And Doctor Screwing) in Hawaii

Healthcare in Hawaii has come a long way since the beginning of the twentieth century. During its history, it has improved the insurance and medical situation of its citizens, but at the same time it has placed a burden on practicing physicians.

The health of native Hawaiians is of special concern to the scholar of Hawaii’s healthcare, because their immune systems are less capable of coping with most diseases than the whites. When European illnesses were first introduced with Captain Cook in 1778, the Hawaiians lacked the antibodies to combat the diseases. “In 2002, Hawaiians (had) some of the worst health statistics in Hawaii for morbid obesity, substance abuse, depression and other mental illnesses, diabetes, respiratory illnesses, heart disease, cancer mortality” (nativehawaiianhealth.net) Due to the fact that native Hawaiians are generally less wealthy than the state’s average person, they need financial aid to pay insurance premiums. Several organizations throughout the islands, such as Oahu’s “Ke Ola Mano,” have represented and advanced the native Hawaiian healthcare agenda.

Emergency medical services are of paramount importance to local healthcare. The Honolulu Department of emergency services was established in 1908, and chartered its own ambulance service in 1916. When the system first began, ambulance drivers were required to have “a chauffeur's license, high school education or equivalency, American Red Cross First Aid Course, and no felony record.” Over the years, required training in CPR and other modern EMT (Emergency medical technician) functions were also tagged onto the job description. By 1977, we had a federally recognized Emergency medical services program that was considered an example for the rest of the nation. “The 911 system” became statewide with the Big Island’s cooperation in 1996.

Nursing statistics over the past six years has shown a general decrease in the number of nurses working in Hawaii. Measures should be taken to rectify this situation, as hospitals cannot be run without nurses.

Health insurance in Hawaii has generally been considered a success. In 1932, Hawaii’s legislature was already debating the topic of mandatory health insurance. By that time, the pineapple and sugar plantations had already given their employees a form of employment based medical insurance. By 1961, state employees were given a choice between Kaiser, HMSA, and Aethna life plans. In 1974, Hawaii enacted mandatory “employment-based health insurance,” or the (HPHCA: Hawaii prepaid healthcare act.) Nationally, this was the first act to push mandatory minimum healthcare standards for workers. In a 1978 report, the act was deemed successful by the Martin Segal Company. Due to several acts following this ground-breakingly controversial act (like the state health insurance program, passed in 1989), health insurance is potentially available to every Hawaii resident. Although we do not have a perfect insurance system, it is a model by national standards.

Our model health insurance system does take its toll on the livelihoods of doctors. Specialist doctors feel that high liability surgeries are more trouble than they are worth, citing high malpractice litigation. Doctors have argued that Hawaii’s high malpractice law should be reformed to make a career in medicine profitable. Insurance companies sue doctors, who aren’t covered by the state, to cut down their own costs of patient coverage. As far as doctors being properly paid by insurance companies, since most of Hawaii’s residents are covered by HMSA, doctors have little choice but to accept their decreasing reimbursements. Specialists are leaving Hawaii for states where they will make a substantially larger income for their work.

Sources:

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=14593658&dopt=AbstractPlus

http://starbulletin.com/2006/05/16/news/story04.html

http://72.14.253.104/search?q=cache:6czOicnwZlwJ:govinfo.library.unt.edu/ota/Ota_1/DATA/1993/9327.PDF+govinfo.library.unt.edu/ota/Ota_1/DATA/1993/9327.PDF&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a

http://www.co.honolulu.hi.us/esd/ems/emshist2.htm

http://www.nativehawaiianhealth.net/history.cfm