HONOLULU — Since 1974, Hawaii has required all employers to provide relatively generous health care benefits to any employee who works more than 20 hours a week. If health care legislation passes in Congress, the rest of the country might barely catch up.
Lawmakers working on a national health care fix have much to learn from the past 35 years in Hawaii, President Barack Obama's native state. Among the most important lessons is that even small steps to change the system can have lasting effects on health.
Hawaiians live longer than people in the rest of the country, recent surveys have shown, and the state's health care system might be one reason. In one example, Hawaii has the nation's highest incidence of breast cancer but the lowest death rate from the disease.
But perhaps the most intriguing lesson has to do with costs. 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.
Why is Hawaiian care so efficient? No one really knows. Hawaiian doctors and hospital and insurance executives offered many theories, including an active population that is culturally disinclined to hospitals, and a health care market dominated by a few not-for-profit organizations. But there was another answer: With nearly 90 percent of the populace given relatively generous benefits, patients stay healthy, and health providers have the money and motivation to innovate.
There are problems. Hospitals on the outer islands are small and losing money. With unemployment rising, so, too, are the ranks of the uninsured — which is now 10.7 percent of non-elderly adults. Only Massachusetts has a lower share of uninsured adults, and the national share is 20.4 percent. Many in Hawaii are worried that legislation moving through Congress could, if it supersedes Hawaii law, allow employers to reduce the quality of care provided. So Hawaiian legislators have pushed for provisions exempting the state.
Richard Caldarazzo, 25, a manager at Lulu's Waikiki Surf Club, said he had worked at restaurants in Ann Arbor, Mich., and Chicago and never got health insurance. After he moved to Hawaii and got a job at Lulu's, "I was really surprised when they told me I'd get insurance," Caldarazzo said. "My parents couldn't believe it."
