I accepted a very arduous travel arrangement requiring that
I take a quickie 3-day trip to Hawaii last weekend to speak at a physician
conference, and also attended a meeting with the fledgling Hawaii Chapter of the ACC. Finally,
we may be able to add some ALOHA to the ACC agenda!
The meeting with the Hawaii Chapter was promising. Hawaii, where everything is more expensive
than the mainland, EXCEPT for health care, is one of the per capita lowest cost
health care spending states, despite also having better population-based outcomes
at lower costs. Hawaii
has a lot to teach us. Stay tuned folks. We can be mentored by our colleagues there.
Even though health care in Hawaii, where ALL
employed people have health insurance, is far from perfect, it’s a lot more
perfect than the rest of the US.
Some surmise this is because Hawaii is more generous
in its treatment of those at the lower end of the economic totem pole (not a
Hawaiian metaphor) than the rest of America. Others theorize that Hawaii is so successful
because it has a population that is genetically superior. We think that is the
case in Washington DC
too (!), but there is absolutely no evidence for it here or in Hawaii, according to
CDC, which notes that Polynesians have some of the most high risk genetic
factors of any subpopulation in the country. Another theory about Hawaii’s
lower health spending and lower morbidity and preventable mortality relates to
the alleged superior lifestyle benefits of Hawaii, where the thinking is that all
citizens spend most of their time surfing (this is again certainly not the case,
and in fact obesity and sedentary lifestyles are very common there). Then there
is the mysterious “Island Factor” not yet discovered by Manhattan,
Puerto Rico, Nantucket, or the Caymans that
might explain things?
Well, the reality of Hawaii’s
relative success is not that complicated: Hawaii’s benefit comes from 20 years of
universal coverage of all working families who have had better access to good
primary and specialty care. The reason Hawaii
has the highest incidence of breast
cancer of all 50 states, for example, along with the LOWEST death rates for breast cancer, is that Hawaii citizens have
access to primary care prevention and surveillance generally. Our CV colleagues
there will nonetheless share that they are just as frustrated with Medicare
spending and payment cuts, and the impending Medicare Rule for 2010 as
everybody on the mainland. They are clear the health care there, while better
in many ways, is in trouble in the future like everywhere else. And it won’t
get fixed by having another Mai Tai.
That said, the lesson of the benefits of great access to
both primary and specialty outpatient care in reducing preventable morbidity
has been discovered not just in the 50th State, but in all other
developed nations except ours.
UPDATED: Check out this piece from the Honolulu Advertiser about my trip.