Reflections on national health care reform based on Hawaii's experience

In 1974, Hawaii began addressing the problem of health care accessibility. As a result of legislative action, near universal health care coverage has been achieved. These include employer mandates to provide adequate health insurance, regulation of insurance products, control of costly health care facilities, and government assistance to those not provided health insurance through employment. By providing primary care, total health care costs are considerably below national average--even though actual cost of living is over 30% greater. Public health statistics suggest a healthier population than the national average. This cannot be attributed to a healthy or relaxed lifestyle or ethnic mix, but rather to the state health care system itself. Economically and culturally, Hawaii closely resembles the rest of the United States, and there has been no evidence of reduced employment due to the aforementioned employer mandate.