Medicare for All no deal in Hawaii

By Bob Jones
MidWeek (Honolulu, Hawaii), Dec. 14, 2016

Psychiatrist Stephen Kemble, Punahou and Harvard Medical School alumnus, former president of Hawaii Medical Association and assistant professor at the UH medical school, has been advocating unsuccessfully for health care reform for at least 20 years.

He’d prefer single-payer, Medicare-for-all – or all-payer, where we’d retain insurance companies but they all would reimburse the same fees for medical services.

But in Hawaii – no deal. HMSA and the private insurers vote thumbs down and our governors and legislators sympathize with them.

A reform-mandated Hawaii Health Authority was created by the 2009 Legislature. Gov. Linda Lingle vetoed it, lawmakers overrode her, but Lingle refused to appoint members or release funds.

Gov. Neil Abercrombie appointed members in 2011, but Kemble says they started dropping out when the talk turned to dumping private insurance for a single-payer system. Then, he says, “Abercrombie tossed it under the bus.”

It hasn’t revived under Gov. David Ige and state health director Dr. Virginia Pressler.

Kemble says, “A fundamental reality is that competition among health insurance plans does not work to provide cost-effective health care. Competition creates perverse incentives and rewards health plans for avoiding coverage of sicker people, and denial of needed care and services.”

Kemble cites an international OECD study, which concluded that doctor visits and hospital days per capita in the U.S. are among the lowest of all industrialized countries, yet those others provide universal coverage while spending half of what we do per capita for health care.

Our total health care spending last year was $3.2 trillion, an average of $9,990 per person.

Would there be tax consequences under single payer? Yes. As The Washington Post put it: You can’t have all the good parts of universal coverage at affordable prices without mandates and regulations and large doses of subsidies. Anyone who says otherwise is peddling hokum.

In Canada, with health care income-tax-paid except for prescription drugs, dental care, ambulance services and prescription eyeglasses, claims are submitted to a single provincial health care agency for reimbursement, whereas here claims are submitted to the many insurance providers trying to squeeze out a profit or at least avoid a loss.

Colorado put single payer on the ballot last month and 80 percent voted “no” because it required a 10 percent hike in the state income tax.

The prevailing fight against single-payer systems seems to be led by the persistent lobbying of insurance providers listed as nonprofits but actually are Blue Cross and Blue Shield insurance affiliates.

However, the past five Hawaii Medical Association presidents, including the current Bernard Robinson, have favored the single-payer system.

Kemble says, “The private insurance business model aligns economic incentives against providers and recipients of health care, rewarding the denial of care.”

He adds: “It’s the paperwork, showing proof of no recurring illness, and prior authorization for certain drugs and medical services that drives our doctors nuts and out of private practice.”

Bob Jones, a MidWeek columnist, can be reached at