The August 1996 issue of Small Business News included my commentary entitled, "Perverted Medicine?" I asked for comments from persons engaged in the medical care delivery.
Whew! I'm almost sorry I did that. I have been overwhelmed by a flood of information about the delivery system both from persons within and those who are customers. And, I regret to inform you that I was correct -- most say I don't know the half of it, the medical care delivery system in this state has been corrupted and perverted and, as usual, the customer and the persons delivering the services are paying the price in dollars, decreased services, frustration, declining professional motivation and capability and on, and on, and on.
Why? What's the root cause? That's an easy question. The customer's out of pocket cost has been separated from the service provided. The decisions on personal medical care have been shifted (or are shifting) from the recipient of the care (you and me) to a standardized form or a faceless bureaucrat, or both. More and more, the professionals are having less and less to say to you and me about viable options. The final result will be medical care in Hawaii comparable to that in the former USSR. Hawaii's Prepaid Health Care Act is a Socialist scheme. Period. For all intents and purposes HMSA and Kaiser are Socialist Government agencies (HMSA's exemption from Hawaii excise tax while providers have to pay it is particularly noteworthy). Let me quote from an anonymous Doctor member of SBH "...quagmire of red-tape, unrealistic expectations, exhorbinant business costs, adversarial attitudes, illogical mandates and endless regulatory headaches the delivery system faces every minute of every day ... puts every citizen at substantial risk to the most inimical sort of health care possible; least common denominator medicine, delivered, not by professionals, but by the newest breed of ersatz practitioner - health plan managers, government regulators and political puppet - masters!"
Did you notice that no mention whatsoever was made about you and me, the patient, and our personal desires or wants? From a patient comes a telling plaintive plea: "Who's setting up the rules?" "My HMSA plan doesn't cover chiropractic care." In other words, she, a consumer who wants to use chiropractic care is effectively frozen out. Her wants are not important to the persons who drafted, passed and amended and amended Hawaii's Prepaid Health Care Act. Furthermore, they're not being held accountable. And never will. You could die because of the Hawaii Prepaid Health Care Act and your family could sue a doctor or a hospital but they couldn't sue the "governing" legislators who decided that you were not smart enough to make you own decisions about your own health care (but indeed, they were). And, they were smart enough to be sure they couldn't really and truly be held accountable for the ensuing long term consequences.
What's the result in real terms? To quote our physician again "Most of those 'in the know' would agree that if everything in medicine was paid fairly, equally, on-time, without threat of litigation, and in cash, I dare say health care costs in Hawaii could be reduced at least 50%?" When it is your health, I don't really think you want or need the 'cheapest', most 'competitive', 'bottom-line' sort of care - such care is likely to be hasty, ill-conceived, poorly implemented, and unprofessional at best. And hazardous to health and longevity at worst (and I say that in spite of the best 'intentions' of my colleagues)."
My comment on that is this: You should make the decision. It's your life and your body. If you want the cheapest most unprofessional care you should be free to opt for it -- but you shouldn't be forced by the government or anyone else to take it.
Now you know why I pay cash for my medical care. I do not trust the system set up by the legislators and their lackeys who view themselves as Godlike in their ability to determine your and my needs and wants. But I trust the providers that I choose after we come to an understanding about my desires. I pay. A third party does not pay. If I use insurance, it is none of the providers business. It is my business. I file the claim. It is my insurance not someone else's.
What's the Bottom Line for you? What can you do?
For the short run, I recommend this for independent small business people: Get yourself a policy outside of the state mandated system. Get one that has $1,000 deductible, or even $5,000. Then follow the rules I use. And keep an emergency medical fund in readily liquid form.
For the long run, we need to get your business and all others out of the function of paying for medical insurance for employees. That act is perverting the whole system because the covered employee thinks his medical care is largely free. He is thus uncritical when it comes to important decisions and he tends to overuse the "free" services.
We need to push to sunset the Hawaii Prepaid Health Care Act. Or failing that, we need to change the deductible to a $500 to $1,000 standard. The standard is now $100 deductible and has been since the act was first passed in 1974. But the best solution is to do away with the employers government contrived obligation for health care costs for employees and get it where it belongs -- on the employee. That action, plus the recently proposed (by Republicans and Libertarians) tax-free medical savings account (MSA) which employers could fund with the dollars they save when they opt for higher deductible plans would actually "save the system for us, the consumers."
Here's a rough idea of how that would work. The employer would pay what he does now for medical insurance into an MSA account which the employee would own and control. The employee would obtain medical insurance and pay for it tax free out of the fund and the rest of the money would stay in the account and grow tax free. Costs for medical care could come out of the fund tax free. The fund would be good for life and could even be used for retirement income. Guess what? Most employees would opt for a high deductible and thus inexpensive policy and sock the rest of the money away. If the employee left one employer for another, nothing would change, he owns his policy, he owns his MSA. He is in control, as he certainly should be.
What's wrong with that plan? Apparently, a whole lot, in the minds of most of our legislators. They refuse, so far, at the national level, to pass the MSA provision. Our state legislators won't even address the topic - too complex for the minds attuned to "governing" you and me.
Vote for Sam Slom, he will tackle it. AND. Read Harry Brown's new book "Why Government Doesn't Work" You will be glad you did.
Politics and electioneering have come to the internet in a big way. Candidates, political parties, the government as well as privateorganizations maintain websites to inform the public and promote theiragendas.
Many of Hawaii's highly visible and financed political candidates haveinternet websites. Listed below are a few of the many websites pertainingto Hawaii's election.
ELECTION '96 WEBPAGE: http://kumu.icsd.hawaii.gov/elect96/ This site run bythe State of Hawaii, provides election results for races statewide, brokendown by each island county. Complete details on the total number of votescast per race including blank and spoiled ballots are listed here. Theprimary results were online about a half hour after they were reported tothe electronic media. The general election results will be posted to thesite the night of the election.
CAMPAIGN SPENDING COMMISSION FINANCE DATABASE
http://election.sdr.com/hi96/.
Campaign finance reports submittedelectronically by candidates running in most of Hawaii's major politicalraces. is available here. The database contains detailed lists of names,addresses and amounts contributed to the candidate on file. It also listscandidate expenditures for the filing period by name and dollar amounts.Interesting stuff here.
SBH/PAYCHECKS HAWAII ENDORSED CANDIDATES
Here are some known website
addresses to PAYCHECKS HAWAII endorsed candidates.
A list of links to more local candidates, political parties and connectionsto the national political scene is available by accessing The HawaiiConnections webpage at http://www.connect.hawaii.com/connect/. From thereselect the links leading to politics. A reprint of this article with activelinks to the pages above is available athttp://www.lava.net/~macpro/election.html. Also remember that SmallBusiness Hawaii maintains its newsletter website athttp://www.hotspotshawaii.com/sbh.html. From the SBH homepage select thelink "1996 Ratings of Hawaii's Legislators" to see how the lastlegislative session fared (not very good)...
* Policy with our website provider does not allow us to include active off-site links.
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