Health-Care Competition

If the solution to our so-called national health-care crisis were government-mandated health insurance provided in large part by non-profit insurance cooperatives, then Hawaii should have the best system in the country. The state mandates employer-provided health insurance, and the industry is dominated by HMSA, a non-profit health insurer. So why are the local hospitals struggling (two on Oahu have filed for bankruptcy) and local, especially rural, doctors leaving our communities? Because without real competition, the dominant payors -- HMSA, MediCare and Medicaid -- can set the reimbursement rates. They keep medical costs down through reduced payments to the providers. The result? Doctors leave for states where reimbursement...