The health crisis in Hawaiʻi demands immediate attention, and Governor Josh Green must step in to address the proposed consolidation between Hawaiʻi Pacific Health and HMSA. This consolidation would only exacerbate the existing issues of limited access to healthcare providers and services.
On the island of Maui, the impact of healthcare shortages is very real. Patients face late-night dialysis appointments, long waits for cancer biopsies, and surgeons operating at odd hours due to a lack of operating rooms. Families are even forced to leave the island for essential medical care.
These challenges are not random or inevitable. They are the direct result of policy decisions, including consolidation, restrictive regulations, low reimbursement rates, and market structures that favor large institutions over competition.
Maui residents bear the brunt of these choices daily. Dialysis patients must endure late-night treatments, and those with suspicious breast findings face months-long waits for biopsies. Even those with urgent psychiatric needs wait for months, if they are seen at all. The human cost of these delays is immense, impacting health, families, and livelihoods.
To understand the root causes, we must examine the forces shaping Hawaiʻi's healthcare system. At the heart of the crisis are Certificate of Need laws, hospital and insurer consolidation, and a two-tier healthcare system that leaves Maui residents with limited choices and extended wait times.
In theory, Certificate of Need laws aim to prevent unnecessary duplication and protect communities from low-quality providers. However, on Maui, these laws have restricted the development of essential services like imaging centers, dialysis facilities, and surgical centers, even when the need is clear and urgent.
The consequences are stark. Maui, with a population similar to Little Rock, Arkansas, has only one major hospital system compared to Little Rock's four. This lack of competition leads to rationed care, growing waitlists, and a prioritization of high-reimbursement services over community-based diagnostics and necessary procedures.
Consolidation further compounds these issues. On Maui, patients face a two-tier system. Kaiser, with its vertically integrated model, often routes patients to Oʻahu for simple procedures, managing costs at the expense of patient convenience. The dominant hospital ecosystem, with little competition, has limited incentives to expand community-based services.
In both systems, patients experience delays, substitutions, and denials. Colonoscopies are replaced with less effective stool tests, and imaging and procedures are deferred. Care is dictated by insurance rules rather than clinical judgment.
The proposed deeper integration between Hawaiʻi Pacific Health and HMSA would intensify this dynamic. Vertical integration between insurers and hospital systems gives them pricing power, reduces transparency, and pushes out independent providers. This is not speculation; it's basic economics.
Research shows that consolidation in healthcare consistently leads to higher prices, while promised improvements in quality and efficiency rarely materialize for patients. When competition decreases, prices rise, innovation slows, and service quality declines. The efficiencies gained by large systems are rarely passed on to consumers.
The harm extends beyond patients. Small businesses and trades suffer as healthcare costs rise and access shrinks. Electricians, plumbers, farmers, and contractors are legally required to provide or purchase health insurance, but in a monopolized market, premiums outpace income, forcing them to cut staff, limit growth, or close down.
This consolidation is not accidental. It is a direct result of the market-driven framework adopted by the Affordable Care Act, which shifted healthcare away from a patient-doctor relationship model and towards a transactional subscription model. Care is now mediated by networks, formularies, and prior authorizations, with control shifting upwards and local-led care weakening.
This logic has spread across the economy, turning us into subscribers rather than owners, renters instead of homeowners, and employees instead of independent operators. Control is concentrated at the top, while local autonomy and resilience erode.
The governor has the power to act. Imposing guardrails on healthcare consolidation, opening Hawaiʻi's insurance market to competition, ending "paper capacity" by requiring approved projects to be built, and enforcing network adequacy laws are all within reach. These actions can begin within months, even if not all problems can be solved overnight.
Maui's healthcare system is failing to meet basic community needs. Consolidation has reduced choices, Certificate of Need has restricted supply, and vertical integration has shifted control away from patients, doctors, and small businesses. The lived experiences of Maui residents make this undeniable.
Governor Josh Green has expressed a commitment to saving lives and improving healthcare. Now is the time to turn that commitment into urgent action. Healthcare consolidation is a powerful driver of rising costs, and the stakes are high. It threatens not just healthcare but the survival of Hawaiʻi's families, private practitioners, tradespeople, and small businesses.
When we look at the core of our political and economic realities, what's truly at stake is our sovereignty and freedom from complete concentrated control over our daily lives and livelihoods. Healthcare consolidation, through rising costs, is a mechanism for consolidating control over our entire economy and trades. Private equity firms and large corporations are exploiting the demand for healthcare to extend their control over various industries.
The impact of healthcare decisions extends far beyond the healthcare sector. It creates a tsunami of affordability issues for all goods and services we rely on. Affordability governs our ability to access housing, food, safety, and ultimately, our ownership over our lives.
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