ARTICLE: In Hawaii's Health System, Lessons for Lawmakers, By GARDINER HARRIS, New York Times, October 16, 2009

The joy of having 50 simultaneous experiments going on: Hawaii has required all employers to make health care available to any 20-hours-or-more employee, and it's done it for 35 years. The outcomes are impressive:

But perhaps the most intriguing lesson from Hawaii has to do with costs. This is a state where regular milk sells for $8 a gallon, gasoline costs $3.60 a gallon and the median price of a home in 2008 was $624,000 -- the second-highest in the nation. Despite this, Hawaii's health insurance premiums are nearly tied with North Dakota for the lowest in the country, and Medicare costs per beneficiary are the nation's lowest. Hawaii residents live longer than people in the rest of the country, recent surveys have shown, and the state's health care system may be one reason. In one example, Hawaii has the nation's highest incidence of breast cancer but the lowest death rate from the disease. Why is Hawaiian care so efficient? No one really knows.

Worth finding out, yes? The encouraging part:

But the Hawaii experience suggests that overhauling health insurance before changing the way care is provided could work, eventually. With more people given access to care, hospital and insurance executives in Hawaii say they have been able to innovate efficiencies. For instance, the state's top three medical providers are adopting electronic medical records -- years ahead of most mainland counterparts. The Hawaii Medical Service Association, the state's largest insurer and a Blue Cross Blue Shield member, recently offered the nation's only statewide system whereby anyone for a nominal fee can talk by phone or e-mail, day or night, to doctors of their choosing. Kaiser Permanente Hawaii, which covers about 20 percent of the state's population, screens 85 percent of its female members ages 42 to 69 for breast cancer, among the highest screening rates in the country.

Most impressive: ERs are not overburdened as a result.