Jack Lewin, MD, who leads the efforts of the Hawaii State Health Planning and Development Agency under the governor’s administration, provided an update on healthcare delivery reform and efforts to increase access for locals at the 2024 Hawaii State of Reform Health Policy Conference.
Lewin highlighted Gov. Josh Green’s (a physician) work and said he is capable of producing a “Camelot” type of effect on healthcare, which is very much needed, he added.
“Think back to the original legend with King Arthur and the Knights of the Round Table for medieval England. They created justice and peace and prosperity, but then Sir Lancelot had an affair with Guinevere—the queen—and Camelot was gone. The point is, Camelots are like that—they’re ephemeral. Every once in a while, there is a bright moment where things happen, where expectations rise and people meet new expectations, and it’s an opportunity where you have to open your eyes and see and participate in. And I actually feel like that is where we are at now.”
— Lewin
Lewin pondered the meaning of living in a decent society, and listed five key things for all citizens to be able to do that. They all relate to equal opportunities: the opportunity for education, public safety, environmental wellbeing, food, housing security for folks who have low incomes, and quality healthcare.
“So, some sort of likely naive people have labeled me a health or healthcare futurist. I don’t really know, I mean Yogi Bear was right when he said making predictions is tough, especially about the future. And then another thought comes to my mind: a wise man once said nothing.”
— Lewin
While it’s important to look towards the future of Hawaii’s healthcare system, Lewin said the state also needs to be focused on the present. He cited Health Resources and Services Administration and U.S. Census Bureau statistics, which show over 35 percent of Hawaii’s residents have to travel significant distances to reach a primary care physician.
“Our Native Hawaiian population, our Pacific Islander population, even our Elders in rural areas—we have a lot of equity issues to tackle. Access, I mean we still have a persistent underinsured population here that’s not huge compared to most parts of the country. But it’s here.”
— Lewin
High costs of care must also be taken into consideration, Lewin said.
“We are part of the American healthcare non-system, are we not? And it’s a mess. It’s really a mess and there’s some good things about it as a physician … There’s a lot of progress we’ve made [over the years]. It’s impressive, it costs a lot, but we are in this system that costs twice as much per capita as the other developed nations of the world—that have universal coverage. “
— Lewin
Healthcare systems in developed countries differ, but they have a couple of things in common that the U.S. healthcare system lacks, Lewin said.
“One, everybody’s in. A defined set of benefits—there it is and everyone’s covered, no question. Two, there is a common overarching administrative and regulatory system instead of the complex nightmare we deal with in this country in that same area; I mean just so many different regulatory and administrative issues to deal with and we spend twice as much.”
— Lewin
While the goal should be venturing towards universal coverage, Lewin said, value-based reimbursement is necessary to create a better future for healthcare professionals.
“We really need to look at the new payment models. We need to implement them. We need to be bold enough to do it. We’re going to have to pilot, and find out what works, and then move forward,” Lewin said.