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Recorded in April 1995, this discussion frames Hawaii's healthcare system against a backdrop of national alarm over costs. Deane Neubauer reports that the United States spends about $950 billion annually on medical care — roughly 14 to 14.5 percent of GDP, the highest in the world — and that costs have risen at roughly twice the inflation rate since Medicare and Medicaid began in 1965. He credits Hawaii's comparatively lower costs to four factors: a plantation-era tradition of primary care, a constrained hospital bed supply, enlightened preventive care policies, and the Kaiser-HMSA insurance duopoly. S. Y. Tan argues that while Hawaii's quality and access are admirable, healthcare is neither a pure right nor a mere commodity; rationing is already happening and the question is whether society will approach it rationally. The two press each other on managed care, gatekeeping, and whether QUEST — then newly launched — represents genuine reform. Callers raise pre-existing condition exclusions, insurance-driven cost inflation, physician pay, and the ethics of heroic end-of-life interventions. Neubauer's closing argument: controlling costs requires reducing demand, which means helping people become healthier.
Transcript
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