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With Congress debating major national healthcare reform, two University of Hawaii academics assessed the leading proposals and evaluated Hawaii's distinctive position. Frank Abou-Sayf, a professor of business with prior experience as chief statistician for HMSA and research director for Kaiser Permanente, was critical of the Clinton administration's plan: he argued that its global cost caps, managed-competition model, and reliance on a federal oversight board would suppress market forces without effective cost discipline. He recommended instead treating employer insurance premiums as taxable employee income, allowing workers to choose plans — a mechanism he argued would restore genuine price competition. George Bussey, a psychiatrist and medical director working within managed-care organisations, agreed that competition was necessary but cautioned that open consumer choice could leave high-risk patients unable to afford comprehensive cover. Both noted that Hawaii had operated an employer-mandate system for two decades and was therefore better positioned than most states. The standing question is whether a national reform framework can extend coverage to the uninsured without eliminating the competitive incentives that have helped contain costs in states like Hawaii.
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