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—Hawaii is the only state to have provided nearly universal access to health care coverage to its residents for almost two decades. We readily acknowledge in our article that there is much about Hawaii's health care system that would benefit from more detailed review. However, we believe that the slowly accumulating body of evidence suggests that in Hawaii as in other places, such as Germany, Japan, and Canada, guaranteeing universal access to health care coverage produces better health outcomes and works to lower costs.We could wait for detailed studies to validate these conclusions (and in fact hope our work stimulates more study of the Hawaii system) but feel that an overview of Hawaii's experience is important for the nation at this critical juncture of health reform.Dr Arensdorf rightly points out the poor status of our mental health/substance abuse system. What he omits is the administration's success
Lewin JC, Sybinsky PA. Hawaiian Health Plan: Less Than Meets the Eye?-Reply. JAMA. 1993;270(17):2052–2053. doi:10.1001/jama.1993.03510170042021
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