The citizens of the offshore state of Hawaii have something that millions of mainlanders without health insurance want. What is noteworthy is that they got it in 1974 because of a union that cared enough for the health of everybody to include everybody, a union that had the militancy and the muscle to write the legislation and see it through the Legislature and become law.

The union in question, the International Longshore and Warehouse Union (ILWU), has a long history of militancy and fighting for social justice for all. They most recently faced down the Bush administration when Bush threatened to use the Navy to take over the docks in the last round of contract negotiations.

In Hawaii the ILWU wrote legislation called the Prepaid Health Care law of 1974. They crafted the law in such a way that, as of 1994, 94 percent of Hawaiians had health coverage. They then led the struggle to have the law enacted. From that day to this, in spite of the inflationary pressure of the profit-driven health industry in our country, the people of Hawaii enjoy better and fuller coverage than any other state in the nation. Hawaii ranks near the top compared to other states in life expectancy and low infant mortality.

The plan requires employers to pay into the plan for every employee who worked 20 hours or more. The employees pay into the plan no more than 1.5 percent of their monthly wages. Even more radical is the provision that any health insurance company that wanted to do business in Hawaii had to accept all comers. Since for-profit insurance companies do not like to insure people that are not 100 percent healthy, this prevented “cherry picking.” As a result, nonprofits like Kaiser-Permanente were left as the main insurers, keeping cost low. When employers trying to evade the requirements hired more part-timers, the Legislature passed the State Health Insurance Program, which is open to all who do not have insurance, and they pay premiums based on income. Legislation has been passed to add those not covered by Medicare, Medicaid, or private insurance, and the law emphasizes comprehensive, preventive care.

In 1994, health care programs for Medicaid and other low-income groups were converted into managed care plans. These programs, along with compulsory auto insurance and workers’ compensation, mean that Hawaiians have the most complete coverage of any state in the union. When the percentage of the gross state product spent on health care in Hawaii is compared to the rest of the states the advantages of the Hawaiian system stand out. In the mid-1990s the national average was 14 percent and for Hawaii it was 9 percent. In other words, more coverage for less money. Survey after survey demonstrated that the majority of small business people approved of the system. With the number of uninsured rising, in New York City, it is now approaching an appalling 27 percent. DC 1707 Executive Director Raglan George Jr.’s column a year ago is more than ever right on the money:

“I say it’s the labor movement itself that should write its own national health legislation. This would put labor at the front door, not back door, of health policies. It is the flip side of labor’s having its own people run for public office, rather than rely on others to protect our interests. Labor has the expertise to write this historic piece of legislation. Labor unions and their negotiated benefits fund leaders have more experience in health care benefits than anyone else in the country.”

When Bill Clinton, newly elected as president, attempted to write new national health care reform legislation, the newspapers had many articles about the Hawaii experience. The headlines read:

Hawaii ranks healthiest in national survey (USA


Hawaiians like their health care system (The San Francisco Chronicle)

Health care in paradise (St. Louis Post-Dispatch)

Hawaii offers look at state of full coverage (USA


Health care is called a model for U.S. (The New York Times)

Hula and health care (The San Francisco Chronicle)

Hawaii shows it can offer health insurance for all (The New York Times)

While mainland debates, Hawaii’s system works (USA Today)

Coverage system resembles proposal expected to be offered by the White House (The Washington Post).

The insurance and drug companies unleashed an unprecedented effort to bury the Clinton initiative. They succeeded, and also buried the example of the successful example in Hawaii. It remains the most progressive of any health care system in the nation and should be publicized. And, of course, due recognition should be given to that most progressive and democratic institution, the International Longshore and Warehouse Union.

David Buxenbaum is a trade unionist. This column originally appeared in the July/Aug. issue of AFSCME District Council 1707’s publication, DC1707 Voice.