ABSTRACT
In the late 1980s public officials in Hawaii believed that their state had entered into a "new era of health care." Since the gubernatorial election of 1994 Hawaii politics has been dominated by its most severe budget crisis since statehood, an event that has threatened to undo much of the liberal health care agenda that prompted the notion of Hawaii as "the health state." This chapter describes the setting of Hawaii, the health state. It assesses the impact of recent Hawaii politics on the dual goal of promoting universal access to care while controlling costs. The idea of Hawaii developing a special character as a health environment began to take form with the election of John Waihee as governor in November 1986. Many requisite ingredients were already in place, perhaps most important the fact that Hawaii is and seeks to remain a healthy place. The population of Hawaii is on the whole remarkably healthy when judged by conventional indicators.
