Enhance Quality of Life

Improve Employment, Education & Investment Opportunities

Upgrade Infrastructure and Review Our Master Planning Process

EMC Recommendations
:EMC Recommendations (continued)

Summary of Recommendations

2005 Final Report

VII. Healthcare
Advances in science and medicine should provide Americans with a healthcare delivery system that is the envy of the world, yet the system is marked by spiraling costs, inefficiencies, and unacceptable and uneven quality.  Access to quality healthcare consistently remains one of the greatest concerns to all Americans.  We need to control costs, while insuring that the providers of healthcare are adequately reimbursed by both private insurers and government programs.  Without adequate reimbursement, there will not be sufficient healthcare providers to meet Hawaii’s needs.

There is a need to develop an infrastructure to deploy electronic medical records (EMR) and digital connectivity among healthcare providers to develop individual personal health records for the people of the state of Hawaii. EMR’s and digital connectivity make it possible for providers to coordinate a patient's care with other providers, thereby: (1) eliminating duplication of tests; (2) sharing  life-saving information instantaneously, reducing medical and drug errors; (3) monitoring drug compliance and crucial preventive screenings, thereby reducing medical emergencies and hospitalizations, and (4) measuring outcomes and performance, thereby improving quality of healthcare. Experts agree this automation would not only save money, but also improve the quality of healthcare, reduce illness and prolong life.

The Commission recommends the formation of a Regional Health Information Organization (RHIO) through the Hawaii Life Sciences Council.  The organization would collaboratively develop polices for standards, interconnectivity and interoperability while addressing the needs for individual privacy.  A statewide Hawaii RHIO would, among other things: provide a neutral forum for discussion and decision making body for community wide policies on interoperability, data exchange, privacy and other issues related to Personal Health Records; coordinate a community-wide effort to obtain government and private funding, including funding for smaller practitioners to adopt EMR technology; and standardize methodologies to measure health outcomes.

VIII. Environment
The health of our economy and lifestyle is linked to the health of our natural resources. Hawaii is truly unique. We are the most isolated land mass on the planet. Our state represents only .2% of the land area of the U.S. Yet, we have the 4th longest coastline of any state. We possess in excess of 25% of the reef fish, 32% of the corals and have the 11th largest state forest reserve system. Ninety percent of Hawaii’s 10,000 native plants, animals and fishes exist nowhere else on earth. Hawaii is indeed a special place. However, our natural resources require stewardship.

Healthy forested watersheds are an essential part of the mountain ecosystem that intercept rain, create condensation, reduce erosion, and increase percolation to deliver a consistent and dependable supply of surface and ground water for Hawaii’s residential, agricultural and commercial uses. Across the state, there are predictions of water consumption exceeding aquifer recharge, wells are producing less water, and water managers are urging conservation. Yet, there is little connection between water use and caring for the ultimate source of that water – forested watersheds.

The funding for watershed management via the conveyance tax revenues is inadequate. The Commission recommends that the state actively pursue additional federal support for our watersheds. An estimated $4-5 million annually is needed to properly protect our watersheds. A consideration is a new dedicated county funding source through a watershed management fee assessed through our municipal water rates. The proposal would be modest at $.06 per 1,000 gallons or less than $1.00 per month for an average Hawaii household.

Another major threat to Hawaii’s economy, natural environment, health and lifestyle is the continuous introduction of invasive weeds, animals, insects and diseases. The cost to control invasive species already in Hawaii, such as termites, fruit flies and Miconia, runs in the hundreds of millions of dollars annually. The cost of prevention of invasive species has been shown repeatedly to be exponentially less than the cost to control pests once established. The Hawaii Department of Agriculture (HDOA) carries the State’s responsibility for border inspections, yet is well below capacity to carry out these duties adequately.

The Commission recommends a review of user fees from importers/shippers to ensure these fees are adequate to properly fund the needed prevention and quarantine programs. Additionally, we should revise state plant import regulations to include an “approved list” approach for new plant introductions.

Lastly, marine life in near-shore fisheries of the main Hawaiian Islands has decreased significantly over the years due to over/destructive fishing practices, habitat degradation from invasive species and polluted runoff. Selective use of Marine Managed Areas (MMA) has proven highly successful in restoring near shore fisheries and coral formations. The Commission recommends the DLNR take responsibility to develop a comprehensive MMA statewide program that balances the cultural, community and recreational requirements with the need to replenish our fisheries.

IX. Tax Policy
The state is projected to have a significant budget surplus in 2006/2007 due to a much stronger economy than originally forecasted. The debate will be how to spend/invest/rebate the surplus. Hawaii’s General Excise Tax (GET) is the largest source of tax revenue for the state. The GET is a flat consumption tax on nearly all goods and services purchased for both visitors and residents alike. The tax also has a pyramid-effect because, unlike many other states, our GET applies at the wholesale and retail level and even taxes the tax.

The Commission recommends a rebate of a major portion of the surplus back to the taxpayer which is called for in our State Constitution. A recommended method that other states have effectively utilized is a moratorium on the GET for food and over the counter drugs/medication. This tax reduction would be applied to all consumers equally but the reduction would have the added benefit of lowering the cost of living proportionally more for the lower income earner.

X. Infrastructure
Hawaii’s port system is of primary importance to this island state and to its visitors. Not only does the vast majority of everything that Hawaii consumes come to us via our ports, the harbors are also experiencing increased use by the passenger cruise industry.

Ensuring adequate, efficient, and safe harbor facilities is essential to the health and future of Hawaii’s economy. At present, Hawaii’s harbors are at capacity, and there are not adequate plans to address the imminent overcrowding that will occur with the advent of new users, expansion of the cruise industry and increasing cargo volumes resulting from a growing economy. It is projected that Honolulu Harbor will run out of space for international cargo this year and for domestic cargo in 2010. Further, the last Harbor Master Plan for Oahu was prepared in 1997 and the needed harbor improvements have yet to be implemented despite cargo volumes considerably exceeding the projections in that plan. Master plans for most of the neighbor island harbors do not exist.

The Commission recommends a public/private partnership to pursue the immediate update and implementation of a master plan that addresses all of Hawaii’s commercial harbors. The plan should incorporate the views of the harbor users, the community, and government. It should accurately forecast the future needs of all our harbor users, identify appropriate harbor and port improvements, and identify funding priorities and funding mechanisms that assess users equitably. Lastly, the plan should have specific deadlines to hold the state Department of Transportation accountable for results.

Additionally, our small boat harbors are at overcapacity and in disrepair. Hawaii deserves better. These harbors should be a showcase for Hawaii, both in terms of local recreational use and tourism.

The Commission recommends that the Legislature pass a resolution directing the DLNR to establish an agreement allowing the lease of small boat harbors to either the counties or private concessions. This step would place the management of these facilities closer to the people. Regulations would require at least 50% of the slip inventory to be affordably priced. Such leases would also require the lessees to significantly upgrade and expand these facilities for the benefit of our economy and our citizens.

XI. Host Culture
The Commission felt strongly that we should conclude our draft recommendations with a statement regarding the importance of the perpetuation of our host culture. The health of Hawaii’s economy, our quality of life, and ultimately Hawaii’s collective identity are founded on a vibrant Native Hawaiian culture and value system. This in turn depends upon a host Native Hawaiian population that is: well educated, healthy, productively employed, adequately housed, and actively involved in perpetuating and sharing a vibrant Native Hawaiian culture.

Increasing legal challenges threaten to undermine significant programs in Hawai’i dedicated to perpetuating Native Hawaiian culture and practice. These legal challenges also threaten programs providing quality education, health, employment and housing for Native Hawaiians. The Commission endorses the Executive branch and the State legislature’s support of the initiation, retention and expansion of these programs – as outlined in the Commission’s “commitment to multi-level actions to perpetuate our host culture” --- including support for the Native Hawaiian Government Reorganization Act of 2005.