How do you kill our Hawaii health-care system?

Two ways: gradually, and then suddenly (as Ernest Hemingway described going bankrupt).

Right now, Hawaii physician supply has become increasingly short of what’s needed statewide by a whopping 820 doctors, according to the University of Hawaii Physician Workforce Assessment.

Already shorthanded, we are now looking suddenly at the pointy end of the COVID-19 coronavirus pandemic coming straight at us full frontal, and it ain’t looking good. Germany President Angela Merkel recently said 60-70% of Germans could be infected: “The process has to be focused on not overburdening the health system.”

Oops, way too late here. We are already overburdened.

The Centers for Disease Control and Prevention and the Nebraska BioContainment Unit estimate only 30% to be infected here, maybe 1% mortality but 3% for elderly over age 65.

Still, not comforting at all.

And it gets worse: 20% of Hawaii physicians, 595 docs, are over age 65 (33% on the Big Island). If only 20% of those docs get sick, and only 2% die, that’s 178 sick and six dead. Those not too sick still shed the virus for five-plus weeks, and sick ones may be out for months. They’ll be isolated from patient care, further overloading the already struggling system, and all that time, office expenses keep mounting and no revenue comes in.

The American College of Surgeons now “recommends each hospital and surgeon should … plan to minimize, postpone, or cancel electively scheduled operations, endoscopies, or other invasive procedures” — i.e., immediately shut down the vast majority of surgical practice, until “we can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs.”

A lot of docs are barely getting by, hanging on by fingertips to practices on the edge of running financially in the red, cursing all the obstacles they face practicing in Hawaii that are dragging them down from doing what they love. That was barely “sustainable,” but now this is career-ending. Suddenly.

If we can’t replace those physician losses this year, that could be the final nail in the coffin of our health-care system. Docs just don’t want to come here, for very obvious reasons: we get worked way too hard, and get paid way too little.

Those docs still standing have a lot of greener pastures to consider, and now it’s even easier to leave.

Colorado just announced any licensed doc can move there and be practicing the next day, and no fee either. The Center for Medicare and Medicaid just announced national emergency regulation suspensions, so now any licensed doc can immediately go anywhere in the country and see patients there, no problem.

What is Hawaii doing?

Well, we are the only state in the nation that taxes their docs for Medicare and Medicaid fees. By federal law, docs cannot pass that on to their patients. (And, Hawaii also has near the lowest Medicare reimbursement rates and by far the highest cost of living. Other than New Mexico, Hawaii is the only state that actually taxes health care. The ethics of taxing health care at all is, quite frankly, not a good look for the Aloha State, and doing so during a pandemic is just vile.

Fortunately, there is a glimmer of hope: a law to exempt all docs and primary care nurse practitioners (and therefore patients, too) from the 4.5% general excise tax: Senate Bill 2542. This could be the difference between survival and failure for some practices.

It would be a minor hit to the state budget, basically a rounding error on $17.3 billion, and a modest fiscal stimulus to our now-dying economy. It would be a major economic stimulus to health care, to the docs and practitioners. It’s a baby step, long overdue — but would move Hawaii in the right direction toward saving our health-care system.

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For more, see petition at www.change.org/Hawaii_GET.

Edward Gutteling, M.D., is the team orthopedic surgeon for University of Hawaii-Hilo athletes; this was prepared for the Hawaii Physician Shortage Crisis Taskforce.