The Legislature is failing abysmally by not facilitating transition of the Hawaii Health Systems Corp. into a sustainable 21st century enterprise.

HHSC encompasses 13 (mostly) outer island hospitals serving the 30 percent of our state’s population on the neighbor islands. That’s 400,000 people, the vast majority of whom receive their primary hospital care at HHSC facilities.

Let’s cut to the chase and state the incontrovertible reasons these hospitals are chronically broke:

» Dismal reimbursements: Outer island residents are disproportionately insured by Medicaid and Medicare, both paying about 77 percent on the dollar. HMSA pays 106 percent of cost, versus a national figure of about 125 percent, and not enough to make up for the pitiful payments from Medicaid/ Medicare.

» The unions: There, it’s said. No one wants to call this spade a spade, but numerous state senators, representatives, the heads of the Honolulu hospitals, heck, even the governor, admit this behind closed doors.

Staff at HHSC facilities are civil service employees, relatively low-paid but enjoying generally stellar health care and retirement benefits. Total employment costs for HHSC consume 75-80 percent of revenue generated — in stark contrast to national figures of 45-50 percent.

The unions are brilliant at pursuing their interests and with a PR machine that portrays their efforts as protecting the public. But, God bless ’em, they know absolutely nothing — nothing — about running a hospital or a health care system.

Reality check: HHSC hospitals are not a works program (though they’re often the largest employer in their communities). What’s so galling is that the unions’ shameless efforts to perpetuate the current unsustainable system — requiring a $72 million-plus yearly state subsidy that must only grow in face of reimbursement decreases and increasing costs — will only, in the very near future, actually result in major job losses as the hospitals are forced to cut services.

What to do? The responsible community members of the five regional boards governing the HHSC hospitals — all unpaid volunteers — are, unlike the legislators, or the unions, immersed in these issues daily.

Recently the three acute-care facilities — Hilo, Kona and Maui — found a potentially interested private partner willing to not just take on management of the ailing facilities but invest in their physical plant, service lines and staffing in ways that would revolutionize health care availability on the outer islands for years to come.

But the necessary legislation — House Bill 1483 — has been diluted, diminished, shriveled and amended by a gutless Legislature so that all that remains is an anemic intent to create yet another task force to study the matter.

The unions and their cowardly legislative minions are holding the future health care of the entire outer island populace hostage to misguided, short-term interests.

This is the ultimate kicking the can down the road — except that around the very next curve, as soon as 2014, the road comes to a very dead end.

And that’s a fact: Medicare payments will decrease by millions of dollars and the recent Hawaii Government Employees Association nurses’ award will increase costs by $11.5 million, boosting the employee costs to 80-85 percent of revenue.

This is not about rocket science. It’s about a future where the outer islands will have health care availability equal to that on Oahu and the mainland; where residents won’t have to move away because of lack of health care resources; where all Hawaii’s residents will see a decreasing burden of subsidy to outer island hospitals.

The point of being a leader is to lead, to make the hard choices that make a difference — not to kick empty cans down a dead-end street.