Nearly every year, the state Legislature starts off with a doctor’s bill.

No matter who is governor, one of the Legislature’s first duties is to deal with an administration bill for emergency funds to pay for the increased costs of the state’s hospital system.

Gov. Neil Abercrombie, according to reports in the Maui News, has already agreed to next year’s emergency request of $14 million for the Hawaii Health Systems Corp.

HHSC runs the neighbor island hospitals plus Maluhia and Leahi hospitals in Honolulu. Essentially they are the remnants of the pre-statehood plantation hospitals and the old county hospital system. They are old; many are run down, inefficient and isolated in areas where pineapple and sugar cane once grew.

By 1965, the counties could no longer afford to run the hospitals and the state came in with subsidies and then in 1967 took over the hospitals.

"HHSC’s financial stability has been a long-standing problem, and merely providing an emergency appropriation is only a temporary Band-Aid approach," Abercrombie’s spokeswoman, Louise Kim McCoy, said in the Maui News report.

She said Abercrombie wanted a "long-term strategy toward long-term sustainability," and would not be opposed to "looking at public-private partnerships."

The problem is that the state hospitals provide most of the health care on the neighbor islands, but most of the money coming into the hospitals is from Medicare and Medicaid, which officials say pays only 65 percent of the cost.

According to audits of the system, the 2012-2006 operating losses were, respectively: $143 million, $112 million, $101 million, $145 million, $131 million, $71 million and $38 million.

Every year, respectively, there were subsidies of between $100 million and $38 million. Notice that the subsidies did not match the losses, so every year the hospitals were still in the red.

Randy Perreira, Hawaii Government Employees Association executive director, noted in the article that the Legislature did not appropriate enough for the pay raises won in the last round of negotiations with the state, so that bill will be paid forward.

In a briefing with legislators earlier this month, HHSC detailed some of the problems: operating financial shortfall, declining government and third-party reimbursements, unfunded collective bargaining costs, aging facilities and lack of resources.

The details include: Kona needing a new hospital, estimated cost $250 million; Hilo Medical Center being 48 years old with no significant renovations; Kauai’s hospital, built in 1952, which still has four-, six- and eight-bed wards; Maui’s hospital’s master plan calling for $500 million in renovations. And Kula Hospital is more than 100 years old.

On Oahu, HHSC officials said Leahi Hospital cottages have "sloping floors, termite infestation and brown water coming out of the pipes."

State Sen. Josh Green, the Kona emergency physician and Health Committee chairman, is calling for a statewide round of public hearings to search for some consensus on what to do.

"There are major governance questions: Should they pursue local partners or partners from the mainland?

"I may propose a 20-year plan to modernize the hospitals. That would force the governor to give us direction," Green said in an interview, adding that so far he has had "zero contact" from Abercrombie on the issue.

Some critics may say that the HHSC problems are somehow related to the federal health care program dubbed Obamacare, but the reality is much starker.

If the state is responsible for public education and does not require schools to break even or turn a profit, then what responsibility does it also have for the basic health of its neighbor island citizens?

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Richard Borreca writes on politics on Sundays, Tuesdays and Fridays. Reach him at rborreca@staradvertiser.com.