A lot of folks in Hawai'i are excited that Barack Obama has put our state on the map.

But Hawai'i figures in the battle between Obama and Hillary Rodham Clinton in another substantive way: Our healthcare system is a key subtext in their debate over national healthcare.

It serves as a good, and for some, not-so-good, example of what can be done to extend adequate healthcare to everyone.

Hawai'i was the first state to mandate (a word that comes up often in the healthcare debate) health insurance for every person employed for at least 20 hours a week. That 1974 law, which required an exemption from less rigorous federal healthcare requirements, became a model for government-required health coverage.

Clinton knows the pluses and minuses of our system because she studied it and had it in mind when she tried unsuccessfully to craft a national universal healthcare system when her husband was president.

The problem is that while our law was pioneering, it is not perfect. In fact, many are beginning to wonder whether it in fact has accomplished what it set out to do. Many business leaders say the law, now festooned with new and expensive benefits and requirements, has become too expensive for many struggling companies. Mandated benefits are chewing up profits and sometimes putting companies out of business.

On the other side, some advocates say that despite the pre-paid healthcare act and follow-on programs such as Quest for the so-called gap-group, there are far too many people in Hawai'i who lack insurance or lack adequate access to healthcare. In fact, they say, that number is growing.

Then there is the growing tension between health insurance companies struggling to hold down cost and providers such as doctors and hospitals who are struggling to remain in business in a sea of red ink.

Can Hawai'i find a way to get back on track so that it again leads the nation in government-sponsored efforts to ensure quality and affordable healthcare for all? That would surely put us back into the center of the debate that Clinton and Obama find so important.

One attempt to answer those questions took place recently at the state Capitol, where the church-based social activism group Faith Action for Community Equity pulled together a remarkable group of physicians, providers, government experts and consumers for a "Healthcare Summit."

FACE was at the forefront in the effort to save affordable housing at Kukui Gardens. Flush with that success, it now seeks a bigger and more challenging task: affordable healthcare.

The tone of the meeting was, to put it mildly, less than sunny.

"Our healthcare system in Hawai'i is broken," declared Richard Meiers, president and CEO of the Healthcare Association of Hawai'i.

Hospitals are losing money, doctors are fleeing to less expensive places and businesses are becoming cleverer about finding ways around the mandatory law, panelists said.

It was clear that there are few who want to see the system of mandated benefits thrown out the window. One did not hear voices clamoring for a completely free-market healthcare system. But no one was willing to accept things as they now are.

Over the next months, FACE and other interested groups will be working hard to pinpoint how our healthcare system can be revived and restructured in a way that preserves quality care while ensuring that care is available for all.

It will take cooperation from providers, from insurers, from government and business and from consumers, who must recognize that quality healthcare is everyone's business.

If we can make it work, whoever wins the presidency won't have to worry about inventing a quality national healthcare scheme from scratch. They can just look to Hawai'i.

Jerry Burris' column appears Wednesdays in this space. See his blog at blogs.honoluluadvertiser.com/akamaipolitics. Reach him at jrryburris@yahoo.com.