Few would dispute that healthcare is among the most essential of government services, and there's no surprise that it is quickly rising to the top of the agenda for Hawai'i's coming legislative session.

That's where it belongs. It's also the ranking concern of The Advertiser Editorial Board, which this week begins a series of discussions about the challenges facing lawmakers, who will convene Jan. 21 armed with few of the resources that have underwritten ambitious programs of the past. In fact, the news from the Council on Revenues, which projects how much the state has to spend, grows continually worse.

Healthcare is perhaps the most important element in the state's "safety net" of services to people who are unable to secure them on their own. But it's not only the poor who need to be worried about the healthcare system.

Nationally, the near-collapse of the financial system has sapped the investments and otherwise compromised the underpinnings of businesses, including those that operate healthcare institutions here and elsewhere.

Only about a fourth of the population are lower-income clients on state-managed medical assistance programs, but diminishing this sector still has repercussions on privately funded medical systems. For example, those on Medicaid who are unable to get medical care often turn to private hospital emergency rooms, and add unreimbursed costs to an already weakened bottom line.

Beyond acknowledging the societal failure of denying healthcare to the needy, allowing the safety net to rupture has trickle-down effects on all of us, and Hawai'i's geographic isolation only makes that vulnerability more acute.

Shoring up the system thus becomes an imperative, especially at a time of anticipated further strain.

Lawmakers have been meeting in recent weeks with the stakeholders. Some things to keep in sharp focus during this process: