Three decades ago, Hawai'i became the first state in the nation to impose what was then seen as a comprehensive plan to offer health insurance to its citizens. The pre-paid health plan mandated coverage through a person's employer.

It was a revolutionary idea at the time, hailed particularly by unions. And why not? If state law demanded coverage, unions could go after other benefits at the negotiating table.

Over the years, the vision has been altered, expanded and watered down. But mostly expanded. During the Waihee administration, the elements of a plan to cover "gap group" residents were put into place. In the overall plan, benefits and services were added at a regular pace, driving up the cost to employers and driving down the relative contribution by employees to their own health coverage.

A natural result was that employers began looking for ways to cut costs. Some took the hard-line position that benefits would go to the employee only, not to family members. Many others shifted to a system of part-time hiring (fewer than 20 hours) so they would not be caught up in the system.

Nonetheless, Hawai'i remains a leader in providing health insurance to its residents. According to a recent AARP report on insurance coverage, as reported by staff writer Greg Wiles, only Massachusetts (which by law requires people to have insurance) has a lower percentage of people without insurance.

The AARP's point was that within that overall number is a sad gap for people age 50 to 64 (when Medicaid kicks in) who are uninsured at a greater level than the population as a whole. Why? Because people in this group are losing jobs and tend to be out of work longer than younger folks.

And to pile misery upon misery, this group naturally has greater healthcare needs than younger people.

Local lawmakers have tried over the years to preserve the best of our pioneering system without breaking the bank. Some have argued that the employer-based system is out of date. That's good, but healthcare advocates say only if a substitute and even more universal system is put in as a replacement.

Otherwise, probably the best course is to work on getting the coverage net as wide as possible, even if it no longer runs as deep as it does today. In other words, making sure than every citizen, from cradle to grave, has access to at least a decent minimal level of healthcare, particularly preventative care. That's a huge policy issue, not just at the national level, where everyone talks healthcare reform, but right here at home as well.