The concept of "universal" health insurance has overcome political barriers, persuading liberals and conservatives of an urgent obligation to insure all Americans. Increasingly, individuals and businesses won't purchase health insurance because it is too costly, and many proposed reforms would force them to do so anyway, punishing those who will not comply and expanding state programs to facilitate greater government dependence for those who cannot comply.

Policy makers and consumers in Hawaii should understand that such mandates threaten to ruin health care rather than improve it for the long term. They can take a lesson from California's Governor Arnold Schwarzenegger, who incorrectly believes that health costs are driven by uninsured patients who crowd emergency rooms, plans to insure people through a massive tax increase: four percent on employers that don't already contribute to their employees' health care. He will also tax physicians and hospitals.

This proposal has many similarities with the new Massachusetts plan that fines individuals and employers who don't purchase health insurance. But we already know that this approach cannot cover the uninsured.

Hawaii has mandated employer-provided health care since 1974. Hawaii's businesses pay the highest percentage of employee health insurance premiums in the country. The Hawaii Prepaid Health Care Act (PHCA) requires almost all Hawaii employers to provide health insurance to employees who work 20 hours or more for four consecutive weeks. Also, an employee's contribution to health insurance coverage may not exceed 1.5 percent of wages. Even though it is still lower than the national average, Hawaii's uninsured rate has doubled in the last twelve years. Forcing enrollment on Hawaiians or higher prices on employers has not solved the insurance problem.

There is a better way: more individual choice. Americans are currently too dependent on employers and restrained by government regulations to take more responsibility for their own health, but preliminary evidence shows that health savings accounts (HSAs) foster personal autonomy in health care. HSAs are a kind of 401 (k) for health, and your property for life. Also, contributions and earnings are non-taxable federally.

HSAs are not the definitive solution to our healthcare problems, but they are a helpful tool to cover people underserved by our insurance system. Surveys suggest that 23 percent of those with HSA-qualified health plans earn less than $25,000 a year, and 39 percent earn $25,000 to $49,000. Most importantly, between one third and one half were previously uninsured. Account-based health care plans are also showing that owners of HSAs actually receive more preventive care, but have over all decreased costs, and no adverse effects on their health.

Meanwhile, many health reform plans at both state and national levels would greatly expand taxpayer-subsidized health care, or mandate people to buy insurance instead. Plans that include HSAs are not spreading in Hawaii because of strict state regulations, including Hawaii's guaranteed issue and community rating insurance laws.

Daniel P. Kessler, business professor at Stanford University, recently published a report showing that government programs actually appear to be most liable for high private insurance premiums in the state of California. Health Affairs published similar results about Medicare, which pays $.95 for each $1 its beneficiaries use and Medicaid pays only $.92. Even a study by the left-leaning New America Foundation notes that people with private insurance pay 22 percent more than necessary to make up for the public sector's underpayment.

If politicians expand programs like Medicaid, for example, providers will have even more government patients, but still not enough government funding. Private premiums would continue to rise, and more people would lose private insurance. We could have even more uninsured Americans.

In the end, we need to make health care more affordable for Americans without sacrificing efficiency, quality and innovation - the great price we pay for big-government medicine. We shouldn't force insurance on our citizens; we should try instead to fix insurance. All states, including Hawaii, should deregulate restrictive insurance laws and encourage more personal freedom of choice in consumer-directed health-care plans. Once insurance is more affordable, people will enroll voluntarily.

Diana M. Ernst is Health Care Policy Fellow at the Pacific Research Institute.