Because the GET is a gross receipts tax, it becomes a significant overhead expense for private practice physicians, making it extremely difficult to be profitable — especially for new doctors who are just starting out and still paying their student loans.
The Economic Freedom of North America 2018 report outlines Hawaii’s statistical paradox — Hawaii moved up a surprising eight notches this year in a national ranking measuring economic freedom in all 50 states, from 45 in 2017 to 37, but its overall economic freedom worsened.

