Last week, Republican strategist Kevin Madden chastised President Obama for choosing to vacation in a "foreign place" like Hawaii, concluding "it's much different than being in Texas." Rush Limbaugh, it turns out, couldn't disagree more. The right-wing radio host and avid golfer not only visits the islands every year. After his New Year's Eve scare with chest pains, Limbaugh had nothing but praise for the care he received there. And for good reason: while Hawaii ranks second in state health care performance, the Lone Star State is a dismal 46th.
For his part, Limbaugh predictably touted his emergency hospitalization as proof of an unrivaled American health care system which needs no reform:

"I don't think there's one thing wrong with the American health care system," Limbaugh said. "I got no special treatment other than what anybody else that would have called 911 and had been brought in with the same kinds of symptoms."

No different than virtually all Hawaiians, that is.
As the New York Times detailed in October ("In Hawaii's Health System, Lessons for Lawmakers"), Hawaii consistently outperforms almost every other state for health care access, quality and costs. While only about 10% of non-elderly adults are without health insurance in there, Hawaii's premiums and Medicare costs per beneficiary are the lowest in the nation. The Times explained a major reason why:

Since 1974, Hawaii has required all employers to provide relatively generous health care benefits to any employee who works 20 hours a week or more. If health care legislation passes in Congress, the rest of the country may barely catch up.

That system also paid dividends for Rush Limbaugh:

One result of Hawaii's employer mandate and the relatively high number of people with health insurance is that hospital emergency rooms in the state are islands of relative calm. In 2007, the state had 264 outpatient visits to emergency rooms per 1,000 people -- 34 percent lower than the national average of 401.

The result is that Hawaii can be found atop the Commonwealth Fund's scorecard of state health care performance. After finishing first in its 2007 assessment, the Commonwealth Fund ranked Barack Obama's birthplace #2 across 30-plus indicators of health care access, cost containment, quality, equity and prevention.
Along with other recent studies, the Commonwealth Fund also confirmed what by now is a truism of the politics of American health care: health care is worst precisely where Republicans poll best.

As in 2007, the scorecard reveals the critical condition of red state health care. While nine of the top 10 performing states voted for Barack Obama in 2008, four of the bottom five (including Arkansas, Mississippi, Oklahoma and Louisiana) and 14 of the last 20 backed John McCain. (That at least is an improvement from the 2007 data, in which all 10 cellar dwellers had voted for George W. Bush three years before.)
And near the bottom in almost category is Kevin Madden's poster child of heartland America, Texas.
They say everything is bigger in Texas and that includes the disaster of its miserable health care system. While from 2007 to 2009 Texas nudged its way from a horrific 48th to a merely miserable 46th in the Commonwealth Fund rankings, the health care system there remains an ongoing calamity for its residents. Among the poster children for the failure of red state health care, Rick Perry's state brought up the rear across the five indicators measured. Even before the recession hit, 25% of Texans were without health insurance, the worst in America. And when it comes to health care access and equity, Texas is dead last.
Despite the horror that is the Texas health care system, in November Newt Gingrich and Governor Perry co-authored a Washington Post op-ed titled, "Let States Lead the Way." In it, Gingrich and Perry cited Texas as a model for the nation. In response, the Post's Ezra Klein simply asked, "how's that working out?"
As residents of the Lone Star State can attest, not very well.
Meanwhile, things are much sunnier in Hawaii. There, an emergency room visit for chest pain, an overnight hospital stay and a battery of cardiac tests won't mean financial disaster for the patient. Just ask the new spokesman for Hawaii and its blue state approach to health care, Rush Limbaugh.