I don’t think Rush Limbaugh realized at the time what a colossal blunder his “I don’t think there’s one thing wrong with the American health care system” comment would turn out to be. And it all comes down to the fact that he was vacationing in Hawaii, which really doesn’t have a health care system with the same features as the American health care system. For one, they have a strong employer mandate that has led to the lowest premium prices in the country:

Hawaii’s health care system is distinct from the rest of the country, in that they passed a version of health reform decades ago, in 1974. The Hawaii Pre-Paid Health Care Act includes a requirement for employers to provide health coverage to their workers. As you may know, a similar requirement on large employers is a key part of the reform now pending in Congress.

And the employer requirement seems, by and large, to have succeeded. It has increased coverage–just under 8 percent of the state’s population is uninsured, second only to Massachusetts–and access to care. At the same time, Hawaii still has some of the lowest health care costs in the nation, despite its high cost of living and without an apparent decrease in quality–as Limbaugh himself discovered.

In fact, Hawaii’s system goes FURTHER than the efforts in the House and Senate to mandate employer responsibility, without complicated Rube Goldberg contraptions that lead to things like the “free rider” problem in the Senate bill. This has not killed jobs on the island and has led to far lower costs.

Hawaii also forces its employers to choose one of a few standardized insurance packages, which feature low co-pays and out-of-pocket expenses.

Hawaii is effectively tied with North Dakota for having the lowest average employer provided insurance premiums and has the lowest employee contribution toward premiums in the country. This is a very impressive accomplishment for a variety of reasons. First, Hawaii basically has the highest cost of living in America. Almost everything except health care costs dramatically more in Hawaii, compared with the mainland. Second, because of the “Prepaid Health Care Act,” the average quality of the employer-provided insurance in Hawaii is substantially greater than the rest of the country. Finally, Hawaii is the state with the second lowest level of uninsured people. None of the other ten states with the lowest level of uninsured are also in the top ten for lowest average single coverage employer health insurance premiums. Based on all metrics (cost, cost growth rate, quality, coverage, life expectancy, etc.), Hawaii has probably the best health care system in the country.

The real world evidence from this country and others points to some clear solutions. Mandating only a few (or one) precisely defined, high-quality, low-cost-sharing benefits packages would help keep costs down. It reduces administrative overhead, helps prevent insurance companies from gaming the system, allows true apple-to-apple comparison shopping, and encourages people to seek early treatment (the more cost-effective kind). Providing everyone with actual high-quality, affordable health insurance is not just morally the right thing to do, but also makes strong financial sense.

If Hawaii falls short anywhere, it’s because they have effectively been barred from fixing some of the more glaring problems. Hawaii received an exemption in 1974 to the federal ERISA law limiting state flexibility in designing health care systems. As such, they can continue to have their employer mandate, but not alter the system to account for employers gaming it through hiring part-time workers that they don’t have to cover. Such allowances for state-based innovation is part of a proposal from Ron Wyden that’s in the Senate bill, but it needs to be improved, and the timeline moved up so states don’t have to put together an exchange only to dismantle it for a different plan that matches federal guidelines.

Finally, to add insult to Limbaugh’s rhetorical injury, the hospital where he stayed in Hawaii, home of the nation’s best health care system, was unionized.

Limbaugh stayed at Queen’s Medical Center, where nursing staff are represented by the Hawaii Nurses’ Association (read: a labor union). The nurses at Queen’s are protected by their contract, which adheres to the ANA’s safe-staffing principles guaranteeing appropriate staffing levels for any patient care unit.

In fact, Hawaii has one of the greatest percentages of organized workers of any state and also had the highest percentage of organized RNs. All private-sector acute care hospital RNs are organized, with just two known exceptions. We’re guessing this might have something to do with why Limbaugh found the Hawaii hospital staff’s work so “confidence-inspiring.”

When Limbaugh was released from Queen’s Medical Center, he cheerily noted, “The treatment I received here was the best that the world has to offer.”

Whether he realized it or not, Limbaugh was praising the care he received from union nurses in one of the country’s most progressive health care systems. On behalf of the labor movement and health reform advocates everywhere, THANKS FOR YOUR SUPPORT, Rush!

Surely Limbaugh will find a way to wriggle out of this, claiming that he was “taken out of context” or just ignoring the deficiencies in his logic, to the delight of his listeners. But it’s worth it for progressives to pile on to this, and demand that the US health care system aligns in terms of cost and quality with Rush Limbaugh’s dearest wishes.