Add my name to the growing list of orthopedic surgeons leaving Hawai'i.

Here is the story that you need to hear: We are in a healthcare crisis.

Everyone seems to be afraid to say it out loud, but I'm going to. Everyone wants to be politically correct.

People think that they need to dance around the issue and are afraid to say the real reason why healthcare is in trouble in Hawai'i.

Here it is. It is quite simple. It is about money. Sadly, it's always about money. It always has been, and it always will be. None of us wants it to be this way, but it is.

Doctors and hospitals are losing money. I am not saying that our profits are down. We have no profits. I am saying that we are, in fact, losing money. Without money, we cannot take care of you.

If your expenses exceed your income, you cannot pay your bills.

The amount of money that we get paid does not equal the amount of money that it costs us to take care of you.

Just look at the financial problems suffered by hospitals and healthcare companies across our state.

Look at the lack of specialists on the Neighbor Islands. Look at the lack of emergency room coverage by trauma surgeons on all islands.

In general, if you're not making enough money to cover your expenses, you must either decrease your costs or increase your income.

To make matters worse, in Hawai'i, we have the lowest reimbursements in the country coupled with the highest cost of doing business in the country. This is not exactly a good business model.

The first way to change this is to lower your expenses. In medicine, there is only so much cost-cutting we can do before it starts affecting the quality of your healthcare. You don't want us to take shortcuts.

In most businesses, the increased cost of doing business is passed on to customers by charging higher prices. In the healthcare industry, government regulations and insurance company contracts prevent us from passing these higher prices on to you. So instead, it often comes out of the doctor's or hospital's own pocket to provide the care for you.

The second way to cover your expenses is to increase your income. There are only a few ways to accomplish this: Charge more or sell more at a price that will meet or exceed your costs.

Charge more: Well, we've already seen that we are not allowed to charge more. Regulations and contracts prevent it.

Sell more: In healthcare, this means increasing the number of patients seen each day. That means less time per patient. If we don't spend enough time with you, we may start to miss things.

We can "sell" a new product or service, but it won't matter if we can't charge you what it costs us to provide it.

Our government thinks that lowering reimbursements will curb the cost of healthcare. Instead, all it does is put more healthcare providers out of business.

You are already spending enough on healthcare. You don't need to pay more. Your insurance premiums and taxes are high enough.

What needs to change is the way your healthcare dollar is spent. A greater percentage of the money needs to be dedicated toward the people who take care of you, not to the insurance company and the government.

The solution is simple. Doctors and hospitals need to be paid at least as much as it costs to take care of you. We should not be losing money.

Our priorities as a community must change.

You need to require insurance companies and the government to devote more to the doctors and hospitals providing services to you.

Insurance companies are in business to make money. We all understand that. We even accept that.

We shouldn't accept how our healthcare dollars are diverted to paying high executive salaries and to maintaining insurance company staff whose primary job is to find ways not to pay for your healthcare.

We shouldn't accept how our workers' compensation and no-fault premiums are diverted to creating and perpetuating legal cases against employees and drivers in order to avoid the insurance company's responsibility to pay for care.

We shouldn't accept government waste. We need to require our state and federal governments to devote more of our Medicaid and Medicare dollars toward healthcare providers. We need to make them stop enabling a growing government health bureaucracy dedicated to regulations and ineffective oversight.

I wish I was the last one departing. However, at least three more orthopedic surgeons are leaving soon.

Neil Thomas Katz is an orthopedic surgeon and a sports medicine specialist in 'Ewa Beach.