Few would dispute that healthcare is among the most essential of government services, and there's no surprise that it is quickly rising to the top of the agenda for Hawai'i's coming legislative session.

That's where it belongs. It's also the ranking concern of The Advertiser Editorial Board, which this week begins a series of discussions about the challenges facing lawmakers, who will convene Jan. 21 armed with few of the resources that have underwritten ambitious programs of the past. In fact, the news from the Council on Revenues, which projects how much the state has to spend, grows continually worse.

Healthcare is perhaps the most important element in the state's "safety net" of services to people who are unable to secure them on their own. But it's not only the poor who need to be worried about the healthcare system.

Nationally, the near-collapse of the financial system has sapped the investments and otherwise compromised the underpinnings of businesses, including those that operate healthcare institutions here and elsewhere.

Only about a fourth of the population are lower-income clients on state-managed medical assistance programs, but diminishing this sector still has repercussions on privately funded medical systems. For example, those on Medicaid who are unable to get medical care often turn to private hospital emergency rooms, and add unreimbursed costs to an already weakened bottom line.

Beyond acknowledging the societal failure of denying healthcare to the needy, allowing the safety net to rupture has trickle-down effects on all of us, and Hawai'i's geographic isolation only makes that vulnerability more acute.

Shoring up the system thus becomes an imperative, especially at a time of anticipated further strain.

Lawmakers have been meeting in recent weeks with the stakeholders. Some things to keep in sharp focus during this process:

• Reducing the proportion of the uninsured should be a prime target. It's encouraging to see legislators now discussing ways to close the gap at least for children — a cost-effective investment because preventive care for this group is relatively inexpensive and avoids costlier interventions.

Elected officials need to keep an eye on healthcare policy developments on the national level, which should help shape spending priorities here.

• Improving reimbursements to providers who treat Medicaid patients is critical to ensure that these people have access to care. State Sen. David Ige, Health Committee chairman, said Medicaid reimbursements go out at about 40 percent below the Medicare level.

• Providers can be encouraged to serve low-income patients if the state streamlines the bureaucratic paperwork that accompany reimbursement claims. That's a clear disincentive to taking Medicaid patients that needs to be removed.

• Access to care is particularly spotty in rural communities, so lawmakers are rightly grappling with ways to make the providers to these communities more sustainable. Legislators are right to search for ways to restructure the Hawaii Health Systems Corporation to improve efficiencies, and efforts to link them more closely with the rural community health centers may yield further savings.

• As in other areas of public employment, the state must negotiate for contracts that reduce labor costs for state hospitals and health centers.

• Lawmakers need to go back at a package of bills that improve the business climate for doctors, especially those willing to work on Neighbor Islands. It's unfortunate that Gov. Linda Lingle cut the $2.5 million for a rural residency program; a smaller-scale program that involves more private participation deserves reconsideration.

• The climate for all doctors would be improved with tort reform that preserves a patient's ability to recover damages within sensible limits. Trial lawyers need to come to the table and help forge a compromise.

All parties, in fact, need to set aside rancor of past sessions and approach the looming healthcare problems with a unity of purpose. And that purpose should be to help ensure that the safety net is strong enough to hold, given the economic chasm that has opened beneath us.