At any given moment and with little prompting, Gov. Neil Abercrombie can deliver an uninterruptable 15-minute riff on why our medical system is in a chaotic mess and why we need big changes to cure it.

In the last five minutes of his solo, I’m willing to bet that Abercrombie will segue into the need for a single-payer plan.

Depending on who is listening, a single-payer medical system is either the invention of a socialist devil and the first sign of the apocalypse or is the most important step we can take to bring sanity and equality to an underperforming medical system.

This is important today because Abercrombie is still pulling whatever levers he can to deliver something.

First, some history: Back in 2010 during the congressional health care debate, U.S. Rep. Abercrombie co-sponsored single-payer medical coverage plans, and while campaigning for governor, Abercrombie continued the push.

“The state will have to come to grips as to whether or not it itself will go into a single-payer plan in order to salvage some kind of capacity for the state employees,” Abercrombie said during a campaign stop.

“We are going to have to come to grips with the state figuring out the entire health care payment system,” Abercrombie continued.

That was then. Now, a year into his administration, Abercrombie is again hoisting the beginnings of a single-payer plan.

Tucked into the end of a news release summarizing his State of the State speech, Abercrombie said he was introducing legislation to “study the efficacy of combining state government health policy, planning and purchasing into a single agency in order to advance transformation of Hawaii’s health care system and universal access.”

The person charged with getting the levers and gears to mesh is Beth Giesting, who works for the state with the heavyweight title of “healthcare transformation coordinator.” She is

the former chief executive officer of the Hawaii Primary Care Association, which represents the state’s 14 community health care centers. Before that, Giesting was the executive director of the Kalihi-Palama Health Center.

Hawaii has good reason to get involved in the health care debate: First, because although about 90 percent of Hawaii citizens are covered by some form of medical insurance, the roughly 10 percent who are not are a great concern.

Second, health care insurance isn’t cheap, it is becoming both more expensive, and by 2014 it will be mandatory.

Finally, the state of Hawaii, in one form or another, either pays for or sets the parameters for the health insurance for one-third of Hawaii’s citizens.

That’s right, the state handles insurance for state and county workers, retired public employees and their spouses, plus Med-Quest, the Hawaii form of Medicaid.

The current system, Giesting says, has lots of problems: We pay for duplicate tests, too many services are split up when they should be coordinated, and there is not enough emphasis on prevention.

“We have a system that isn’t working,” says Giesting.

First off, there can be more coordination toward complete electronic records and using that system to analyze what is working. The system, Giesting says, needs to become sustainable, reliable and satisfactory.

This may not be the single-payer model of Abercrombie’s dreams, but some first steps toward efficiency are welcome.

Richard Borreca writes on politics on Sundays, Tuesdays and Fridays. Reach him at rborreca@staradvertiser.com.