The hospital that would evolve into The Queen’s Health Systems was first proposed in 1855 by King Kamehameha IV, who witnessed with alarm the epidemics, especially smallpox, ravaging the native population.

It would take several years of persistent fundraising from government and private sources before the king and Queen Emma could establish The Queen’s Hospital in 1859. It has been growing every since.

Today, we hear echoes of that history.

As Hawaii emerges from the devastating COVID-19 pandemic, the state’s largest private hospital system has proposed a $1 billion expansion and modernization plan of The Queen’s Medical Center, its flagship campus on Punchbowl Street. Among other things, Queen’s would increase the number of bed space from 575 to 715 and double the size of its overtaxed emergency room. This follows an announcement in July of plans to expand the Queen’s West Oahu campus.

These are welcome developments. Hawaii has one the fewest number of hospital beds per capita, according to a 2019 study by the Kaiser Family Foundation. And the entire state and Pacific Rim depend on Queen’s, which houses the state’s only Level 1 Trauma Center and organ transplant center.

But the project also reminds us of the challenges facing health care in Hawaii — and the importance of long-term planning.

Just a few months ago, hospitals statewide were overflowing with COVID-19 patients; triage tents, field hospitals, makeshift intensive care unit rooms and talk of rationing care demonstrated how little capacity we have in a major health crisis. And not just in infrastructure: About 700 medical relief workers had to be brought to Hawaii, at considerable expense, to help care for the ill.

Of course, it’s hoped that we won’t have to endure another pandemic-level health disaster for a long time — or ever again. But hope won’t be enough. It will take farsighted planning, not only from private hospitals with expansion plans like Queen’s and Adventist Health Castle, but from public policymakers as well.

While Hawaii is one of the healthiest places in the nation — thanks to the Prepaid Health Care Act, for one — the population continues to grow, and more critically, age. The state lacks enough doctors and nurses, a shortage exacerbated by Hawaii’s high cost of living. People living in rural areas need better access to care, including telemedicine. And the demand for high-quality long-term care facilities and geriatric medicine will only expand.

Yes, we’re encouraged to see some of Hawaii’s critical hospital systems plan for the future.

It’s a good start.