The Affordable Care Act extended health care coverage to 20 million previously uninsured people but has not controlled escalating health care costs. Americans, and Alaskans in particular, have the most expensive health care in the world. Also, our health care system is not the best. The United States ranks an embarrassingly low 33rd worldwide in overall maternal health and 31st for life expectancy. Virtually all of the countries ahead of the U.S. have some form of government-controlled health care system.
A "single-payer system," where health care is financed by a single public body, not only controls costs, it improves quality. Government-imposed price controls, similar to those seen with Medicare and Medicaid, both of which are highly successful and administratively efficient programs, are the only proven way to effectively control health care costs, and are typically associated with a single-payer system.
I believe economic pressure will be the ultimate straw that brings Alaska and the rest of the United States to adopt the single-payer system. Government can't guarantee our health, but it can deliver a less expensive, more efficient and overall better health care delivery system than what is in place today.
While it would be most efficient to implement a single-payer system on the federal level, it is entirely possible to do this on the state level as well. In Alaska, waivers will need to be obtained from the federal government to accommodate and consolidate Medicare, Medicaid, VA, Tricare and Alaska Native Health administration so that the federal funding is channeled through the state of Alaska, the administrator of the single-payer system.
There will be economic disruption and risk. Hospitals, insurance companies and sub-specialty physicians will earn less under a single-payer system and will lobby extensively against it. But, despite the likely intense opposing political pressures, economic forces will ultimately prevail in bringing in a single-payer system. We have no choice — the state can't afford the alternatives.
Other states (California, Vermont, Colorado) have tried to implement a single-payer system but their initiatives failed (or will fail) primarily due to projected high costs. But Vermont's proposed health care plan, which came the closest to being implemented, offered coverage in excess of the most expensive premium platinum coverage plan available under the ACA exchange. An economically viable Alaska plan would need to offer fewer top-of-the-line benefits and would therefore cost less than the plan offered in Vermont. And, as seen in many other single-payer countries, continued access to supplemental private insurance would allow patients to purchase more comprehensive coverage than a public plan might offer, and at a much lower cost than rates seen today because the private insurance companies would be competing against the public plan.
Our federal government is floundering over what to do about health care. Because of the economic pressure caused by the extraordinarily high Alaska health care costs that consume more than 30 percent of our total state budget, we have an opportunity to lead and prevail where other states have failed. Alaska has the most to gain by far, compared to other states, and is thus in the best position to successfully implement a single-payer system. We are unlikely to recover from recession without addressing this issue.
Alaskans have the opportunity to lead the way and be pioneers to make this work and be successful. Renowned health care economist Alice Rivlin said that "long-run fiscal policy is health policy." Single-payer is the way to go and is key to making Alaska great again.
Dr. Alan Gross is a lifelong Alaskan and an orthopedic surgeon who has practiced since 1994. He also holds a master's degree in public health and is a commercial fisherman. He lives in Petersburg.
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