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11/7/2018
Point of View: A real fiscal plan for Alaska’s future

By ALAN GROSS

The climate is rapidly changing and, while the Lower 48 is choking on smoke, heat, and drought, Alaska’s economy is being choked by its high health care costs. People won’t move here and our economy cannot and will not significantly grow because of them.

Alaska’s extraordinarily high health care costs have prevented most non-resource based business from moving here. For example, why doesn’t a famous airline based out of Alaska, have its headquarters or phone banks in Alaska? It’s the health care costs for employees, triple the national average, that are keeping companies like that airline and many others from having their headquarters in our state. I believe we have no choice and should evolve into adopting a single payer health care system to control costs. It would overnight, change the economy in Alaska, and for the better. And it doesn’t have to involve everyone, all at once, or for that matter, at all.

Some people think a single-payer heath care system has to involve everyone. It doesn’t. Many people have a health care payment system that they are happy with and should be able to keep that, if they want. Many laborers and other unions who have negotiated benefits might initially be reluctant to change their current health care payment and delivery system, as might Alaska Natives and veterans and others who might be happy with their current system. Let them opt in later.

When people think of single-payer some think it means socialism. It isn’t. Our current system is beyond repair and is so distorted that it has almost nothing to do with capitalism anyway, nor can it, because of the way our system is designed with third-party intermediary private health insurance companies combined with Alaska’s geographic isolation and monopolies. And some people think single-payer means getting health care for free. It doesn’t. You would pay for it, one way or another, at cost, but without a for-profit third party insurance company intermediary. And, a single-payer system doesn’t necessarily mean we have to change our federal tax system to create a national health program. That may be what ultimately happens, but in my opinion, we need to first adopt a smaller public option plan and demonstrate to skeptics that it can work before our country is ready to change our tax code.

I believe Alaskans should have the option of buying into a different type of health payment plan. Some people in Alaska are quite literally getting killed by the costs here and there has to be a way out if our economy is to grow and if we want our kids to have jobs here.

I favor a phased-in, state-administered health plan allowing individuals (eg. commercial fishermen and farmers), and small groups the option to buy into it, at cost. This cohort of people represents those hardest hit by our current system, but larger groups, ultimately even including state and public employees, might have the option of buying into the plan at a phased-in later date, and likely would if it could be shown that both access and quality aren’t compromised, which I believe will not be a major problem. The plan could still pay providers very reasonable fees at or above Medicaid’s current levels, which are already the highest in the country, and would likely cost participants less than half of what many are currently paying today.

This would throw the door wide open in our state for youth and new business to venture north. And, while there would undoubtedly be difficulties encountered as the plan unfolds, that’s a great reason to pilot this as a small project, so that it can be adjusted and improved before it grows.

President Trump wants states to come up with their own innovative health plans after the Republican-led House and Senate in Washington, D.C., failed so miserably to improve the ACA. Well, here you go Mr. Trump, and I think this represents a far better long-term fiscal plan for Alaska than anything else I’ve heard this election cycle. It’s time to do something different if we’re going to bring a vibrant economy back to this state.

Alan Gross, MD, is a lifelong Alaskan originally from Juneau, and a commercial fisherman and orthopedic surgeon. He currently resides in Anchorage.