By Jennifer Perkins, MD for Juneau Empire


How much longer are we going to tolerate incremental approaches to fix a broken health care system that feeds off disease and profits on the sick? Extremely high health care costs have become so common place that we rarely question them. News headlines flash “Plan to control drug prices,” and “Medicaid work requirements to cut state costs,” while casualties of the pharma-driven opioid epidemic pile up on the inside pages.

I am part of the problem. As a family doctor, I direct the flow of health care dollars through the drugs I prescribe, the tests I order and the specialists I refer to. I do not set the prices; in fact, as an employed physician, I often have no idea what they are. The incredible complexity of financing is a direct result of the “profit-driven disintegration of our health care ‘market.’” I moved to Alaska to work for an innovative, nonprofit system truly committed to the health of their population. I love my work, my team and my patients. I am frustrated that all of us do not have access to this quality care. The health care system I imagine focuses on wellness, not just the absence of disease. When we get sick, we receive the appropriate care without the financial burden.

Our health care system is killing us. Literally thousands of people die every year from lack of insurance. Figuratively, lives are forever altered by too many unnecessary, profitable medical procedures and too little focus on preventative health. Health care costs for families skyrocket, shifted from ever-wealthier insurance companies. Teachers fight tooth and nail for mediocre coverage while their wages stagnate. Small businesses flounder under the unpredictable burden of providing employee plans. Large businesses lose competitive advantage on the international stage. Health care consumes a dominant chunk of state budgets (35 percent in Alaska), while its hardworking residents remain without insurance or inadequately covered.

In other industrialized nations, hardship from medical expenses is rare. All provide some version of universal coverage, liberating citizens from the stress of medical bills when coping with accident or illness, and at a much lower cost. Our market-based system has failed us. The time for single payer is now.

In a single payer system, everyone is covered by a comprehensive health plan that is publically funded but privately delivered. This allows innovation in health care delivery by privately owned physician groups and hospital systems. The government does not run your health care, they pay for it. In fact, they already are. The federal government spends more per person than in most countries that provide universal coverage. We match the feds with individual contributions and still do not get better outcomes. Sweden, considered one of the best systems in the world, spends about half and pays people when they are sick. By centralizing the payer, we shift incentives from procedures to prevention and contain outrageous costs.

Some say that definitive reform is out of reach, that it is not politically viable. As Nelson Mandela said, “It always seems impossible until it’s done.” Yes, we are a country that contains extremes of values and opinions, of independence and free market priorities, and we all have bodies that may fail us at unpredictable times. It is time to demand a system that promotes our health and protects us from financial hardship when ill.

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