The problem with medical insurance in general is that there is insufficient pressure on either providers or consumers to cut costs.  Doctors in Alaska are generally over-paid, and there is no incentive for them to cut their fees.  If there were a single payer system, the single health care payer would be able to bring cost containment pressure to bear on providers.  The other problem is that there is little incentive for consumers to cut costs if they aren't the ones paying - indeed, the pressure on them is to get the most expensive care possible in order to get the most mileage out of their deductibles, and because of the perception that expensive = better.  There needs to be a system in place to incentivize  comparison shopping and price containment for consumers, coupled with price transparency throughout the health care system.