Charles, as you well know, most of the extra cost we pay in Alaska is a result of the over large social medicine programs operating in the state that are wholly supported by government dollars and this is setting the market rate for medical services in the state. 

Take a look at ANMC or SEARHCC for easy examples. These groups are using two separate pools of funds for their patients and even though each was intended to wholly fund the treatment of the patient they are dipping from both, allowing them to effectively spend nearly double what is expected.

The majority of patients who are seen at ANMC or SEARHCC are funded via Native Health Care funds AND at the same time through Medicaid funds. 

Since the Native Health Care organizations operate extensively in each region of the state, they have set the market rate and because they hare effectively circumventing cost controls, they have set it quite high.