So, your solution is to put everyone in essentially the same system that you complain about.   The root of the problem is that almost nobody in Alaska pays for medical care, so there really are no market signals.   People without insurance do without medical care and when they must have it show up at the ER and don't pay, leaving the bill for everyone else.   Almost everyone else is covered by employer or government provided plans with low deductibles and copays and strict stop-loss limits.   I've sat across the table from State employee unions and listened to them whine about how expensive their medical care was when all they were paying was a minimal deductible and $4 - $8 prescription copays.   The State was paying in those days $800+/mth/ee.   That said, the State's is among the more economical big employer plans because 20 yrs. ago we insisted that there be some copays and deductibles so employees would have to reach in their own pockets at least a little bit.