Dunleavy claims state will reinvent health care in Alaska at lower cost. Don't hold your breath.

The institutions that provide health care in Alaska are part of a complex web. It will be difficult to predict how changes will impact the overall system and the lives of hundreds of thousands of people.

Alaska health care will not be reinvented by the Dunleavy administration, the Alaska Legislature and the next governor.

But Gov. Mike Dunleavy appears to think that he is the one who can lead the way with little or no preparation.

Read what he said to reporters last week about why he is interested in accepting $272 million in federal health care subsidies in the next year—perhaps to be followed by similar subsidies in the four years that follow—under Trump’s so-called big beautiful bill.

The $272 million has to be spent by the end of the next fiscal year and the rules have yet to be established. The bureaucratic pressure to do things quickly will collide with reality and make it all the harder to ensure the money is spent wisely.

Here’s what Dunleavy said about spending what he hopes will be a $1.4 billion subsidy from the feds over five years. His words convey a lack of vision and thought.

“The question I had was is this going to be a subsidy? Is this gonna be something that we have to go back to the federal government every year to subsidize? And the reason that I blessed this application was it wasn’t going to be. It was gonna be transforming the system we have now to a much better system that’s understandable, low cost and effective. We don’t have that now for the most part. I think most of us agree it’s very difficult to understand how we get diagnosed, how we’re sent to our specialists, how does insurance play into that, etc. So the idea behind this was to break that cycle and develop a new system that in the end will be lower cost, we hope, using technology, better at diagnosing and then better at addressing what the issues are.”

“I don’t wanna, I don’t wanna talk about when I was a kid. But when we were a kid the hospitals were for cases of trauma, you got hit by a car, you broke a leg. That sort of thing. Now there’s a lot of high utilizers in the system for a whole host of reasons. The idea behind this as it was explained to me, and I think it’s a great idea—federal government will seed our ability to develop a brand new system that really kind of works out the issues of how do we diagnose, how do we prescribe, how do we deal with the various medical issues that people have and how do we do it from a distance or where you’re located. If it was just a subsidy and it was going be an ongoing year after year after year that would be a whole different ballgame,” Dunleavy said.

Reinvent health care in Alaska? Spend $272 million this year when the rules are not written? Repeat the pattern in the four years that follow? Create a “brand new system” with lower costs? Not likely.

The scope of the health care challenge in Alaska and the unrealistic timetable created by Congress—a Republican exercise in throwing money at a problem for a political goal—are prescriptions for waste, fraud and abuse.

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