Life at the Last Frontier
Alaska is the Last Frontier. Well, literally, as Alaska is an US state that is less than 2% developed! About 50 miles or so outside of the major cities, you lose cell phone contact, and you need satellite phone. Many of the villages do not have a connection to the Alaska highway network, highways that are basically dirt roads over long stretches with one lane in each direction. For instance, there is no road to Nome.
Nome gets their supply by air or barges. If a barge cannot deliver due to harsh weather conditions, a dangerous shortage arise like when a couple of years ago a storm canceled the last fuel delivery before onset of the sea-ice and Nome was about to run out of fuel by March.
Reaching a doctor may be a problem
The rural villages off the road system depend on supply flown in by float planes or bush pilots and/or shipped up the river with little motor boots. These planes also serve to fly out sick people or pregnant women to the next hospital and fly midwives into the villages. Thus, for Alaskans a newspaper headline Woman gives birth on float plane to Ketchikan appears normal. Many rural Alaskan women fly to the next city two weeks before the anticipated delivery. Of course, spending the time in a hotel and paying for the flight costs a lot. Thus, home delivery is very common.
Health insurances don’t understand the distances in Alaska
When people get sick and their health insurance requires to choose an in-network doctor, things become even worse. In a state that is only 2% developed, the number of specialists is already low too. The problem is not to find an excellent specialist. On the contrary, there are doctors who graduated from Harvard, Stanford, UCLA, and alike. They live in Alaska because they want to.
The problem are the high operation costs in Alaska that prohibit these specialists to sign in-network contracts. The number of patients is small and the required equipment is expensive. Thus, the cost of the equipment per patient is naturally higher than in a high populated state like New York or California.
Insurance pays for out-of-state treatment even when it is more expensive than the out-of-network in-state specialist
Often the nearest in-network specialist is out-of-state in Seattle, Washington. For someone in Interior Alaska, this means first flying out on a bush plane to Fairbanks, and then a 3 hours 55 minutes flight on Alaska Airlines from Fairbanks to Seattle. Then there is still the ride to the specialist.
Once you are away from Alaska it also means that you are in an environment where there are so many people. Can you imagine what it means when you come from a 70 inhabitants village? Some Alaskans never have seen so many people before in their lifetime. It seems like ants. Furthermore, the patients are outside of their family and friends support network. These conditions are stressful and not beneficial for the healing process.
Alaskans pay a lot out of pocket despite having health insurance
The alternative is to go to a specialist who is outside of the insurance’s network, but in state. Then the insurance pays 200% of the allowable for Medicare, when you are lucky! It means that the patient has to pay the difference between the crumbles the insurance pays and what the real costs that the specialist charges.
Health insurances just don’t understand Alaska. They are not aware that there is a state in the US that is only 2% developed. Alaskans can’t just drive to the next town. It is an 8 h drive from Fairbanks to Anchorage in summer. Add up to 4 hours in winter when the roads are plowed, more when it snows in the Alaska Range. The train from Fairbanks to Anchorage takes 12 hours and only rides during the tourist season (Mid May to end of August). Otherwise it just transports supplies, and military items between these towns and bring coal from the Usibelli mine in Healy that has the cleanest coal on Earth. Flying from Fairbanks to Anchorage is about 1 hour on a propeller plane.
Facit: Thus, even when you live in Alaska’s largest city, Anchorage (here live about 50% of the Alaskans), when you are sick, you don’t only have the problem to be sick, but also face the problem of very expensive health care as insurances don’t account for the high health care costs and low infrastructure of Alaska. The other problem is that you might get affordable care, but then can’t continue working and miss out on the support of family and friends because you have to leave the state.
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Photos: G. Kramm
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