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Flaks, Facts & Intelligent Debate: Health Care in Alaska

Back on July 21, 2012, Shannyn Moore wrote a heartfelt essay on the State of Alaska’s reported consideration of the idea of sending some state-insured retirees outside for medical treatment. Moore is her mother’s primary support. That support would be missing, Moore pointed out, if her mother had to go Outside for treatment.

In an attempted response, Commissioner Becky Hultberg of the Alaska Department of Administration wrote a Compass piece for the Daily News. Well, she is supposed to have written it. We’ll have to hope it was her press aide, who has since been disciplined. Because as a response to the issues Moore raised, it was an embarrassing failure.

Shannyn Moore doesn’t need WC’s help in defending herself. She is perfectly capable of dealing with her critics. In a phrase, WC pities the fool. But as an exercise in logical fallacies and deception, the essay credited to Commissioner Hultberg is worth study. She begins,

It’s unfortunate when we debate without facts — and even more unfortunate when incorrect statements can mislead people. Such is the case with Shannyn Moore’s column last Sunday on state health care plans, in which she claimed that retirees and employees will be forced to leave the state for care.

So the Commissioner opens with a classic ad hominem fallacy. An attack on Moore, rather than addressing the issues. Not a strong start, if you value logic, informed debate and critical thinking. The Commissioner continues,

Ms. Moore is absolutely incorrect. The state has no plans to force retirees and employees to travel for health care, and never said it did.

Well, then at a minimum the State of Alaska is sending mixed signals. There are many reports that the State is considering Outside treatment plans. In fact, in another classic fallacy, the Commissioner next nearly admits that the State is considering that very idea. She says,

Over the past decade, however, the cost of these plans has soared. In 2001, the annual cost of state employee and retiree health care was about $280 million. By 2011, that grew to about $630 million and the unfunded liability for retiree health care ballooned to $4.1 billion.

WC sees the distinction now. Commissioner Hurtley very nearly admits the State is considering shipping its insureds Outside to save money, but isn’t yet planning to do so. But wait. Moore never claimed that State was planning to do so. She said the State was threatening to do so. So we have a classic straw man fallacy. WC hasn’t gotten to a post on the straw man fallacy. So many fallacies. So little time. Briefly, the fallacy occurs when an opponent attacks a position a person hasn’t taken. Commissioner Hurtley attacks Moore’s claim that the State plans to ship patients outside. But Moore never claimed that was the State’s plan; she claimed that State was considering the idea. Which it is.

The Commissioner continues,

Health care costs are more than doubling every 10 years, while the oil production that pays for most of these benefits is declining at a rate of 5 percent to 7 percent annually. The long-term sustainability of these health plans is in jeopardy. As commissioner of the Department of Administration, my job is to address that problem.

Every thinking Alaskan needs to study the report the Commissioner alludes to in saying costs are doubling every decade. But the claim that oil production is declining is largely irrelevant. Oil revenue is increasing or level. It’s pretty much a non sequitur fallacy to raise it here. WC looks to the government to control costs regardless of the levels of state income. We can have a separate debate about oil field production and the Commissioner’s boss’s plans to cure frostbite by rubbing snow on the frozen area. But not here.

The Commissioner continues,

My department is examining both the patient and the provider side of the medical economics equation, looking at what adjustments can be made to reduce the rate of cost growth while maintaining quality coverage. This is a highly complex area, and there are no easy solutions.

Platitudes. Public relations white noise.

On the patient side, we are establishing a culture of wellness and personal responsibility for health as a workplace value. While in some cases patients are unable to control their health condition, for most, lifestyle choices and behaviors have health consequences that drive costs. We are working to provide our members with resources, education and incentives to do their part in improving their overall well being.

By taking personal responsibility, costs can be reduced and quality of life improved. Among the resources introduced this year for active employees are Weight Watchers at Work, tobacco cessation and free preventive care along with new tools to help people with chronic conditions manage their health. We hope to introduce similar offerings to the retiree population.

The State is late to the wellness party, but exactly how does this relate to the cancer treatments that Moore wrote about? And the Commissioner implies that wellness services are available to all Alaskans for whom the State provides medical services. Actually, it’s less than 9% – it’s current state employees only. Retirees, Medicaid and Medicare beneficiaries aren’t eligible.

On the provider side, we recognize the excellent medical provider community we have in Alaska. We want this community to be successful, yet we need to work on containing costs.

We have documented many examples of medical procedures performed in Alaska that are charged at several times the rates of those performed in the Pacific Northwest. While we recognize that costs will be higher in Alaska, they cannot be double or triple the costs in the regional market. I have started discussions with representatives of the provider community over the course of the past year, and those discussions will continue.

Perhaps if Commissioner Hurtley had a bit more schooling in economics and understood the economies of scale, she wouldn’t claim surprise that costs for medical services at, say, Norton Sound Regional Hospital are two or three times higher than in Seattle, Washington. Hospitals demonstrate economies of scale. Add construction and energy costs in Bush Alaska, and the difficulties recruiting good physicians in rural Alaska, and of course you have multiples of base costs. The ISER report is pretty clear about this. If we are going to provide health care across the state, we are going to spend multiples of stateside costs. The Commissioner shouldn’t pretend surprise.

The Commissioner then confesses,

We are exploring extending travel benefits to members for certain procedures. Elsewhere in the country, employers have found success through regional “centers of excellence.” These programs identify quality medical providers, both in and out of state, and establish discount contracts with them. We seek quality and value. Our members deserve no less. Alaskans are no strangers to medically necessary travel, but access to out-of-state centers of excellence would be a voluntary option if the overall cost of the procedure and travel is equal to or less than the local cost. This choice will benefit all Alaskans.

So Moore was right. You have to get to the penultimate paragraph of the Commissioner’s essay, but Moore has it right. The State is considering/threatening to ship Alaskans outside for treatment. Excuse me. “Considering extending travel benefits.” There’s an undertaker-class euphemism if WC has heard one. And note the claim of “excellent medical provider community” in the preceding paragraph and now the claim that they are less than excellent? Oh. Cheaper.

The Commissioner concludes,

Sitting on our hands is not an option, but rushing forward without public input is also unwise. We welcome new ideas on how we can slow the growth of these costs to the state while maintaining quality health care. We are engaging with stakeholders across Alaska on our proposals to address this challenge. If you know of a group interested in such a presentation, please contact me — we welcome the dialogue.

But the State – indeed, the Commissioner – is rushing forward. There are “discussions with the provider community.” The State is clearly shopping outside services. And the State doesn’t “welcome new ideas” or your boss would have endorsed a state-sponsored health care exchange which might, you know, increase competition. But WC won’t bring Neocon tropes to the discussion.

And you’ll forgive WC, he hopes, but he’s not interested in a presentation by someone who is so fundamentally dishonest. Someone who, in a brief opinion piece, can create a textbook illustration of multiple logical fallacies. Someone who begins a debate by claiming her opponent lied, and then ultimately admits it is all true.

Oh, and remember a state employee was paid to write this thing.


WC blogs semi-pseudonymously at the blog Wickersham’s Conscience.




9 Responses to “Flaks, Facts & Intelligent Debate: Health Care in Alaska”
  1. Kelly says:

    Thank you WC!
    Excellent dissection and commentary. Hultberg wrote an unbelievable column. Pathetic actually.

  2. Z says:

    Factoring in flight costs, isn’t this actually more expensive?

    • Mo says:

      Insurance often doesn’t cover air fare or lodging and meals.
      Alaska employees insurance, for example, doesn’t cover more than two flights per year, and those are only for treatment, not diagnosis. So if you have to fly out of state for a cat scan, no airfare for you! You also get to pay the hotel bill and meals, not to mention the fun of being sick and stressed away from your own home.

      So, yes, it’s more expensive – but only for the patient and their caregiver, not the insurer.

  3. There are plusses and minuses to sending folks Outside for treatment. We’ve done it…because there were no qualified providers in the state. But the trend is more and more procedures are done closer to home. We’re lucky here in Anchorage–or along the rail belt for that matter. Folks in Barrow, Bethel, Unalaska, Kotzebue–heck, they have to fly to town for most procedures. And whether it’s “Outside” or not, it still may be hundreds of miles from home.

    Be careful what you wish for (hometown care). There are many cases where state-funded care mandates in-state treatment which is inappropriate. Just sayin’. Very nice photo, btw, of the Alaska Air 737-800.

  4. Dmitri says:

    I would imagine that state-insured retirees comprise a not-insiginfiacnt portion of health care consumers. If the state does begin to ship them Outside for a procedure, those same exact economies of scale alluded to in the post would start to work against every other insurance plan in the state, and more and more of Alaska’s healthcare would drift down to Seattle.

    Yes, it does cost more to treat people in Alaska, but Ms Moore certainly provided an excellent illustration of why it’s worth it. If Commissioner Hultberg really is “welcoming of ideas for maintaining quality health care, ” then she should be welcoming of Ms Moore’s comments, and not have greeted them with a censure so vituperous as to be unseemly coming from one of the state’s highest officers.

  5. Zyxomma says:

    Thanks, Conscience, for another great post. I read both Shannyn’s article and Ms. Hultberg’s very phony response, and your conclusions are irrefutable. Well done.

  6. John says:

    Thank you for reading the commissioner’s aide’s opinion piece so I didn’t have to.

  7. Alaska Pi says:

    Thanks WC!
    The only plus on the side of Ms Hultberg’s “contribution” which I can see is that it was printed as an opinion piece and not as an article(=press release passed on as a story, an all too common device for getting a POV in print in recent times) . As such, her language is open to the criticisms you level so clearly and concisely.
    It bothers me a great deal that, whether she wrote this or not, a State Commissioner , whose Department has very important duties , would attach their name to such a poor piece of work.

    page 10

    “The Department of Administration provides centralized administrative services to state agencies in matters of finance, personnel, labor relations, leasing of space, central mail distribution, property management, risk management, procurement, retirement and benefits programs, information and telecommunication systems, and operation and maintenance of 15 state-owned buildings in Juneau, Anchorage, Palmer and Fairbanks.

    The operation of all other state agencies depends on the efficient operation of administrative services in the Department of Administration. The goal of the department is to provide efficient and effective services to all agencies. The workload of the department is directly related to and dependent upon the programs of other agencies and the services they require.”

    I agree there is nothing useful to be gained in accepting this (yes, very) dishonest presentation of Ms Hultberg’s as a legitimate response to Ms Moore’s ,
    I am so very weary of this kind of gobbeldygook derailing and messing up real discussion of issues, events, and policies.
    Now I have to shut up or I’ll be doing an ad hominem dealie myself

Check out what others are saying...
  1. […] essay was a textbook example of logical fallacies. AKM at The Mudflats was kind enough to post the essay as well, giving WC a lot of additional readers. Among those additional readers, apparently, was […]