The last sentence is illogical (as is usual with Wohlforth articles).  It's not that "competition doesn't work in this market", it's that there is not competition all across the market.  More competition in certain health care sectors would help.  Specialists that have a monopoly force the costs up for everyone, including general practitioners.  Competition would, in theory, make the costs specialists charge fall to earthly levels.  But with few people in the state that buy insurance and with corrupt state medical boards ... nothing good will happen to health care in AK for generations to come.  Our best option would be to have interstate insurance pools, instead of state-based.  But I believe this is a law that would have to change on the federal level.