More than 30 years later, some of the same conditions persist. We have fewer doctors and other health professionals per capita than other states. Chronic conditions surrounding habitual choices have become entrenched, creating their own expensive infrastructure to deal with their byproducts. As our state income drops with the end of the largess of Prudhoe Bay oil, our health costs grow. In 1969 the state's health programs totaled approximately $30,000. Today that budget is a whopping $1.6 billion!

Why does it cost this much? As one health professional explained to me, "We spend about 98 cents of our health expense dollar on chronic conditions and 2 cents on prevention." As long as we deal primarily with problems after they have become intractable, we are doomed to exponential growth of the health budget.

Why haven't we fixed these problems? It isn't simple, but some of that deficit comes down to political incentives, the lack of budgetary tools and oversight.

Promises made: To win and stay in office, elected officials promise better service and budget cuts. Real action, the kind that cuts long-term costs, often doesn't look impressive. When primary health care succeeds, people do not get sick. It is hard to base a campaign slogan on that. We choose what looks dramatic, and we change programs constantly, chasing after appearances, not long-term outcomes.

Tools for improvements: Analyzing the effectiveness of any governmental program is difficult, and tools to demonstrate outcomes had not been developed until relatively recently. I believe that a "results" budgeting tool, if correctly implemented, does give us that kind of analysis. This year's legislative cycle has a unique impediment, and we have neither the tools nor the time to analyze or change the Health and Social Services Department budget.

Time: With a shrinking budget, hundreds of important issues tug for time in the legislative arena, a limited engagement of four months. Health issues tend to take a back seat in the furious waging for limelight in the Capitol. The HSS budget, nearly one-fourth of the state's operating budget, requires a total reallocation of focus to decrease escalating costs and ensure health safety. We're three weeks into a rushed one-month speed course through the second-largest department budget. The rush is a special session, called by the governor smack dab in the middle of the Legislature's constitutionally mandated task, the budget. This rush shoves aside the intense, but more thorough, review that traditionally transpires during the first months of session. This crash process is more maddening because of the dramatic restructuring of HSS during the past year.

We lack the time, the tools or the political incentive to fairly address the growing health costs and needs of Alaskans. To answer this dilemma, the Joint House and Senate Minority Caucus has formed a Bipartisan Legislative Health Caucus. I was chosen to co-chair that group.

The first meeting, from noon to 1 p.m. Wednesday in the Capitol's Butrovich Room, will focus on increasing health costs and safety and is titled "Stop Fiscal Hemorrhaging in Health Services: A discussion of how to decrease health cost drivers -- chronic conditions and crisis prevention.'' This one-hour discussion is open via the Legislative Teleconference system. Call your local Legislative Information Office for details on how to be a part of the meeting.