I don't.  Specialists in other states charge far less than they do in Alaska.      They all bear the same debt load.     And, most make seven figure incomes, leaving plenty of disposable income.  The number of news physicians and specialist is kept artificially low by the very same schools charging those high tuitions to ensure high salaries.   As for technology advances, most of the "advances" are made by the NHI, pharmaceutical companies merely produce a commercial product from those advances.    The prices charged for supplies and diagnostic tests like MRI's are disproportionate to the cost of those machines, all in the name of profit.   This is why we are the only developed country that still leaves health care to the greed of a capitalist system.