Indian Health Service: The single-payer system experience

posted at 2:56 pm on September 1, 2009 by Ed Morrissey

Almost two months ago, I wrote about the single-payer system of which most Americans have never heard: the Indian Health Service.  The catalyst for the post was the death of a five-year-old girl who got misdiagnosed as depressed instead of having stomach cancer, thanks to a lack of resources for proper testing and diagnosis.  The AP reported at length about the grossly underresourced single-payer system for Indian reservations.  This weekend, the Wall Street Journal picked up the story and explained further the failures of the IHS:

The IHS attempts to provide health care to American Indians and Alaska Natives in one of two ways. It runs 48 hospitals and 230 clinics for which it hires doctors, nurses, and staff and decides what services will be provided. Or it contracts with tribes under the Indian Self-Determination and Education Assistance Act passed in 1975. In this case, the IHS provides funding for the tribe, which delivers health care to tribal members and makes its own decisions about what services to provide.

The IHS spends about $2,100 per Native American each year, which is considerably below the $6,000 spent per capita on health care across the U.S. But IHS spending per capita is about on par with Finland, Japan, Spain and other top 20 industrialized countries—countries that the Obama administration has said demonstrate that we can spend far less on health care and get better outcomes. In addition, IHS spending will go up by about $1 billion over the next year to reach a total of $4.5 billion by 2010. That includes a $454 million increase in its budget and another $500 million earmarked for the agency in the stimulus package.

Unfortunately, Indians are not getting healthier under the federal system. In 2007, rates of infant mortality among Native Americans across the country were 1.4 times higher than non-Hispanic whites and rates of heart disease were 1.2 times higher. HIV/AIDS rates were 30% higher, and rates of liver cancer and inflammatory bowel disease were two times higher. Diabetes-related death rates were four times higher. On average, life expectancy is four years shorter for Native Americans than the population as a whole.

Rural Indians fare even worse, as data from Sen. Baucus’s home state show. According to IHS statistics, in Montana and Wyoming, Indians suffer diabetes at rates 20% higher, heart disease 12% higher, and lung cancer rates 67% higher than the average across all IHS regions in the country. A recent Harvard University study found that life expectancy on a reservation in neighboring South Dakota was 58 years. The national average is 77.

Part of this comes from unhealthy lifestyles, too.  Terry Anderson quotes Kelly Eagleman, an officer of the Chippewa Cree band in Montana, “We all smoke. We lay on the couch. But when something happens to us, we’re the first to point and say that the clinic should have fixed us.”

But Eagleman also thinks the top-down bureaucracy of the IHS creates big problems.  Native Americans on the reservations know that the money from the IHS will run out about half-way through the year; their proverb, “Don’t get sick after June,” is a warning that there will be no resources for treatment.  Eagleman has pushed for autonomy and a limited amount of privatization on his reservation, using IHS money as block grants to run their own clinics outside of the IHS bureaucracy.  That decision provides better and more consistent care.

This demonstrates that the proper measure of “efficiency” isn’t the money spent on administration but the outcomes from the health-care system.  Congress sets the level of spending on IHS, and obviously sets it far too low.  Given this track record, it’s really not terribly difficult to extrapolate what will happen in a “public plan” that pushes insurers from the field.

Maybe Congress should fix the health system it already runs before assuming the arrogance to fix the one that works perfectly well for the vast majority of Americans.


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This is a real concern. However, I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

A nephew of mine whose mom is Indian was diagnosed at an Indian clinic with a fractured tibia last summer, & when they said it would take at least a week to get a cast for him, they took him to a private doctor, who said it wasn’t broken. He was good as new in about a week. Good thing he never got that cast.

jgapinoy on September 1, 2009 at 3:01 PM

I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

You sound like Czar Van Jones.

portlandon on September 1, 2009 at 3:01 PM

AnninCA on September 1, 2009 at 2:59 PM

O_o

Because Native Americans are practically discriminated against doesn’t mean they won’t screw up a “public plan?” That’s incredible logic.

The Calibur on September 1, 2009 at 3:01 PM

This is a real concern. However, I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

Speaking as someone with an Indian bloodline – you never know what the hell you are talking about.

izoneguy on September 1, 2009 at 3:02 PM

Oh, this can’t be because universal health care doesn’t work, it has to be because whites are racists.

Yeah, that’s it.

Spiritk9 on September 1, 2009 at 3:02 PM

AnninCA on September 1, 2009 at 2:59 PM

Allah’s big sister speaks again–with no specifics, of course, and no real argument for anything

In the Land of Vague Platitudes, “Ann”, specific examples and focused arguments are King.

“iffy”?? It’s a government-run single-payer system: It’d exactly what Obama intends to foist on the entire nation.

Janos Hunyadi on September 1, 2009 at 3:03 PM

..”It’s”

Ann’s non-posts are like Kryptonite……

Janos Hunyadi on September 1, 2009 at 3:05 PM

This is a real concern. However, I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

So, your take home message from this was that single pay government health care has no accountability for the despicable health care because Native Americans have always been treated poorly?

a capella on September 1, 2009 at 3:06 PM

AnninCA on September 1, 2009 at 2:59 PM

Maybe you can enlighten us to the plethora of big government bureaucracies that are efficient and well run?

kirkill on September 1, 2009 at 3:07 PM

That’s incredible logic.

The Calibur on September 1, 2009 at 3:01 PM

Even worse, the logic goes: We’ve tried many government programs, and they’re all incredibly inefficient:

Post office
Welfare
Social Security
Medicare
Medicaid
Military (works but is inefficient)
etc.

Therefore if we create another program, we’ll be so efficient that we’ll save money over the free market.

It’s like the definition of insanity joke — doing the same thing over and over again and expecting different results.

Daggett on September 1, 2009 at 3:10 PM

This is a real concern. However, I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

So now we can treat the entire population unfairly? I thought liberals were supposed to be champions of the idea that if government can do something to a minority group then it can do it to to everyone else?

gwelf on September 1, 2009 at 3:11 PM

This just in….
Natives are RAAAcccccisssttttttt!
No wait. That’s not it.
The Natives are RAAAcccccisssttttttt! Restless.
Yeah. I like that better.
NEVER AGAIN!

Blacksmith8 on September 1, 2009 at 3:11 PM

This is a real concern. However, I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

How about the problems encountered with the Veterans’ Administration? Government run healthcare provided to two different populations, under two separate programs, and they both provide suboptimal healthcare.

And then factor in the lack of immediate service providing such as MRIs in Canada. Government run programs are more inefficient, and while that may only cost an hour or two at the DMV, at the hospital it can be fatal.

rbj on September 1, 2009 at 3:13 PM

This “feature” of how our government, especially Congress, does its job is infuriating to me. There is a problem in a certain area, and Congress establishes one or more government programs intended to combat the problem. Years later, results of these programs range from bad to reprehensibly atrocious. Yet this is used as evidence for Congress to EXPAND operations in this area since, obviously, the problems are so great. It never seems to occur to our politicians to actually get something running right before attempting a broader program of the same type.

jwolf on September 1, 2009 at 3:13 PM

as the rev. lowry said at the inauguration…

we’re still waiting for the red man to get ahead man..

ain’t gonna happen as long as the government is uh taking care of them…and thats what the left wants…

right4life on September 1, 2009 at 3:14 PM

Well, OK, here’s my take. I think this population is often ignored congressionally.

There is such horrible poverty problems. This is a group that is isolated and designated as “different.” That’s the basis for my remark that I’m not sure it’s a legitimate comparison.

Contrast this to Medicare, who are more mainstream. You don’t see the same issues.

AnninCA on September 1, 2009 at 3:15 PM

My advice, leave the reservation.

WashJeff on September 1, 2009 at 3:16 PM

This is a real concern. However, I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

What do you mean? Indians get to live on government reservations, just like the poor. They are getting the medical treatment that obama wants for all of us.

Hiya Ciska on September 1, 2009 at 3:16 PM

I live in a town that borders the Navajo Reservation. IHS is a poor substitute for private health insurance or even Medicaid. Most Navajos who have the option take the insurance route, just like everyone else who can.

mchristian on September 1, 2009 at 3:19 PM

My wife used to work at IHS. If I were to ask her what she thought of government-run healthcare; her anwer could be summed up in a number of expletives, and then “awful”.

Norwegian on September 1, 2009 at 3:20 PM

I live in a town that borders the Navajo Reservation.

mchristian on September 1, 2009 at 3:19 PM

You live in Flagstaff?

Norwegian on September 1, 2009 at 3:21 PM

It is to difficult to asign the virtue of fixing what is broken to Obama. So far he has only broken everything he gets his hands on.

fourdeucer on September 1, 2009 at 3:22 PM

AnninCA on September 1, 2009 at 3:15 PM

More gibberish: No specific examples; no clear arguments made; no points of view explained; bad grammar adding to the hazy confusion of a simple mind.

Seriously, you write like someone suffering the side effects of anti-psychotic medications. Is this blog part of the rehab / therapy?

Janos Hunyadi on September 1, 2009 at 3:22 PM

Contrast this to Medicare, who are more mainstream. You don’t see the same issues.

AnninCA on September 1, 2009 at 3:15 PM

The prejudice or the crappy care? Clearly spoken like someone who has never deal with the crappy system that is Medicare or the crappy system that is the IHS. Same crap, different members.
I used to work for Medicare. It’s a clusterfark.

mjk on September 1, 2009 at 3:22 PM

mchristian on September 1, 2009 at 3:19 PM

If you live in Gallup, stay away from the KFC place–although the smell hitting you as you walk in should warn anyone off

Janos Hunyadi on September 1, 2009 at 3:24 PM

You live in Flagstaff?

Norwegian

Farmington, NM

mchristian on September 1, 2009 at 3:24 PM

Farmington, NM

mchristian on September 1, 2009 at 3:24 PM

Hey, I am practically your neighbor! Durango, CO here.

Norwegian on September 1, 2009 at 3:26 PM

There was a resident that I trained with that was sadly pretty poor as a physician. Enough to get by, but no shining light by any means. When she graduated she was going to practice in a govt. network in Indian Reservations.

My friend turned to me and said, “That bi**h is gonna kill more Indians than Custer!”

It was one of those jokes you feel bad at laughing about later, when the seriousness of it set in, but I’d be lying if I said I didn’t laugh like heck when he said it.

The system is terrible, and it obviously doesn’t attract the best and the brightest to its ranks.

DrAllecon on September 1, 2009 at 3:26 PM

This is a real concern. However, I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

My best friend is Native American.

There is a saying in Indian country – “If you think you can trust the federal government, just ask an Indian.”

The way the government has treated this population ought to be a lesson to us all, particularly liberals who tend more to trust their needs to it. Native Americans found out the hard way, and quickly, that this sort of dependency arrangement is only as good as the paper it’s written on.

capitalist piglet on September 1, 2009 at 3:28 PM

Well, OK, here’s my take. I think this population is often ignored congressionally.

There is such horrible poverty problems. This is a group that is isolated and designated as “different.” That’s the basis for my remark that I’m not sure it’s a legitimate comparison.

Contrast this to Medicare, who are more mainstream. You don’t see the same issues.

AnninCA on September 1, 2009 at 3:15 PM

Baaaaahhhhhh!!!! – How old are you?
Have you ever know anyone that used MediCare?
My mother had to use it because she had no health insurance after my Dad retired. My dad is a vet so he still gets VA care and he says it is OK.
My mother was denied many treatments for her medical conditions. They pretty much did the take the blue pill treatment. I will relate your post to her the next time I visit her gravesite.

izoneguy on September 1, 2009 at 3:30 PM

This demonstrates that the proper measure of “efficiency” isn’t the money spent on administration but the outcomes from the health-care system. Congress sets the level of spending on IHS, and obviously sets it far too low

Given the fact that my wife couldn’t get basic health insurance for years because of a precondition- and a relatively minor one at that- I’m going to have to disagree with you this time.

Your comparison is someone off basis anyway. Looking at the health system of a relatively poor, third world country isn’t a very useful point of reference. To compare apples to apples, you need to indicate health care spending per GDP. A better comparison would be France, which has a hybrid insurance model of public and private systems.

But how can you say that cost is irrelevant as a yardstick? Do you think the US has unlimited resources to dedicate to healthcare?

Maybe Congress should fix the health system it already runs before assuming the arrogance to fix the one that works perfectly well for the vast majority of Americans.

Since the US health care is on course to demand 20% of total GDP, yes, it does provide good health care to those with access to insurance. But the reason you have to introduce change is because these levels of spending in an aging population are completely unsustainable. Not to mention, people who have even the smallest precondition and lose their jobs may be up the creek- but that will never happen to you, right?

foreverright on September 1, 2009 at 3:32 PM

““Don’t get sick after June,””

Obama’s new campaign slogan…

Seven Percent Solution on September 1, 2009 at 3:33 PM

IHS sounds like the Bureau of Indian Affairs. They are supposed to be keeping money in trust for them but refuse to give an accounting. Yes, we have their money-Where is it?-don’t know. Lawsuits are in the judicial system as we speak.

Tom

marinetbryant on September 1, 2009 at 3:38 PM

This is a real concern. However, I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

You must be wearing hip boots because you just keep stepping in it, if you know what I mean! An “iffy” comparison, really? If America can’t keep their promises and treaties with the Indians what makes you think you, I or anyone else is going to have it better once Obama takes over our health care? THE GOVERNMENT DOES NOT CARE ABOUT YOU, ME OR ANYONE ELSE! THEY ONLY CARE ABOUT CONTROLLING US!

fbcmusicman on September 1, 2009 at 3:44 PM

Hear me, my fellow Americans. My heart is sick and sad. From where the sun now stands, I will support Barack Obama no more forever.

Hinmahtooyahlatkek on September 1, 2009 at 3:57 PM

There is such horrible poverty problems. This is a group that is isolated and designated as “different.”

Ann, No one is required to live on the res. It isn’t a prison camp.

mchristian on September 1, 2009 at 3:59 PM

Hey, I am practically your neighbor! Durango, CO here.

Norwegian

Small world.

mchristian on September 1, 2009 at 4:02 PM

Obama wants Federal health insurance to keep insurance companies honest. What do we have to keep federal medicine honest? Nothing?

seven on September 1, 2009 at 4:04 PM

This is a real concern. However, I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

That’s putting it mildly. We’re suddenly concerned with them? yeah, right.

beekiller on September 1, 2009 at 4:09 PM

Have you ever know anyone that used MediCare?
My mother had to use it because she had no health insurance after my Dad retired. My dad is a vet so he still gets VA care and he says it is OK.
My mother was denied many treatments for her medical conditions. They pretty much did the take the blue pill treatment. I will relate your post to her the next time I visit her gravesite.

izoneguy on September 1, 2009 at 3:30 PM

I don’t doubt you. That’s also why I don’t think public health option is really all that radical. Anyone would want to get beyond this, if they can. It’s a “better than nothing” kind of solution.

AnninCA on September 1, 2009 at 4:10 PM

Ann, No one is required to live on the res. It isn’t a prison camp.

mchristian on September 1, 2009 at 3:59 PM

Forgive me if I’m totally behind on Indian issues. I did watch a great program on NPR about the movement and, what you say, is exactly what that program said. I’m probably still caught up in the biography about Andrew Jackson, who really was anti-Indian and triggered the Trail of Tears. But in any case, I do not really “get” Indian issues.

It seems that there is dire poverty and devastation in a lot of ways. It seems that the system is so oppositional that I think everyone gave up on resolution.

But that’s just my take.

AnninCA on September 1, 2009 at 4:14 PM

Actually, it’s easy to compare the government with private enterprises and tout the success of the latter to critique the former. However, it is really an “apples to oranges” comparison for reasons below:

(1) government is definitely much larger in scope than even the largest of private entities in the United States (and this country does have behemoths). As an example, the tech titan Microsoft employs around 70,000 people in the whole of United States, while the state of Texas itself employed 266,000 people in 2003 alone. Let’s see if we can find a politician who can run on a platform that specifically targets reduction in headcount of state employees.

(2) the scope of the government can extend to a complete universe of aspects of human lives, whereas private enterprises tend to be narrow in their scope. While we can argue that the private enterprises can, in unison, encompass the same sphere of activities that the government partakes in, it is easy to see that’s fallacious. For example, the private industry takeover of a basic utility like power can easily evolve into a catastrophe like Enron. When there is a situation when you can switch power to a less loaded grid and thereby maximize profits, which can result in a loss of power to a hospital emergency, killing lives, there is no logical middle ground possible (transcripts from Enron power operations did reveal myriad such conversations).

It is therefore undeniable that the government does have an important role to play in engaging in areas where the private enterprises do not enter (because it is guaranteed to have a low ROI : think of the ROI our defence forces have). Does the government have overhead? Absolutely. Can the bureaucracy be corrupted? Absolutely. But the answer to just get rid of the government and replace it with private enterprises at all levels is too simplistic a response, IMHO.

peter_griffin on September 1, 2009 at 4:16 PM

Well, OK, here’s my take. I think this population is often ignored congressionally.

There is such horrible poverty problems. This is a group that is isolated and designated as “different.” That’s the basis for my remark that I’m not sure it’s a legitimate comparison.

Contrast this to Medicare, who are more mainstream. You don’t see the same issues.

AnninCA on September 1, 2009 at 3:15 PM

You are amazing, and I don’t mean that in a good way.

a) Medicare is seriously screwed up to the point that many doctors, especially in “low reimbursement states” like Oregon, won’t even take Medicare patients.

b) Go to http://www.usdebtclock.org and tell me how Medicare is so great seeing how it’s a completely unsustainable, unfunded nightmare coming at us.

c) There is NOT ONE government agency that runs as efficiently as the private sector. It costs the government $1.61 to spend a dollar. That means every dollar they spend had 61 cents of grant request creation, grant review, administration, etc, etc.

I think you need to think seriously on this quote:

“You cannot legislate the poor into freedom by legislating the wealthy out of freedom. What one person receives without working for, another person must work for without receiving. The government cannot give to anybody anything that the government does not first take from somebody else. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that my dear friend, is about the end of any nation. You cannot multiply wealth by dividing it.”
~~~~ Dr. Adrian Rogers, 1931

PastorJon on September 1, 2009 at 4:16 PM

I don’t doubt you. That’s also why I don’t think public health option is really all that radical. Anyone would want to get beyond this, if they can. It’s a “better than nothing” kind of solution.

AnninCA on September 1, 2009 at 4:10 PM

You’re wasting your time…but I guess you know that. ;)

beekiller on September 1, 2009 at 4:17 PM

You are amazing, and I don’t mean that in a good way.

a) Medicare is seriously screwed up to the point that many doctors, especially in “low reimbursement states” like Oregon, won’t even take Medicare patients.

b) Go to http://www.usdebtclock.org and tell me how Medicare is so great seeing how it’s a completely unsustainable, unfunded nightmare coming at us.

c) There is NOT ONE government agency that runs as efficiently as the private sector. It costs the government $1.61 to spend a dollar. That means every dollar they spend had 61 cents of grant request creation, grant review, administration, etc, etc.

I think you need to think seriously on this quote:

“You cannot legislate the poor into freedom by legislating the wealthy out of freedom. What one person receives without working for, another person must work for without receiving. The government cannot give to anybody anything that the government does not first take from somebody else. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that my dear friend, is about the end of any nation. You cannot multiply wealth by dividing it.”
~~~~ Dr. Adrian Rogers, 1931

PastorJon on September 1, 2009 at 4:16 PM

If you’re actually a pastor…you should really look into a different career.

beekiller on September 1, 2009 at 4:21 PM

This is a real concern. However, I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

So are you saying that other populations who have been treated unfairly would also suffer under similar plans?

African-Americans have historically been discriminated against and have experienced higher levels of poverty. Why would you want to subject them to the same sort of health care?

Asher on September 1, 2009 at 4:23 PM

Amen PastorJon

Remember to remind them that most of the $1 of value they get out of $1.61 spent comes in the form of military harware and govt. buildings — in other words tangible hard assets they can count on the books. When it comes to a lot of social welfare programs they are back to the Carter era of getting 33 cents on the $1 for a dollar spent these days.

trollkiller on September 1, 2009 at 4:28 PM

So are you saying that other populations who have been treated unfairly would also suffer under similar plans?

African-Americans have historically been discriminated against and have experienced higher levels of poverty. Why would you want to subject them to the same sort of health care?

Asher on September 1, 2009 at 4:23 PM

I think she’s saying that it is better than no health care at all…and no possibility of health care…ever.

beekiller on September 1, 2009 at 4:28 PM

Asher on September 1, 2009 at 4:23 PM

I think what AnninCA is talking about is providing the base minimum care to those communities who do not have any right now, just because private insurance would consider them to be an attrocious ROI.

If I had my own private insurance company which was answerable to shareholders, I would definitely think long and hard before I chose to insure a group that was both (a) poor and (b) prone to diseases because of unhealthy lifestyle resulting from (a). In fact, there is all likelihood that I would not have insured them.

Hence the role of the government as a last resort insurer for such people. Will that be as effective as private sector? Of course not, because the private sector does not even insure such people. There are some roles which yield low ROI, and only the government can fill in those roles since no one else would. Please read my previous post on this thread as well.

peter_griffin on September 1, 2009 at 4:30 PM

It seems that there is dire poverty and devastation in a lot of ways. It seems that the system is so oppositional that I think everyone gave up on resolution.

I have been on many Indian reservations here in Oklahoma and around the country. Most of these problems exist because of the “nanny state” these people live with much like many welfare ghettos. Continued government control in our lives will eventually turn this whole nation into one big ghetto.

fbcmusicman on September 1, 2009 at 4:33 PM

1.4 times higher

GAAAAACK!

I hate Hate HATE this terminology. It is at best ambiguous, and at worst misleading. Does it mean 1.4 times as much, or 2.4 times as much? Let me explain the difference:

Let’s say John has 10 cookies, but Mary has 14 cookies. She has 4 more cookies than John has. The number of cookies she has is 4 higher than the number John has. Got it? 4 more/higher. Well, how do you compare 4 to how many John has? It is 40% of what John has (aka .4), so you can say “Mary has 40% more cookies than John has”.

We could describe the number of cookies she has as “1.4 times as many as John has”. But we can’t say she has “1.4 times more” or “1.4 times higher”, because she only has “0.4 times” (4) more/higher than John has.

And don’t even get me started on “times less/fewer”. How can someone have “5 times less” or “10 times fewer” of something?

The Monster on September 1, 2009 at 4:34 PM

peter_griffin on September 1, 2009 at 4:30 PM

What you are proposing is a different solution than what is currently being debated by Congress.

chemman on September 1, 2009 at 4:34 PM

fbcmusicman on September 1, 2009 at 4:33 PM

Please take a chance to read my comments on this thread, I am sure we can have a meaningful debate …

peter_griffin on September 1, 2009 at 4:35 PM

Indian Health Service should be changed to a block grant for the tribes to run there own health services. Plus more should be done to decrease the unemployment rate that reaches 40 percent plus n some reservations.

Jacob Hammond on September 1, 2009 at 4:35 PM

If this healthcare abortion passes I can only cringe at the prospect of visiting a clinic run like the DMV and being treated like an Indian.

Good Lord, why do I even bother going to work and paying my taxes if this is the future I’m purchasing?

F*ck

skree on September 1, 2009 at 4:38 PM

fbcmusicman on September 1, 2009 at 4:33 PM

Good point. I have talked to Tribal Leaders in the Cherokee Nation and the Navajo Nation. Both groups told me the same thing. The Government (U.S.) holds all reservation lands in trust for perpetuity. Since the land really isn’t theirs it is nearly impossible to get venture capital or loans to start businesses. Lack of business opportunity thus no job development leads to these high levels of poverty. Until the government gives them the land outright the problem will continue.
The Cherokee’s are trying to get around this by taking some of the profits from their casino’s and building a small business incubator. I sincerely hope they are successful in this endeavor.

chemman on September 1, 2009 at 4:41 PM

chemman on September 1, 2009 at 4:34 PM

I do not even know what is in the Congress bill, since it changes depending on roughly an hourly basis. However, I was responding to the generic claims that the government can do no good any situation, since I believe it is an unfair comparison in a lot of cases.

peter_griffin on September 1, 2009 at 4:46 PM

This is a real concern. However, I don’t think we’ve ever treated this population even remotely fairly, so it’s an iffy comparison.

AnninCA on September 1, 2009 at 2:59 PM

So, our past mistreatment of Indians makes the current mistreatment of Indians ok?

Regardless of how Indians were treated in past centuries, is it reasonable to assume that a larger system for all Americans will work better than the smaller system run just for Indians, when the same government is in charge of it?

hawksruleva on September 1, 2009 at 4:54 PM

However, I was responding to the generic claims that the government can do no good any situation, since I believe it is an unfair comparison in a lot of cases.

peter_griffin on September 1, 2009 at 4:46 PM

Other than brute-force projects (military operations, and roadbuilding, for example) what is the Uncle Sam good at?

hawksruleva on September 1, 2009 at 4:55 PM

Plus more should be done to decrease the unemployment rate that reaches 40 percent plus n some reservations.

Jacob Hammond on September 1, 2009 at 4:35 PM

Is that worse than Detroit?

hawksruleva on September 1, 2009 at 4:56 PM

hawksruleva on September 1, 2009 at 4:55 PM

I would respond to your question with another question : can you point to a government job description which the private industry does (either exactly very closely) and yet achieves a significantly worse result? Please read my previous comment here so that we can be on the same page: http://hotair.com/archives/2009/09/01/indian-health-service-the-single-payer-system-experience/comment-page-1/#comment-2648505

peter_griffin on September 1, 2009 at 5:00 PM

Quit giving them free health care on the Res. and they will either die off or change their ways. Ditto for the entire American population. Outside of veterans, I don’t think the govt. should handle anyones health care.

I grew up around Lumbees (area of where the Lost Colony got lost in NC). They are an unrecognized tribe but still get a lot of government services. The other tribes like the Cherokee don’t want to share the governmental pie with them. The other tribes correctly point out that lots of them are not full blooded. There are a lot of blond haired blue eyed Lumbees as well as those of mixed African descent.

The Lumbees are always sore over their lack of recognition, their lack of being catered to by the Federal Govt., their lack of being able to get a casino going… But, over the years, they have more adapted to modern society; and, while they have a more destructive lifestyle than the surrounding “white” population, I have seen an enourmous increase in their wealth and moderninity in my lifetime. I believe a large part of this came from them not being so catered too by the Federal Govt.

Saw the other side of the coin when I worked aircraft in Alaska. The Fed. Govt. used to fly the Inuit, et al. in for conferences in Anchorage periodically. It usually coincided with their flying in to pick up their checks. The Govt. would lecture them on the evils of alcohol, drug abuse, high sugar diet and smoking. They would sit there and smoke, drink and eat junk food through the lecture with money from their Govt. checks.

trollkiller on September 1, 2009 at 5:02 PM

hawksruleva on September 1, 2009 at 4:55 PM

In other words, my take is that there are very few government projects that the private enterprises will be willing to partake in, because the low ROI nature of most government tasks would make cause private companies (with fiduciary obligation to their shareholders) to reject them.

peter_griffin on September 1, 2009 at 5:03 PM

peter_griffin on September 1, 2009 at 5:03 PM

Typo : meant “because the low ROI nature of most government tasks would cause” instead of “because the low ROI nature of most government tasks would make cause”

peter_griffin on September 1, 2009 at 5:04 PM

I say the govt. should stay out of everyones health care except veterans; and, in that case, the veteran should have a private option.

With regard to the Indian reservation focus. I grew around Lumbees in the “Lost Colony” area of NC. I am considered Indian by a lot of my friends who say it is more a state of mind than skin color.

Having grown up around Lumbees and having worked in Alaska around the Inuit and Oregon around the Klamath when working aircraft, I can say that the Lumbees (who are discriminated against by their fellow tribes for not being full blooded) do better economically than those tribes on the Federal Govt. dole.

The Lumbees in NC have made major strides forward economically over my lifetime. They have never been accepted fully at the govt. feeding trough. And, while they are sore over it, they have a higher level of economic development than other tribes in general.

In comparison the Inuit et. al., who are generally poorly treated by whites in Alaska, fly into Anchorage periodically to pick up or spend govt. cheques. The govt. often provides lectures on Alcohol and drug abuse, high sugar diets, and smoking. Ironically, they often sit there and smoke and eat junk food during the lectures with the money from their govt. checks.

While all my Lumbee buddies would love to feed at the govt. trough, they are successful and tend to be very self reliant and do not want too much govt intrusion into their lives.

trollkiller on September 1, 2009 at 5:19 PM

Oops! Sorry for retyping that more or less same post twice.

trollkiller on September 1, 2009 at 5:21 PM

If you’re actually a pastor…you should really look into a different career.

beekiller on September 1, 2009 at 4:21 PM

A pastor, or anybody else, that doesn’t, as gently as possible, tell somebody they are missing the truth, is doing them a disservice. I don’t think I could have been more gentle in letting her know she’s claiming the equivalent of saying the sky is under us and the ground is above.

PastorJon on September 1, 2009 at 6:02 PM

I think she’s saying that it is better than no health care at all…and no possibility of health care…ever.

beekiller on September 1, 2009 at 4:28 PM

So both of you are saying us poor black folks are too stupid to ever pull ourselves out of poverty, unless the good ol’ gubmint-man comes a helpin’.

We sure are lucky to have magnanimous white folks like you and AnninCa looking out for us.

Squiggy on September 1, 2009 at 6:30 PM

Um, sorry. Should have said “looking out fo us”. Right “beekiller”?

Squiggy on September 1, 2009 at 6:31 PM

I am native American. I’ve been to those hospitals.

You wait all day to be seen, and most of the time unless YOU know what’s wrong with you the dr doesn’t pay enough attention (they’re too busy trying to get through the crowds of patients) to really understand the issue and people get misdiagnosed or told they’re fine ALL THE TIME.

I would rather spend a LOT more money and get real health care than go back there again.

One Angry Christian on September 1, 2009 at 7:27 PM

Correction

Government run healthcare provided to two different populations, under two separate programs, and they both provide suboptimal substandard healthcare.

slp on September 2, 2009 at 1:01 AM

Americans are becoming more aware of the US government single payer Indian Health Service that is by any unbiased measure a failure. Add to that the VA and Medicare mismanagement and one easily sees the future of American’s medical treatment under ObamsCare. Yet our leaders ignore what has failed and push to place all Americans under similar programs. This government ongoing travesty does not even address the cutting of Medicare to support ObamaCare, the under funding of the VA and the Indian Health Service by congress, the cost of ObamaCare and the infringement of our economic freedom and civil liberties.

amr on September 2, 2009 at 9:05 AM