The results are in, argues The Center for Public Integrity’s Wendell Potter: America’s healthcare system underperforms due to “the belief that the free market…can work as well in health care as it can in other sectors of the economy.” Don’t tell that to the more than 2 million Native Americans who receive their medical care through a federal service known as the Indian Health Service (IHS).

This division of the Department of Health and Human Service (HHS) is tasked with providing healthcare to “Indian” populations in the US and operates 26 hospitals, 59 health centers, and 32 health stations. This experiment in American socialized medicine has gone abysmally by all accounts, leading to easily preventable deaths and rapidly deteriorating infrastructure. Fortunately, a variety of market-oriented reforms can improve the health of millions of Native Americans in the US.

A “right” to healthcare actually means that if you live in one of the nearly 330 Indian land territories in the US, you get the chance to find out…how government promises amount to little positive change. Victoria Kitcheyan of the Winnebago Tribe of Nebraska describes horrifying conditions, such as in government run facilities with “emergency room nurses who do not know how to administer such basic drugs as dopamine; employees who did not know how to call a Code Blue; an emergency room where defibrillators could not be found or utilized when a human life was at stake…”

One large issue is the absence of skilled physicians; the Government Accountability Office found in August of 2018 that “the overall vacancy rate for providers…was 25 percent, ranging from 13 to 31 percent across the areas.” There are undoubtedly issues with providing competitive pay, but if the IHS wants to offer a rate on par with local competitors, they need to get HHS’s permission in a lengthy, bureaucratic process (i.e. creating special new pay tables that must be evaluated and approved by higher-ups).

Donald Warne, the first Native American doctor to be on the national Board of Directors of the American Cancer Society, describes how a lack of know-how, skilled personnel, and general investment results in basically no preventative care, where things like cancer screenings simply do not occur and “People are suffering and dying unnecessarily.” The predictable response to this malaise is to call for more funding, especially considering that the current level of care likely violates US treaty obligations.

But at a nearly $6 billion annual budget serving 2.2 million, just dividing up the budget and giving lump-sum payments to each individual would result in each and every covered Native American receiving more than $200 per month to purchase medical services. This is more than enough to purchase some combination of basic insurance and direct primary “subscription-style” access to doctors. In the town of Bartlesville, Oklahoma, home of the Delaware Indian Tribe, a direct primary provider offers a range of basic services for $20-$100 per month (depending on age). To cover hospitalization costs, tribe members could either use Obamacare plans or even cheaper medical sharing plans (talked about more here) that, unlike Obamacare plans, are not more expensive in rural areas.

And of course, buying health insurance care in-bulk (i.e., family plans) is cheaper than each individual signing up for their own plan. It’s difficult to predict the arrangements that would result from IHS giving tribe members lump-sums instead of directly providing care, but it’s hard to see it being worse than the miserable status-quo. Congress has an opportunity to improve health-care for millions of marginalized Americans, by tying continued funding to the exploration of more decentralized forms of medical care. Socialized medicine in America has failed, and we need more of a free-market, not less.