According to many on the left, medicine is just too important to be left to market forces. Fortunately, patients needn’t travel to countries such as England or Sweden to find out what “rights” they can look forward to under a government-run system. More than two million American Indians have the misfortune of receiving care through the Indian Health Service (IHS), an agency within the Department of Health and Human Services. While the government means well in attempting to directly provide care to Native Americans, the abysmal results speak to the fundamental failure of federal management of healthcare. Instead of adopting these failed models and doubling-down on big government, America should move toward a genuinely market-based approach that delivers for all.
Listening to advocates for socialized medicine, Americans could be forgiven for thinking our healthcare system is wholly at the whims of Wall Street and devoid of any government involvement. This could not be further from the truth. Between hundreds of billions of dollars of Medicaid and Medicare spending, insurance mandates, and the prospect of physician price-fixing in the near future, the American healthcare sector is thicketed in red tape. But all these failures pale in comparison to the IHS and its devastating human toll.
Across 330 Indian land territories in the U.S., IHS directly foots the bill for hospitals and physicians and dictates the level and quality of care. According to its patients, this much talked about “right” to healthcare amounts to very little in reality. According to Victoria Kitcheyan of the Winnebago Tribe of Nebraska, Native Americans expecting decent, comprehensive quality of care will instead encounter, “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…”
Fortunately, federal oversight bodies are starting to take notice. In August, HHS’s inspector general (IG) released a report excoriating the service for poor management, coordination, and standards of care. After interviewing many personnel, the IG noted, “Officials reported that the lack of structure could lead to frequent changes in policy as leadership changed. In some cases, policies lacked detail and were not specific or prescriptive in mandating particular actions.” Communications between IHS area offices and hospitals are next to non-existent, resulting in festering problems that are never addressed. In one case, an IHS-employed doctor abused children for years but retained employment with the agency despite multiple complaints and reports.
The agency is often forced to take and retain whatever skilled personnel they can get, due to a 25 percent systemwide vacancy rate for providers. Compensation is lousy, and if an agency hospital wants to offer enough to make the job worth a doctor’s while, they must submit to a mind-numbingly complex HHS approval process.
This dire reality is hardly the “democratic socialist” utopia alluded to in Sen. Bernie Sanders’ (I-Vt.) speeches. But it is very likely what government-run healthcare writ large would look like if brought to America. Contra the prognostications of politicians and talking heads, there are far better and more practical ways to improve healthcare in America. Already, 9 out of 10 Americans have health insurance and 77 percent of the overall public rate their quality of care as “good” or “excellent.” But many reasonably fear that they could be priced out of the system if, say, specialist bills pile up quickly. Underlying prices are high, since Americans have little skin in the game and basically no incentive to search for the most cost-effective doctors and institutions.
Expanded use of tools such as Health Savings Accounts, particularly for low-income Americans who could qualify for matching government deposits depending on their finances, would empower patients to choose the doctor and hospital they deem best while encouraging shopping around and putting downward pressure on prices. This model would not be without its difficulties but is surely preferable to the failed Indian Health Service model. Americans, particularly those from groups who have been on the receiving end of injustice after injustice, should not be forced to endure government-provided care. The stakes are simply too high.
Catalyst articles by Ross Marchand