Kevin MD asks how single-payer advocates account for the failure of the Indian Health Service. I don't know enough about the IHS to say whether it's a failure, but for the sake of discussion, the answer is easy: As the saying goes, programs for the poor are poor programs. Native Americans are among the poorest, most marginalized, most disenfranchised constituencies in American life. That a charity program for them would be underfunded and rarely improved is among the least surprising facts you could possibly tell me. It's like asking why, in the private system, the poor seem to have it so bad. The answer is because they're poor. The virtue of single payer, and all integrated national systems, is that it puts the poor and downtrodden in the same system as the rich and politically powerful. If the rich want a decent system, then the poor get one too. In other countries, there's a word for this: Solidarity. In our country, we call it universalism. Update: Or, as El Cid says in comments, "I am shocked, just shocked at any suggestion that a U.S. government program based on solemn promises to our native American communities is operated with anything less than perfect dedication."
