Native Americans’ Plight Testament to Single-Payer Dangers


Among the most troubling trends in a report out last month from the Centers for Disease Control and Prevention was a significant decline in life expectancy among Native Americans.

Non-Hispanic American Indians and Alaskan Natives, as the CDC categorizes them, had life expectancy of 65.2 years in 2021. That’s 6.6 years fewer than in 2019 — a bigger drop than any other racial group. It’s also nearly 11 years lower than the national average.

This decline should be curious to supporters of government-run, single-payer health care. Native Americans have access to the federally run Indian Health Service. And yet, Native American life expectancy is plummeting.

It’s yet one more data point showing that single-payer health care does not deliver the positive health outcomes its proponents claim.

Take a closer look at what is shortening the lives of Native Americans, and a saddening picture emerges. Yes, 21.4% of the life-expectancy decline between 2020 and 2021 resulted from COVID-19.

But almost the same share was attributable to “unintentional injury” — a category that includes drug overdoses. Another 18.6% resulted from chronic liver disease and cirrhosis, while suicide accounted for 5.4% of the drop.

The decline in life expectancy would have been even more dramatic were it not for a marked decrease in deaths from conditions like influenza, pneumonia and congenital malformations over that same one-year period, according to the CDC report. So the overall healthcare situation may be worse than these statistics suggest.

Add it all up, and members of the Native American population are dying at alarming rates from what Princeton economists Anne Case and Angus Deaton have termed “deaths of despair.” And the federal government deserves some of the blame.

The official mission of the Indian Health Service is “to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.” The agency hasn’t just fallen short of that goal — it has failed on a massive scale.

Like most single-payer systems, the Indian Health Service suffers from a chronic dearth of resources and an appalling lack of accountability.

The Service spent just over $4,000 per patient in 2017, according to a recent report from the Government Accountability Office. That’s a little more than half what Medicaid spent per patient that year — and less than one-third what Medicare spent.

Meager levels of funding have forced the agency to cut corners, endangering patient health as a result. Long waits, subpar care and outright negligence are all too common.

The quality of agency staff is, at best, questionable. An investigation by The Wall Street Journal found that the Indian Health Service routinely hires physicians with histories of malpractice, regulatory sanctions and even criminal convictions.

Timely, high quality care is in such short supply at Indian Health Service facilities that tribal members often seek care outside the system — at immense personal expense. According to a recent report, more than 500,000 Native American patients have done exactly this, resulting in more than $2 billion in medical debt.

This kind of dysfunction is endemic to single-payer systems the world over. When the government is in charge of distributing limited healthcare resources, rationing, negligence and suffering invariably result.

Supporters of single-payer — most notably Sen. Bernie Sanders, I-Vt. — love to point out that U.S. life expectancy is lower than in other countries with government-run health care. The implication is that American patients are somehow dying from a lack of socialized medicine.

The sad decline of Native American life expectancy undermines that claim — and provides ample evidence that single-payer is a brand of health policy to be avoided at all costs.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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