No, I wouldn't trust US Health and Human Services because the government cannot manage to serve a much smaller population through Indian Health Service without racking up years of tragedy and mismanagement. If they cannot succeed with a smaller group then why would I trust them with a bigger group?
This, unfortunately, is wrong in the USA. The IHS is not staffed by elected officials.
The Native Americans who need our help, and do not receive it from the government IHS, do not have any way of democratically bringing about a more efficient team to run their health services.
The ONLY solution therefore must be a private one.
It's accountable to elected officials in Congress and the White House, OTOH, those elected officials are not in any meaningful sense accountable to the population served by IHS.
> The ONLY solution therefore must be a private one.
The structural problems with IHS incentives and accountability don't mean that there is a better private solution, and private services to Native American communities often are poor, too, because private industry isn't really all that interested in solving problems for people that have very little money to pay for the solution.
One of the big problems with US government institutions aimed at the Native American population like IHS is that the population they serve is small and diffuse so that it has basically zero electoral power and can impose no accountability.
The patchworks of demographics, identity, media narrative, alliances, and horse-trading that determine government representation and policy are extremely complex and require immense energy to influence in the smallest of ways.
They are vanishingly unlikely to budge for your pet technocratic issue. Doing surgeries correctly is not, in any meaningful sense, up for a vote, nor is anyone going to win elected office on a doing-surgeries-correctly platform.
Basic societal infrastructure (in this case, universal healthcare) is not a pet technocratic issue. When did we become a first world country in name only?
The irony of such levels of defeatism in a forum that proclaims opportunity is at every turn is astounding. Hope is not a strategy, but chances of success are not zero.
The Indian Health Service exists. The sexy ideological and identitarian battle over whether the federal government should provide health care to Native Americans is already won. But democracy fundamentally lacks an accountability mechanism for pesky little details like the quality of the service provided.
People can bring a class action suit against a private company, but the government is much harder and often impossible to deal with in court. The Department of Interior proved that fairly well with their continued incompetence even in the face of a court system.
> Everyone gets a vote.
Yes, but its a majority game. Heck, look at all the diversity news on HN or the diversity reports by tech giants. See any mention of enrolled members of Native American tribes? See any VC funding to solve the smaller problem (might have been a nice place to test all that basic income stuff)? Heck, Google can block one of the tribal community colleges in Google Voice and no one gives a solitary damn.
"People can bring a class action suit against a private company"
Not anymore. I guarantee you that any private company that would try to provide those services would have a "you can't join a class action; you have to go through arbitration" clause.
