When flame meets straw (man, that is)

It gives me no pleasure to do this, but sometimes even friends let loose with such jaw-droppingly bad arguments that it is impossible for me not to redirect a bit of the old Respectful Insolence in their direction. So it was earlier, when I saw an unreasonable article by an otherwise reasonable guy sneak into my newsfeed. If you want to see an example of a bad analogy, watch Dr. Kevin Pho have at it in a post entitled We’ve Tried Single Payer Health Care, and It Has Failed.

Quoth Kevin:

Based on an agreement in 1787, the government is responsible to provide free health care to Native Indians on reservations. And, as you can see from this scathing story from the Associated Press, that promise has not been kept.

It is a horrible story about how badly underfunded and run the Indian Health Service (IHS) is, certainly a story worthy of comment. Unfortunately, Kevin uses the story as an excuse to indulge his dislike of anything resembling a single payer system by laying down one of the worst arguments I’ve ever seen anywhere (and I do mean anywhere):

And, after Haiti, where in the Western hemisphere do men have the lowest life expectancy? It’s on Indian reservations in South Dakota.

The primary reason, not surprisingly, is lack of money, compounded by a difficult time recruiting physicians and other clinicians. Indeed, many Indian health clinics cannot “deal with such high rates of disease, and poor clinics do not have enough money to focus on preventive care.”

So, if you’re in the camp that supports a Medicare-for-all-type solution to our health care woes, consider how that same government, whom you’re entrusting to be the single-payer, has neglected the Indian Health Service.

Because the IHS is just like a Medicare-for-all type solution to the problem of the uninsured.

This is nothing more than a massive “guilt by association” argument, along with a nice straw man. The straw man in Kevin’s argument is the assumption that anyone has ever proposed anything resembling the IHS as health care reform. The shorter (guilt by association) version of Kev’s argument goes:

  • The IHS is underfunded and poorly run. It is a government health care program.
  • Therefore any government funded health care program that Congress can come up with is likely to be just as bad.

Unfortunately for Kevin’s argument, there is no inherent reason to assume that this will necessarily be the case, and Kevin is drawing historically ignorant inferences. After all, it’s not as though the government doesn’t have a 200+ year history of making promises to Native American tribes and then breaking them, is it? It couldn’t be, could it, that this is just another example of a broken promise in a long line of broken promises? It couldn’t be that the enormous burden of chronic disease and profound poverty, not to mention the consideration that the reservations are considered to be nations with varying degrees of sovereignty, could it? But, no, to Kevin, the sordid history of how the U.S. has mistreated Native Americans as demonstrated by the failure of the IHS to provide adequate care on the reservations is damning evidence that single payer health care would, if implemented, fail. To Kevin, the IHS is an attempt at single payer insurance and damning evidence that it has “failed.”

It must be nice to be able to ignore so blithely all the factors that make this comparison specious at best.

Of, course, it’s odd that Kevin briefly mentions the V.A. system early in his post, as though it were as bad as the IHS. It’s not. In fact, the V.A. routinely delivers excellent care. If I were a V.A. doc, I’d be profoundly insulted by that insinuation.

There are certainly reasonable arguments to be made against a single-payer system, but, unfortunately, Kevin’s isn’t one of them. As for me, I used to think a lot like Kevin in that I was profoundly opposed to any sort of single-payer plan. Even so, I’ve said it before, and I’ll say it again. We already have government-run health care in the U.S. It’s here; our system is not a free market and has not been one ever since I first entered medicine back in the 1980s. The government in essence sets what physicians and hospitals can charge for any procedure through Medicare reimbursement rates, and the third party payers use that as a baseline to negotiate their rates of reimbursement with hospitals. Indeed, we have the worst of both worlds. We have in essence a government run system that doesn’t provide the the one benefit that, whatever its inherent faults and shortcomings, any government-run system should be able to claim over a private system: universal coverage.

The longer I see the dysfunction in the system the less able I become to defend it. I’m sure that practicing in one of the most economically depressed (if not the most economically depressed) region of the nation probabably hammers home the problems in our health care system. Perhaps that’s why I no longer fear single-payer the way I used to.