Since we cannot even fund IHS for a full year at a time with significantly less people than the entire US population, I think you might want to look at what the actual funding versus cost would be.
The problem with the way that Native Americans are treated in the US is a lack of political will and the totally fucked power dynamic between the political institutions that have (or have not really) developed in the shadow of Western dominance of the continent.
Canada has universal healthcare and health outcomes for the First Nations are poorer there too. It's really not an apples to apples comparison, since there's so much other fraught bullshit involved.
So, who exactly is going to protect the small business owner or the poor soul who now has to work two jobs each under 20 hours?
The point stands, if we in the USA cannot get it right for IHS or VA, then we won't get it right for the majority. If you cannot do the little things, don't expect to do the big things.
The act (which I am sure the author has not read) has already cost people insurance and failed at reducing costs for everyone else. It cut medicare money (read the act), and reduced the effectiveness of the non-employer health saving funds. We are more dependent on employers, not less. It bungled the wording of the exchanges to screw up the tax benefits (perhaps public review would have helped this point). I await the report that the fraud prevention in the act hasn't resulted in the required savings.
The IHS nor the VA are representative of the US population, nor are the politics around Indian or veteran affairs representative of how politicians deal w/ the general public.
Nor is there necessarily a connection between small and large projects. What's the political will to get these small things done? What are the consequences when they fuck up? Does it threaten a politician's chances at getting reelected? Is it likely to hurt industry's bottom line? Is it going to generate a significant amount of negative press?
Small projects are not necessarily representative of the governments ability to get things done, and the IHS as i've pointed out is definitely not representative for a whole pile of reasons.
I also don't get why people are so concerned that it cut medicare money. Isn't the point to reduce how much medicare costs?
Yes, I read what you wrote and disagree with it. I have seen no evidence that the USA can execute on massive projects when it has shown no ability to do it in pilot programs. If the VA and IHS don't represent the pilots for this bill then what does? That is one reason there is a fair history in the USA of pilot programs. In the US, small projects are fair predictor of larger success because of a pilot first culture.
No, the cut in Medicare is justified by the saving from fraud detection. Perhaps you are thinking Medicaid?
That is a different argument from your initial assertion.
The IHS's failure is not an indication that the us government can't execute on healthcare.
Additionally there are plenty of regulatory agencies in the US that do a phenomenal job at what they do even in the face of dire circumstances, the FDIC being a really good example. Literally hundreds of banks went out of business between 2008 and 2010 (see: http://www.fdic.gov/bank/individual/failed/banklist.html ), and the FDIC unrolled those institutions, found other banks to take over depositor accounts, without any substantial problems.
The government can and does work, even if it doesn't always. The question is how can we ensure that government's interface with the healthcare system is one of the systems that does work.
> That is a different argument from your initial assertion.
No, it is the same - the government failed with less people and now is attempting something with almost all. I then added information about how the US government generally goes about social programs (pilot -> nationwide).
> The IHS's failure is not an indication that the us government can't execute on healthcare.
Yes, it is.
As to the rest of your post, I did not and have not argued that the government doesn't do some decent things in other fields. The FDIC unrolls have happened before 2008 and they have a plan for it that worked in the past.
Once again, they are attempting a lot of stuff with no previous experience, uncertain regulations (even now), and failure in their two previous large scale programs (IHS and VA). Add to this resistance from states and even doubt casting by Senators and Representatives that voted for it, it has very little hope of working.
It would have been a good start. Figure out how to get the fraud down and fix the payment / paperwork. Pilot a few different schemes and look at some of the state programs. Cutting the funding was not the most brilliant part of the bill.
If you're looking for a specific pilot program for the affordable care act, how about the Massachusetts law? It's not quite as popular as medicare, and it looks like MA residents don't think the law is perfect, but they also seem to prefer it to not having it at all[1]. I don't think anyone who is serious is saying it is a failure.
http://richheape.com/american-indian-healthcare.htm