Health Outcomes for Tribal Communities in Urban Areas

The government pays for or directly provides for more than 50% of all health care services in the U.S. through military/VA, Medicare/Medicaid (CMS), Indian Health Services (IHS) and other programs/facilities.
Pick a specific government program or provider from readings Discuss the services provided. Then differentiate the effectiveness of this program versus the efficiency of this program in regard to the premise of "your tax dollars well spent." What would should change and why?