The National Defense Authorization Act passed Wednesday by the U.S. Senate includes $282 million for construction at Ellsworth Air Force Base near Rapid City.

The construction will prepare the base for B-21 Raiders, aircraft meant to serve as replacements for the B-1 bombers that were designed in the 1970s. The B-21 bombers are expected to arrive in South Dakota at some point before 2030, alongside thousands more military members and families. 

The base’s commander told the Black Hills Forum and Press Club last year that the base’s population is set to grow by about 4,000 people, to nearly 12,000. That anticipated growth has sparked legislative discussions on ways the state might financially support entities like the Douglas School District, which serves Ellsworth.

U.S. Senate passes defense bill that bars gender-affirming care for service members’ kids

The $282 million for Ellsworth in Wednesday’s defense authorization bill is only part of what’s expected to be $1.5 billion in B-21-related construction at the base. Separate from that construction is the cost of procurement: Each of the at least 100 B-21 aircraft the Air Force expects to purchase — to be spread among Ellsworth and other bases — will cost about $700 million.

The bill also includes $2.6 billion for B-21 procurement.

In a news release on the legislation, South Dakota Republican John Thune praised the 83-12 vote as a win for the state. The construction money will support the building of environmental shelters, a B-21 weapons generation facility and a B-21 squadron operations center.

“The men and women of Ellsworth Air Force Base carry out a critical mission in service to America’s national defense, and South Dakotans have cause to celebrate with this year’s National Defense Authorization Act,” Thune said in the news release. “The B-21 mission will be supported by the authorization of key infrastructure and facilities, and service members everywhere will receive sizable salary increases, particularly junior enlisted members.”

The defense bill also includes a controversial clause that bars service members from using their military insurance to cover children’s “medical interventions for the treatment of gender dysphoria that could result in sterilization.”

Wisconsin Democratic Sen. Tammy Baldwin, the Senate’s first openly LGBTQ member, voted against the bill and accused Republicans of seeking “cheap political points” by barring gender-affirming care coverage. 

Ellsworth temporarily moving 17 planes and 800 people to North Dakota

But that clause drew praise from South Dakota Republican Rep. Dusty Johnson when the bill passed the U.S. House last week. 

Like Thune, Johnson lauded the bill’s support for the B-21 program, but his news release on the vote bore the headline “Johnson Votes to End Woke Policies, Strengthen Military, Get Tough on China.”

“Politically ‘woke’ culture has infiltrated our military, but this bill puts an end to some of those policies like paying for gender transition treatments for youth,” Johnson said in the release.

He also praised the bill for moving the military away from “promoting critical race theory,” for preventing military members from being required to use electric vehicles, and for authorizing a study on China’s use of the Shanghai Shipping Exchange to engage in “unfair trade practices.”

Johnson pushed to include the China clause in the defense bill in May. 

Sen. Mike Rounds, R-South Dakota, called out pay raises for service members in a news release sent over the summer, when the Senate Armed Services Committee passed the bill. Rounds, a member of the committee, also supported the bill in the full Senate on Wednesday.

“This year’s NDAA includes a 4.5 percent pay raise for our men and women in uniform, as well as back pay for our military members whose promotions were impacted by holds in the Senate,” Rounds said in a news release. “We never want our men and women in uniform entering a fair fight, we always want them to have the advantage. 

In spite of all the glitter, the dramatic headlines about stunning accomplishments and life-saving interventions as well as the raving of some politicians about the “best health care system in the world,” the U.S. health care system is, at its core, fundamentally dysfunctional.

How can I make such a provocative statement? The U.S. spends nearly twice as much per capita on health care as does any other developed country. In spite of this expenditure, 8-10% of Americans still have no health care coverage while most comparable countries provide health care coverage to all citizens.

Spending at this level would perhaps be acceptable if the population was in fact benefiting with better health outcomes. Here too we fall short. If we look at any of the usually cited metrics of population health such as life expectancy or infant mortality, the U.S. results are worse. Especially concerning is the fact that the U.S. rate of maternal mortality — women dying related to childbirth — is among the highest in the developed world and is getting worse.

U.S. residents increasingly express their dissatisfaction with the health care system. The Gallup organization recently reported that approval ratings on the quality of American health care are the lowest they’ve been in more than two decades.

All this has come to the fore with the recent tragic shooting of the CEO of UnitedHealthcare in New York. Though details continue to emerge, it appears the assassination-style killing was carried out by a young man intent on sending a message of both anguish and hostility toward the health insurance industry. He reportedly wrote in his notebook, “What do you do? You wack the CEO at the annual parasitic bean-counter convention.”

As disturbing and troubling as are the events surrounding the murder, the public reaction to it is similarly distressing. There has been a huge outpouring of support for the shooter almost as though he is being glorified as a folk hero. Additionally, online, there has emerged a range of merchandise (T-shirts, etc.) seeming to applaud the event. These reactions appear to confirm the broad-based unhappiness with health care services and how they are financed.

How can we understand or make sense of these developments? In the U.S., unlike many other developed countries, we have largely treated health care as a commodity to be bought and sold on a capitalistic, free-market model. In my view, this arrangement underlies many of the problems we have encountered.

I am not anti-capitalist. For a large part of the economy, this model has served us well. At the same time, I believe there are sectors of the economy where it does not work as well. We need to be smart enough — and tough enough — to sort out which is which.

In the classic capitalist model, profit and/or market share increase when the perceived value of the product or service increases. What we have too often seen in the health insurance industry is that in order to push up profits, the industry has restricted the services covered or, alternatively, has increased the barriers to receiving those services.  This has been highly successful from an industry perspective in that profits have soared, but for many patients who are all too often in a captive market, it has restricted or denied needed care.

What to do? There is no immediate, simple answer. It would seem, though, that the events of the last several weeks should serve as a wake-up call. We have serious problems that demand serious thinking and open-minded discussions.

The fundamental lesson from these events, I believe, is that when profit drives health care decisions, investors win and patients lose. We can and must do better.

Staff Reports

BROOKINGS – The South Dakota State women improved their win streak to six games on Tuesday night as the Jackrabbits blew out Dakota State 84-47.

SDSU (10-2) shot 47.2% from the field and was 7-of-21 from three. Brooklyn Meyer led the way with 16 points. Emilee Fox had 12 points and Katie Vasecka had 11 points. Haleigh Timmer had a double-double with 11 points and 11 rebounds. Kallie Theisen had eight points and eight rebounds. Paige Meyer had eight points and seven assists.

SDSU led 20-16 at the end of the first quarter. The Jacks then pulled away before halftime as they outscored the Trojans 14-4 and led 34-20 at halftime.

The Jacks would then take a 54-35 lead into the fourth. They made seven of their last eight field goals, while the Trojans made one of their final 10 shots. SDSU outscored DSU 30-12 in the final frame.

DSU shot 26.6% from the field and was 6-of-26 from three. The Trojans were led by Lilli Mackley who had 14 points. Angela Slattery had nine points and five rebounds.

SDSU dominated the glass, out rebounding DSU 57-35. The Jacks forced 11 turnovers and scored 15 points off of them. SDSU was 9-of-17 at the free throw line and DSU was 7-of-10 at the charity stripe.

SDSU will close out the non-conference portion of its schedule on Sunday at No. 6 ranked Texas. Tip off between the Jacks and Longhorns is scheduled for 2 p.m. You can watch the game on SEC Network+ or listen to the game on AM 570 WNAX.