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A Smart Federal Investment

A column by Byron Dorgan about federal spending.
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In the coming weeks, we will hear a lot about the budget, the deficit and the need to make hard choices when it comes to federal funding. I agree with that. But the choices also have to be smart choices.

There will be those who seem to know the cost of everything and the value of nothing, who will want to take an ax to the budget without consideration of what works and what doesn’t.

We can do better than that. There are some things we do in our federal government that are more important than others. Some that literally save lives.

While in the Senate, I worked on a program called the Special Diabetes Program for Indians (SDPI). SDPI funds programs and services to prevent and treat diabetes among American Indians. It is also a program that is not only saving lives but also saving the federal government money. As a federal program that provides a strong return on the federal investment, Congress must understand the need to extend SDPI.

The toll that diabetes takes both on our population in the U.S. and on our federal health system has been well documented. Diabetes affects about 26 million Americans. About one-third of every Medicare dollar is spent on people with diabetes—a cost of $174 billion to the U.S. economy in one year alone. It is predicted than one in three Americans born in 2000 will develop some form of diabetes during their lifetime and the problem is growing. New data from the National Institutes of Health showed that diabetes among people under age 20 rose by 23 percent in the last decade, a rate that would see a doubling of the disease in every future generation.

If the numbers are staggering for the national population, they are devastating in the American Indian/Alaska Native (AI/AN) community. The prevalence of type 2 diabetes—the most common form of the disease—is nearly triple among AI/ANs as among the general population.

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As the former Chairman of the Senate Committee on Indian Affairs, I remember the story of Caitlin Baker, a 16-year-old member of the Muscogee Creek nation. At a Committee hearing, she described how her “peers feel that Type 2 diabetes is inevitable. They tell [her] that they know they will get it eventually because their parents, grandparents, and other family members have all had diabetes.” This isn’t how a 16 year old should view her future.

Congress created SDPI in 1997 to address this growing epidemic in Indian country, and the program is making a real difference. In partnership with tribal communities across the country, SDPI has delivered on Congress’ challenge, and has demonstrated that the science of diabetes prevention can be translated to diverse communities to prevent diabetes in those at risk and to address the most compelling complication of diabetes which is cardiovascular disease. As a result of intensive data collection and analysis from 404 programs in 35 states, we can document that cholesterol levels and mean blood sugar levels have declined and blood pressure has been well controlled. All of these measures are strong predictors of the likelihood of someone with diabetes developing complications.

And for those who are focused on reigning in Medicare costs consider this: the incidence of end-stage renal disease (ESRD) for American Indian and Alaska Native people with diabetes has declined by nearly 30 percent since 1996 as a result of this program. This is a greater decline than for any other racial or ethnic group. ESRD is the largest driver in the growth of Medicare, and SDPI is helping to bend the Medicare cost curve in the right direction. And more importantly, it is saving lives!

During my time in the Senate, I fought for continued support of this critical program and made it a top priority. I still believe that SDPI is our nation’s most strategic and effective effort to address diabetes in tribal communities. SDPI is a model for how—through a sustained and focused effor—the federal government, working in partnership with communities, can save lives and transform communities to create a better future where Caitlin and her friends do not live in fear of developing diabetes.

When I left the Senate, I created an organization called the Center For Native American Youth to reach out to Indian children to provide opportunity to those who have been left behind. We work on teen suicide prevention, education opportunity, diabetes issues and more.

We can all do better working together on these issues. And a good place for us to start right now is to tell Congress that providing funding for SDPI will save lives and save money. It’s the right thing to do, right now!

Byron Dorgan is a former United States Senator (D) from North Dakota. He is now a senior policy advisor at Arent Fox and serves as co-chair, along with Phil English, of the firm’s government relations practice.