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Indian health care rations in Walter Reed's shadow

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By now, the entire nation knows about veterans under the care of the Walter Reed Army Medical Center in Washington. Veterans who had given everything to the war effort were found to be living in squalid conditions, with the usual complement of rotting floors and mouse droppings, wall mold and cockroaches, flophouse mattresses and carpet stains. Such were their government-assigned way stations in their transition back to civilian life after suffering grievous wounds.

These wounded were outpatients, a key word that will suggest to many Americans a far remove from the confines of Walter Reed hospital. In fact, as emphasized in the original reporting of the Washington Post, the worst of the outpatient buildings was right down the street from Walter Reed, in close proximity to Capitol Hill and the White House. Any Washingtonian who wants to can drive by it without serious inconvenience.

This means that 535 members of Congress and their multitudinous staffs, the White House and its employees, and federal agencies with their own staffs could not summon the energy necessary to care for our wounded even when they were right under the very noses of oversight authorities. It took citizen concern for men and women who could not altogether care for themselves, as well as national newspaper attention, to bring their plight to the light of day. Officials make plenty of stopovers at Walter Reed, of course. But to take a cue from national commentator E.J. Dionne, they serve only to modernize, for media consumption, the Potemkin village of yesteryear - take the photo op and get the VIP types outta here. They've got fund-raising to do and re-election to worry about.

The question everywhere in Washington these days is pretty obvious: if Congress, the White House and the agency secretariats couldn't be bothered with such dire problems on their home turf involving the most deserving among us ... what else will they overlook until the publicity turns sour?

Indian people are not outpatients so much as out-of-the-way patients. Their health care plight takes place, for the most part, a thousand or more miles from the outpatient warrens of Walter Reed. Like wounded veterans, they've given about all they could to this nation, and they've served in its armed forces in greater proportion than any other population group. The first people of this land will never begrudge veterans the greater care they are bound to receive because concerned citizens and the Fourth Estate exposed a modern Potemkin village. But more than others, they have to wonder how long it will be before their own health care system gets proper exposure.

Sen. Byron Dorgan, D-N.D., chairman of the Senate Committee on Indian Affairs, has begun to bring the health care rationing of tribes home to a disengaged White House. In listening sessions around the country, he is hearing actual examples of real-life health care rationing and sharing them with his colleagues on the Senate floor and in every other available forum. As the case becomes clearer, the day comes nearer when Indian health care will get the funding it needs. The hunch in this corner is that if Indian health care were adequately funded, the Indian Health Care Improvement Act reauthorization would not dominate the debate on Indian issues in Congress.

But we now know that funding, and the priorities of compassion that drive it, is not the only strike against Indian health care. In derailing the reauthorization last year, the Justice Department put out an unofficial white paper that argued against the reauthorizing bill on grounds it would establish a religion (some healers have a numinous status in some Native cultures), expose the government to legal liabilities (in the event of malpractice by traditional Indian healers) and transgress the constitutional ban on racial preferences (urban Indians, including some not enrolled in tribes, might receive services under the reauthorization, meaning funds would be directed not on the basis of tribal affiliation but of racial identity).

Given the white paper's unofficial status (it wasn't even on DOJ letterhead), the reaction from Indian country was furious - and that last clause is the reason why. The White House has found a thousand reasons to be against the reauthorization, so an eleventh-hour attack on health care for Indians as race-based was a new frontier in gratuitousness. The White House contention that it wasn't aware of the DOJ white paper reeks of plausible deniability; you don't find a thousand reasons to oppose a bill, only to faint with astonishment when a thousand-and-first is found. The DOJ paper shows a whiter shade of pale now, having been to the White House for polishing as official policy.

The thing to remember about a Potemkin village is that the more complex it becomes, the more unreal it seems. Dorgan's reckoning seriousness, bolstered by Indian community voices far from Washington and Indian organizations and allies within it, is the best prescription we know of for bringing Indian country the full ration of health care.