Rep. Pallone: Inadequate health care funding equals inadequate services


An old health care funding concept has recently been converted to a mathematical equation. It is: ihc$=ihcs. Simply explained: inadequate health care funding provided by the federal government equals inadequate health care services to American Indian peoples.

Since the beginning of the contractual relationship between tribal governments and the U.S. government, the federal funding system has consistently provided inadequate health care funding, failing to fulfill this aspect of the agreement. The contract called for Indian peoples to relinquish vast amounts of their prime homelands and natural resources, in exchange for, among other things, on-going federal heath care. The land transfers occurred. Adequate funding for Indian health care did not.

The provision of health services to members of federally recognized tribal governments grew out of the unique government-to-government relationship between the federal government and tribal governments. This long-standing relationship is affirmed in the U.S. Constitution, as well as various treaties, court decisions, federal statutes, Executive Branch policies and tribal government law. These legal strings verify that tribal governments retain their inherent powers as nations, self-governing authority and the ability to enter into legally binding agreements with the federal government.

The health-care system that serves Indian peoples is known as the Indian Health Service (IHS). Currently, the IHS meets approximately 40 percent of the health care needs of Indian peoples, due to a shameful lack of federal funding.

The current IHS budget is $2.9 billion. For the IHS to meet the health care needs of the vast majority of the under-served within its service population, funding would have to be increased six fold. The National Indian Health Board estimates that $18 billion is needed to have the health care system run effectively and efficiently. However, Indian peoples and the IHS would settle for yearly incremental increases, starting this fiscal year with a $5 billion dollar budget.

Without moving forward with accelerated funding increases for the IHS, well-documented problems will continue and undoubtedly be joined with additional problems for this health-care system and the federal government. For example, as a result of the inadequate health-care capabilities of the IHS, the federal government has paid more than $24 million in malpractice settlements and judgments in the past 48 months alone. Some lawsuits brought by Indian patients or their families have been dismissed by federal judges on technicalities or other legal justifications.

Makeshift operating and recovery rooms equipped with minimal, unqualified staff are becoming more commonplace in federally sponsored Indian hospitals and health clinics. These doctors and support staff often have poor professional track records, and when coupled with inadequate medical equipment and supplies, the result is an environment that cannot insure the well being of Indian patients. There is no doubt why some federal judges have referred to the IHS services as substandard.

The health care provided by the IHS is often considered less comprehensive than what privately insured Americans receive. At times, patients in the IHS system have to do without some essential medical procedures and exams, such as mammograms or gall bladder surgery. On average, Americans receive $3,800 each in health care per year. The IHS is able to provide approximately $1,300 per Indian person.

Nevertheless, if similar health-care services were mandated for non-Indian people of this country, there would be major outcry and resistance from, among others, lawmakers, medical professionals, health insurance agents and patients. If such health-care mistreatment would not be tolerated in the general population, why are such services deemed acceptable for Indian peoples?

Given such facts, if the Congress and the president do not provide the on-going health-care funding necessary to run the IHS system appropriately, the health-care problems for Indian patients will worsen. When this happens, the federal government will continue to mismanage crucial funding through the back end of the accountability system via malpractice lawsuits and settlements.

The federal government has a legal and moral responsibility to provide adequate health-care funding for the IHS. For too long, businessmen and nearly every state have become very wealthy reaping the benefits of the historically flawed relinquishment of Indian land. The least that the President and the new Congress can do beginning in January is to fulfill both obligations by ensuring that adequate health-care funding exists for American Indian peoples.

Rep. Frank Pallone, Jr., D-N.J., currently serves as an active member of the Native American Caucus of the U.S. House of Representatives. He has recently been named the Vice -Chair of the Caucus.