More than three decades ago another health care debate focused on Indian country. At the time, there were too many dilapidated medical facilities, an inability to recruit and retain health professionals (especially American Indians), as well as a host of other structural deficits, Congress responded in 1976 by passing the $1.6 billion Indian Health Care Improvement Act.
The Office of Management and Budget recommended a veto. OMB’s deputy director, Paul O’Neill, said the IHS didn’t need the money because there was “no evidence that a vast infusion of funds. … would achieve better or faster results than are being achieved under orderly program growth.” O’Neill argued that extra money would not be effective because Indian health statistics were “especially in connection with causes of death, e.g., alcoholism, accidents and suicide, associated with reservation social conditions, i.e., poverty, isolation and inadequate housing. Unfortunately, we have not been especially successful in combating alcoholism and suicides in non-reservation areas.”
Fortunately, President Ford had other advisers, including Dr. Ted Mars who responded directly to O’Neill in a memo. “Admittedly, I am biased as a physician in favor of equity in length of life so you will have to excuse my considering the humanitarian aspect along with the budgetary, pragmatic and political. Failure to adjust the present course is in my opinion a flagrant deprivation of human rights in a measurable as well as dramatic way.”
President Ford did the right thing. “I am signing this bill because of my own conviction that our First Americans should not be last in opportunity.”
Indeed, since that October 1976 signing, the evidence is that the Indian Health Care Improvement Act worked and helped significantly improve care for American Indians both on reservations and in urban areas. But, perhaps, more important was President Ford’s notion that “First Americans should not be last in opportunity” when it comes to health care.
That very phrase was rolling around in my mind as I listened to President Barack Obama talk about reform last week.
“This is what the debate in Congress is all about: Whether we’ll keep talking and tinkering and letting this problem fester as more families and businesses go under and more Americans lose their coverage; or whether we’ll seize this opportunity – one we might not have again for generations – and finally pass health insurance reform in 2009,” the president said while urging for action.
Talking and tinkering has been the standard fare for congressional reauthorization of IHCIA. This is not a new proposal, it’s not particularly complicated, and it certainly ought to find a way to travel from the Capitol to the president’s desk in less time than a rewrite of the entire health insurance system in the United States.
But as the National Indian Health Board points out on its Web site: “For 10 years, tribal leaders, members and advocates have worked tirelessly with Congress to pass a modern IHCIA but our efforts have not been successful. Reauthorization is long overdue – it is time to pass H.R. 2708 this year.”
While the president and Congress struggle over rewriting the broader health care reforms, it seems to me this one measure is a test of the system. If Congress cannot (after a decade) enact a health care measure that has a track record of success, then how is it possible to rewrite the entire health care insurance system in a few legislative moments?
The answer is; it’s impossible.
The health care reform proposal in the House, for example, has provisions that mandate health insurance for employers and individuals (with exceptions). But how will that work in Indian country? What is the impact on an already under-funded IHS? Does this health care reform plan end or limit treaty obligations? Or, on a practical level, will a family that fishes seasonally be required to buy health insurance?
There are far too many questions for any bill that requires debate at a frenetic pace. But here is one answer: If Congress rushes through this process, it will be likely that First Americans will continue to be last in opportunity.
Mark Trahant is the former editor of the editorial page for the Seattle Post-Intelligencer. He was recently named a Kaiser Media Fellow and will spend the next year examining the Indian Health Service and its relevance to the national health reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. www.marktrahant.com.