funding Indian health care

Op-Ed By Mark Trahant

More than twenty years ago the BBC captured the essence of bureaucracy in a sitcom called, “Yes, Minister.” The basic plot was that the Minister for Administrative Affairs, Jim Hacker, would come up with an idea – sometimes wonderful, sometimes odd – only to have its implementation sidetracked by civil servants.

Hacker’s nemesis, Sir Humphrey Appleby, once described his task as “the traditional allocation of executive responsibilities has always been so determined as to liberate the ministerial incumbent from the administrative minutiae by devolving the managerial functions to those whose experience and qualifications have better formed them for the performance of such humble offices, thereby releasing their political overlords for the more onerous duties and profound deliberations which are the inevitable concomitant of their exalted position.”

Of course bureaucracy in the United States is different. Our civil servants have far less power than they do in the United Kingdom.

 Op-ed by Mark Trahant

The idea that American Indians should be exempted from any mandate to purchase health insurance has almost become a given in the debate about health care reform.

 Last week Speaker of the House Nancy Pelosi wrote to the National Congress of American Indians and said: 
“We cannot ask Indian people to be penalized for choosing to use the Indian health care system. The House bill will ensure that the exemption from the financial penalties is extended to federally recognized tribes and that tribally provided health care benefits are appropriately protected.”


 The Senate Finance bill already contains such a provision. 

 I’ve wondered about this mandate from the beginning of the process. I know too many people who do not participate in the mainstream economy; many of these folks are either unable or unwilling to navigate such a complex system. Imagine someone who hunts, fishes or is involved in a subsistence enterprise, figuring out what part of their income should be used to purchase even subsidized health insurance.

But even if you agree with the exemption – as I do – there remains another issue to resolve, the money. Unless health care reform substantially improves the funding stream for the Indian health care delivery system, then the individual exemption is only a guarantee of permanent disparity.