Indian Health Care Service

Has the Indian Health Service been an effective, government-run delivery system?

Consider this from a White House memo: “While there has been improvements in health status of Indians in the past 15 years, a loss of momentum can further slow the already sluggish rate of approach to parity. Increased momentum in health delivery and sanitation as insured by this bill speed the rate of closing the existing gap in age at death.”

In other words progress is slow. But Dr. Ted Marrs wrote the memo on April 26, 1976, and the subject was about the original Indian Health Care Improvement Act. “In 1974 the average age at death of Indians and Alaskan natives was 48.3. For white U.S. citizens the average age of death was 72.3. For others, the average age was 62.7.”

Dr. Marrs wrote that the “bottom line” was an unavoidable connection between “equity and morality” when there is a more than twenty year differential in age at death between Indians and non-Indians.

So what do the numbers look like now?

The most recent Indian Health Service data on general mortality statistics is about a decade old now. But it showed that the twenty-year differential has been reduced to a difference of less than five years. “The American Indian Alaska Native life expectancy at birth (both sexes) for the IHS service area population was 72.3 years,” according to the recent IHS report:“Regional Differences in Indian Health, 2002-2003 edition.” Compare that with the average life expectancy for all U.S. races, 76.9 years.

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.

Indian Country & Health Care Reform

By Mark Trahant

          Members of Congress receive effortless health care. Like all government employees, there is a federal benefit plan with a basket of insurance options. But that's Plan B.

The better deal is the full service clinic staffed by Navy doctors. ABC News Medical Editor Tim Johnson reported last week about Capitol Hill clinics where "lawmakers receive top-notch, wait-free care, and money is largely no object. Members pay a flat annual fee of $503, and it covers all expenses - without submitting claim forms to their insurer."

There is one fee, great medical service, and not even the bother of filing for insurance. And the Capitol Hill clinic never runs out of money in June. Effortless.

Indian country has a different financing mechanism. Plan A is, of course, the Indian health system, the combination of federally-run Indian Health Service facilities plus those health care programs managed by tribes or urban Indian organizations. Plan A is a system that's regularly characterized as "starved" because it is funded with annual appropriations, instead of based on patient need. Here is the rub: the Indian health system is so under funded that it does not count as a qualified insurance plan (despite the treaty and statutory promises).

So Plan B is Medicaid. Medicaid is the country's insurance plan for low-income families, pregnant women, people with severe disabilities and older people who do not qualify for Medicare (and for long-term care, but that's another column). The funding for Medicaid is an entitlement. If someone is eligible, the money is there. Medicaid is a partnership between the federal government and state governments.

Indian Country & Health Care Reform

By Mark Trahant

WASHINGTON - There is near universal agreement: the Indian Health Service needs more money. At the National Indian Health Board Consumer Conference last week several members of the U.S. Senate and House were critical of the historic under-funding of IHS. These were Democrats, Republicans, some representing Indian country constituents, others from districts with no reservations and few tribal members. Yet they communicated the same message: the United States made a health care promise to Native Americans and it's wrong to fund a system with substantially less money than what is spent per person on federal prisoners.

The Indian health system's funding is so low that many patients are counted as part of the uninsured population in government data.

The Senate Finance Committee's health reform concept paper put it this way: "The IHS itself has stated that its funding does not allow it to provide all the needed care for eligible Indians. As a result, some services are ‘rationed,' with the most critical care given first. ... The reality of this under-funding is that money for contract health services does not last the entire year, forcing IHS to limit services to circumstances involving a ‘loss of life or limb' circumstance. This predicament is so common in Indian Country that many tribal members fear that if they need care after June, they will be forced to go without."

The Obama administration at least added 13 percent to its IHS funding request. But it's a small step and neither the Executive Branch nor the Congress has made funding parity a priority or even a proposal.

So many tribes have stepped up and contributed their own money to improve health care in Indian Country. This ranges from paying extraordinary medical bills of tribal members to purchasing health insurance.

Hurrah.