Alaskan Native community

Op-ed by Mark Trahant

I started my exploration of health care reform in July.

“The federal government accepts a double standard: Any discussion about rationing – or government care – is off the table unless you’re a member of an American Indian tribe or Alaskan Native community with a sort of pre-paid insurance program (many treaties, executive orders and laws were specific in making American Indian health care a United States’ obligation),” I wrote back then.

Six months later – or half way into this project – I am struck by how Indian Country is both a part of the health care debate and yet absent from its larger discussion.

We’re part of the conversation every time critics blast the Indian Health Service as a failure of government. We’re also included in the larger reform measure – the Indian Health Care Improvement Act – was added to the larger bill. That’s a good thing because this bill (unlike the original) has been awfully difficult to move through the Congress.

But we’re absent from the conversation because neither the Congress nor the Executive Branch has articulated what lessons can be learned from the history and experience of the Indian health system as it applies to the larger issue of health reform. It’s particularly frustrating to watch the politicians who are quick to point out the weaknesses of that system even though they have never proposed adequate funding or the dreaded idea of rationing.

Consider how the money question goes beyond Indian Country: If the federal government can’t deliver on this one, relatively small promise, how is it going to make good on remaking one-sixth of the economy in a few thousand pages of legislation?