A culture of fear in Indian Country

Journalist Rebecca Clarren shares insights into the culture of fear in Indian Country she experienced in central Oregon while reporting for InvestigateWest and The Nation on the topic of punitive discipline and substandard curricula at a Native American public school.

A political system where it’s easier to spend than to save, and to borrow than tax

Oped by Mark Trahant

The month of December promises to be full of drama: Will the Senate pass health care reform? Is there enough time to debate the hundreds of expected amendments before Christmas? And at the top of the wish list, are there really 60 votes to pass a bill?

The notion of requiring a super-majority in the Senate may be one of our nation’s most anti-democratic traditions.  The Senate elects two members from each state. California’s 36 million citizens get two votes – exactly the same two votes as Wyoming’s 532,000 people. The super-majority makes matters worse because senators representing less than 40 percent of the population can block the legislation that most Americans favor.

The Senate has a unique history and in that favorite argument used by so many, “we have always done it that way.” But let’s be clear about this, the structure of the Senate does not represent democratic values. Why does this matter? Especially when it’s worked for more than two centuries? It matters because health care reform is a test of our continued ability to govern ourselves.

Politicians have been putting off difficult decisions for generations and we are moving toward a date of resolution. The requirement of fixing health care must be seen in the context of a political system where it’s easier to spend than to save, and easier to borrow than to tax.

The current scare over health care rationing makes this point exactly: No one has to give up anything.

Back to the future: Public health hospitals

Indian Country & Health Care Reform

By Mark Trahant

          Seattle-based Amazon.com, the world’s largest online retailer, will move into its new headquarters near Lake Union next year. Then Amazon will leave an old Art Deco building, once known as the U.S. Marine Hospital.

          What if we took this empty building and turned it into a hospital? What if we staffed it with federal employees? What kind of health care would that look like?

          The answers are in our history. Congress passed a law in 1789 that provided for health care for sick and injured merchant seamen. But the thinking, even then, was broader. Philadelphia faced an extraordinary Yellow Fever outbreak in 1783 that killed more than 4,000 people (out of a population of 37,000). And therefore the primary mission of the new health service was to intercept diseases brought home by sailors returning from sea.

          The Public Health Service and the marine hospital network eventually expanded across the country. This was the first “public option” because this government plan was funded by a monthly deduction from the seaman’s wages. The scope of medical activities grew as well, ranging from the treatment of epidemic diseases to industrial hygiene.

          The PHS could have become the basis for a national, federal health care delivery system. By the 1970s marine hospitals and clinics served American Indians, the urban poor, as well the agency’s traditional clients of merchant marines and some federal retirees.

          “These hospitals have a record of service to this nation, and especially to its merchant seamen, which is long and distinguished,” President Richard Nixon wrote in a veto message to Congress over the funding of public health.

Indian country and health care reform:Will ‘grandma’ redefine this debate?


By Mark Trahant
You hear a lot about grandma now that Congress is back to work on health care reform legislation.

“Poor old grandma” is a reason opponents say they will fight health care reform. Grandma will lose services, her Medicare will be less than it is, and some bureaucrat far away will decide when it’s her time to die.

This is not the first time this debate has surfaced. In the 1960s opponents of Medicare used the phrase “poor old grandma” to warn that the legislation would rob elderly of their Social Security or provide insufficient care. They were wrong, of course. Medicare has probably become the most popular government program ever. These days it’s common to speak as if Medicare is the universal coverage for American elderly. (Medicare is for the elderly and disabled, Medicaid is partnership with the states aimed at some people with low-income.)

And that’s mostly true. Mostly. But Indian Country was largely left out of the original Medicare and Medicaid, plan, a problem that was fixed when President Ford signed the 1976 Indian Health Care Improvement Act into law.

Rick Lavis, a Republican, who was working for Arizona Sen. Paul Fannin, sent a memo to the Ford White House raising the question why it was even necessary to amend the law to include American Indians and Alaskan Natives. Then Lavis answered his own question by saying the act would “permit Indian Medicare and Medicaid beneficiaries to utilize their benefits in IHS facilities, which under present law is disallowed.”

Lavis also argued that the IHS should be reimbursed at 100 percent rates in their facilities because “the federal government has obligations to provide services to Indians.