Mark Trahant is a writer, speaker and Twitter poet. He is a member of the Shoshone-Bannock Tribes and lives in Fort Hall, Idaho. Trahant’s new book, “The Last Great Battle of the Indian Wars,” is the story of Sen. Henry Jackson and Forrest Gerard.

By Mark Trahant

Which rally drew more people? One Nation Working Together or Glenn Beck’s Restoring Honor? Left or right? Liberal or Conservative?

“Per usual the rally’s attendance numbers are being disputed by the left and right,” writes John Hudson in The Atlantic Wire. “While a number of progressive bloggers claim the “One Nation” rally drew a larger crowd than Beck’s August event, the Associated Press and others are challenging that claim.”

The logic here is counting people at a rally is evidence that Americans want a smaller, less taxing government, the kind of government that the Tea Party advocates.

But if you really want to count numbers then consider that while tens of thousands of Americans marched for or against government policy, compare that to Europe where ten times as many marched against their governments’ austerity measures. (These marches, I should mention, are small by European historical standards.)

Nonetheless: Austerity is our future.

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This is one of those stories where the allegations are just jaw-dropping. The Associated Press has the story. The ACLU‘s news release about it contains a quote from a woman who says, “They treat us just like guinea pigs when it comes to Indian Health Services.”

SIOUX FALLS, S.D. (AP) — The American Civil Liberties Union said Monday that it filed a federal lawsuit against the Indian Health Service to obtain information about whether pregnant women on the Cheyenne River Sioux Reservation are being pressured to have labor induced against their wishes.

Robert Doody, executive director of the ACLU of South Dakota, said there is no obstetric care available on the reservation and many women are being told they must have their labor induced on a particular day without being given information about the risks and benefits of induction.

For nearly a decade, women on the Cheyenne River reservation have had to travel at least 90 miles to St. Mary’s Healthcare Center in Pierre to have their babies, he said.

“There is no opportunity to give natural birth on the Cheyenne River reservation,” Doody said Monday. “They have to go to St. Mary’s and be induced, or they have to face the possibility of severe complications.”

National IHS spokesman Thomas Sweeney said Monday that he could not comment on a pending lawsuit.

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Mark Trahant is a writer, speaker and Twitter poet. He is a member of the Shoshone-Bannock Tribes and lives in Fort Hall, Idaho. Trahant’s new book, “The Last Great Battle of the Indian Wars,” is the story of Sen. Henry Jackson and Forrest Gerard.

By Mark Trahant

We hate health care reform. The bill was too many pages, too complicated and didn’t fix all the problems right now, this minute. (One of America’s core democratic values is our impatience.)

But the why is fascinating. Many of us hate the reform bill because it went too far; but most of us are unhappy because health care reform didn’t go far enough. We wanted more action, a smarter health care system, even, more government to make our health care system work smarter.

Yet that voter angst – both for and against – set the stage for this November election and the Republicans’ Pledge to America. “In a self-governing society, the only bulwark against the power of the state is the consent of the governed, and regarding the policies of the current government, the governed do not consent,” the pledge says. (Except that some of us do give our consent.)

Elections are policy choices. And this GOP Pledge is a clear guide about what Republicans would do if given power. There are significant implications for Indian Country in this document (even though American Indians and Alaska Natives aren’t mentioned at all).

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Nearly three decades ago, Dr. A. Scott Devous was convicted on drug distribution charges.

Now leaders of the Crow Tribe want him out of his job as head of the Crow/Northern Cheyenne Hospital. And they want an audit by the federal Indian Health Service, which runs the hospital, citing resistance to reforms proposed by the new CEO.

As Matthew Brown of the Associated Press reports:

Records show the doctor voluntarily relinquished his license to practice medicine in Wyoming in 1983, just before his indictment on federal drug charges. He was incarcerated after a jury found him guilty of abusing the painkiller Demerol and passing the drug to a girlfriend.

Devous was released in 1984 and his license was reinstated three years later. But he ran into trouble again after returning to Wyoming in 1990, according to records obtained by The Associated Press. After failing to notify officials that he was resuming work in the state — a condition of his re-licensing — Devous’ license was suspended for 90 days.

Gwen Florio

Dr. Yvette Roubideaux, director of the Indian Health Service, penned the following opinion piece on Mark Trahant’s yearlong series of columns on Indian Country and health care reform. Trahant’s work has been featured every Monday in Buffalo Post, as well by news organizations, websites and other publications around the country:

By Yvette Roubideaux, M.D., M.P.H.

Mark Trahant is completing a comprehensive and unprecedented series of columns on health reform and the Indian health system. These columns have shed new light on the Indian Health Service (IHS) and how it is influenced by and impacted by the rest of the U.S. healthcare system. These columns were made more timely and relevant by the historic passage of the Affordable Care Act and reauthorization of the Indian Health Care Improvement Act that occurred during Mr. Trahant’s work this past year

These columns have helped put the spotlight on the IHS, which is a health care system that serves 1.9 million American Indians and Alaska Natives from 564 Tribes in 35 states. The IHS rarely is mentioned in the national media, but it serves a critically important role to address the health disparities faced by American Indians and Alaska Natives. Many Americans do not understand the role of this health care system, or the treaty obligations and trust responsibilities that led to its formation over 50 years ago.

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For months, the Health Rights Organizing Project had a mission – the coalition of 30 grass-roots community organizations around the country worked hard to convince Congress to pass the Indian Health Care Improvement Act.

Among its pitch, writes Susan Olp of the Billings Gazette, was a publication by the group titled “An American Debt Unpaid: Stories of Native Health.”

The legislation became effective when in March, when President Barack Obama signed the the Patient Protection and Affordable Care Act, which permanently reauthorizes the Indian Health Care Improvement Act.

Just one thing:

The act is no longer dependent on annual reauthorization. And the new law authorizes the Indian Health Service to continue its programs and add some new ones, such as mental and behavioral health services, long-term care, dialysis, health care for Indian veterans and urban Indian health programs.

What the bill didn’t do was allocate the money to fully fund the present programs or any new ones.

So the coalition is back at work with a new booklet: “Native Health Underfunded & Promises Unfulfilled: The Importance of Investing in the Indian Health Service.”

“I have seen people walking around with severe pain, with orthopedic malformations that were never addressed, people addicted to painkillers because they can’t get procedures, people who need substance abuse treatment but can’t receive it, and even people taking their own lives because of a number of factors, including depression,” says Kevin Howlett, health director of the Confederated Salish and Kootenai Tribal health Department.

To read the publication, go to http://www.nnaapc.org/publications/20100814NativeHealthUnderfunded.pdf.

Gwen Florio

Mark Trahant has spent the past year as a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes and writes from Fort Hall, Idaho. Comment at www.marktrahant.com. His new book is “The Last Great Battle of the Indian Wars,” the story of Sen. Henry Jackson and Forrest Gerard.

What will the Indian health system look like a decade from now?

That’s an impossible question to answer. There is the potential of a court ruling striking down at least part of the Patient Protection and Affordable Care Act. And, there is always the possibility of Congress will rewrite the law (I view this as remote because there would have to be a Super Majority to enact something else.)

But in the meantime there is a new foundation already under construction. The building that will rest on that structure will not be the same as the one in place now.

Let’s start with the patient. Right now, according to the Kaiser Family Foundation, nearly half of all American Indians and Alaska Natives are either uninsured or rely solely on the Indian Health Service. But health care reform changes that. Big time. Beginning in four years, hundreds of thousands of people will become eligible for insurance through government programs (such as Medicaid) because of new income rules. This insurance can be used to pay for services at Indian health system facilities – or at competing health care centers. (Think about how many private walk-in clinics promise no waiting.)

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Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes and writes from Fort Hall, Idaho. Comment at www.marktrahant.com. His new book is “The Last Great Battle of the Indian Wars,” the story of Sen. Henry Jackson and Forrest Gerard.

A fast year: Lessons from the Indian Health system

A year goes by fast. Way too fast. Thirteen months ago I plunged into my “year-long” exploration of the Indian health system. It’s been fascinating because there has so much activity: Congress enacted the Patient Protection and Affordable Care Act and included with that bill the permanent authorization of the Indian Health Care Improvement Act.

My idea was to explore two basic questions. First, what lessons from the Indian Health Service ought to be a part of the national health care reform debate? And, second, what is the impact of health care reform on the Indian Health system? (I’ll write about that next week.)

In some ways the first question is the most difficult because of its complexity. The “story” of the Indian Health Service told in Congress and by news organizations is primarily the story of how the government runs a health care delivery system.

Sometimes that even reflects a positive message.

“It may come as a shock to many that when I compare the private insurance industry to the Indian Health Service, VA, Medicare and Medicaid, it is the private insurance industry that is the worst,” writes Dr. Richard Anderson in the Cody Enterprise. “The reason for this is that when compared to government agencies, insurance companies are not in the business of providing health care benefits as much as the denial of such benefits to make a profit for shareholders. That’s why government agencies have much lower overhead and are more efficient in delivering services.”

Far more often, however, the story is about how government fails as a provider. A recent post on KevinMd.com is an example of that narrative: “So, if you’re in the camp that supports a Medicare-for-all-type solution to our health care woes, consider how that same government, whom you’re entrusting to be the single-payer, has neglected the Indian Health Service.”

What’s interesting to me about both these posts is that they were written after Congress enacted health care reform legislation. We’re still fighting over a law that already passed (and, as I have written before, one that will be impossible to repeal until at least 2012).

But this narrative – Indian Health as a single-payer (success or failure) – misses the complexity. It’s hard to find many news stories at all that describe the role of Indian Health Service as a partner and funder of tribal, non-profit and urban health care organizations. Even though that activity represents more than half the IHS budget.

That’s why I would change the name of the Indian Health Service. It’s no longer a “service,” it’s a system. And in the coming decades I believe the IHS will provide even fewer direct health care services, while continuing to grow in areas associated with funding or the support of medical innovation and practices.

So what are some lessons from the Indian Health System that ought to be a part of the national health care reform debate? Three quick ones:
• A demonstration of what it takes to support and operate a rural health network, even in remote locations, using practices such as telemedicine;
• Experiences with an early implementation of an electronic record system for patients, information that will be valuable as other providers move away from paper records;
• Searching for a financial model that is frugal, yet fully funded. Neither the IHS (nor any private or government provider) has discovered the right balance. Not yet, anyway. But the topic should be a part of the discussion.

But perhaps the most important lesson is the Indian Health system’s history with the care and management of chronic diseases, especially diabetes.

Diabetes is the most expensive disease in America. It’s the fifth leading cause of death, surpassing AIDS and breast cancer combined. It represents nearly a quarter of all hospital spending and as much as one out of five health care dollars are spent on caring for someone with diabetes.

Unfortunately this epidemic is not news in Indian Country. American Indian and Alaska Natives are three times more likely to have diabetes than the white population (and four times more likely to die as a result).

Because of these grim statistics, the Indian Health system has much practical experience in disease management. For example the Special Diabetes Program for Indians supports community-directed programs, ranging from increased training to “best practices.” Over the decade the program reports a reduction in mean blood sugar levels of 13 percent in IHS patients as well as reduced LDL (or bad) cholesterol and significant reductions in protein in urine (a sign of kidney dysfunction). There are also promising statistics on fewer cases of end-stage kidney disease and other complications.

The diabetes crisis is not over – but Indian Country’s experiences could be helpful to the larger debate showing the importance of education and community-based efforts.

Additional resources:

New England Journal of Medicine: Article by Surgeon General Regina Benjamin on “Finding My Way to Electronic Health Records.

Financial Times: New report shows diabetes costs $83 billion a year in hospital bills.

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes and writes from Fort Hall, Idaho. Comment at www.marktrahant.com His new book is “The Last Great Battle of the Indian Wars,” the story of Sen. Henry Jackson and Forrest Gerard.

A single phrase is often used to define the Indian health system: “Government-run.” Add those two words to any discussion about health care or reform and most people reach an immediate conclusion about the merits of the agency.

Now it is time for the phrase to disappear because it no longer accurately describes the Indian health system. After all, tribes or tribally authorized nonprofit agencies administer more than half of the IHS budget, through the Self-Determination Act or Self-Governance compacts.

Certainly the federal government plays a huge role in this health care delivery system – across the country. “As in all industrial nations, the U.S. government plays a large role in financing, organizing, overseeing, and, in some instances, even delivering health care,” said a report last August by the Robert Wood Johnson Foundation.

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