Medicare turns up regularly in discussions about federal involvement in health care, and how it should or shouldn't be done, but there's another model out there also deserving of examination right now: The U.S. Indian Health Service, described on its web site as "The Federal Health Program for American Indians and Alaska Natives." You'll look in vain for its role in the bit health care debate. It should be.
Mark Trahant, the former editorial page editor of the Seattle Post-Intelligencer (and a member of the Shoshone-Bannock Tribes in eastern Idaho), has started writing about just that. He has become a fellow at Kaiser Media, which sponsors in-depth health reporting, and today posts an initial column on the subject which should be a must-read.
The health program has old roots, growing from a mission to sent physicians to work on a smallpox outbreak in 1834. It isn't a perfect system, and even new Health and Human Services Secretary Kathleen Sebelius has called it a “historic failure”.
But Trahant argues there's a more solid core underneath the failure. Trahant:
As National Congress of American Indians Vice President Jefferson Keel testified to Congress recently, “The truth is that the IHS system is not so much broken as it is ‘starved.’ Indeed, Dr. Yvette Roubideaux, the agency’s new director, said during her confirmation hearing that the funding shortage is her top concern because IHS has not been able to keep up with its obligations. The General Accountability Office reported last year that because of shortages in budget, personnel and facilities “the IHS rarely provides benefits comparable with complete insurance coverage for the eligible population.” It spends about one-third less per capita than Americans in general and half of what’s spent for the health care of a federal prisoner. Often that means a rationing of care, especially when it means contracting with doctors outside the IHS network.
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).
But the federal management of its health care network is full of inconsistencies, including the way the government pays itself. Medicare only reimburses IHS or tribal health facilities for 80 percent of the costs; so an already underfunded IHS essentially subsidizes Medicare. According to the National Congress of American Indians fixing this one problem would add $40 million a year to the budget.
This may sound odd, but I think with sufficient resources, the Indian Health Service could be the model for reform. The agency already knows how to control costs and the successful operation of a rural health care network. So much so that many rural non-Indian communities are looking for ways to tap into the system for the general population.