Sunday, August 30, 2009

Giving It Back To The Indians

Max Baucus received more than one unwelcome series of hard questions from Montanans, and they weren't all in town halls. Some were in tribal councils. Even before finding himself embarrassed at a town hall meeting which he thought would be an easy mark for the Obamacare proposals, Baucus thought he would at least be safe heading into Native American territory where most medical care is either provided by the federal government or paid for by the federal government.

Democrat Baucus is one of the architects of Obamacare, as well as one of its leading prophets and apostles. He doesn't seem to know his fellow Montanans very well, however. Before being dressed-down by the descendants of the pioneers at the Museum of the Rockies while trying to sell his "Make Health Happen Montana" snake oil, Baucus took his show to the Flathead Indian Reservation near Pablo, Montana. And much like Obama's Little Big Horn surprise in Bozeman, the Native Americans weren't buying the snake oil. It may only be a movie staple, but the men and women on the reservations know "this white man speaks with a forked tongue."

Apparently thinking that the Flathead Reservation (Blackfoot, Cree, Chippewa and other) Montana natives are still living in the Nineteenth Century, Baucus planned on handing out a few beads and a secret stash of whiskey and having the Injuns do a rain dance and leave. The Senator found out quickly that he wasn't in a Republic Films B-Western. The Three Mesquiteers weren't going to come to his rescue, and the cavalry was back in Bozeman preparing for the Great Chief from Washington to arrive. Instead, he encountered a very modern and very focused crowd of disbelievers.

Interestingly, there were two different groups of Indians there to oppose Obamacare, though their common goal was the same. About two-thirds of the tribal members were there to protest the straight-up government care they were getting, and the other one-third was there to represent the tribal members who have received federal funds but have provided the care through their own tribal medicine councils and native doctors.

For either group, the IHS (Indian Health Service) is a bane. The IHS provides approximately $2100 per Native American for health care. This is about one-third of what it costs the average American for health care costs, but it is on the same level as Finland, Japan, Spain and a few other western social democracies. For the Indians who depend on the fully-governmental care, the numbers are not good. Infant mortality is 1.4 times as high as non-Hispanic whites, HIV/AIDS rates are thirty percent higher, and liver cancer kills at a rate twice that of non-Hispanic whites. Diabetes kills four times as many Native Americans. Among the rural Indians, the rates are about 20% worse. And lung cancer for rural Indians kills at a rate 67% higher. Life expectancy on the reservation in nearby South Dakota is 58 years, compared to our national average of 77.

The horror stories of long waits for medical treatment, resulting in death or permanent disability are legion. Mis-diagnoses after hours, days or weeks of waiting to see a doctor are more like the rule than the exception. As a good liberal-in-conservative's-clothing, Baucus responded to these questions with his promise to declare a "health state of emergency" on the Fort Peck Reservation, and to investigate the use of IHS funds while promising more of the same. Two months later the Government Accountability Office reported that the IHS had "lost" $15.8 million worth of medical equipment, supplies and support materials. Where it could trace the money in other cases, it found things like $700,000 worth of computers which had been ruined by bat dung while being poorly-stored before delivery to the local "health" offices. So naturally, the answer is to spend more money instead of promoting governmental efficiency and honesty. Ladies and gentlemen, the Native Americans have seen the final preview of state-run health care.

The alternative to straight-up government run facilities is funding by the government, but administration by the local Indian tribes. These do much better than the others, but still have a poor record compared to the outside. However, the locally-administered plans cannot be blamed entirely on the people working in them. Now we look at the "low cost" of the allotment per native and find out that the cost in dollars may be low, but the cost in lives is high. The money, however carefully and faithfully administered by the Indians, usually runs out in late spring or early summer. The saying on the reservations is "don't get sick after June."

Tribal-contracting, as this method is called, is about as efficient as it can be, given its inadequate funding. And unlike many outsiders blaming "the system" for all their ills, the Indians running the programs tend to be quite realistic. Kelly Eagleman of the Chippewa Cree Band on the Rocky Boy's Reservation says "We tend to want to blame a system, but we don't look at ourselves. We all smoke. We lie on the couch. But when something happens to us, we're the first to point and say the the clinic should have fixed us." Wouldn't that be refreshing to hear from the government medical lobbyists and legislators who are blaming McDonalds and Burger King for health problems resulting from obesity?

The Cree Band has used the federal funds to provide its own health care. Dr. Dee Althouse at the Rocky Boy's Reservation says that she often finds herself working to save lives and limbs, deferring routine health care until there is money available. But even at that, their success rates in every category far exceed those in the IHS-run system, which receives exactly the same amount per native per year. Unlike the IHS-run system, the Chippewa Cree Band runs its own hospital, hired a registered dietician who convinced the local grocers to label shelves with nutrition information and recommendations, have a wellness center wth a gym, track, basketball courts, and swimming pool. This alone has cut diabetes rates by an amazing twenty-plus percent in five years.

The wholly-owned and operated IHS system has shown that government-run medical facilities are less than useless. The tribal-contracting model has shown that money is simply badly allocated along with supplies, facilities and staff, and that determining necessary medical care solely by adding columns of figures is not a good way to go. After applying "cost-benefit" analysis, the government has determined that both the amounts and the allocation of resources is just about right. In neither model is a combination of individual, government and private funding and administration even considered. A thousand dollars more per patient each year is going to make no significant difference. The money will simply be badly spent, although it would be of some help to the tribal-contracting groups.

Senator Baucus, I think the Indians have given it back to you. Their knowledge of publicly-run health care is not theory--they live it, as long as the system doesn't kill them. Like the rest of us, they want health care reform, but not government-run, government funded health services. They've seen it, and they know it doesn't work. You later called the protesters at the Museum "the closest thing to a mob you've ever seen." At least you had the good grace not to call the Native American protestors a "bunch of wild Indians."

I used the beautiful painting of the Indian medicine man (above) to illustrate two sad truths. The medicine being practiced by the IHS is far more expensive, and no more effective. And at least the medicine man truly cared what happened to his people.

18 comments:

AndrewPrice said...

Lawhawk, Once again, it's shown that the government just can't run health care. I've been seeing articles about 4000 British giving birth in places odd places in hospitals because they can't get into rooms, about dangerous conditions, etc. etc., and that's exactly what seems to be going on in the VA system and, apparently on the reservations. Government is not the answer.

StanH said...

I think we are heap big trouble if Barry gets his way. Great example of the federal governments incompetentcy. Lawhawk that’s a picture of coming healthcare in rural towns across America.

Writer X said...

Did Baucus think he would be welcomed with open arms on the reservation simply because he was a democrat? Talk about not knowing your audience.

LawHawkSF said...

Andrew: In the words of a man whose initials are RR: "Government isn't the solution--government is the problem." That President knew that the federal government had strict limits on its constitutional powers. And the control of our very lives and being is not among those limited powers.

LawHawkSF said...

StanH: I'm presently holding fast to the belief that "no army [or government] is so powerful as an idea whose time has come." That time has come, and we must make the most of it in the coming months and years. The idea is freedom, and it's an idea unfamiliar to the powers-that-be in the current administration.

WriterX: The definition of madness is doing the same act over and over, each time expecting a different result. Baucus misjudged his audience, assuming all Native Americans want to be on the public dole. Having made a complete fool of himself, he repeated the act at The Museum of the Rockies.

HamiltonsGhost said...

Lawhawk--Once again, the Democrats assumed that if their messiah proposed it, it must be good, and everybody will love it. They've received surprise after surprise ever since Obamacare became the source of great public inquiry. It's time for them to wise up, stop looking at the president's January poll-ratings and look at his current poll-ratings. Simply saying "it's what the president wants" isn't moving anybody except the hardcore left. They had better learn fast how to explain and justify the Obamacare takeover, or be prepared for more protests and lost election.

Tennessee Jed said...

This was an incredibly good post, Hawk . . . a final preview of what to expect under government run healthcare. The painting is great as well. This all shows what we can expect.

Joel Farnham said...

What is interesting is that we don't have to look to Canada or Cuba for the future of ObamaCare, er... KennedyCare....er.... KopechneCare. We just have to look at how the Health Care for Indians...er Native Americans, or the Health Care for the Veterens to see how the US government will deal with the general public.

We don't have to look beyond our borders.

LawHawkSF said...

Tennessee: Thanks again. I thought the painting was profound. Spirituality and the worth of their fellow man was a major part of the Native American way of looking at life and death. That depth of feeling almost leaps off the canvas. Somehow, I can't picture that medicine man doing a cost-benefit analysis before treating his sick patient.

LawHawkSF said...

JoelFarnham: I don't even have to look that far. A couple of years ago, San Francisco mandated employer-provided medical coverage for all but the smallest businesses, and for everyone else, it was provided by the already financially-floundering City. As a result, the facilities which were already overloaded, understaffed and questionably credentialed became even less efficient. Fortunately, doctors and hospitals with decent staffs, good doctors and A-grade facilities were not forced to accept the City's coverage, so we can still get good private care in town. I'm waiting for them to try to fill that gap, and it will be the thing that finally drives me out of town once and for all. Unless, of course, they pass Obamacare, in which case there would be no point in moving. I'll just go quietly and cost-effectively in my current home.

Individualist said...

LawhawkSF

I know that there is some rule from the treaties of the 19th century that states that Tribal Land is sovereign and we deal with them by treaty. This is the reason they are allowed to have Casinos on there tribal land. Given those tribes with successful casinos is it possible for them to reject the government plan and cut a deal with an insurance company for a traditional plan as if they were an employer. If I were them and my tribe had the money that would be the route I'd take.

Individualist said...

Lawhawk

If you ever go to South Dakota to see Mt. Rushmore, nearby is an Indian Park where they are blasting out a sculpture of Geronimo on a Horse out of a mountain. The Indians there do tale charity donations from the american people but in there literature they have refused government money more than once. They want it to be an Indian monument. It's funny they are the one that are channelling the true spirit of the founding fathers now.

Self Reliance.

LawHawkSF said...

Individualist: There have been some moves in that direction. But unfortunately, there is another force at play here. Habit becomes dependence becomes addiction. Although I understand the Native American right to some sort of compensation for the land taken from them and the obligations created by the treaties, there does come a point at which even a conquered people have to make the decision whether to remain dependent and therefore subservient, or to assert the other treaty rights and act independently. Without that decisions there can be no further progress. Sooner or later a decision has to be made--to assimilate or become fully independent. Otherwise the world would still have Angles and Saxons staying in their designated pockets of land, waiting for the handouts from the Normans in London.

The monument has been almost entirely funded by tribal donations and tourist fees. That's independence. I believe the monument is actually Crazy Horse, who along with Sitting Bull, was one of the most important chiefs who decided to fight to the death for their native lands. The Lakota Sioux and other plains and northern tribes pushed the army back and were the ones who gave Custer his final lesson in underestimating your enemy. Now that I can admire. Geronimo is a hero of the SouthWest tribes, and a leader of the Apache.

Individualist said...

Lawhawk

You are right it is Crazy Horse.

I remember seeing it. Tell you what the Indians don't think small. They figure it will be another 100 years or so before they finish.

I understand your point about assmilating but I think with the casino thing the tribes have to good a deal going. The benefit is for that money earned to allow them to be free of the government. Still you think that eventually it will have to be that the Indians themselves assimulate. I think they could find a way to do that and maintain their cultural heritage.

LawHawkSF said...

HamiltonsGhost: The element of surprise is a major component of successful campaigns, whether civil or military. Right now, those surprises are working in favor of freedom and conservative causes. It's now time for the Republican leadership to join in the cause (not try to claim it), and do what it's supposed to do. Listen to the groups, organize the movement, announce a unified Republican/conservative plan, and stick to it without selling out the principles of the people who are about to put them back in power.

So far, all I see is Republican "leaders" half-heartedly defending the movement, while continuing their course of compromise on overarching conservative principles and saying "no" without offering viable alternatives. Defense doesn't win football games, and it doesn't win elections. John McCain and the RINOs lost by playing defense. Now it's our turn. Where are our leaders? Where are the movers and shakers who take seriously the apostle Paul's advice to Timothy--"Study to show thyself approved unto God, a workman who needeth not to be ashamed, rightly dividing the word of Truth?"

LawHawkSF said...

Individualist: I am not personally advocating nor particularly committed to either assimilation or independence. As you say, there could be a very good combination of both, with each member making that decision individually. But at the governmental level, a choice will ultimately have to be made, and just as it is with us, the underlying decision is how to create wealth for your people, given the tools you have, rather than wait for help which either won't come or will be inadequate. The casinos are a good start, but only a start, toward building an entire economic infrastructure.

I think that if the tribes wish to remain separate, they will ultimately have to re-negotiate the treaties which now leave them as neither fish nor fowl. But that alternative will have to include giving up further assistance from the federal government. Under this alternative, they would not be treated like foreign nations, since their land is right in the middle of our land. Giving up the reservations entirely is not really an acceptable alternative, so I'm guessing this might be the one time where we could justifiably agree to a form of dual citizenship. No alternative will be easy, but it's fast approaching time to fish or cut bait.

Pahude said...

As a student of American imperialism over the Indian nations I find your description of the present Indian condition in Wyoming quite accurate.

Comparing care provided to the Indian nations to whatever government option is devised is an inane comparison, though. The Indian nations are aptly called reservations but in reality were territory prisons and like most prisons have long been provided with substandard services.
Why not compare it to the care our legislative members receive (a public/private alternative)? Works a lot better, but is also a lot more expensive.
So there is a continuum, depending on how much you spend. And that is what it comes down to; whether it is it an efficient use of resources. But even before that, there is the question: is this the purpose of government? This is where the issue truly resides and where all of our bickering originates.

LawHawkSF said...

Pahude: My article was not meant to be in any way an exhaustive study of Indian/United States history and relations. In fact, you might be surprised to find that I agree that the reservations were essentially territorial prisons.

That said, I see nothing inane in comparing government-run health care as proposed by Obama to that on the reservations. The comparison being made was between purely government-run health care versus funded care as it is administered by the local tribes themselves. The tribal-run care was better on almost every count, using exactly the same amount of money per capita. It can certainly be argued that on the reservations, the tribes have been short-changed. But the concept remains the same. At best, under the plans originally laid out by the single-payer advocates, non-Indians would still receive far less than adequate medical care, which tangentially might mean that the conditions on the reservations might get even worse.

There is very good reason not to compare it to what federal elective officials receive, since neither non-Indians nor Indians will receive that kind of care under the Obama proposals. The legislators made it very clear that they will be exempt from the terrible care to be provided to both US citizens and Indians.

Quite simply, the "government option" is unacceptable, no matter how it is administered and no matter to whom it is provided, Indian and non-Indian alike.

Our argument on the pages of this blog have been that the only role government should have in health care is making sure that it is uniform, fair and ethical nationwide (including the reservations). The federal government cannot print money fast enough to make health care provided by a national health service work either efficiently or ethically. The cost-benefit method is the worst possible model when the decisions are being made by government officials who can't even balance their own personal checkbooks.

Post a Comment