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.