America is in the midst of a healthcare reform debate that has been a long time coming. It's the kind of debate that starts with a central truth - our healthcare system is not working. The definition of how it isn't working varies. For those of us who have healthcare insurance through our employer, the rising cost of healthcare and the demands that puts on our budgets and our employer's bottom line are concerns. For the uninsured and under-insured, the nation's healthcare system fails to provide coverage and empower wellness every day. Uninsured and under-insured Americans also factor into the costs insured Americans pay. People who work for and in the many industries associated with healthcare have their own two cents to toss into the debate too. So, it comes as no surprise that the healthcare debate has heated up as the Obama Administration tries to usher reform through Congress. Likewise, it comes as no surprise that some lawmakers and organizations are working to make sure that addressing disparities in accessing healthcare is part of that healthcare reform.
The Associated Press recently reported that Black, Latino and Asian lawmakers are seeking to broaden healthcare legislation to include more funding for community health centers that provide care to poor neighborhoods. Among the Asian Caucus, Congressional Black Caucus and Congressional Hispanic Caucus there are 91 legislators with the power to influence and shape healthcare reform legislation. Armed with research showing the ramifications of healthcare disparities in communities of color, these legislators are pushing hard for funding and for the public option.
I've been following the healthcare reform debate and discussing it with family and friends. Most of them are concerned that the public option appears to be in trouble on the Hill while others are concerned about whether coverage for reproductive health care would become a political issue that will threaten coverage through a public option. But one friend pointed me toward the healthcare crisis facing Native Americans as an under-examined example of healthcare gone wrong and an under-utilized guide to what we need to avoid as we seek to reform healthcare for all Americans.
Tim Giago recently tackled the subject
of how healthcare reform would impact Native Americans in an article entitled How Will Universal
Health Care Affect Native Americans?.
Giago, an Oglala Lakota and the publisher of Native Sun News, points out that healthcare
in America may be failing but, by way of comparison, Health and Human
Services Secretary Kathleen Sebelius calls the health care of Native
Americans a "historic failure." Our government,
obligated through treaties and agreements, provides healthcare to Native
Americans through the Indian Health Service. So, the "historic
failure" is actually another government failure in a shamefully long
line of government failures involving Native American people.
Giago poses some very important
questions about whether healthcare reform will cover Native Americans
too, how it will impact care on reservations and in urban areas and
whether reform will impact the Indian Health Service. He also
points out that Americans who point to Canada and Europe as examples
of how "socialized" medicine can go wrong may want to look closer
to home and at the government run Indian Health Service.
Giago's piece provides some insight into the key issue funding plays in the failures of the Indian Health Service. He quotes the new head of the Indian Health Service, Dr. Yvette Roubideaux, saying "It's clear that there's a call for change and improvement in the Indian Health Care Service, and it's also clear the IHS has been significantly under-funded for many years. The staff of Indian Health Service has been doing the best it can with limited resources, and in some cases they are providing excellent quality of care with limited resources."
In other words, if we want public healthcare to work we've got to come up with the money to fund it. To that Giago adds a question - as legislators search for ways to fund the estimated $1.5 trillion required to fund healthcare reform, how will the budget cuts anticipated to free up those funds impact the Indian Health Service? The answer to that question is playing out in Congress right now.
Those of us who champion healthcare reform point to that one central fact - our healthcare system is not working. With the perspective provided by the Indian Health Service we should take care to learn how programs might be set up to fail through a lack of adequate funding. How and if a program is adequately funded speaks volumes toward our commitment to that program. Will we rob Peter to pay Paul and, if so, who gets to play Peter and who gets to play Paul? Will we fund healthcare for the long term or set it up to go broke in a few years? We should also take care to address the barriers to accessing healthcare that exist in communities across the nation, on reservations and in urban areas. If we're going to do it we need to do it right lest we expand the historic failure of healthcare for Native Americans nationwide. As advocates and legislators demand that healthcare reform include a public option we should all keep in mind that if we wouldn't want it for our family we shouldn't propose it for anyone else's and we should fund healthcare reform as if our lives depended on it.
