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.