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Health | Opinion
Mark Trahant: Indian Health Service paradox


"Call it the Indian Health Service paradox. The IHS is the largest direct provider of health care in the U.S. Public Health System. Yet it’s an agency either unfairly maligned as a “disaster” or absent from the discourse about health care reform. That’s too bad because the agency is a sustainable model for universal care.

The federal government’s delivery of health care for American Indians and Alaskan Natives began more than two centuries ago, first in the War Department and then at the Bureau of Indian Affairs. Congress transferred those functions to the Indian Health Service in 1955. Today, the agency is a comprehensive health delivery system for nearly two million American Indians and Alaskan Natives, mostly living on Indian reservations and in rural communities in 36 states.

IHS critics correctly point out the disparities between American Indian health and the general population. The General Accountability Office reported in 2005 that because of shortages in budget, personnel and facilities “the IHS rarely provides benefits comparable with complete insurance coverage for the eligible population.” Often that means a rationing of care, especially when it means contracting with doctors and hospitals outside of the IHS network.

So how could IHS be any sort of model for health care reform? The answer: The Indian Health Service is sustainable; the patchwork we call a health care system is not. "

Get the Story:
Mark Trahant: The Indian Health Service Paradox (Kaiser Health News 9/16)

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