"I have a utopian idea: Too bad there’s not an easy way to turn this notion around. What if the legislation was drafted at the clinic level and then sent up instead of down? Or, written from the patients’ point of view? Imagine a budget that fully-funded clinics and then used the remaining funds to staff the regional and central offices? A memo might read: “We’d love to fund the important bureaucracy … if only we could afford it.”

The push for national health care reform is going in the opposite direction. Decisions are being made that will reshape the entire care system without considering how it will impact the government programs already in operation, such as the Indian Health Service. A recent letter by the National Indian Health Board and other Indian organizations supports the effort, but asks for consideration of an amendment to protect IHS. “While H.R. 3200 takes important steps to improving access to health insurance and preventative health care services for all Americans, the bill does not take into account the unique position of Indian health care providers,” the letter said. “Moreover, the bill does not respect the fact that Indian people have already paid for their health care by ceding millions of acres of land.”

House Natural Resources Committee Chairman Nick Rahall has proposed amendments that will ensure some preservation of the IHS delivery system – perhaps with even added money from new insurance sources."

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