"There’s an old joke: A Native American student comes home from a geography lesson, shows his grandfather a map, and then asks, “What did we call the United States before it was a country?” His grandfather answers, “Ours.”

I thought of this joke recently in the context of the U.S. Indian Health Service. Perhaps the agency’s history, its shortcomings and its chronic underfunding have all been acceptable to Indian Country because the system itself is “ours.” It’s been “ours” for most of our generation – a little more than five decades – where American Indian and Alaska Natives could receive health care in a system that was, and is, unique.

A quick look at the history: Since 1955 the Indian Health Service was transferred from an rickety network of hospitals and clinics run by the Bureau of Indian Affairs to a real health care system. In that same time frame the agency went from being a slice of the BIA to being larger than the BIA with a budget of $4.4 billion and some 15,000 employees. During that time there were substantial improvements in Indian health, including reducing overall mortality by 28 percent in the past thirty years, while still falling short in health parity for Native Americans.

That brings me back to the definition of “ours.”

Since 1955 that definition has meant government-run health care, mostly in the form of direct services operated by the Indian Health Service. But that definition has been changing slowly since the enactment of the Indian Self-Determination and Education Assistance Act of 1975. That law, of course, gives tribes as well as tribal and urban Indian organizations the right to contract for the management of these federal programs. Already more than half of IHS is run under contract – and that number should grow even more quickly because of changes under the Patient Protection and Affordable Care Act."

Get the Story:
Local control and new money: Making a health care system ‘ours' (Mark Trahant 7/26)

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