Gazette opinion: More than money needed to fix IHS problems

2014-06-02T00:00:00Z 2014-08-20T16:58:14Z Gazette opinion: More than money needed to fix IHS problems The Billings Gazette
June 02, 2014 12:00 am

Here’s the good news.

Native Americans needing treatment through the federal Indian Health Service could experience extraordinarily long wait times, misdiagnoses and wrong dosages of medicine.

The good part of that is at least those are the problems that the service knows about and can identify.

What’s not so easily defined are the numbers of people who have had to suffer irrevocable medical conditions because of the delays or subpar care, or even died because of another in a long line of broken promises made by the federal government to American Indians.

However, Montana should be doubly proud of itself because it took a leadership position in addressing these real and, in many cases, dire needs with the Indian Health Service. And native leaders didn’t settle for the same old excuses when they heard them.

Kudos to Montana Sen. Jon Tester, D-Mont., who is the chairman of the Senate’s Indian Affairs Committee. He’s taken on the issue of IHS care here, which desperately needs addressing, and he’s in a unique position of power to help make changes.

More than that, though, Montana should be proud of the people who showed up for Tuesday’s hearing in Billings on the agency and its problems.

Indian Health Service Acting Director Dr. Yvette Roubideaux suggested that an influx of cash would be good medicine for the IHS’ ills. And almost as soon as it was suggested, tribal leaders discounted that idea, saying money wasn’t necessarily the issue as much as management and efficiency.

We’re proud that our area tribal leaders didn’t let the IHS folks off the hook with that same, tired excuse.

Just throw money — the battle cry of any bureaucracy, it seems. And yet the leaders knew that money and management are two distinct things.

Crow Tribal Chairman Darrin Old Coyote said that even though funding through the IHS for the Crow people increased, most of the increase was eaten up by administration and very little went to direct care.

Crow leaders also pointed out that after 2011 flooding, services like obstetrics, which were closed in the midst of the disaster, were never reopened.

We’d suggest that IHS may be spending a lot of money, and that its leadership would like to spend a lot more. But spending money in this case may be more akin to putting a bandage over a gunshot wound. Sure, it may cover it up — hide it from plain sight — but it won’t fix the real problem.

Money may indeed play a role in the IHS debate. And it’s hard to argue that money isn’t part of the problem, when the average IHS client gets less than $3,000 when the average Medicare beneficiary gets $12,000.

But management is about making the right priorities and getting the most for your money. In this case, tribal leaders appear to be on the right track by requesting forensic audits and suggesting there are many areas of redundant services. The money is being disbursed, it just doesn’t flow correctly to American Indian patients.

We hope that Tester’s hearing won’t be the final word on the matter. Instead, we hope it was just the beginning. We urge Tester and others, like Wyoming’s John Barrasso, who has been part of Indian issues in the West, to continue to push for answers.

Hopefully after more investigation and more answers, the IHS and the federal government can put together a plan to help American Indians who are experiencing catastrophic health care challenges, from suicide to diabetes to heart attacks. At that point, hopefully adding more resources to the IHS budget will not be an exercise in throwing good money after bad. Right now, given the testimony on Tuesday, how could anyone be sure if more money was given to IHS that it will be spent correctly and effectively?

Finally, there is an unmistakable parallel going on currently. Congress is demanding answers in what is apparently a very broken Veterans Administration health care system. The issues, in many cases, are identical to the IHS’ and center on access to care and quality of care.

Folks across the country have been outraged that we’d dare treat our veterans this way.

Meanwhile, the same kind of treatment for Indian tribes continues largely because it — for so many, even those of us who live closer to the issue — is out of sight and therefore out of mind. Watching both issues happen simultaneously, it’s not too hard to wonder: Why does the VA issue draw criticism by the truckload, but few notice the shoddy treatment at the Indian Health Service?

There are probably some uncomfortable answers to that question.

And yet the truth remains: We have an obligation to both sets. We’ve made the commitment to our soldiers that we would take care of them in return for their service. We made a commitment to Native Americans — sometimes several hundred years ago — to take care of them.

We must do a better job of seeing those commitments through.

Copyright 2014 The Billings Gazette. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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