The ultimate insult to the Land Exchange

ok, here's a novel idea for those in the Puzzle Palaces across the United States who are looking for something good to do. For those who are at the level to effect some of the detrimental "policies," ruminate over this idea. If you're a Tribal member who is just trying to live, take a listen, think it over and just think how much better some of the things discussed on this blog would be if the policies were construed to really help the average Indian. If you had five minutes with Yvette Roubideaux, newly appointed Director of the Indian Health Service, would you consider discussing this? In Rapid City, Sioux San hospital is in a different IHS world. I know, I've been there. You have to wait hours to get in sometimes. That, however, is better than the lot most of us are dealt away from Sioux San, where we may wait days to get in to see a doctor, or in a few sad instances, the rest of our lives. This is our Indian version of a discussion on Health Care Reform.

The Indian Health Service Problem: Contract Health Services

Let's put some Indians out of jobs. That's all that some people will hear so let's just put that out there up front so at least it's acknowledged. We need to re-evaluate the money that is spent on contract health administration. The ADMINISTRATION of those funds is an area where we can make the greatest, quickest impact. Will we lose jobs? Yes. But when it comes to surgery, treatment, emergency room treatment, medication, dental work, the average Indian will take the treatment over some highly paid administrator's jobs.

When we have to literally be dying on the front steps of a clinic to get a referral for services that are not offered at the IHS clinic, it's high time to shift some of the money to the areas where it's needed. When we have to be the first one to call in the morning to get an appointment, it's time to re-think what injury means to the administrators. When you have to call the day before to get an appointment the next day, it's time to figure out how you're supposed to know if you're going to be sick the next day. When you have to wait weeks to have a dental crown finished, or when you have to go several days with a cavity because you weren't the first to call in for a same-day appointment, it's time to start requiring these highly paid administrators to stand in line at the IHS clinic with the rest of us when their teeth get a cavity. When several million dollars are sitting in reserve at any given IHS clinic, at any regional office, it's insulting that the IHS administrator will deny you a referral, will let you suffer, will let the condition worsen.

So, what to do, what to do? Centralize the process. Issue an IHS insurance card. Re-vamp the rules. If you're an Indian, you already know the obstacles to getting treatment. There is a ton of paperwork that needs to be completed....before you become injured, before a doctor places healing hands on you. If its not, well, guess who gets the bill when you heal? If you don't call within 72 hours of treatment, you get the bill. If you live outside your reservation, you have to prove economic ties to the community where you live, despite the fact that back home, your ancestors signed away land and asked that you receive medical treatment in exchange for that. If you're 18 and nobody ever explained this to you before you got injured, then IHS just saved several thousand dollars because you didn't jump through their hoops. If you never lived off your reservation and nobody explained the rules before you got injured after you moved to another reservation, the IHS Contract health workers will attempt to look woeful when they deny payment because you didn't fill out their paperwork BEFORE you got injured, despite the fact that you have lived in the area much longer than the minimum required as part of the "economic ties theory."

The agreement (treaty) stipulated that we'd exchange part of our land base for several provisions, chief among them, education, and medical treatment. These provisions were sealed in the battle-blood of our ancestors. They never envisioned, nor did they sign provisions, that an Indian Health service would take over the oversight of this health provision and put all kinds of obstacles in the way of meeting the U.S. government's obligation. Look at any treatment today.

We, the infirmed, the injured, the elders, have to "prove" we are "eligible" for treatment.

That wasn't in the treaty.

My grandfather's grandfather didn't expect this to be the way things were. They signed away part of their Native Land in exchange for several key provisions to take care of their grandchildren. They didn't expect for the same Indian Health Service to hold literally millions of dollars in "reserve" year after year after year. The cannons of treaty construction would mean that "reserves" should be construed for a "season," not for years after years after years.

If you read the CFR closely, Title 42 C.F.R 136.23, you will see that service will be provided to certain persons but the requirement for proof is not spelled out. In other words, it should, as any legal eagle will tell you, rest on the Federal government to prove that you are not eligible. There is no provision in the law that stipulates that the person will be penalized with a bill if they do not report their status prior to becoming injured within the boundaries of a service area other than their own service area, even though they have met the economic ties definition and have lived there long enough.

Or, Or, Or...§ 136.25 Reconsideration and appeals. (a) Any person to whom contract health services are denied shall be notifiedof the denial in writing together with a statement of the reason for the denial. ... and then:
(1) May obtain a reconsideration by the appropriate Service Unit Director of the original denial if the applicant submits additional supporting information not previously submitted...

That doesn't always happen, especially if you are dealing with a Contract Health Administrator who is charged with protecting a budget.

So, let's remove several highly paid administration offices, and centralize the process. Issue an IHS insurance card to every tribal member. Then pay the bills to meet the obligation that the United States signed on to in the treaty. The money follows the card, no matter where the tribal member lives. Even if they go to Haskell Indian Nations University, from an off-reservation address, their medical bills will be paid for by the United States in honor of our ancestors' wishes when they signed away some of their land base.

If Yvette Roubideaux was serious about "bringing reform to the IHS and improving the quality of and ACCESS to health care in the IHS," maybe this is a good starting place to generate some ideas about some out-of-the-box crazzzy version of change. Then again, if some crazy lunatic puts another rider on any congressional action, and somebody else is asleep at the wheel again, maybe nothing will change. Maybe Indians will continue to wait for surgeries, continue to wait for dental treatment, continue to wait to see specialists that the IHS doesn't have on staff. Maybe Contract health administrators will continue to get raises for going "under budget" and storing more away in the IHS reserves. Doesn't that seem strange? They do a "good job" by not expending funds that are set aside for our healthcare. Put it all on an IHS charge card and you will find out exactly how much it really costs to uphold the treaty provision. Something needs to change because at this rate we're not going to be getting any better all by ourselves.

"If we're not doing well in certain areas what can we do to make improvements..."

Shake the tree and see what fruit appears, I'm sure we'll all appreciate it.