Published November 05, 2009
"Don't get sick after June" is a well known saying in Indian Country. It refers to the month when the federally managed Indian Health Service (IHS) program runs out of money.
It's "a pretty accurate mantra," according to Kathleen Sebelius, the Secretary of the Department of Health and Human Services, which oversees the program.
IHS is a shameful example of how patients suffer when their care is relegated to a government bureaucracy that rations care. IHS, in fact, characterizes the service it provides as a "rationed health care system." As many in Congress continue to push for a public option run by the government, Americans should familiarize themselves with the tragic story of IHS.
American Indians experience far worse health outcomes than the rest of the nation. The numbers are staggering: Americans Indians have a 40 percent higher infant mortality rate, are twice as likely to die from diabetes, 60 percent more likely to suffer a stroke, and 20 percent more likely to have heart disease. American Indians born today can expect to live 5 less years on average than the average American.
Behind these numbers are heart-breaking stories of American Indian patients. Ta'Shon Rain Little Light -- a five year-old -- had stopped eating and walking and complained her stomach hurt. The Indian health clinic said she was depressed. She visited the clinic 10 more times over the coming months before her lung collapsed and she was taken to a hospital in Denver. There, she was diagnosed with terminal cancer and died only weeks later.
Rhonda Sandland couldn't get help for her advanced frostbite until she threatened suicide. Though her hands were purple and she could not dress herself, she could not get an appointment at the Indian health clinic. When she finally got one, the clinic decided to remove five of her fingers. Fortunately, a visiting doctor intervened and gave her drugs insteadÃ¢â‚¬â€�saving her fingers.
Ardel Baker was suffering from severe chest pains and was sent by ambulance from her local clinic to the nearest hospital. Attached to her, literally, was a note written on U.S. Department of Health and Human Services letterhead: "Understand that Priority 1 care cannot be paid for at this time due to funding issuesÃ¢â‚¬Â¦. A formal denial letter has been issued."
IHS covers health services for about 1.8 million Indians at a cost of more than $4 billion a year. While the amount spent per patient under IHS is less than the average spent on the average American's health care in a year, the per capita spending for IHS is very comparable to that of countries that have been held up as examples of what proponents of government run health care believe our health care should look like, such as Great Britain, Japan, and Spain.
IHS's substandard and rationed care isn't simply the result of insufficient funding, but also mismanagement and neglect.
Last year, Montana Democrat Senator Jon Tester determined that IHS facilities were collecting only 60 percent of the money they were owed by other insurers. As a result, last year IHS lost as much as $532 million, or about 13 percent of the program's income.
The true cost of IHS mismanagement is far worse than could be documented, according to a recent audit by the Government Accountability Office (GAO). IHS officials who were being investigated attempted to obstruct GAO's investigation by fabricating hundreds of documents. Nonetheless, GAO found that IHS had 5,000 property items lost or stolen, worth about $15.8 million, between 2004 and 2007. Missing items included vehicles, medical equipment, and computers containing sensitive data -- including Social Security numbers.
Not only are resources mismanaged by IHS, so are patients. GAO reported waiting times at IHS facilities between 2 to 6 months for physicals, women's health care, and dental services. Many facilities turn away at least 25-30 patients a day. And 21 percent of pregnant women have three or fewer prenatal visits -- well below the American College of Obstetricians and Gynecologists minimum recommendation of 14 visits per pregnancy.
IHS patients also have limited access to doctors. Native Americans are often required to travel over 90 miles each way to obtain care. IHS reports they can't even fill all of their available jobs for physicians -- 18 percent of them are unfilled. For dentists in particular, the job vacancy rate is 31 percent while patients report they cannot access basic dental care. If there is a problem with a tooth, it just gets pulled.
Across America, Native Americans face fewer choices and a lower quality of care because politicians in Washington -- the same politicians behind today's reform effort -- believe they know best. Sadly, IHS is not the only government-run health program that denies choice, rations care, and mismanages public resources. Forty percent of doctors currently refuse to treat Medicaid patients. Medicare teeters on the verge of bankruptcy and is already rationing care; both programs are rife with billions of dollars of waste, fraud, and abuse.
All Americans should have the same choices of health care choices enjoyed by members of Congress, who can select from more than 10 different private health care plans. I've introduced a bill, the Patients' Choice Act, along with North Carolina Republican Senator Richard Burr and Representatives Paul Ryan (R-Wis.) and Devine Nunes (R-Calif.), that would guarantee that all Americans -- including Native Americans -- would be able to choose the health care coverage that best meets their individual needs without raising taxes, increasing the debt, or rationing care.
Single payer, government-run health care has long been a dream of the principal authors of the health "reform" bills moving through Congress. Any public option, however watered-down, that makes it into final bill will be designed to move us closer to that goal. The American people have good reason to be concerned. If you like Indian Health Services you'll love the public option. But don't get sick after June.
Oklahoma Republican Senator Tom Coburn, M.D. is a practicing physician and member of the Senate Indian Affairs Committee.