Indian Health Service (IHS), the federally-funded health care program for American Indians and Alaska Natives, is the primary source of health care for around 2.2 million Native Americans in thirty five states across the U.S. The IHS program is consistently underfunded, leading to significant health problems and deficiencies in care for Native Americans. IHS is failing the millions of Native Americans who rely on the program for health care. While the United States purports to symbolize freedom, democracy, and equality, this broken system constitutes a major violation of civil and human rights for our citizens, not for people in developing countries, not for foreigners in an authoritarian government, not for immigrants; not for “others”, but for Americans.
A series of negotiations, treaties, and legislation that have occurred since the inception of the U.S. Constitution obligate the U.S. government to provide quality health care to Native Americans through the Indian Health Service, a program that was created in 1955. The IHS, along with several other federal programs such as the Assistance for Indian Children with Severe Disabilities, Direct Home loans for Native Americans, and Indian Child and Family Education, was intended as a remedy for the historical abuse and mistreatment of Native Americans which have made the group highly vulnerable to poverty and disease. Despite this moral and legal obligation to provide health care to the historically underserved Native American population, Indian Health Service is a highly inadequate program. The program’s funds are so scarce that the quality of care provided has been called “horrifying” by Senator John Barrasso and has led to a multitude of cases of negligence and malpractice.
With little to no access to quality care from this health care system, Native Americans face staggeringly disparate health realities than other Americans. On average, American Indians die five years sooner than the rest of America; in some states, their life expectancy is as much as twenty years shorter than the national average. Compared to other citizens, they are 60% more likely to commit suicide, twice as likely to die in childbirth, and five times more likely to die from tuberculosis. The glaring discrepancies seen between Americans and Native Americans portray a deeply inadequate system that degrades American Indians through its persistent underfunding and flagrant insufficiencies.
A closer look at specific failures of the system illuminates unacceptable examples of the real stakes of IHS’ flaws. Lisa White Pipe, a tribal council member for the Rosebud Sioux tribe in South Dakota, lost her father to cancer after being delayed by IHS approval for specialized care. She says, “We’ve lost faith in the IHS, but we have no alternatives to go anywhere else.” This feeling of distrust and helplessness is not uncommon and not unwarranted. In another instance of mistreatment, Debra Free of the Winnebago tribe in Nebraska was overmedicated by IHS nurses. In South Dakota, Wakanda Gonsalves died after being misdiagnosed at an IHS clinic. In another case, a heart attack victim was forced to wait ninety minutes for care. One tribe member described an IHS facility where employees “did not know how to call a Code Blue” and “where defibrillators could not be found or utilized when a human life was at stake” in the emergency room. The list of horrific grievances goes on, and goes overlooked. IHS has faced hundreds of federal investigations into malpractice claims, and yet little has changed. Frequent misdiagnosis and malpractice cause many tribal members to fear and distrust the service, isolating populations from any viable source of care.
Overall, the deficiency in quality care boils down to a severe lack of funding. In 2013, the Indian Health Service spent $2,849 per person, significantly less than the $7,717 per person for health care spending nationally. Tribal members often tell a cruel joke: “Don’t get sick after June.” This sardonic quip means that by summer, IHS has typically spent all of its meager fiscal year budget, and thus will not be able to help anyone who gets sick after June. The IHS budget falls under discretionary federal spending, meaning there is no set, mandatory amount budgeted for each year. This causes the year-to-year spending allocations for Indian Health Service to be rationed and restricted by limits in federal funding and other congressional priorities.
To remedy the long-standing colonialism and paternalism that have allowed the U.S. government to overlook and disregard the urgency of the problems that are faced by Native Americans, legislatures must implement a significant increase in mandatory, entitled funding. They also need to start a complete overhaul of the IHS leadership, which has too often degraded Native Americans by allowing unqualified providers to harm the very civilians they are tasked with treating. With IHS currently restricted by discretionary spending bills, the program’s funding, which can mean the difference between health and sickness, or life and death, falls under the capricious whims of the government. For instance, since 2017, President Trump’s administration has proposed both cuts and increases for the IHS budget as part of a gamble to get funding for his US-Mexico border wall. In 2017, the program stood to lose millions in its budget; by 2018, Trump completely switched opinions, offering expansions to the program in return for funds for the border wall. Rather than relying on mercurial legislative gambles to define how much care Native Americans will receive, or how many lives will be lost in the underfunded hospitals, IHS deserves, and requires, entitled funding to consistently replenish the program and keep up with the dire needs of the 2.2 million Americans it serves.
The Indian Health Service’s severe underfunding and pervasive problems represent a broken system that is failing the Native American population and that symbolizes our country’s continued mistreatment of Native Americans as a whole. American citizens are suffering. They are indeed the very same population from whom colonists once stole land and abused until eventually promising “affordable” healthcare as compensation. Legislatures have neglected to face the problems within the Indian Health Service program that plague Native Americans around the country. IHS deserves a total revamp complete with significant legislative actions from Congress that designates IHS as an entitlement program and promises a long-term commitment to increased funding.