The Health Care America Refuses To Provide

Genocide is always and everywhere a political occurrence.

— Irving Louis Horowitz, Genocide

As you’re reading this I’m sure your eyes are beginning to roll, indicating how peeved you’re probably getting over yet another tirade on the subject of health-care-overhaul. Fear not. To prevent this article from joining the all-embracing tautology of other recent health care polemics, a juxtaposition of statistics will suffice: according to the U.S. Census Bureau, 20 percent of the general population under the age of sixty-five is without health care coverage; one out of three, if not more, American Indians and Alaskan Natives, under the age of sixty-five, is either uninsured or dependent on the deficient services provided through the IHS (Indian Health Service).

As claimed by the Office of Minority Health, an adjunct of the Department of Health and Human Services, as of 2008 there were an estimated 4.9 million people who classified as American Indian and Alaskan Native alone or American Indian and Alaskan Native integrated with one or more other races [sic]: comprising only 1.6 percent of the U.S. population. The IHS, according to the Office of Minority Health, provides services to only 39 percent of American Indians and Alaskan Natives — that is approximately 1.9 million individuals out of 4.9 million who qualify for IHS services. This laggard expanse of services comes at a time when American Indians and Alaskan Natives are plighted by appalling conditions and afflictions such as:

• infant death rates 40 percent higher than the rates that exist for whites;
• death rates from alcoholism and tuberculosis approximately 650 percent higher than overall U.S. rates;
• a male population twice as likely as white men to have liver and IBD cancers;
• a male population 1.8 times more likely as white men to contract stomach cancer and, twice as likely to die from stomach cancer;
• a female population 2.4 times more likely as white females to contract, and die from, liver and IBD cancers;
• a female population 40 percent more prone than white females to get kidney/renal/pelvis cancers;
• 31 percent of the population will die before the age of 45; “…the overall adjusted death rate for American Indians is 35 percent greater than the U.S. rate…” (The age-adjusted death rate for those living in the Aberdeen area — a region that harbors most of the Lakota-Sioux reservations in South Dakota, has risen beyond 1,000 percent); ((Goldsmith, M.F. (1996). First Americans face their latest challenge: Indian health care meets state Medicaid reform. JAMA, 275, 1786; also see Voss, Richard W., Victor Douville, Alex Little Soldier, and Gayla Twiss, Tribal and shamanic-based social work practice: a Lakota perspective, Social Work, Vol. 44, 1999.))
• higher rates of diabetes and obesity than the general population;
• an unemployment rate of 49 percent — approximately five times the national rate.

What no one is talking about right now is how the most blighted class of people in this country, the most marginalized group of people in the history of the U.S., will be affected by the proposed health-care-reform-bill. But perhaps that is because this bill may not actually provide any measures to ameliorate these abysmal conditions at all. And that may be the case because no one has ever really talked about the historical and ongoing destruction of this country’s native population honestly and publicly enough.

There are many bones to pick with the judicatory infrastructure of the United States of America concerning the failed restitution of history’s most victimized and terrorized peoples. For now, let us focus on bringing an ailing population back to good health through a program hatched for the absolute benefit of a class it is designed to provide services for, alongside being unequivocally structured according to how the said class determines it to be.

What I am asking, and what we should all be asking is: Why is it so difficult to provide fair and equal health care to an entire group of people that comprise less than two percent of the general American population? And: Will the administration’s health-care-reform-bill ensure fair and equal care be provided for American Indians and Alaskan Natives? And more importantly: If so, will the provisions enumerated for American Indians and Alaskan Natives, included in the health care proposal, be drafted along the former and latter parties’ terms, unescorted by any equivocal provisos and/or tendentious legislative furnishings?

Health care as a euphemism for the euphemism that is assimilation

Health care for American Indians and Alaskan Natives is essentially the extenuation of assimilation programs, sanctioned and directed by the IHS under the auspices of the Department of Health and Humans Services (DHHS).

In 1921 a piece of legislation known as the Snyder Act warranted legislative authority for a federal health program designed to provide services to American Indians and Alaskan Natives. According to literature on the IHS website, the act authorized funds “for the relief of distress and conservation of health…[and]…for the employment of…physicians…for Indian Tribes throughout the United States.”

However, even prior to the ratification of the Snyder Act of 1921, the United States government was well involved with juridical “health care” measures (i.e. expedients) designated for the remaining native population. Holly T. Kuschell-Haworth wrote for DePaul Journal of Health Care Law in the summer of 1999:

The Origins of Federal Native American Health Care Attention to Native American health care began in the nineteenth century when contagious diseases, such as smallpox, threatened the once substantial populations of Native American people. The Federal government’s earliest goals were to prevent disease and to speed Native American assimilation into the general population by promoting Native American dependence on Western medicine and by decreasing the influence of traditional Indian healers. In 1849, responsibility for Native American health was transferred from the War Department to the Bureau of Indian Affairs (BIA). The BIA oversaw the use of congressional appropriations for the establishment of health programs for Native Americans. Responsibility for Native American health has since endured many organizational transfers, and now resides with the Indian Health Service (IHS), an operating division of the Department of Health and Humans Services (DHHS). ((Kuschell-Haworth, Holly T., “Jumping Through Hoops: Traditional Healers and the Indian Health Care Improvement Act,” DePaul Journal of Health Care Law, 1999.))

In 1976, the United States passed the Indian Health Care Improvement Act. This piece of legislation detailed the U.S.’ responsibilities, citing: “Congress hereby declares that it is the policy of this Nation, in fulfillment of its special responsibilities and legal obligations to the American Indian people, to meet the national goal of providing the highest possible health status to Indians and to provide existing Indian health services with all resources necessary to effect that policy.” (I’ve added the italics to emphasize the obscene irony of these words with respect to the real, physical effects of the referenced promulgation).

Aside from the year the Ramones released their first album, 1976 also happened to be the year the U.S. government admitted to running a covert program of involuntary sterilization, affecting about 40 percent of all American Indian women of childbearing age. ((Dillingham, Brint, “Indian Women and HIS Sterilization Practices,” American Indian Journal, vol. 3, no. 1 (1977), pp. 27-28. For more info on this, see Churchill, Ward, “In the Matter of Julius Streicher: Applying Nuremberg Precedents in the United States,” From A Native Son: Selected Essays on Indigenism, 1985-1995 (Boston: South End Press, 1996).)) Article II of the United Nations 1948 Convention on Punishment and Prevention of the Crime of Genocide explicitly proscribes involuntary sterilization as a means of “preventing births among” a targeted population. Nonetheless, the IHS — an adjunct of the Bureau of Indian Affairs (BIA) at the time, authorized and administered the illicit sterilizations. The putative termination of the program resulted in the transfer of the IHS to the Public Health Service. There were no indictments or punishments for those reprehensibly involved.

Furthermore, it was revealed in 1990 that the IHS was inoculating Alaska Inuit children with Hepatitis-B vaccine — after the WHO placed an interdiction on this particular vaccine for having a strong correlation with HIV-Syndrome, which is, in essence, directly linked with AIDS. In 1992, a “field test” of Hepatitis-A vaccine, also HIV-correlated, was controlled on reservations in the northern Plains region. ((Andrea Smith, “The HIV-Correlation to Hepatitis-A and B Vaccines,” WARN Newsletter (Chicago: Women of All Red Nations, summer 1992).))

The IHS fails as it continues to expand assimilationist health care

Founded in 1955, the IHS is a federally administered health care program, accredited by the Joint Commission on Accreditation of Healthcare Organizations. It was designed to provide services for North America’s members of the 546 federally recognized indigenous tribes. Those who receive IHS services reside mainly on reservations and rural communities within thirty-six states, mostly contained in the Western U.S. and Alaska.

IHS dependents are not eligible for access to the bulk of hospitals and medical practitioners ubiquitous throughout the U.S. They are restricted to services provided by the clinics and hospitals that contract with the IHS only. Moreover, the majority of IHS facilities are located within “contract health service delivery areas” comprising reservations, the counties circumscribing the reservations, and the adjacent counties. The IHS itself approximates that 43 percent of American Indians and Alaskan Natives live outside the parameters of “contract health service delivery areas.” And according to Bonnie Duran, writing for the American Journal of Public Health in 2005: “…more than 60 percent of members of US tribes reside outside their home reservations at least part of the year, but only 1 percent of the IHS budget is earmarked for urban Indian health care [urban clinics service, in toto, nearly 600,000 individuals].” ((Duran, Bonnie M., American Journal of Public Health, May2005, Vol. 95 Issue 5, pp. 758-758.))

In the 1950s the U.S. passed a sequence of “termination” statutes by which, in the words of American Indian scholar, author and activist Ward Churchill, “the federal government unilaterally dissolved more than a hundred indigenous nations and their reservation areas.” Furthermore, concomitant ruling was enforced to “encourage” the relocation of sizable “numbers of Indians from the remaining reservations to selected urban centers;” a colonial tactic designed to obviate any recrudescence of social solidarity within native communities. ((Churchill, Ward, “Since Predator Came: A Survey of Native North America Since 1492, From A Native Son: Selected Essays on Indigenism, 1985-1995 (Boston: South End Press, 1996), p. 26. Also, see House Concurrent Resolution 108 of August 1953, which promulgated a policy of “unilaterally dissolving specific native nations.” This resulted in the “suspension of federal services to and recognition of the existence of”: the Menominee on June 17, 1954 (ch. 303, 68 Stat. 250); the Klamath on Aug. 13, 1954 (ch. 732, 68 Stat. 718, codified at 25 U.S.C. § 564 et seq.); the “Tribes of Western Oregon” on Aug. 13, 1954 (ch. 733, 68 Stat. 724, codified at 25 U.S.C. § 691 et seq.); and more. In total, 109 nations were statutorily “terminated” in the 1950s. Some were restored and federally recognized in the 1970s. Also, see the Relocation Act (PL 959) of 1956; for more info on the latter “Act,” see Fixico, Donald L., Termination and Relocation: Federal Indian Policy, 1945-1960 (Albuquerque: University of New Mexico Press, 1986).)) These legislative instruments were prorogued (suspended but not dissolved) in the 70s, but by the 90s the federal relocation program had succeeded in pushing more than half of all U.S. indigenous peoples out of reservations and into city ghettos, under the ostensible objective of “assimilation.” Would you care to be prodded out of your home and marshaled into an economically depressed area of one of America’s major cities? I didn’t think so.

Owing to the fact that the preponderance of IHS facilities are located not in city ghettos but on and around reservations, concurrent with the actuality that virtually half the native population resides nowhere near service areas on account of former federally mandated relocation programs, not only substantiates the concern that adequate health care is not being provided to America’s indigenous, but that these conditions are federally ignored, and met with silence and depraved indifference.

As regards financial deficiencies, IHS is bracketed for budgetary purposes as a discretionary program. In other words, there is no federal guarantee that there will ever be adequate pecuniary allocations (funding) for the IHS. On the other hand, for the general public, being predominantly Eurocentric, white-American, Medicare and Medicaid are federal prerogatives. And those who are eligible are guaranteed plenary (full) access to their programs. To adduce another excerpt from Bonnie Duran’s piece in the American Journal of Public Health in 2005: “For reservation-based populations, the level of per capita funding is less than half of what is provided to those on Medicaid and in prison.” ((Duran, Bonnie M., op. cit.))

In 2005 the General Accountability Office (GAO) controlled a study that revealed a number of IHS facilities with zero funding to contract for “non-urgent care.” The same GAO study discovered that eleven out of thirteen facilities surveyed had zero to limited ability to treat chronic pain. Seven out of thirteen facilities had zero to limited ability to perform cancer screenings. ((James, Cara, Karyn Schwartz, and Julia Berndt, “A Profile of American Indians and Alaska Natives and Their Health Coverage, Race, Ethnicity and Health Care,” Kaiser Family Foundation, September 2009, p. 6.)) Let me remind the reader that these findings pertain to a specific group of people who are, at the very least, twice as likely as white folks to contract, and die from, preventable cancers.

As if that isn’t bad enough, despite the claim that Congress still allocates funds for the IHS (in lieu of the expiration of the Indian Health Care Improvement Act in 2000), the IHS only receives 50-75 percent of the requisite funding needed to operate. ((Goldsmith, M.F. (1996). First Americans face their latest challenge: Indian health care meets state Medicaid reform. JAMA, 275, 1786; also see Voss, Richard W., Victor Douville, Alex Little Soldier, and Gayla Twiss, Tribal and shamanic-based social work practice: a Lakota perspective, Social Work, Vol. 44, 1999.)) Regardless of the increase of federal appropriations over the years, the amount of real money doled out has decreased. To put it another way, the IHS is virtually bankrupt. The amount of federal allocations may have increased, but the amount of actual capital put into the system has considerably decreased.

Meanwhile, the Pima of Arizona suffer the highest diabetes rates in the world. And in 2007 their tuberculosis rate was 5.9 compared to 1.1 for whites. ((Katel, Peter, (2006, April 28), “American Indians,” CQ Researcher, 16, 361-384.))

The 1.8 million-acre San Carlos Apache Reservation, home to a community of 13,000, is one of the poorest reservations in the States. Writing for Congressional Quarterly, Peter Katel quotes Tribal Chairwoman, Kathleen W. Kitcheyan, lamenting: “We suffer from a poverty level of 69 percent, which must be unimaginable to many people in this country, who would equate a situation such as this to one found only in Third World countries.” ((Katel, Peter, (2006, April 28), “American Indians,” CQ Researcher, 16, 361-384.))

Less than a tenth of the recent bonuses awarded to certain peoples by certain businesses, generated by the taxpayer bailout could have sufficiently extended IHS services and advanced aid to improve these inimical conditions greatly. It is the very least this country could have done on behalf of long overdue reparations.

At the end of the day, it doesn’t matter which end of the political spectrum one is ensconced in — negligent and damaging policy written by U.S. lawmakers is negligent and damaging policy. If one leans further to the right, obdurate ethnocentrism (the whole “…I’ve seen one Indian, I’ve seen ‘em all…” mentality) often accompanies those at the helm. If one leans further to the left, liberal and “humanitarian” agendas often obfuscate the implications attached to policy destined for nothing short of the same old hegemonic ends. In the words of Oscar Wilde, “Patriotism is the virtue of the vicious.” It does not matter whether one is right, center, or left.

The syndicated creation of disease and destitution

Would it surprise you if I told you that most of these despairing conditions could have been prevented? Well, it’s true — they could have been prevented. More than one half of the nation’s uranium deposits, one-fourth of its low-sulfur bituminous coal reserves, one-fifth of its oil and natural gas, alongside substantial deposits of copper and other ores are confined within the margins of reservations. ((Churchill, Ward, “Native North America: The Political Economy of Radioactive Colonialism,” From A Native Son: Selected Essays on Indigenism, 1985-1995 (Boston: South End Press, 1996), p. 147; also see Garrity, Michael, “The U.S. Colonial Empireis as Close as the Nearest Reservation,” Trilateralism: The Trilateral Commission and Elite Planning for World Management, ed. Holly Sklar (Boston: South End Press, 1980), pp. 238-68.)) These resources are lucrative, to say the least. They are also lethal once taken from out of the ground and/or processed on site. Nonetheless, it is peculiar to find the most impoverished demographic in the U.S. residing directly above a copious amount of the world’s most profitable resources. As claimed by Ward Churchill, in his essay “The Political Economy of Radioactive Colonialism,| the natural resource base of the Navajo alone is far greater than that of Luxembourg, Lichtenstein, and Monaco, combined. ((Churchill, Ward, “Native North America…,” From A Native Son…, p. 150; also see U.S. Commission on Civil Rights, The Navajo Nation: An American Colony (Washington, D.C.: U.S. Government Printing Office, 1976).))

Through a series of ratified acts (e.g., Indian Reorganization Act, 1934), the U.S. defined itself as the primary governing body of Indian reservations, establishing a system of tribal council governments for each reservation, whose main responsibilities (under the rubric of “economic planning”) include: minerals-lease negotiations, contracting with external corporations, long-term agricultural leasing, water-rights negotiations, land transfers, and more. History has shown that such “economic planning” is nothing but a damaging strategy for an exploitative U.S. bylaw apparatus.

After decades of uranium mining on American Indian territory, many lives have been ruined. Uranium tailings, fifty to sixty feet high litter the defunct mining sites situated on reservation lands releasing radon, actinides (responsible for long-term radioactivity), and other debris into the topsoil and groundwater of the surrounding regions. There is no such thing as “safe doses” of radiation. The debris that sullies the climes of Indian country is replete with alpha-emitting substances often resulting in cancers and other degenerative diseases. Remember that most IHS facilities cannot afford to offer cancer screenings.

Dr. Gordon Edwards, writing for Perception magazine in 1992, explained that leftover uranium tailings contain about 85 percent of the original radioactivity found in the ore. They emit at least 10,000 times the amount of radon gas (able to travel a thousand miles in just a few days) as the undisturbed ore. In the Southwestern U.S., schools were once built using uranium tailings as construction material. ((Edwards, Dr. Gordon, President of Canadian Coalition for Nuclear Responsibility, “Uranium: The Deadliest Metal,” Perception Magazine, v. 10 n. 2, 1992.))

The Nuclear Regulatory Commission (NRC) estimates radon emissions from uranium tailings in the Southwestern U.S. will result in over 3,000 cancer deaths per century over the entire North American continent. Other researchers posit that this assertion is underestimated by at least a factor of ten. ((Edwards, Dr. Gordon, President of Canadian Coalition for Nuclear Responsibility, “Uranium: The Deadliest Metal,” Perception Magazine, v. 10 n. 2, 1992.))

By the 1950s cases of lung cancer, pulmonary fibrosis, pneumoconiosis, silicosis, tuberculosis, birth defects, kidney damage, and more, began to show up in populations near uranium mining sites. By 1978, the GAO had recorded 140 million tons of “on site tailings piles at twenty-two abandoned and sixteen operational mills.” There are more than 1,100 abandoned uranium mines in the Navajo Nation alone. Continued production results in the creation of six to ten tons of tailings annually, alongside small cell carcinoma for the Navajo miners. ((Quartaroli, MaryLynn, “Leetso,” the Yellow Monster: Uranium Mining on the Colorado.))

Yucca Mountain, situated on Shoshone Nation land, is a proposed nuclear waste repository site. Left with thousands of tons of nuclear waste per annum, U.S. nuclear power facilities are desperately seeking a place to store their ever-increasing stockpiles of deadly wastes. America’s best idea thus far is to stuff it all inside a mountain, on land that does not belong to the U.S.

Backed by the Ruby Valley Treaty and the Nevada Enabling Act, Yucca Mountain and its surrounding region are not U.S. territory, therefore not for federal use. Not surprisingly, this injunction is flouted by military nuclear weapons testing on Shoshone land, during which 700-ton explosives are detonated. Moreover, nearly 70 percent of the nation’s gold mining occurs upon Shoshone Nation land, despite the fact that gold ore is commonly found throughout the U.S. What’s wrong with industrial gold mining, you may ask. Well, for one, it’s stupid.

Gold mining is a highly nocuous vocation. Not only does it threaten the health and livelihood of miners and occupants of the surrounding communities, but it is deleterious to its own and surrounding landbases, ultimately threatening the natural ecology of the region.

Tons of rock must be extracted from the earth to extricate an ounce of gold. The processing of the metal involves (depending on its metallurgical makeup) the application of a diluted cyanide solution (sodium cyanide), sulfuric acid, mercury, and other noxious and fatal substances, alongside being water intensive (drawing intensively from a diminished water-table).

There are literally thousands of other examples I could provide to illustrate how the U.S. and its corporate collaborators create poor health conditions and abject poverty among an already marginalized population for their own profitable gains and neocolonial, hegemonic aspirations. And matters are made desperately worse by the incompetence of the IHS.

Seeking solutions

Rectifying a longtime problem, one as grisly as the diminution of America’s indigenous, followed by destructive protocol delegated by U.S. decree, is indeed a difficult task at hand. As regards restoring a broken and virtually bankrupt IHS, some lawmakers are pushing for the reauthorization of the Indian Healthcare Improvement Act.

On October 14th, Rep. Martin Heinrich, D-N.M., sent a letter to Speaker Nancy Pelosi, Majority Leader Steny Hoyer and Education and Labor Committee Chairman George Miller urging “the inclusion of reauthorization of the IHCI Act as part of comprehensive health insurance reform,” reports. In the words of Heinrich, “Our country desperately needs health insurance reform — but our pursuit of reform cannot leave Native Americans behind,” he said. “I represent tens of thousands of Native Americans in central New Mexico, and my constituents have made it clear that they cannot wait any longer for health care reform in Indian country.”

According to New Jersey Rep. Frank Pallone: “Less is spent on providing health care to American Indians per capita than any other sub-population. In fact, we spend more to provide health care to federal inmates than we do for American Indians.” As reported at, Pallone is appealing for an amendment to the current health care bill that would add changes to services for American Indians to “any health care reform that happens in Congress.”

Many wonder, though, would reauthorizing the Indian Healthcare Improvement Act, with a few additional furnishings, really ameliorate the problem at hand? Obviously, U.S. legislation has not worked thus far and, moreso, it has been the driving impetus behind the historical disintegration of this country’s indigenous.

If anything is to suffice, health care services for Native Americans must be developed in accord with Native Americans’ requirements and wishes. Services must incorporate the indigenous traditions and practices of each tribe, alongside the option to access conventional methods of treatment.

More capital should be injected into the system. There are absolutely no excuses to do otherwise. The money is there — it’s just being misspent, primarily on an already-bloated defense budget. Allocations for environmental clean-up costs must be put in place, too. And clean-up projects must be enforced with full speed ahead. This would — with the adequate sanitation gear — provide a massive amount of new employment as well.

A concerted effort, from all angles, on behalf of U.S. policy-makers, must culminate in an unprecedented level of reparations that not only rectify centuries of genocidal maltreatment, but also recognize, with respect, indigenous sovereignties. This includes the withdrawal of all unwanted military and corporate activity/occupation from Indian country. In the end, the health of one’s landbase is commensurate with the health of one’s community.

Frank Smecker is a writer and social-worker from VT. He can be reached at: Read other articles by Frank, or visit Frank's website.

3 comments on this article so far ...

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  1. Annie Ladysmith said on November 18th, 2009 at 2:00am #

    SMecker, have you been to Alaska? The plight of everyone up there (native and Caucasian alike) is pretty dismal. People need to stop alcohol and their lives would get much better. I guarantee you THIS IS THE ROOT PROBLEM, that, and glue sniffing. So put your rhetoric to work and go up to Anchoridge and help those poor people ( both yellow and white) to get off booze and glue. Social worker from Vermont is all i need to know!

  2. Rebekah Lee said on November 24th, 2009 at 4:09pm #

    Annie Ladysmith have you been sniffing glue too? Did you even read the article and understand what it was about? It is about how the Native American population will be affected by the proposed health care reform bill. The article also explains the history of health care for Native Americans. Your views are oversimplified and insulting to Native Americans. Drug abuse is only part of the symptom of what is wrong. The “root problem” with your response would be “not reading”.

  3. Tommy said on November 25th, 2009 at 3:23pm #

    I was born between the Uinta and Oray Reservations. Our closest neighbors were Utes. Some of my family members have married Utes. Their biggest problems are ignorant whites.