Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

Perhaps one reason why the massive health care reform legislation is in so much trouble is that few people understand the details. The bill is massive, complicated, packed with official government jargon and so many specifics were kicked forward to regulators at some future point (such as figuring out the real Medicare cost reductions or definitions of basic terms such as “quality”). On top of that, there was confusion about the nuts and bolts of what program was in, and what was out. Essentially it was a secret process, except when there were leaks over specific proposals.

The bill followed the time-honored way of legislating. A senator says, “yes” after the bill is sweetened. Then another senator is wooed. And another until a super majority is found and the bill itself is hardly identifiable. Political horse-trading is one of the reasons people are angry about health care reform (as well – and this is important – a genuine debate about the role of government). It looks unfair and unseemly.

But does it have to be that way in the 21st century? Can legislation or policy be forged in an open and transparent manner? This won’t resolve the debate about philosophy, but at least it allows people to have a say all through the process.

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Tags: Health care reform, Mark Trahant, National Health Service Institute For Innovation and Improvement

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

Did health care reform die at the ballot box? I’ve been reading on Twitter how pleased Republicans are with Scott Brown’s win for Ted Kennedy’s Senate seat. It’s a game changer.

The best way to catch the wave of that particular thought is to search Twitter using the hashtags #hcr or #tcot (health care reform and True Conservative on Twitter). The comments boil down to a push to “slow down” the government “take over” of the health care system.

Unfortunately “slow down” in this context means kill. Starting over is a process measured in years, not the months ahead before a new round of congressional elections.

Democrats say they’d still like to press ahead with a health bill, but it’s likely to be smaller. The House could, in theory, pass the current Senate bill without changes, sending it directly to the president. But that seems to be unlikely because those Democrats who weren’t all that excited about health care reform now have an easy exit. It’s scurry time in DC.

The really tough thing about the chain of events is that it will be tricky to keep the Indian Health Care Improvement Act as part of any larger package; that likely means starting over as its own bill. Senate Indian Affairs Chairman Byron Dorgan told the Bismarck Tribune on Jan. 13 that the Indian Health Care Improvement Act remains a priority. Perhaps he can find a way to restart the bill on its own.

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Tags: buffalo post, Health care reform, Indian Health Care Improvement Act, Indian Health Service, Mark Trahant, Native American news

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

The Indian health system is stuck in a world of conditional sentences. That’s a sentence with the phrase, “if … then.” If Congress passes health care reform, then …

There are many variables based on a complex grid of “ifs.”

The most important conditional sentences involve the Indian Health Care Improvement Act. There are slightly different versions in both the House and Senate bills. If the House language is the one to prevail, “then” means one thing. But that meaning changes if it’s the Senate version, or even if it’s a merged bill.

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Tags: buffalo post, D-Mass., Dr. Yvette Roubideaux, Health care reform, Indian Health Care Improvement Act, Indian Health Service, Mark Trahant, Native American news, U.S. Rep. Barney Frank

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

What is the business model for the Indian health system?

On the surface this is a preposterous question because the U.S. government promised to fund the health care needs for American Indians and Alaskan Natives. It’s also supposed to be a simple business: Congress funds the system (the Indian Health Service, tribal contract facilities and urban programs), the agency spends that budget, and patients are treated.

But that’s why the question is not outlandish. The Indian health system has never had enough money – and therefore it’s essential to secure as many resources as possible in order to effectively treat the most patients.
“As we look at the Indian Health Service, we need to think of it as a business,” said Yvette Roubideaux, M.D., director of the Indian Health Service. “A lot of people think of the Indian Health Service as a service. It’s a service that provides health care to American Indians and Alaskan Natives.

“People who work in IHS think of their positions not just as jobs, but also as something important personally. Many people feel like they are on a mission working for the Indian Health Service – and I think that’s great. But I also think we have to recognize that we are a health care system – and that we’re a business. We have to look at how we run our organization, to improve the way we do business.”

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Tags: buffalo post, Dr. Yvette Roubideaux, Indian Country and Health Care Reform, Indian Health Service, Mark Trahant, Native American news

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

This New Year I am experimenting, instead of resoluting. (I know, it’s not a real word. But it just sounded right.) I’m interested in how technology can play a role in behavior change, how to eat less, drink enough water, exercise more, and sleep better.

The tool I’m playing with is called a Fitbit. I’ll write more about that later, but it’s already interesting because it measures steps, your sleep pattern (although I am quite ready to argue about falling asleep in the chair while watching TV. The device (and my family) says “yes,” but I know better.

I see how this technology could be helpful to wellness programs. Sunday I walked 11,289 steps (not quite 3 miles), consumed more than 2,000 calories and slept 8 hours, waking up 7 times during the night.

We change what we measure – and that includes our own behavior. Just by watching my personal data, I am inclined to walk more and eat less.

But that’s only part of what could make Fitbit important to a wellness routine. Part two will come when others I know are on the system and add their stats through social networks. Think of a community of folks who are rooting for your success, for your better health, as you urge them forward.

This is more experiment, than a resolution. But this is the season for resolutions – and for many that means it’s time to quit smoking.

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Tags: buffalo post, California Rural Indian Health Board, Centers for Disease Control, Health care reform, Hopi Reservation, Indian Health Service, Mark Trahant, National Tribal Tobacco Prevention Network, Native American news, Smoking cessation, Tribal casinos, Tulalip Tribes

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

I started my exploration of health care reform in July.

“The federal government accepts a double standard: Any discussion about rationing – or government care – is off the table unless you’re a member of an American Indian tribe or Alaskan Native community with a sort of pre-paid insurance program (many treaties, executive orders and laws were specific in making American Indian health care a United States’ obligation),” I wrote back then.

Six months later – or half way into this project – I am struck by how Indian Country is both a part of the health care debate and yet absent from its larger discussion.

We’re part of the conversation every time critics blast the Indian Health Service as a failure of government. We’re also included in the larger reform measure – the Indian Health Care Improvement Act – was added to the larger bill. That’s a good thing because this bill (unlike the original) has been awfully difficult to move through the Congress.

But we’re absent from the conversation because neither the Congress nor the Executive Branch has articulated what lessons can be learned from the history and experience of the Indian health system as it applies to the larger issue of health reform. It’s particularly frustrating to watch the politicians who are quick to point out the weaknesses of that system even though they have never proposed adequate funding or the dreaded idea of rationing.

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Tags: buffalo post, Health care reform, Indian Country and Health Care Reform, Indian Health Care Improvement Act, Indian Health Service, Mark Trahant, Native American news

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

Early Monday morning the Senate moved health care insurance reform one step closer to becoming law. But the steps ahead, in political terms, must be perfect.

But I don’t want to bury the lede: The Indian Health Care Improvement Act is now in both the Senate and House version of health care reform. That means it’s off the table when the Senate and House iron out differences in Conference Committee (probably in early January). If health care reform becomes law, so does the Indian Health Care Improvement Act. That should open up new revenue stream for the Indian Health system with new money for long-term care, more cancer screening and better mental health treatment options.

Other provisions in the health care bill itself should open up further resources, ranging from broader eligibility for Medicaid to higher reimbursement rates in rural areas.

Make no mistake: Indian Country benefits significantly from this health care reform legislation.

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Tags: buffalo post, Health care reform, Indian Health Service, Mark Trahant, Native American news

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

ORLANDO, Fla. – There are two master narratives about the Indian Health Service.

First, everyone knows the Indian health system needs more money. Everyone, it seems, except the collective members of Congress who, when they write budgets, can’t seem to appropriate at least as much money as they do for the U.S. Bureau of Prisons.

And, second, critics say the Indian Health Service represents the failure of government-run care with complaints ranging from rationing to mismanagement of government funds. Just last week Sen. Tom Coburn, R-Oklahoma, repeated this narrative in his attack against the Senate’s health care reform bill. He again called the IHS “a failure.”

These two narratives stick because the truth is far more complicated. It’s hard to communicate a “yes, but” message in a political context. Yes, the IHS does ration care – but that’s because it has only so much money in its budget. Yes, the IHS isn’t perfect with its spending (or insurance billing operations), but is that also a reflection of its limited budget? We really won’t know the answers unless the agency gets adequate funding.

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Tags: buffalo post, Health care reform, Indian Health Service, Institute for Healthcare Improvement, Mark Trahant, Native American news, U.S. Sen. Tom Coburn

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

ORLANDO, Fla. – What do we want in a health care system?

It’s a question Dr. Donald Berwick asked an audience of 5,000-plus people at the Institute for Health Care Improvement’s National Forum on Tuesday.

Such an easy question. I can quickly rattle off answers: I want health care for my family. I want to be able to see a doctor when I’m ill. I want to be made healthy.

Stop. Berwick asks again. What do you really want? I want to be healthy.

This time think about it. Step back. Inhale. Think. Exhale. What do you really, really want?

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Tags: buffalo post, Dr. Donald Berwick, Health care reform, Institute for Health Care Improvements, Mark Trahant